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Pneumonia Flashcards

1
Q

Pneumonia

A

inflammation of the alveoli, distal airways,
interstitium

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2
Q

Inflammation due to infection is called pneumonia (T/F?)

A

True

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3
Q

Non- infective pneumonia types and location

A

seen in interstitium
o Idiopathic interstitial pneumonitis
(idiopathic pulmonary fibrosis)
o Connective tissue disorders

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4
Q

How does organisms get into the airways in pneumonia

A
  • Inhalation
  • Aspiration
  • Haematogenous spread
  • Direct spread form mediastinum
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5
Q

MC way of MOs entry in pneumonia

A

Inhalation

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6
Q

Why does organisms enter in pnenumonia

A
  • Defect in host defences
    o Specific
    o Non specific – Systemic (old age,
    alcoholism, immunosuppression,
    institutionalization), local (smoking,
    COPD)
  • Virulent organism
  • Large infective dose
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7
Q

Main types of classification of pneumonia

A
  • Community acquired pneumonia
    o Typical lobar pneumonia
    o Atypical
  • Hospital acquired pneumonia
    o Early
    o Late
    o Ventilator-associated pneumonia
  • Aspiration pneumonia
  • Pneumonia in immunocompromised host
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8
Q

MO associated with ventilator- associated

A

Acenatobacter

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9
Q

Who are at higher risk of getting aspiration pneumonia

A

Unconscious patients
alcoholics
swallowing disorders

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10
Q

Typical MOs causing pneumonia

A

o Streptococcus pneumoniae
o Haemophilus influenzae
o Staphylococcus aureus
o Klebsiella pneumoniae
o Pseudomonas aeruginosa

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11
Q

Atypical MOs causing pneumonia

A

o Mycoplasma pneumoniae
o Legionella species
o Respiratory viruses (influenza)
o Chlamydia pneumoniae

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12
Q

CAP typical lobar pneumonia MOs

A

o Streptococcus pneumonia
o Haemophilus influenza

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13
Q

CAP atypical pneumonia MOs

A

o Mycoplasma pneumonia
o Legionella species
o Respiratory viruses

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14
Q

Streptococcus pneumonias aka

A

Pneumococcus

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15
Q

Clinical features of pneumonia

A
  • Vary from mild to severe
  • Fever with chills & rigors
  • Cough
  • Dyspnoea
  • Pleuritic pain
  • Systemic symptoms
    o Myalgia, headache
    o Confusion
  • Febrile, tachycardic, tachypnoeic
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16
Q

Signs of typical pneumococcal pneumonia

A

signs of lobar consolidation

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17
Q

Signs of Pneumonia due to atypical organisms

A

more systemic Sx
Signs are not localized

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18
Q

Difference between typical and atypical

A

TYPICAL
Onset- sudden
Fever- High
Chills, rigors - Usual
Sputum - Mucopurulent
Hemoptysis - Common
Lung signs - consolidation
Effusion- common
CXR - Alveolar
Response to Rx- Yes

ATYPICAL
Onset- Gradual
Fever- not High
Chills, rigors - unusual
Sputum - not prominent
Hemoptysis - uncommon
Lung signs - few
Effusion- uncommon
CXR - interstitial
Response to Rx- No

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19
Q

Mendelson Syndrome

A

Chemical pneumonitis due to aspiration.
Eg- Emergency C- section

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20
Q

Fever w chills and rigors DDs

A

Pyelonephritis
Cholangitis
Abscess
Malaria

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21
Q

why is aspiration causing pneumonia in the apical or posterior segment of the Right lower lobe segment

A

Right bronchi is wider, shorter and more in-line with the trachea

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22
Q

Dx tests done for pneumonia

A

CXR
Microbiology - Gram stain, Sputum cullture, ABST, blood culture, urinary antigens

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23
Q

Supportive tests done for pneumonia

A

FBC
ESR
CRP
BUN
SpO2, ABG
ECG

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24
Q

findings of pneumonia

A

CXR- air bronchogram

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25
Air bronchogram
can see airways inside the consolidated area
26
supportive tests findings of Pneumonia
FBC- high neutrophils High ESR, CRP
27
blood cultures will be positive only in
severe cases of pneumonia
28
Rx of pneumonia depends on
Home vs hospital General ward vs ICU
29
Home Rx for pneumonia is considered in
patients who are at a state of taking and complying with pills
30
Hospital based treatment for pneumonia is considered in
* Vital signs o PR>120 bpm o RR>30/min o Temp >400C * Radiograph o Multi lobar involvement o Complications (abscess, effusion) * Co-morbities (diabetes, heart failure, COPD, malignancies, renal failure) * Systemic complications (hypotension, confusion, oliguria) * Advanced age * Unable to take oral drugs * Poor family/social support
31
ICU care for pneumonia is considered in
* Hypoxameia (PaO2<60 mmHg) * Hypercarbic (PaCO2> 50 mmHg) * Acidotic * Hypotensive (DBP <60, SBP < 90) * Oliguric (UOP < 30) * Uraemic * Confused
32
CURB 65
Pneumonia is severe if 2 or more of the following are present * Confusion * Blood urea > 7 mmol/L * Respiratory rate > 30/min * Diastolic blood pressure < 60 mmHg * Age > 65 * Multi lobar * PaO2 < 8kPa (60 mmHg) * Blood culture is positive
33
ABx therapy is based on
* Suspected organism * Patient & underlying conditions * Availability * Cost
34
ABx therapy for ambulatory patients with typical lobar consolidation previously well young adult
o Amoxicillin (pneumococcal) o Macrolide (drug resistant SP)
35
Interstitial shadowing with systemic feature (atypical pneumonia) ABx
Macrolide (clarithromycin)
36
Co-morbidities present ABx therapy for ambulatory patients with pneumonia
o Respiratory fluroquinolones (levofloxacin) o Amoxicillin / clavulanate PLUS macrolide
37
ABx therapy for hospitalized patients
* Respiratory fluroquinolone (moxifloxacin, levofloxacin oral or i.v.) * Beta lactam (cefotaxime, ceftriaxone) i.v. PLUS macrolide (clarithromycin
38
Mx principles besides ABx for pneumonia
* Fluid resuscitation * Oxygenation * Monitoring * Ventilation if necessary
39
Possible causes if the patient is improving for 48-72 hours
* Wrong diagnosis (malignancy, haemorrhage, infarct) * Resistant pathogen * Wrong drug * Wrong dose * Unusual pathogen * Nosocomial superinfection * Underlying lung pathology (bronchiectasis, bronchial obstruction) * Complications
40
Complications of pneumonia
* Sepsis with multi organ failure * Respiratory failure * Metastatic infections * Lung abscess * Pleural effusion
41
How long does it take for fever to resolve in pneumonia
2-4 days
42
how long does leucocytosis take to resolve in pneumonia
3-4 days
43
How long does CRP take to reduce
1-3 days
44
How long does it take for CXR abnormalities to resolve
3- 12 week
45
Bronchopneumonia
Bronchial breathing +patchy shadowing on CXR- patchy consolidation not confined to one lobe
46
Klebsiella pneumonia is MC in
Pt with heart disease, lung disease, DM, alcohol excess, malignancy
47
Clinical features of Klebsiella
Sudden onset with severe systemic illness Purulent sputum- gelatinous, blood stained
48
mainly affected lobe in Klebsiella
Upper lobe
49
sputum characteristics of Klebsiella
Redcurrant jelly
50
Mycoplasma pneumonia generalized features
headache, malaise often precede chest symptoms by 1-5 days
51
Extrapulomary features of Mycoplasma pneumonia
* Myalgia, arthralgia * Rashes, erythema multiforme * Haemolytic anaemia,thrombocytopenia * GI symptoms –vomiting, diarrhoea * Meningoencephalitis and other neurological abnormalities * Myocarditis and pericarditis
52
CXR findings of Mycoplasma pneumonia
usually one lobe involvement but sometimes bilateral, no correalation between XRay appearance and clinical symptoms
53
WBC levels in Mycoplasma pneumonia
not raised, 50% Cold agglutinins positive
54
Dx of Mycoplasma pneumonia
confirmed by increased complement fixing antibodies
55
Rare findings of Mycoplasma pneumonia
Lung abscess Pleural effusions
56
Rx of Mycoplasma pneumonia
Macrolides/ tetracyclines
57
Staphylococcus aureus pneumonia seen in?
Following preceding viral illness/IVDU/prolong catheters
58
Common features in Staph aureus Pneumonia
Empyema cavitation Abscess formation Pneumothorax Septicemia Metastatic abscess
59
BP , RR and PaO2 levels in Staph aureus pneumonia
Hypoxemia Hypoventilation Hypotension
60
Respi failure can be seen in
Pneumonia due to Staph aureus
61
Frequent cause of exacerbation in COPD patient seen in
Haemophilus influenzae pneumonia
62
Rx of pneumonia due to Haemophilus influenzae
Oral amoxicillin 500mg/3 days
63
Pneumonia that can occur due to exposure to birds
Chalmydia psittaci
64
Sx and signs of pneumonia due to Chlamydia psittaci
Muscle pain liver and spleen occasionally enlarged Occasionally photophobia and neck stiffness
65
Legionella pneumonia can be seen in
Outbreaks in individuals staying in hotels institutions or hospitals where shower facilities or cooling systems are contaminated with organism
66
Sx of Legionella pneumonia
Prodromal virus like illness Dry cough, confusion, diarrhoea
67
FBC findings of Legionella
Lymphopenia without marked leukocytosis
68
Sodium levels and albumin levels of legionella pneumonia
Hyponatremia Hypoalbuminaemia
69
liver transaminase levels in Legionella pneumonia
Increased
70
Ix done for Legionella pneumonia
Urinary antigen test
71
Rx of legionella pneumonia
Macrolides
72
Pneumonia seen in alcoholics
Klebsiella
73
Pneumonia Extrapulmonary features are mostly seen in
Mycoplasma
74
Anemia seen in mycoplasma pneumonia
Cold AIHA
75
Photophobia and neck stiffness in pneumonia is
Chlamydia psittaci
76
Pneumonia due to outbreaks in a common place
Legionella
77
Klebsiella mainly affects ... part of the lung
upper lobe
78
Pneumonia due to a preceding viral illness is
Staph aureus
79
Myocarditis and pericarditis is associated with.... pneumonia
Mycoplasma
80
Neurological features can be seen in..... pneumonia
Mycoplasma
81
Lung abscess is rare in..... pneumonia while common in..... pneumonia
Mycoplasma Staph
82
Pneumonia associated with COPD
Haemophilus influenzae
83
Hepatosplenomegaly is associated with..... pneumonia
Chlamydia psittaci
84
Pneumonia associated with fungal infection
Pneumocystis jiroveci
85
Pneumocystic jiroveci is mostly seen in
Immunocompromised and HIV patients
86
CXR findings of Pneumocystis pnenumonia
B/L hilar shadowing
87
HRCT findings of Pneumocystis jiroveci
Ground glass appearance
88
SpO2 feature in pneumocystis pneumonia
desaturates with exercises
89
type of cough in pneumocystis jiroveci
Dry cough
90
Dry cough seen in what types of pneumonia
Pneumocystis Legionella
91
Rx of pneumocystis pneumonia
Cotrimoxazole
92
Pneumonia and Hyponatremia ?
Legionella
93
Pneumonia and diarrhea?
Legionella
94

Pulmonology (13 decks)

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