Pneumonia Flashcards
Presentation of pneumonia?
Sob, fever, cough productive of sputum, haemoptysis, pleuritic chest pain. Delirium, sepsis
Possible signs of pneumonia?
Tachycardia, tachypnoea, fever, hypoxia, hypotension, confusion
Characteristic signs on chest of pneumonia?
Focal coarse crackles
Dullness to percussion
Bronchial breath sounds
Severity assessment to CURB65?
Confusion
Urea>7
Resp rate>30
Blood pressure systolic less than 90 and diastolic equal to or less than 60
Age over 65 or equal
Most common causes of pneumonia?
Streptococcus pneumonia, haemophilus influenza
Other causes of pneumonia?
- Moraxella catarrhalis- immunocompromised/ chronic pulmonary disease
- Pseudomonas aeruginosa- cystic fibrosis or bronchiectasis
- Staphylococcus aureus- cystic fibrosis
Definition of atypical pneumonia?
Cannot be cultured or detected by gram stain. Don’t respond to penicillins, treated with macrolides (clarthiromycin), fluoroquinolones (levofloxacin), tetracyclines (doxycycline)
Which organism can you get due to infected water supplies or air conditioning unity’s. It causes hyponatraemia by SIADH? (Cheap holiday)
Legionella pneumophila
A milder pneumonia, with erythema multiform rash, target lesions pink rings pale centres. Can also cause neurological symptoms?
Mycoplasma pneumonia
Mild- moderate chronic pneumonia in child with wheeze?
Chlamydophila pneumonia
Exposure to animals and their bodily fluids. Think farmer with flu like illness?
Coxiella burnetii Qfever
Contracted from infected birds, parrot owner?
Chlamydia psittaci
5 causes of atypical pneumonia?
Legions of psittaci MCQ
When do you get fungal pneumonia?
Pneumocystis jiroveci- immunocompromised- low CD4 count poorly controlled or new HIV.
How does fungal pneumonia present?
Dry cough without sputum, night sweats, sob on exertion.
Treatment for fungal pneumonia?
Co-trimaxazole ( trimethoprim/sulfmethoxazole) Septrin given prophylactically with those with low CD4 count
When do you send a urine sample for antigen testing?
Legionella and pneumococcal urinary antigens
Which antibiotics to give and how long for?
- Mild CAP- 5 days amoxicillin or macrolide
- Moderate to severe CAP- 7-10 days dual antibiotics amoxicillin/ macrolide
Beta lactamase stable penicillin co-amoxiclav, ceftriaxone or pipperacillin with tazobactma and a macrolide in high severity
Complications of pneumonia?
Sepsis, pleural effusion. Empyema, lung abscess, death
CRP testing?
Less than 20mg/dL- dont offer antibiotics
20-100- consider delayed antibiotic prescription
More than 100- offer antibiotic therapy
What should all cases of pneumonia have?
6 weeks CXR
Progression of pneumonia?
1 week: fever resolved
4 weeks: chest pain and sputum production reduced
6 weeks cough and sob reduced
3 months: all symptoms resolved except fatigue
6 months: most people will feel back to normal
Leading cause of bronchitis?
Viral- 80% episodes happen in winter/autumn
Presentation of acute bronchitis?
Cough- productive or not
Wheeze
Rhinorrhoea
Sore throat
Low grade fever
