Pneumonia Flashcards
What is Pneumonia?
An infection of the lung tissue resulting in inflammation and sputum filling of the airways and alveoli.
What are the 3 main types of Pneumonia?
- Outside of Hospital - Community-Acquired.
- After 48 hours since Hospital Admission - Hospital-Acquired.
- Inhalation of Foreign Materials - Aspiration Pneumonia.
What is Aspiration Pneumonia due to? (5)
- Poor Dental Hygiene.
- Swallowing Difficulties.
- Prolonged Hospitalisation/Surgical Procedures.
- Impaired Consciousness.
- Impaired Mucociliary Clearance.
Which sites are most affected by Aspiration Pneumonia?
Right middle and Lower lung lobes (larger calibre and more vertical orientation of the right main bronchus).
Commonest Causative Organisms (5).
- S. pneumoniae (50%).
- H. influenza (20% - COPD).
- M. catarrhalis (immunocomprised/chronic pulmonary disease).
- P. aeruginosa (CF, Bronchectasis).
- S. aureus (CF & After Flu).
What is Atypical Pneumonia?
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.
Causative Organisms of Atypical Pneumonia (5).
Legions of Psittaci MCQ :
1. Legionella Pneumophilia.
2. Chlamydia Psittaci.
3. Mycoplasma Pneumoniae.
4. Chlamydydophila Pneumoniae.
5. Q Fever (Coxiella Burnetti).
What is Legionnaire’s Disease characterised by?
Infected water supplies or AC units; characterised by lymphopenia and hyponatraemia due to SIADH (cheap holiday).
What is Chlamydia Psittaci infection characterised by?
Contact from infected birds e.g. new parrot.
What is Mycoplasma Pneumoniae infection characterised by? (5)
- Erythema Multiforme - varying-sized target lesions (pink rings with pale centres) and Erythema Nodosum.
- Meningoencephalitis, GBS, Immune-Mediated Neurological Disease.
- IgM Cold Agglutin - Haemolytic Anaemia, Thrombocytopenia.
- Dry Cough.
- Bullous Myringitis - Painful Vesicles on Tympanic Membrane.
What is Chlamydydophila Pneumoniae infection characterised by?
School-aged child with a mild-moderate chronic pneumonia and wheeze.
What is Q fever characterised by?
Exposure to animals and their bodily fluids - e.g. farmer with a flu-like illness.
What is Fungal Pneumonia characterised by?
Pneumocystic Jiroveci (PCP) infection causing dry cough, SOB on exertion and night sweats.
What is Idiopathic Interstitial Pneumonia?
Non-infective pneumonia e.g. Cryptogenic Organising Pneumonia (Bronchiolitis as a complication of RA or Amiodarone Therapy).
What is Klebsiella pneumoniae infection characterised by?
Alcoholics - red-currant sputum (gram-negative anaerobic) + increased risk of complications.
Which infection causes Herpes Labialis (Cold Sores)?
Pneumococcus (Streptococcus Pnuemoniae).
Examination Findings in Pneumonia (3).
- Bronchial Breath Sounds.
- Focal Coarse Crackles.
- Dullness to Percussion.
What are Bronchial Breath Sounds?
Harsh breath sounds equally loud on inspiration and expiration, caused by consolidation of lung tissue around the airway.
What are focal coarse crackles due to?
Air passing through the sputum in the airways similar to using a straw to blow in a drink.
What is the dullness to percussion due to?
Lung tissue collapse and/or consolidation.
Assessment of Severity in Hospital (5).
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.
Assessment of Severity in Community.
CRB-65 (without Urea) - any score above 0 is an indication for hospital referral.
Management Based on Severity of Pneumonia (3).
- 0/1 - Treatment at Home.
- 2 - Hopsital Admission.
- 3+ - Intensive Care Assessment.
Investigations in Community of Pneumonia (2).
- CRB 0/1 - No Investigations.
- Point of Care Test (if possible) - CRP > 100mg/L = offer antibiotics.
