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RESP (Respiratory Medicine) > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What is Pneumonia?

A

An infection of the lung tissue resulting in inflammation and sputum filling of the airways and alveoli.

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2
Q

What are the 3 main types of Pneumonia?

A
  1. Outside of Hospital - Community-Acquired.
  2. After 48 hours since Hospital Admission - Hospital-Acquired.
  3. Inhalation of Foreign Materials - Aspiration Pneumonia.
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3
Q

What is Aspiration Pneumonia due to? (5)

A
  1. Poor Dental Hygiene.
  2. Swallowing Difficulties.
  3. Prolonged Hospitalisation/Surgical Procedures.
  4. Impaired Consciousness.
  5. Impaired Mucociliary Clearance.
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4
Q

Which sites are most affected by Aspiration Pneumonia?

A

Right middle and Lower lung lobes (larger calibre and more vertical orientation of the right main bronchus).

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5
Q

Commonest Causative Organisms (5).

A
  1. S. pneumoniae (50%).
  2. H. influenza (20% - COPD).
  3. M. catarrhalis (immunocomprised/chronic pulmonary disease).
  4. P. aeruginosa (CF, Bronchectasis).
  5. S. aureus (CF & After Flu).
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6
Q

What is Atypical Pneumonia?

A

Pneumonia caused by an organism that cannot be cultured in the normal way or detected using a gram stain. They don’t respond to penicillins.

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7
Q

Causative Organisms of Atypical Pneumonia (5).

A

Legions of Psittaci MCQ :
1. Legionella Pneumophilia.
2. Chlamydia Psittaci.
3. Mycoplasma Pneumoniae.
4. Chlamydydophila Pneumoniae.
5. Q Fever (Coxiella Burnetti).

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8
Q

What is Legionnaire’s Disease characterised by?

A

Infected water supplies or AC units; characterised by lymphopenia and hyponatraemia due to SIADH (cheap holiday).

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9
Q

What is Chlamydia Psittaci infection characterised by?

A

Contact from infected birds e.g. new parrot.

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10
Q

What is Mycoplasma Pneumoniae infection characterised by? (5)

A
  1. Erythema Multiforme - varying-sized target lesions (pink rings with pale centres) and Erythema Nodosum.
  2. Meningoencephalitis, GBS, Immune-Mediated Neurological Disease.
  3. IgM Cold Agglutin - Haemolytic Anaemia, Thrombocytopenia.
  4. Dry Cough.
  5. Bullous Myringitis - Painful Vesicles on Tympanic Membrane.
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11
Q

What is Chlamydydophila Pneumoniae infection characterised by?

A

School-aged child with a mild-moderate chronic pneumonia and wheeze.

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12
Q

What is Q fever characterised by?

A

Exposure to animals and their bodily fluids - e.g. farmer with a flu-like illness.

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13
Q

What is Fungal Pneumonia characterised by?

A

Pneumocystic Jiroveci (PCP) infection causing dry cough, SOB on exertion and night sweats.

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14
Q

What is Idiopathic Interstitial Pneumonia?

A

Non-infective pneumonia e.g. Cryptogenic Organising Pneumonia (Bronchiolitis as a complication of RA or Amiodarone Therapy).

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15
Q

What is Klebsiella pneumoniae infection characterised by?

A

Alcoholics - red-currant sputum (gram-negative anaerobic) + increased risk of complications.

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16
Q

Which infection causes Herpes Labialis (Cold Sores)?

A

Pneumococcus (Streptococcus Pnuemoniae).

17
Q

Examination Findings in Pneumonia (3).

A
  1. Bronchial Breath Sounds.
  2. Focal Coarse Crackles.
  3. Dullness to Percussion.
18
Q

What are Bronchial Breath Sounds?

A

Harsh breath sounds equally loud on inspiration and expiration, caused by consolidation of lung tissue around the airway.

19
Q

What are focal coarse crackles due to?

A

Air passing through the sputum in the airways similar to using a straw to blow in a drink.

20
Q

What is the dullness to percussion due to?

A

Lung tissue collapse and/or consolidation.

21
Q

Assessment of Severity in Hospital (5).

A

CURB-65 in Hospital :
1. C - Confusion (New Disorientation to Time, Place and Person or AMTS < 8/10).
2. U - Urea > 7.
3. R - Respiratory Rate > 30.
4. BP = Hypotensive.
5. 65 - Age > 65.

22
Q

Assessment of Severity in Community.

A

CRB-65 (without Urea) - any score above 0 is an indication for hospital referral.

23
Q

Management Based on Severity of Pneumonia (3).

A
  1. 0/1 - Treatment at Home.
  2. 2 - Hopsital Admission.
  3. 3+ - Intensive Care Assessment.
24
Q

Investigations in Community of Pneumonia (2).

A
  1. CRB 0/1 - No Investigations.
  2. Point of Care Test (if possible) - CRP > 100mg/L = offer antibiotics.
25
Q

Investigations of Pneumonia (2).

A
  1. Minimum - CXR, Blood Test.
  2. Moderate/Severe - Sputum Culture, Blood Culture, Legionella and Pneumococcal Urinary Antigen.
26
Q

X-Ray Findings in Pneumonia.

A

Consolidation.

27
Q

Investigation of Fungal Pneumonia.

A

BAL (Bronchoalveolar Lavage) - demonstrate PCP (Silver Stain with characteristic cysts).

28
Q

Management of Pneumonia (5).

A
  1. Local Guidelines.
  2. Moderate/Severe/Septic - IV Antibiotics and then Oral Antibiotics.
  3. Mild CAP - 5 Day Course of Oral Antibiotics (Amoxicillin or Macrolide).
  4. Moderate/Severe CAP - 7-10 Day Course of Dual Antibiotics (Amoxicillin + Macrolide).
  5. B-Lactamase Stable Penicillin e.g. Co-Amoxiclav, Ceftriaxone, Piperacillin with Tazobactam should be used.
29
Q

Management of Atypical Pneumonia (3).

A
  1. Macrolides e.g. Clarithromycin.
  2. Fluoroquinolones e.g. Levofloxacin.
  3. Tetracyclines e.g. Doxycycline.
30
Q

Management of Fungal Pneumonia (3).

A
  1. Septrin - Co-Trimoxazole (Trimethoprim + Sulfamethoxazole).
  2. IV Pentamidine - Severe Cases.
  3. Steroids if Hypoxic.
31
Q

Complication of Fungal Pneumonia.

A

Pneumothorax.

32
Q

Prophylaxis against Fungal Pneumonia.

A

CD4 Count < 200mm3 should receive PCP Prophylaxis.

33
Q

Complications of Pneumonia (5).

A
  1. Sepsis.
  2. Pleural Effusion.
  3. Empyema.
  4. Lung Abscess.
  5. Death.
34
Q

Prognosis of Pneumonia (5).

A
  1. 1 Week - Fever.
  2. 4 Weeks - Chest Pain and Sputum Production.
  3. 6 Weeks - Cough and Breathlessness.
  4. 3 Months - Most Symptoms except Fatigue.
  5. 6 Months - Back to Normal.
35
Q

Follow-Up of Pneumonia.

A

CXR at 6 weeks to ensure consolidation has resolved and no underlying abnormalities e.g. lung tumour.

36
Q

Pneumococcal Vaccine Types (2).

A
  1. Conjugate.
  2. Polysaccharide - covers more serotypes (commonly used).
37
Q

Pneumococcal Vaccine Ages.

A
  1. Children at 2 months, 4 months and 12-13 months.
  2. 65+ and At-Risk Groups - One-Off.
  3. Splenic Function + Nephrotic Syndrome - Every 5 Years.
38
Q

Examination Findings of Pneumonia.

A

Increased tactile vocal fremitus and dull percussion note.

RESP (Respiratory Medicine) (35 decks)

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