pneumonia Flashcards
sudden onset differential diagnoses of sob (seconds to mins)
Pneumothorax trauma Aspiration Pulmonary oedema Pulmonary embolism
Acute onset differential diagnoses of sob (hours to days)
Asthma COPD RTI Pleural effusion Lung tumours Metabolic acidosis
chronic sob differential diagnoses
COpD Lung tumours Anaemia Valvular heart disease Cardiac failure Cystic fibrosis Interstitial lung disease Chest wall deformities Neuromuscular disorders
Differential diagnoses of productivite cough
COPD
TB
Bronchiectasis
Pulmonary oedema
Differential diagnosis of non-productive cough
Asthma Post nasal drip GORD Drugs (ACEi) Sarcoidosis
resp causes of fever
LRTI.URTI pneumonia COPD lung tumour Empyema Bronchiectasis TB Lung abscess
Differences between LRTI and pneumonia
LRTI-
Acute illness
Cough main symptom and +1 other LRTI symptom:
-fever, sputum, sob, wheeze, chest discomfort or pain
Pneumonia
Viral or bacterial infection of LRTI. Acute inflammation with an infiltration of neutrophils in and around the alveoli and terminal bronchioles
–>Consolidation shows on CXR. This is how you confirm diagnosis
common pathogens of HAP
- Gram negative enterobacteria
- Methicillin-resistant staphylococcus aureus (MRSA)
- Pseudomonas
- Klebsiella
Common pathogens of CAP
1 Strep pneumonia
2 Atypical pathogens- legionella, mycoplasma pneumonia
3 Viral causes including influenza, RSC and COVID
4 haemophilus influenza
What is pneumonia
Acute inflammation secondary to infection
Two types of how pneumonia can affect lung
Lobar
Bronchopneumonia (1 or more lobes, bronchioles and adjacent alveoli)
What are the 4 stages of inflammation
1) Congestion- Inflammation leads to leaky pulmonary capillaries causing alveolar exudate
2) Red hepatisation – haemorrhagic inflammatory alveolar exudate with no gas exchange in alveoli
3) Grey hepatisation – Fibrinopurulent inflammatory exudate (alveoli full of neutrophils and dense fibrous strands. Purulent sputum)
4) Resolution (without abx) – final stage of processing exudate left (monocytes clear the inflammatory debris and normal air filled lung architecture is restored
Risk factors
Old Child Hospitlaisation MAle Autumn/winter Smoking alcohol IV drugs Viral illness Underlying lung pathology Immunocompromised Aspiration risk
symptoms of pneumonia
Fever PRoductive cough sOB Pleuritic chest pain Malaise Haemoptysis Loss of appetite
Signs of pneumonia
Low GCS Delirium Increased RR, HR Low BP Cyanosis Low o2 sat decreased chest expansion Increased vocal remits / vocal resonance Crepitations/bronchial breathing Pleural rub
What is bronchial breathing
What can it indicate if present
Harsh breath sounds with an audible gap between inspiratory and expiratory phases
-Indicate consolidation or fibrosis
bedside tests for suspected pneumonia
Basic obs inc RR and o2 sat
Sputum exam and culture
URine dip and antigens for pneumococcal and legionella pneumonia
Bloods ?
FBCs, U&Es, BMs LFTs & CRP
Blood cultures
Arterial blood gas
Atypical serology
Imaging
CXR
Specialist imagin
CT chest for complications. resistant pneumonias
Bronchoscopy if pt immunocompromised or in ITU
What is used to decide whether patient needs admission to hospital
CURB 65
Confusion - AMT<8/10 or disorientated Urea >7 Resp Rate>30 BP <90/60 Over 65yo
0-1 Outpatien/community management
2 points hospital management
>3 critical care/ICu
What does bronchopneumonia look like
Patches of inflammation separated by normal lung
CXR appearance shows multiple small nodular or reticulonodular opacities which tend to be patchy
What does lobar pneumonia look like
CXR appearance shows opacification following a lobe pattern with air bronchograms
Management of pneumonia
Smoking cessation
Supportive treatment including analgesia, oxygen, antipyretics, IV fluid
Chest physiotherapy mainly for chronic resp infections
Abx
What abx would you use for mild and moderate cap
ORal abx (usually amoxicillin/ amox and clarithromycin)
What abx ue for sever cap
IV co amoxiclav plus clarithromycin
What abx use for mild to moderate hap
Oral co-amoxiclav
What aux to use for severe hap
IV tazosin
What to treat aspiration pneumonia
Broad spectrum abx and metronidazole
complications
Parapneumonic effusion
Lung abscess
What is empyema and when should you suspect
Collection of pus in the pleural cavity adjacent to the consolidated lung
Consider this if no signs of clinical improvement or recurrent fever in resolving pneumonia
following up pneumonia
CXR in 6 weeks to rule out malignancy
Smoking cessation
Influenza vaccine if high risk
