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Year One - Respiratory System > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What is pneumonia?

A

It refers to infection of the lung tissue, resulting in inflammation and sputum production within the airways and alveoli

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2
Q

What are the two classifications of pneumonia?

A

Community Acquired Pneumonia (CAP)

Hospital Acquired Pneumonia (HAP)

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3
Q

What is the most common pneumonia classification?

A

Community acquired pneumonia

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4
Q

What is community acquired pneumonia?

A

It is defined as pneumonia that is contracted outside of the hospital

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5
Q

What is hospital acquired pneumonia?

A

It is defined as pneumonia that is contracted within 48 hours or more after hospital admission

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6
Q

Why is it important to distinguish between pneumonia classifications?

A

The causative organisms vary and therefore the first line antibiotic guidelines are different

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7
Q

What are the seven bacterial organisms associated with pneumonia?

A

Streptococcus Pneumonia

Haemophilus Influenza

Group B Strep

Staphylococcus Aureus

Mycoplasma Pneumonia

Legionella Pneumophila

Klebsiella Pneumoniae

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8
Q

What is the most common bacterial organism associated with community acquired pneumonia?

A

Streptococcus pneumonia

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9
Q

What is another term for streptococcus pneumonia?

A

Pneumococcus

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10
Q

Is streptococcus pneumonia gram positive or gram negative?

A

Gram positive

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11
Q

What are the four characteristic features of streptococcus pneumonia?

A

Coccus shaped

Catalase test negative

Partial haemolysis reaction on blood agar

Optochin sensitive

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12
Q

What colour does streptococcus pneumonia present as on blood agar?

A

Green

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13
Q

What virulence factor is associated with streptococcus pneumonia?

A

IgA protease

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14
Q

What are the three clinical features associated with streptococcus pneumonia pneumonia?

A

Rapid onset

Fever

Herpes labialis

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15
Q

What is the second most common bacterial organism associated with community acquired pneumonia?

A

Haemophilus influenza

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16
Q

Which two patient groups tend to be affected by haemophilus influenza?

A

COPD patients

Pre-vaccinated/unvaccinated children

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17
Q

Which patient group tend to contract group B streptococcus pneumonia?

A

Pre-vaccinated infants, often contracted during birth from group B streptococcus colonising the vagina

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18
Q

Which patient group tend to be affected by staphylococcus aureus?

A

Those affected by a recent influenza infection

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19
Q

What are the two signs of staphylococcus aureus pneumonia on CXR?

A

Pneumatoceles in multiple lobes

Consolidation in multiple lobes

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20
Q

What are pneumatoceles?

A

They are air-filled cavitary lesions

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21
Q

What is atypical pneumonia?

A

It is pneumonia caused by an organism that cannot be cultured in the normal way or be detected using a gram stain

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22
Q

Which antibiotic are atypical pneumonia bacteria resistant to? What three alternatives can be administered?

A

Penicillin

Macrolides

Fluoroquines

Tetracyclines

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23
Q

What two bacteria cause atypical pneumonia?

A

Mycoplasma pneumonia

Legionella pneumophilia

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24
Q

What are the four clinical features of mycoplasma pneumonia pneumonia?

A

Dry cough

Autoimmune haemolytic anaemia

Bullous myringitis

Erythema multiform

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25
Q

What is erythema multiform?

A

It is a rash characterised by varying sized target lesions formed by pink rings with pale centres

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26
Q

What classification of autoimmune haemolytic anaemia is associated with mycoplasma pneumonia?

A

Cold AIHA

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27
Q

What investigation can be used to identify mycoplasma pneumonia?

A

Cold agglutinin test

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28
Q

What type of agar is used to grow mycoplasma pneumonia?

A

Eaton agar

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29
Q

Due to mycoplasma pneumonia pneumonia being atypical, what two pharmacological agents are used to treat it?

A

Macrolide antibiotics

Doxycycline

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30
Q

Is legionella pneumophilia gram positive or gram negative?

A

Gram negative

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31
Q

What is another key feature of legionella pneumophilia?

A

Coccobacillus shaped

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32
Q

How is legionella pneumophilia transmitted?

A

It is transmitted via showers, hot tubs and air conditioning systems

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33
Q

What are the three clinical features associated with legionella pneumophilia pneumonia?

A

Dry cough

Hyponatraemia via SIADH

Lymphopenia

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34
Q

Which two patient groups tend to be affected by Klebsiella pneumonia pneumonia?

A

Alcoholics

Diabetics

35
Q

What clinical feature is associated with Klebsiella pneumonia pneumonia?

A

Red currant jelly sputum

36
Q

What three viral organisms are associated with pneumonia?

A

Respiratory Syncytial Virus

Parainfluenza Virus

Influenza Virus

37
Q

What is the most common viral organism associated with pneumonia?

A

Respiratory syncytial virus (RSV)

38
Q

What fungal organism is associated with pneumonia?

A

Pneumocystis Jiroveci

39
Q

Which patient group tends to be affected by Pneumocystis jiroveci pneumonia?

A

Immunocompromised patients (HIV)

40
Q

What CD4 count makes HIV patients vulnerable to Pneumocystis jiroveci pneumonia?

A

100 - 200

41
Q

What are the five clinical features associated with Pneumocystis jiroveci pneumonia?

A

Dry cough

Dyspnoea on exertion

Desaturation on exercise

Absence of chest signs

Night sweats

42
Q

What is the main clinical feature of Pneumocystis jiroveci pneumonia?

A

Desaturations on exercise

43
Q

Due to Pneumocystic jiroveci pneumonia being atypical, what pharmacological agent is used to treat it?

A

Co-trimoxazole

44
Q

How do we prevent pneumonia in HIV patients with a low CD4 count?

A

We administer them prophylactic co-trimoxazole

45
Q

What are the ten clinical features associated with pneumonia?

A

Productive Wet Cough

High Fever > 38.5°C

Dyspnoea

Pleuritic Chest Pain

Tachypnoea

Tachycardia

Bronchial Breath Sounds

Focal Coarse Crackles

Percussion Dullness

Sepsis

46
Q

What are bronchial breath sounds? What is the cause?

A

They are harsh breath sounds that are equally loud on inspiration and expiration

These are caused by consolidation of the lung tissue around the airway

47
Q

What is the cause of focal coarse crackles?

A

They are caused by air passing through sputum

48
Q

What is the cause of percussion dullness?

A

Lung tissue collapse and/or consolidation

49
Q

What are the five investigations used to diagnose pneumonia?

A

Bloods

Arterial blood gases

Sputum cultures

Throat swab

CXR

50
Q

What three blood tests are used to diagnose pneumonia?

A

Full Blood Count (Increased Neutrophil Count)

Urea & Electrolytes (Increased Urea Levels)

CRP (Increased CRP Levels)

51
Q

Which infective organism group would cause an increased neutrophil count?

A

Bacterial

52
Q

What is the typical trend seen in CRP levels during infection?

A

There is a delayed response, therefore they may be low on first presentation then spike a day or two later

53
Q

What additional blood test should all pneumonia patients receive?

A

Blood culture

54
Q

Which patient group may have pneumonia but normal inflammatory markers?

A

Immunocompromised

55
Q

In which pneumonia patients, should an arterial blood gas investigation be conducted?

A

Those that are unwell, specifically those with decreased saturation levels or pre-existing respiratory disease

56
Q

Why do we conduct arterial blood gases in pneumonia patients?

A

It is used to assess or monitor respiratory/metabolic acidosis and the blood lactate level

57
Q

How are sputum cultures/throat swabs used to investigate pneumonia?

A

They are used to identify the causative organism, and therefore guide treatment

A bacterial culture or viral PCR is conducted on the sputum sample in order to obtain this information

58
Q

What is the investigation of choice when diagnosing pneumonia?

A

CXR

59
Q

Why is it recommended that CXR’s are not conduced unless there is diagnosis doubt or in severe/complicated patients?

A

It only confirms clinical findings and doesn’t actually change the management plans

60
Q

What is the sign of pneumonia on CXR?

A

Consolidation

61
Q

What are the two supportive management options for pneumonia?

A

Oxygen Therapy

IV Fluids

62
Q

When is oxygen therapy indicated to treat pneumonia?

A

If patients are hypoxic, with sats < 92%

63
Q

When are IV fluids indicated to treat pneumonia?

A

If patients are hypotensive or dehydrated

64
Q

In most cases, what is the first line antibiotic used to treat CAP?

A

Amoxicillin

65
Q

What is the second line antibiotic used to treat CAP?

A

Macrolide antibiotics

66
Q

Name three macrolide antibiotics

A

Erythromycin

Clarithromycin

Azithromycin

67
Q

What is the typical antibiotic course for mild community acquired pneumonia?

A

Oral amoxicillin or macrolide for a course of five days

68
Q

What is the typical antibiotic course for moderate to severe community acquired pneumonia?

A

Oral amoxicillin AND macrolide for a course of 7 - 10 days

69
Q

In which circumstance would IV antibiotics be recommended to treat pneumonia?

A

When the patient is vomiting

70
Q

How can we monitor the efficacy of antibiotic treatment?

A

We repeat blood tests after 3 days of treatment, which should show reduced levels

WBC is more reliable than CRP due to its delayed response

71
Q

What risk stratification scoring system is used to determine community acquired pneumonia management?

A

CURB-65

72
Q

In a primary care setting, what risk stratification scoring system is used to determine community acquired pneumonia management? Why?

A

CRB-65

This is due to the inability to obtain a serum urea result

73
Q

What does ‘C’ in the CURB-65 score represent?

A

Confusion (Abbreviated Mental Test Score < 8/10)

74
Q

What does ‘U’ in the CURB-65 score represent?

A

Serum Urea > 7mmol/L

75
Q

What does ‘R’ in the CURB-65 score represent?

A

Respiratory Rate > 30/Min

76
Q

What does ‘B’ in the CURB-65 score represent?

A

Blood Pressure: Systolic < 90, Diastolic < 60

77
Q

What does ‘65’ in the CURB-65 score represent?

A

> 65 Years Old

78
Q

What does a CRB65 score of 0-1 indicate?

A

The patient can be managed within the community, with administration of antibiotics

79
Q

What does a CRB65 score > 2 indicate?

A

The patient should undergo hospital assessment, with treatment including the administration of antibiotics and supportive management options

80
Q

What does a CRB65 score > 3 indicate?

A

The patient should undergo hospital assessment, which usually requires intensive care management

81
Q

What are the five complications of pneumonia?

A

Sepsis

Pleural Effusion

Empyema

Lung Abscess

Measles

82
Q

What is a risk factor of aspiration pneumonia?

A

NG tube insertion

83
Q

In aspiration pneumonia, which lung region tends to be affected? Why?

A

Right lower lobe

Due to the anatomy of the airway the right bronchus is more straight and vertically orientated than the left side

Year One - Respiratory System (14 decks)

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