Pneumonia - 120 Flashcards
Historically there are 2 types of pneumonia, what are they and how are they different?
Typical - abrupt onset, high fever, purulent sputum, focal consolidation
Atypical - gradual onset, dry cough, myalgias, headache
What is the clinical definition of pneumonia?
Inflammation and consolidation of the lung
What is the most common bacterial cause of pneumonia?
Streptococcus pneumoniae. Tend to cause lobar pneumonia. Abrupt onset, medical emergency.
What is a clinical sign that someone has pneumonia caused by Psuedomonas aeriginosa?
Copious green sputum
What is pharyngitis? What is it commonly caused by?
Inflammation of the pharynx/throat. The majority of acute cases are viral, e.g. EBV, HSV. It can be bacterial - Strep.
What is epiglottitis? How would it be recognised clinically?
Inflammation of the epiglottis, it is a medical emergency. 4 Ds - drooling, dysphagia, drawn and dysphonia. IV cefuroxime given, airway secured.
Name some risk factors for pneumonia
Foreign travel - TB, Legionella (Mediterranean), Pseudomonas (SE Asia, Australia)
Institutions
Alcoholism
Co-morbidity
Occupation - animals
Drugs - MST and atropine, both decrease mucociliary action
What investigations are done for suspected pneumonia?
Sputum - AFB, culture, gram stain Urine - Legionella Ag Blood - cultures, WBC, urea, serology ECG CXR
If someone has been diagnosed with community acquired pneumonia and is not severely ill how would you treat them?
Don’t do any microbiological investigations, give empiric antibiotics. If you want to give specific ABX then do blood culture and sputum examination
If someone is severely ill and has been diagnosed with community acquired pneumonia how would you treat them?
Start on empiric ABX whilst doing further tests such as: sputum examination, blood culture, urinary Ag
What is the diagnostic approach to hospital acquired pneumonia?
Sputum/tracheal aspirate and blood culture. Give empiric ABX. If there is failure to respond do a bronchoscopy and then give specific therapy.
What does CURB65 mean?
It is a way of predicting mortality in community acquired pneumonia, it is recommended by the British Thoracic Society for the assessment of the severity of pneumonia.
C - confusion
U - urea >7mmol/L
R - resp. rate >30
B - blood pressure <90/60
If a patient has 2 or more and is over 65 years they are admitted to ITU
What ABX are given for uncomplicated and complicated pneumonia?
Uncomplicated - amoxicillin and clarithromycin
Complicated - IV cefuroxime and clarithromycin
What are some complications that can occur from pneumonia?
Empyema, ARDS, abscess,bronchiectasis, PE
What does the Haldane effect state (in basic terms)
Oxygen dissociation increases CO2 carriage
