Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine 1 - Clinical > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What is pneumonia?

A

Inflammatory condition of the lungs caused by infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does pneumonia lead to?

A

Fluid and blood cells leaking into the alveoli.

The infection spreads across the alveoli and eventually the lung tissue becomes consolidated, impairing the gas exchange due to reduced ventilation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the three types of pneumonia?

A

Bronchopneumonia = patchy throughout 1 lung

Lobar pneumonia = consolidation in entire lobe

Interstitial pneumonia - inflammatory - viral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does severe bronchopneumonia/lobar pneumonia not respond to?

A

Large consolidation -> shunt V=0

Does NOT respond to O2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does bronchopneumonia respond to?

A

V/Q mismatch

Responds to O2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the most common cause of pneumonia?

A

Streptococcus pneumonia, which is generally community-acquired

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Presentation

A

Shortness of breath

Cough productive of sputum

Fever

Haemoptysis

Pleuritic chest pain (sharp chest pain worse on inspiration)

Delirium (acute confusion associated with infection)

Sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Signs

A

There may be a derangement in basic observations. These can indicate sepsis secondary to the pneumonia:

Tachypnoea (raised respiratory rate)
Tachycardia (raised heart rate)
Hypoxia (low oxygen)
Hypotension (shock)
Fever
Confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Chest signs of pneumonia

A

Bronchial breath sounds.

Focal coarse crackles.

Dullness to percussion due to lung tissue collapse and/or consolidation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hospital acquired pneumonia

A

Lower respiratory tract infection that develops more than 48 hours after hospital admission.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the most common organisms that cause HAP?

A

Pseudomonas aeruginosa
Staphylococcal aureus
Enterobacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Aspiration pneumonia

A

This occurs in patients with an unsafe swallow.

Risk factors include stroke, myasthenia gravis, bulbar palsy, alcoholism, and achalasia.

On chest x-ray the right lung is most commonly affected, as the right bronchus is wider and more vertical than the left bronchus, making it more likely to facilitate the passage of aspirate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Staphylococcal pneumonia

A

A gram-positive cocci found in clusters.

It is found in intravenous drug users, elderly patients, or patients who already have an influenza infection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Mycoplasma pneumoniae

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Chlamydophila pneumoniae

A

School aged child with a mild to moderate chronic pneumonia and wheeze.

Be cautious though as this presentation is very common without chlamydophilia pneumoniae infection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Coxiella burnetii

A

This is linked to exposure to farm animals and their bodily fluids.

The MCQ patient is a farmer with a flu like illness.

AKA Q fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Chlamydia psittaci.

A

This is typically contracted from contact with infected birds.

The MCQ patient is a from parrot owner.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is atypical pneumonia?

A

Caused by an organism that cannot be cultured in the normal way or detected using a gram stain.

They don’t respond to penicillins and can be treated with macrolides or tetracyclines.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How to remember causes of atypical pneumonia?

A

Legions of psittaci MCQs”

M – mycoplasma pneumoniae
C – chlamydydophila pneumoniae
Qs – Q fever (coxiella burnetii)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is Pneumocystis jiroveci (PCP)?

A

Fungal pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Who does Pneumocystis jiroveci (PCP) occur in?

A

Immunocompromised.

It is particularly important in patients with poorly controlled or new HIV with a low CD4 count.

22
Q

Investigations

A

Chest xray
FBC (raised white cells)
U&Es (for urea)
CRP (raised in inflammation and infection)

23
Q

Investigations in moderate or severe cases

A

Sputum cultures
Blood cultures
Legionella and pneumococcal urinary antigens (send a urine sample for antigen testing)

24
Q

Antibiotics

A

Mild CAP: 5 day course of oral antibiotics (amoxicillin or macrolide)

Moderate to severe CAP: 7-10 day course of dual antibiotics (amoxicillin and macrolide)

25
Q

Complications

A

Sepsis
Pleural effusion
Empyema
Lung abscess
Death

26
Q

Severity assessment

A

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

Out of hospital - do not count urea

27
Q

What does CURB 65 predict?

A

Mortality
Score 1 = under 5%
Score 3 = 15%
Score 4/5 = over 25%

28
Q

What should you do based off of CURB-65 scores?

A

Score 0/1: Consider treatment at home

Score ≥ 2: Consider hospital admission

Score ≥ 3: Consider intensive care assessment

29
Q

Treatment

A

Oxygen to keep O2 saturations above 94%

Fluid management

Analgesia if patients have pleuritic chest pain. Paracetamol 1g/6 hours (Max. 4g 24hours)

Antibiotics can be given orally for patients who are not nil by mouth and are managed in the community. However, for severe pneumonia Intravenous route is required.

Follow up appointments are organized for 6 weeks and CXR could be repeated at this time if there are complications or symptoms have not resolved.

30
Q

Prevention

A

Pneumococcal vaccine protects against Streptococcus pneumoniae

31
Q

When is the pneumococcal vaccine offered?

A

Three injections at the age of 2 months, 4 months and 12-13 months.

32
Q

Who should be offered the pneumococcal vaccine?

A

People aged 65 years and older and those in at-risk groups

33
Q

What is a sign of streptococcus pneumoniae?

A

Rusty brown sputum

34
Q

Differential diagnosis

A

Tuberculosis
Lung cancer
Pulmonary embolism
Pulmonary odema
Pulmonary vasculitis

35
Q

What is bronchopneumonia?

A

Most common pneumonia found in children

Accounts for 85% of all respiratory system diseases in children under two years of age

Bronchopneumonia is a type of pneumonia that causes inflammation in the alveoli.

36
Q

What is the most common cause of death in children under 5?

A

Bronchopneumonia

37
Q

What causes bronchopneumonia?

A

Staphylococcus aureus, Klebsiella pneumoniae, Haemophilus influenzae, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Escherichia coli.

38
Q

What are the symptoms of bronchopneumonia?

A

Productive cough
Purulent sputum
Dysepnea
Rigor
Pleuritic pain

39
Q

What is lobar pneumonia?

A

Non-segmental pneumonia

Radiological pattern associated with homogeneous and fibrinosuppurative consolidation of one or more lobes of a lung in response to bacterial pneumonia

40
Q

What are the three types of pneumonia?

A

Bronchopneumonia = patchy throughout 1 lung

Lobar pneumonia = consolidation in entire lobe

Interstitial pneumonia - inflammatory - viral

41
Q

What are the risk factors for pneumonia?

A

Smoking
XS alcohol
Extremes of age
Preceding viral illness
Pre-existing lung condition (COPD, CF)
Chronic illnesses, immunocompromised (HIV, cancer therapy)
Hospitalisation (after 40 hours)
IV drug users

42
Q

What causes rusty brown sputum?

A

Strep pneumoniae

43
Q

Signs of pneumonia complications

A

Swinging fevers
Sweats
Raised WCC/CRP
Weight loss
Failure to improve

44
Q

Treatment for CURB-65 score of:

0-1

A

Community treatment

Amoxicillin

If patient has a penicillin allergy, prescribe clarithromycin or doxycycline

5 day course of antibiotics

45
Q

Treatment for CURB-65 score of:

2

A

Hospital treatment

Amoxicillin + clarithromycin (atypicals)

If patient has a penicillin allergy, prescribe levofloxacin

5-7 day course of antibiotics

46
Q

Treatment for CURB-65 score of:

3 or more

A

ITU

Co-amoxiclav + clarithromycin

If patient has a penicillin allergy, prescribe levofloxacin or co-trimoxazole

7-10 day course of antibiotics

47
Q

Aspiration pneumonia treatment

A

Anaerobes

Use amoxicillin + metrodinazole

48
Q

What are the causative agents in community acquired typical pneumonia?

A

S. pneumoniae
H. influenxae

49
Q

Discuss S. pneumoniae

A

Accounts for 80% of cases
Particularly associated with high fever, rapid onset and herpes labialis
A vaccine to pneumococcus is available

50
Q

Who is H. influenzae seen in?

A

Those with COPD
COPD exacerbation

51
Q

Klebseilla pneumonia

A

Primarily affects the upper lobes resulting in a cavitating pneumonia, presenting with “red-currant” sputum.

It is caused by a gram-negative anaerobic rod.

Furthermore, there is an increased risk of developing complications including empyema, lung abscesses and pleural adhesions.

Patients at risk of Klebsiella pneumonia are those with weakened immune systems such as elderly, alcoholics, and diabetics.

Additional at-risk groups include patients with malignancy, chronic obstructive pulmonary disease, long term steroid use and renal failure.

Medicine 1 - Clinical (41 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions