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(ZUZ) Respiratory MED > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What is pneumonia ?

A

Inflammation of the lung parenchyma with the normal air-filled lungs becoming filled with infective liquid (known as consolidation)

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2
Q

What is CAP ?

A

community-acquired pneumonia: caught outside of hospital

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3
Q

When is a diagnosis of HAP made?

A

a pneumoniacontracted > 48 hrs after hospital admission that was not incubating at the time of admission.

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4
Q

What is Ventilated acquired pneumonia ?

A

48 hours post intubation

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5
Q

Aspiration pneumonia what is it?

A

caused by theinhalation of oropharyngeal or gastric contents
This brings bacteria found in these environments into the lungs

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6
Q

Aspiration pneumonia- in what patients is it seen ?

A

associated with patients who are unable to adequately protect their airway, it may be seen in patients with:

  • Reduced conscious level
  • Neuromuscular disorders
  • Oesophageal conditions
  • Mechanical interventions such as endotracheal tubes.
  • neurological dysphagias- stroke, epilepsy, alcoholics, drowning
  • At risk- nursing home residents and drug overdose
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7
Q

Typical CAP organisms

A

Streptococcus pneumoniae (most common)
Haemophilus influenzae
Moraxella catarrahalis

Less:
Staphylococcus aureus and MRSA
Pseudomonas aeruginosa
Klebsiella pneumonia
Group A strep pyogenes
anaerobes

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8
Q

Haemophilus influenzae- common in ….

A

COPD patients

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9
Q

Moraxella catarrahalis seen in ……

A

immunocompromised patients or those with chronic pulmonary disease

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10
Q

Pseudomonas aeruginosa in patients with …..

A

cystic fibrosis or bronchiectasis

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11
Q

Klebsiella pneumonia seen in …

A

alcoholics

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12
Q

Atypical organisms causing CAP

A
  • Legionella pneumophilia
  • Mycoplasma pneumoniae
    -Chlamydia pneumoniae
  • Coxiella burnetii (Q fever)
  • Psittacosis- chlamidophila psittaci
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13
Q

What does atypical organism mean?

A

organism that cannot becultured in the normal way or detected using agram stain must use serology to identify
They don’t respond to penicillins and can be treated withmacrolides (e.g. clarithomycin),fluoroquinolones
(e.g. levofloxacin) ortetracyclines (e.g. doxycycline)

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14
Q

Mycoplasma pneumoniae: signs ?

A
  • Dry cough
  • Atypical chest signs/x-ray
  • Erythema multiforme seen-> varying sized “target lesions” formed bypink rings withpale centres
  • neurological symptoms in young patient in the exams.
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15
Q

Legionella pneumophilia: typical history, where caught from?

A

water sources, travel, infected air conditioning units

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16
Q

Legionella pneumophilia: what can it present with? (think electrolyte imbalance, WBC)

A

Commonly present with:
Hyponatraemia
SIADH
lymphopenia

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17
Q

HAP common organisms

A
  • Staphylococcus aureus or MRSA
  • Gram negative bacili
    • Pseudomonas aeruginosa
    • Escherichia coli
    • Klebsiella pneumoniae
  • Strep pneumoniae
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18
Q

What are viral causes of pneumonia?

A
  • Cytomegalovirus- in immunocompromised eg. bone marrow recipients
  • Influenza
  • Adenovirus
  • RSV (Respiratory syncytial virus)
  • Rhinovirus
19
Q

What are fungal causes of pneumonia?

A

Pneumocystis jiroveci (PCP)- HIV patients
Aspergillus spp- in prolonged neutropenia

20
Q

Idiopathic interstitial pneumonia caused by

A

non infective causes-
cryptogenic organizing pneumonia
complication of rheumatoid arthritis or amiodarone therapy

21
Q

Aspiration pneumonia organisms

A

Mixed infections- Viridans streptococcus and anaerobes

22
Q

Differentials of cough

A

Heart failure w/ pul oedema
PE
Lung cancer
Acute exacerbation of bronchiectasis
Interstitial lung disease
URTI
Pneumothorax
TB

23
Q

Differentials of consolidation on CXR

A
  • Pneumonia
  • TB
  • Lung cancer
  • Lobar collapse
  • Haemorrhage
24
Q

What would help differentiate TB from CAP

A
  • Subacute presentation
  • Night sweats, loss of appetite and weight loss, fatigue
  • Born in country with high incidence TB- non-uk born
  • HIV, immunocompromised, drug use, homelessness
25
Q

Symptoms ?

A
  • cough- productive- green/yellow sputum
  • Dyspnoea
  • Fever
    -Malaise
  • Haemoptysis
  • Pleuritic chest pain
  • Delirium
  • sepsis
26
Q

Signs of pneumonia

A
  • Fever
  • Tachycardia
  • Tachypneoa
  • reduced oxygen sats
  • Hypotension (shock)
  • Confusion
  • Cyanosis

Chest signs
- Reduced breath sounds
- Bronchial breath sounds
- Focal coarse crackles (bibasal)
- Dullness to percussion
- Increased vocal fremitus

27
Q

Most important Investigations for pneumonia? if febrile? if high curb-65? low O2 stats?

A
  • CXR
  • FBC, U&Es, CRP
  • Sputum culture
  • Consider blood cultures if febrile
  • If high CURB-65 score need Atypical pneumonia
    screen – serology and urine legionella test
  • ABG if low sats
28
Q

CURB-65 stand for

A

C- confusion
U- urea >7mmol/l
R- Resp rate >= 30
B- BP Sys <90 or dia <60
65- >65 yrs old

29
Q

What do you do if CURB-65 =0

A

Low risk
NICE recommend thattreatment at homeshould be considered (alongside clinical judgement)

30
Q

What do you do if CURB-65 = 1 or 2

A

intermediate risk
NICE recommend that hospital assessment should be considered

31
Q

What do you do if CURB-65 = 3 or 4

A

high risk
NICE recommend urgent admission to hospital

32
Q

What do you do if CURB-65 = 4 or 5

A

(>15% mortality)
should be managed in HDU or ITU
Non-invasive ventilatory support should always be offered here

33
Q

CRP can guide antibiotic management. What are the parameters?

A
  • CRP < 20 mg/L - do not routinely offer antibiotic therapy
  • CRP 20 - 100 mg/L - consider a delayed antibiotic prescription
  • CRP > 100 mg/L - offer antibiotic therapy
    (usually over 100 in pneumonia)
34
Q

Management of pneumonia

A

A-E- Check for indications of sepsis
Oxygen titrated to saturations
IV fluids
Appropriate analgesia- Paracetamol/ NSAIDs
Antibiotics

35
Q

Low severity: Mild CAP- antibiotics ?

A

-Amoxicillin
- Tetracycline (doxycycline) or macrolide (clarithromycin) if penicillin allergic
5-7 days

36
Q

Intermediate severity: Moderate CAP antibiotics ?

A

Dual therapywith a beta-lactam (e.g. amoxicillin) and a macrolide (e.g. clarithromycin)
- Tetracycline (doxycycline) if penicillin allergic
7-10 days

37
Q

High severity: Severe CAP antibiotics ?

A

IV beta-lactamase stable beta-lactam(e.g co-amoxiclav) and a macrolide (e.g. clarithromycin)
- Tetracycline (doxycycline) if penicillin allergic
- 7-10 days may be extended to 14 or 21 days depending on clinical circumstance

38
Q

HAP antibiotic treatment ?

A
  • Should follow local guidelines based upon local microbial knowledge.
    First line - Co-amoxiclav
    Second line- Severe -Tazocin (piperacillin/tazobactam) or meropenem
39
Q

If MRSA risk- which antibiotics?

A

Vancomycin and Linezolid

40
Q

PCP- which antibiotics?

A

trimethoprim/sulfamethoxazole known as co-trimoxazole

41
Q

Flu then has pneumonia, already had abx but still deteriorating - give …

A

co-amoxiclav

42
Q

Follow up arrangements for pneumonia

A

Follow up in clinic in 6 weeks with a repeat CXR to ensure resolution

  • HIV test
  • Immunoglobulins
  • Pneumococcal IgG serotypes
  • haemophilus influenzae b IgG
43
Q

Non-resolving pneumonia causes

A

CHAOS mnemonic

  • Complication- empyema, abscess
  • Host- immunocompromised
  • Antibiotic- inadequate dose, poor oral absorption
  • Organism- resistant or unexpected organism not covered by empirical antibiotics
  • Second diagnosis- PE, Cancer, organising pneumonia

(ZUZ) Respiratory MED (21 decks)

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