Pneumonia * Flashcards
What is pneumonia
Fluid exudate in alveoli = Inflammation of the lungs caused by infection
What are the most common causes of CAP pneumonia
Strep pneumonia
H.Influenzae
Mycoplasma Pneumonia (Atypical)
What is the pathology of Pneumonia
Typical = bacteria invades and exudate forms inside alveoli LUMEN causing SPUTUM Atypical = Bacteria invades and exudate forms inside Alveoli INTERSTITIUM causing DRY COUGH
What causes Community acquired pneumonia
Strep Pneumonia
H Influenzae
Mycoplasma Pneumoniae
H.influenzae
What are the presentations of Pneumonia
Typical =Productive cough w/ rust sputum
Atypical = Dry cough w/ low fever
Pleuritic chest pain; worse w/ breathing
Tachypnoea and Tachycardia and Hypotension
Pyrexia
No URTI Sx
What are the auscultation signs of pneumonia
Bronchial breathing Dull percussion Pleural rub Coarse crackles Wheeze
What are the causes of Hospital Acquired Pneumonia (Gram Negative Bacilli)
Pseudomonas Aureginosa
E coli
Kiebsella
Staph Aureus
What are the causes of Atypical Pneumonia
Legionella Pneumoniae
Mycoplasma Pneumoniae
C. psitacci
Chlamydia Pneumoniae
What is HAP
Hospital acquired
- > 48 hrs after admission
- Lower respiratory tract infection
What is Staph Aureus Pneumonia
Common with IV drug users, elderly and IC patients
Use macrolide as B Lactam resistant
Presents with Bilateral Bronchopneumonia
What organism causes upper resp tract infection with red currant sputum
Klebsiella (Gram negative rod)
What are the features of Mycoplasma pneumonia
Flu, myalgia, dry cough and headache
Caused by cold? autoimmune haemolytic anaemia
Can lead to GBS
What is the typical pneumonia caused by poor hotel air conditioning
Legionella pneumonia
presents with flue and dyspnoea with dry cough
-check for hyponatraemia and abnormal LFT
-Tx = Clarythromycin
What are the investigations for Pneumonia
CURB-65
1st-CXR = Consolidation, effusion, abscess and empyema
Sputum and Culture
What is the Mortality scoring for Pneumonia
CURB 65 C - Confusion U - Urea >7mmol/L R - Resp rate >30 B - BP <90/60 65 - Patient over 65
With what CURB65 score should they be discharged and treated with amoxicillin/macrolide
0-1
macrolide if penicillin allergies
With what score should the patient be admitted and treated with both Amoxicillin and macrolide
2
When should a patient be considered for ITU and treatment with IV Co-amoxiclav and macrolide
3-5
What is the general management of Pneumonia
Oxygen 94-98 (88-92 if w/COPD)
Antibiotics (Amoxicillin, macrolide and Co-Amoxiclav)
Anagesia for chest pain
Fluids
How can Pneumonia be prevented
Pneumococcal vaccine against strep pneumonia
Why are HAP causatives more severe than CAP
Mostly Drug resistant
How can Pneumonia be contracted
Inhaled pathogens and Aspiration
What are the RF for Pneumonia
Immunocompromised
IVDU
Hx of resp disease
Age extremities
What is the difference between typical and atypical pneumonia pathology
Typical = exudate in lumen w/ sputum Atypical = exudate in interstitium w/ dry cough
What causatives of pneumonia show multilobar lesions CXR
S Pneumonia
S Aureus
Legionella
What causatives of Pneumonia show Multiple abscesses on CXR
S Aurues
What Causatives of Pneumonia show Upper lobe lesions on CXR
Klebsiella
EXCLUDE TB
-Rule out TB w/ Ziehl Neelson first
Which Pneumonia is AIDS defining
Polycystitic Pneumonia from P Jurovecci
In CAP, when should amoxicillin be used
CURB 0-2
In CAP, when should Co-amoxicalv and Clarithromycin be used
CURB 3-5
What CAP exception requires Clarithromycin as first line regardless of CURB Score
Legionella
-PHE Notifiable disease
What is the main presentation difference between typical and atypical pneumonia
Typical = Prurlent cough
Atypical = Dry cough w/ low fever
In what patients is aspiration pneumonia seen in
Stroke
Bulbar palsy
Myaesthenia gravis
-Mycoplasma pneumoniae
-Gastric contents aspirated into the lung = destruction
What is the diagnostic sign see in CXR for pneumonia
Consolidation
Air bronchogram
-Fluid filled bronchi surrounding Alveoli
When is CAP typicaly contracted
in the community or <48hrs in hospital
