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YR3: RESPIRATORY LO's > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

Define Pneumonia

A

infection of distal lung parenchyma.

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2
Q

How can pneumonia be categorised?

A

Community or hospital
Typical or atypical (Mycoplasma, Chlamydia, Legionella)
Aspiration or Immunocompromised

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3
Q

Which 10 infections may cause CAP?

A 
Streptococcus pneumoniae (70%) 
Haemophilus influenzae 
Moraxella catarrhalis (COPD) 
Chlamydia pneumonia 
Chlamydia psittaci (causes psittacosis) 
Mycoplasma pneumonia 
Legionella (occurs anywhere with A/C) 
Staphylococcus aureus 
Coxiella burnetii (causes Q fever)  
TB
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4
Q

Which infections may cause HAP?

A

Gram-negative enterobacteria (Pseudomonas, Klebsiella)

Anaerobes (due to aspiration pneumonia)

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5
Q

List 6 risk factors for pneumonia

A 
Age  
Smoking  
Alcohol 
Pre-existing lung disease (e.g. COPD)  
Immunodeficiency 
Contact with patients with pneumonia
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6
Q

Describe the epidemiology of pneumonia

A

5-11/1000

CAP responsible for > 60,000 deaths per year in the UK

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7
Q

List 9 symptoms of pneumonia

A 
Fever  
Rigors  
Anorexia 
Malaise  
Cough  
Sputum (yellow/ green/ rusty)
SOB 
Pleuritic chest pain  
Confusion (in severe cases/ elderly)
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8
Q

List 4 atypical symptoms of pneumonia

A

Headache
Myalgia
Diarrhoea/ abdominal pain
DRY cough

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9
Q

List 12 signs of pneumonia

A 
Pyrexia  
Tachypnoea 
Tachycardia 
Hypotension 
Cyanosis  
Decreased chest expansion  
Dull to percuss over affected area  
Increased tactile vocal fremitus over affected area  
Bronchial breathing over affected area 
Pleural rub
Coarse crepitations on affected side  
Chronic suppurative lung disease (e.g. abscess)- clubbing
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10
Q

What are the suitable investigations for pneumonia?

A 
Bloods
CX
Sputum culture
Urine dip: Legionella
Bronchoscopy
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11
Q

Which bloods are taken in pneumonia?

A 
FBC (high WCC) 
LFT (abnormal in legionella)
U+Es (Urea high in severe)
CRP (high)
Blood cultures
RBC (Mycoplasma agglutinates)
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12
Q

What is seen on CXR of a patient with pneumonia?

A

Lobar patchy shadowing
Pleural effusion
Klebsiella often effects upper lobes
May detect abscesses.

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13
Q

When in bronchoscopy performed in pneumonia cases?

A

if Pneumocystitis carinii is suspected

If Pneumonia fails to resolve

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14
Q

What management does each CURB-65 score indicate?

A

0-1: PO Abx, home
2: Admit
3+: ITU

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15
Q

Describe the use of antibiotics in bacterial pneumonia

A

Oral Amoxicillin or Clarithromycin (0-1)
Oral or IV Amoxicillin + Clarithromycin (2)
IV Cefuroxime/Co-amoxiclav + Clarithromycin (3+)

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16
Q

When would you add metronidazole to the baseline antibiotics being used to treat a pneumonia?

A

Aspiration
Lung abscess
Empyema

17
Q

What supportive treatment may be necessary in treating pneumonia?

A

Oxygen
IV fluids
CPAP, BiPAP or ITU care for respiratory failure
Surgical drainage for lung abscesses + empyema

18
Q

What are the clinical features of instability when discharge planning for pneumonia? How many equates to high risk of re-admission and mortality?

A 
High temperature
Tachycardia
Tachypnoea
Hypotension
Low oxygen sats 
>,2
19
Q

What would you consider in a non-resolving pneumonia?

A 
Other causes:
PE
PH
RHF
Drug toxicity
Unusual pathogens
Alveolar haemorrhage
20
Q

List 2 approaches to prevention of pneumonia

A

Pneumococcal vaccine
Haemophilus influenzae type B vaccine
Only usually given to high risk groups (e.g. >65, splenectomy)

21
Q

List 5 complications of pneumonia

A 
Pleural effusion  
Empyema 
Abscess
Septic shock  
ARDS
22
Q

What are the extra complications of Mycoplasma pneumonia?

A 
Erythema multiforme 
Myocarditis 
Haemolytic anaemia 
Meningoencephalitis  
Transverse myelitis  
GBS
23
Q

Describe the prognosis for patients with pneumonia

A

Most resolve within treatment within 1-3 weeks

Severe pneumonia has a high mortality

24
Q

What system is used to assess severity of pneumonia?

A 
CURB-65 score:
Confusion < 8 AMTS 
Urea > 7 mmol/L 
Respiratory rate > 30/min 
BP: systolic < 90 mmHg or diastolic < 60 mmHg  
Age > 65 yrs

YR3: RESPIRATORY LO's (16 decks)

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