Pneumonia Flashcards

1
Q

What is pneumonia?

A

Pneumonia is the infection and inflammation of the lung parenchyma.

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2
Q

Describe the pathophysiology of pneumonia.

A

Debatable methods of invasion include:
- damage to muco-ciliary escalator by prior infection or smoking.
- inhibition of cough reflex e.g. because of neurodegenerative disorder or opioid drug use.
- inhibition of IgA.
- damage to alveolar macrophages.

can all cause pathogens to accumulate in the lungs.

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3
Q

What are symptoms of typical pneumonia?

A

Fever
Cough with purulent sputum
Dyspnoea
Pleuritic pain
Fatigue

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4
Q

What are clinical signs of typical pneumonia?

A
  • Tachypnoea (and accessory muscle use, intercostal retraction).
  • Unilateral decrease in chest expansion (lobar pneumonia).
  • Increase tactile fremitus (vibration when saying ‘ninety-nine).
  • Percussion: dullness (signifies fluid).
  • Ausculation: bronchial breath sounds and crackles.
  • Tachycardia.
  • Septicaemia: rigors.
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5
Q

What are the complications of pneumonia?

A

Respiratory failure by causing acute respiratory distress syndrome (ARDS).

Septic shock: the causative agent enters the patients bloodstream, releasing cytokines.

Pleural effusion.

Emphysema.

Lung abscess.

Hypotension: sepsis or dehydration is usually the underlying cause.

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6
Q

What are the causative organisms in children and younger individuals?

A

Viruses (e.g., RSV, influenza).
Pneumococcus.
Mycoplasma (atypical pneumonia).

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7
Q

Which bacteria are the most common cause of community acquired pneumonia?

A

Streptococcus pneumoniae.
Haemophilus influenzae.
Moraxella catarrhalis.
Influenza virus.

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8
Q

Which bacteria are the most common cause of hospital acquired pneumonia?

A

Gram-negative bacteria.
Staphylococcus aureus (MRSA).
Streptococcus pneumoniae.
Pseudomonas.

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9
Q

Discuss pneumonia treatment (Hint: BAPP).

A

Breathing: maintain oxygen saturation levels.
Antibiotics: treat the underlying cause (check hospital guidelines).
Pain: give analgesics.
Pneumococcal vaccines for those at risk, e.g., diabetics, the immunosuppresed and those over 65.

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10
Q

What are the causes of recurrent pneumonia?

A

Recurrent pneumonia most commonly occurs in patients with underlying lung disease such as COPD or bronchiectasis, immunocompromised patients, and those with local obstructive processes such as a tumour.

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11
Q

What is the difference between bronchopneumonia and lobar pneumonia?

A

In bronchopneumonia, the infection can be spread throughout the lungs, involving the bronchioles as well as the alveoli. A CXR will show patchy areas spread throughout the lungs.

In lobar pneumonia, the infection causes complete consolidation of a whole lobe of the lung, meaning the entire region is filled with fluid.

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12
Q

Define the mechanisms of defence in the respiratory system.

A

Macrophage mucociliary escalator > alveolar macrophages > mucociliary escalator > cough reflex.

General immune system: humoral and cellular immunity.

Respiratory tract secretions.

Upper respiratory tract acts as a filter.

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13
Q

What investigations can be performed?

A

CXR: look for infiltrates.
Sputum sample: identify causative organsim.
Monitor oxygen sats.
Bloods: Raised WCC and inflammatory markers (CRP).
Urinary antigen test: for pneumococcal or legionella antigen.
Arterial blood gas (ABG).

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14
Q

How is the severity of pneumonia assessed (CURB-65)?

A

Confusion.
Urea > 7 mmol/L.
Respiratory rate > 30/min.
BP <90/60 mmHg.
>65 years old.

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15
Q

What are the ways in which pneumonia can be acquired?

A
  • inhalation of a pathogen.
  • aspiration of food and fluids.
  • haemotogenous spread e.g. IV drug users.
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16
Q

What are the stages of pneumonia?

A
  1. Congestion stage (days 1-2) - vasodilation and vascular permeability > alveolar exudate.
  2. Red hepatisation (days 3-4) - white and red blood cells and fibrin accumulate in the infected area > consolidation.
  3. Grey hepatisation (days 4-7) - RBCs start getting destroyed and take a new appearance.
  4. Resolution (days 8+) - breakdown of grey hepatisation and clearance (productive cough).
17
Q

what is considered hospital acquired pneumonia?

A

pneumonia acquired after > 2 days in hospital.

18
Q

what does a CXR of lobar pneumonia show?

A

consolidationof alveoli and associated bronchi of a particular lobe e.g. left upper loble, right middle lobe etc.

19
Q

what does a CXR of bronchopneumonia show?

A

diffuse, patchy, reticular and nodular opacities, commonly present at the base of the lungs and bilateral.

20
Q

what does a CXR of interstitial pneumonia show?

A

diffuse, patchy, but primarily reticular and perihilar (at hilum of the lungs).