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3- Respiratory Medicine > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What is pneumonia?

A

Acute respiratory illness associated with recently developed radiological pulmonary shadowing that can be segmental, lobar or multilobar

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2
Q

Classification of pneumonia is

A

Community acquired
hospital acquired
Immuno compromised pneumonia

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3
Q

What is lobar pneumonia?

A

Homogeneous consolidation of one or more lung lobes, often with associated pleural information

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4
Q

What is bronchopneumonia?

A

Patchy, alveolar consolidation associated with bronchial and bronchiolar inflammation
Open effect both lower lobes

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5
Q

Incidence of community acquired pneumonia

A

5 to 11 in 1000 adults

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6
Q

Percentage of community acquired pneumonia from all lower respiratory tract infection

A

5 to 12%

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7
Q

Age more at risk of community acquired pneumonia

A

Even though all ages are affected extreme of age are more at risk

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8
Q

Mode of transmission of community acquired pneumonia

A

Droplets

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9
Q

Most common infecting agents in community acquired pneumonia

A

Streptococcus pneumoniae

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10
Q

Type of bacteria, causing community acquired pneumonia

A

Streptococcus pneumonia
Mycoplasma pneumoniae
Legionella pneumophila
Chlamydia, pneumonia
Haemophilus influenza
Staphylococcus aureus
Chlamydia psittaci
Coxiella burnetii
Klebsiella pneumoniae

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11
Q

Viruses causing community acquired

A

Influenza
para influenza
Measles
Herpes Simplex
Varicella
Adenovirus
Cytomegalovirus
Coronaviruses (SARS cov, and mers cov)

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12
Q

Clinical features of community acquired pneumonia

A

Systemic - Fever, Rigors , Shivering, Malaise , Delirium

Respiratory - cough short painful
and dry, mucopurulent sputum, hemoptysis sometimes , pleuritic chest pain with referral to the shoulder or anterior abdominal wall, upper abdominal tenderness if lower lobe pneumonia or associated hepatitis

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13
Q

People more at risk of mycoplasma pneumonia infection . (CAP)

A

Young people, rare in the elderly

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14
Q

Demographic more at risk of Haemophilus influenza infection . (CAP)

A

Elderly

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15
Q

If a patient had influenza which type of bacteria would you suspect in the pneumonia? . (CAP)

A

Staph aureus

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16
Q

Bacteria associated with alcohol abuse, and in pneumonia. Presents with severe bacteremic llness. (CAP)

A

Klebsiella pneumoniae

17
Q

Findings in clinical exam in community acquired pneumonia

A

Signs depend on stage of pneumonia
Dull to percussion if consolidated
Bronchial breathing
whispering pectoriquoly
Crackles
State of nutrition
Herpes labiales or rusty sputum if streptococcal infection

18
Q

Differential diagnosis of pneumonia

A

Pulmonary-Infarction
Pulmonary/ pleural tuberculosis
Pulmonary edema
Pulmonary eosinophilia
Malignancy, broncho alveolar cell carcinoma
Cryptogenic organizing pneumonia

19
Q

Investigation in community acquired pneumonia

A

Full blood counts - high wbc, neutrophil leukocytosis if bacterial , hemolytic anemia if mycoplasma

Urea and electrolytes marker of severity, - high urea, hyponatremia

Liver function test - hypoalbuminemia for severity

ESR Crp - not specifically elevated

Blood cultures for bacteremia

Cold agglutins- positive if mycoplasma

Arterial blood gases for ventilatory failure or acidosis

Sputum for culture

Oropharynx swab for PCR

You’re in for pneumococcus and legionella

Chest x-ray

Pleural fluid

20
Q

Findings on chest x-ray in lobar pneumonia

A

Patchy opacification evolving into homogenous consolidation of affected lobe

Air bronchogram present

21
Q

Management of community acquired pneumonia

A

Oxygen therapy, if tachypnea hypoxemia, hypotension or acidosis

Fluid balance with iV

Antibiotic, depending on clinical context usually five day

Analgesia with paracetamol, Co-Codamol or NSAID for pleural pain

22
Q

Antibiotic of choice in uncomplicated CAP

A

Amoxicillin 500mg three times daily

23
Q

Antibiotic given in staph infection

A

Flucloxacillin and clarithromycin

24
Q

Complications of pneumonia

A

• Para-pneumonic effusion - common
• Empyema
• Retention of sputum causing lobar collapse
• Deep vein thrombosis and pulmonary embolism
• Pneumothorax, particularly with Staphylococcus aureus
• Suppurative pneumonia/lung abscess
• ARDS, renal failure, multi-organ failure (p. 198)
• Ectopic abscess formation (Staph. aureus)
• Hepatitis, pericarditis, myocarditis, meningoencephalitis
• Arrhythmias (e.g. atrial fibrillation)
• Pyrexia due to drug hypersensitivity

25
Q

What is hospital acquired pneumonia

A

New episode of pneumonia at least two days after admission to the hospital

26
Q

Second, most common hospital acquired infection

A

Hospital acquired pneumonia

27
Q

People more at risk of hospital acquired pneumonia

A

Old
Patient in intensive care units, especially on mechanical ventilation

28
Q

What is healthcare associated pneumonia?

A

Development of pneumonia in people who spent at least two days in hospital or attended hemorialysis you need or received IV antibiotics or stayed in a nursing home or long-term care facility

29
Q

Clinical features/ investigations of hospital acquired pneumonia

A

Hospitalized
Purulent sputum
new radiological infiltrates
Unexplained increase in oxygen requirements
fever
leukocytosis or leukopenia

30
Q

Hospital acquired pneumonia differentials

A

Pulmonary embolism
ARDS
Pulmonary Oedema
Pulmonary haemorrhage
Drug toxicity

31
Q

In which form of pneumonia is microbiological confirmation more important , CAP or HAP

A

HAP

32
Q

Factors predisposing to HAP

A

Reduced immune defences (e.g. glucocorticoid treatment, diabetes, malignancy)

Reduced cough reflex (e.g. post-operative)

Disordered mucociliary clearance (e.g. anaesthetic agents)

Bulbar or vocal cord palsy

Aspiration of nasopharyngeal or gastric secretions

Immobility or reduced conscious level

Vomiting, dysphagia (N.B. stroke disease), achalasia or severe reflux

Nasogastric intubation

Bacteria introduced into lower respiratory tract

Endotracheal intubation/tracheostomy

Infected ventilators/nebulisers/bronchoscopes

Dental or sinus infection

Bacteraemia

Abdominal sepsis

Intravenous cannula infection

Infected emboli

33
Q

Management of HAP

A

Oxygenation
Fluid balance
ATBs

34
Q

Which pulmonary dx overlaps with suppurative pneumonia

A

Pulmonary abscess

35
Q

Risk factor for suppurative pneumonia

A

Inhalations of septic material during operation on nose, mouth, throat or vomitus

Bulbar / vocal palsy

Achalasia

Esophageal reflux

36
Q

Clinical features sir suppurative pneumonia

A

Cough with large amounts of sputum, sometimes fetid and blood-stained

Pleural pain-common

Sudden expectoration of copious amounts of foul sputum if abscess ruptures into a bronchus

High remittent pyrexia

Profound systemic upset

Digital clubbing may develop quickly (10-14 days)

Consolidation on chest examination signs of cavitation rarely found

Pleural rub common

Rapid deterioration in general health, with marked weight loss if not adequately treated

37
Q

Investigations in suppurative pneumonia

A

Homogenous lobar or segmental opacity for consolidation or collapse

Cavitation and fluid level if abscess

38
Q

Management of suppurative pneumonia

A

Amoxicillin /metronidazole

39
Q

Pneumonia in immunocompromised clinical features

A

fever
cough
breathlessness

3- Respiratory Medicine (12 decks)

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