Pneumonia Flashcards
What is pneumonia?
Pneumonia is simply an infection of the lung tissue.
How does pneumonia present on a CXR?
Pneumonia can be seen as consolidation on a chest xray.
What are the three classifications of pneumonia?
If the pneumonia developed outside of hospital it is labeled labelled “community acquired pneumonia”.
If it develops more than 48h after hospital admission it is labelled “hospital acquired pneumonia”.
If it develops as a result of aspiration, meaning after inhaling foreign material such as food, then it is labelled “aspiration pneumonia”.
Presentation of pneumonia
Shortness of breath
Cough productive of sputum
Fever
Haemoptysis (coughing up blood)
Pleuritic chest pain (sharp chest pain worse on inspiration)
Delirium (acute confusion associated with infection)
Sepsis
What signs can indicate a secondary sepsis to pneumonia|?
Tachypnoea (raised respiratory rate) Tachycardia (raised heart rate) Hypoxia (low oxygen) Hypotension (shock) Fever Confusion
What are the characteristic chest signs of pneumonia?
Bronchial breath sounds. These are harsh breath sounds equally loud on inspiration and expiration. These are caused by consolidation of the lung tissue around the airway.
Focal coarse crackles. These are air passing through sputum in the airways similar to using a straw to blow in to a drink.
Dullness to percussion due to lung tissue collapse and/or consolidation.
What severity assessments are used outside of hospital and inside of the hospital?
Out: CRB-65
In: CURB-65
The only difference is that out of hospital you do not count urea.
What does CURB 65 stand for?
C – Confusion (new disorientation in person, place or time)
U – Urea > 7
R – Respiratory rate ≥ 30
B – Blood pressure < 90 systolic or ≤ 60 diastolic.
65 – Age ≥ 65
How does the curb score predict mortality?
Score 1 = under 5%
Score 3 = 15%
Score 4/5 = over 25%
What should you do based off the scores from the CURB-65 scale?
Score 0/1: Consider treatment at home
Score ≥ 2: Consider hospital admission
Score ≥ 3: Consider intensive care assessment
Cause of pneumonia
Streptococcus pneumoniae (50%) Haemophilus influenzae (20%)
What is atypical pneumonia?
The definition of atypical pneumonia is pneumonia caused by an organism that cannot be cultured in the normal way or detected using a gram stain.
Medication for atypical pneumonia?
They don’t respond to penicillins and can be treated with macrolides (e.g. clarithomycin), fluoroquinolones (e.g. levofloxacin) or tetracyclines (e.g. doxycycline).
Atypical pneumonia - Legionella pneumophila (Legionnaires’ disease).
This is typically caused by infected water supplies or air conditioning units. It can cause hyponatraemia (low sodium) by causing an SIADH.
The typical exam patient has recently had a cheap hotel holiday and presents with hyponatraemia.
Atypical pneumonia - mycoplamsa pneumoniae
Mycoplasma pneumoniae. This causes a milder pneumonia and can cause a rash called erythema multiforme characterised by varying sized “target lesions” formed by pink rings with pale centres. It can also cause neurological symptoms in young patient in the exams.
