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Y3 Conditions > Pneumonia > Flashcards

Pneumonia Flashcards

Hospital acquired + Community acquired + Bronchopneumonia

1
Q

Pneumonia

What do we commonly use to assess severity?

A

CRB-65
CURB-65

the U is only used in hospital settings

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2
Q

Pneumonia

What investigations do we usually do in the community?

A

basic obs

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3
Q

Pneumonia

What might be found on an X-ray?

A

consolidation
(usually lower lobes)

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4
Q

Pneumonia

What bloods are useful to take and why?

A

FBC, U&Es, LFTs, CRP

(severe infection)

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5
Q

Pneumonia

What microbiological investigations might be done?

A
  • Blood cultures
  • Sputum culture and sensitivity
  • Investigations for atypical bacteria and pathogens
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6
Q

Pneumonia

What are some atypical pathogens?

A

Legionella pneumophila.
Mycoplasma pneumoniae.
Chlamydophila pneumoniae.

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7
Q

Pneumonia

What are the 4 top CAP pathogens?

A
  • Streptococcus pneumoniae
  • influenza A
  • Mycoplasma pneumoniae
  • Chlamydophila pneumoniae
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8
Q

Pneumonia

What are the top HAP pathogens?

2

A
  • gram negative enterobacteria
  • staph aureus
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9
Q

Pneumonia

ABx should be used for treatment, but the choice of which should be guided by local protocols.

Examples include:

A
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10
Q

Pneumonia

General management (non-prescribing).

A

Oxygen for hypoxia.
Fluids if dehydrated.

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11
Q

Pneumonia

When is follow-up recommended for?

A

6 weeks

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12
Q

Pneumonia

When should you order a CXR?

A

appropriate in cases of persisting signs and symptoms or if there is a high risk of underlying lung pathology

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13
Q

Pneumonia

What vaccinations should be offered to high risk pts and those over 65y?

A

Influenza vaccination and pneumococcal vaccination

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14
Q

Pneumonia

What is the definition of HAP?

A

‘pneumonia that develops 48 hours or more after hospital admission, and that was not incubating at hospital admission

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15
Q

Pneumonia

What is the highest risk for HAP?

A

mechanical ventilation

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16
Q

Pneumonia

Name 5 gram-negative bacteria often causative of HAP?

A
17
Q

Pneumonia

Name 2 gram-positive bacteria often causative of HAP?

A
18
Q

Pneumonia

Name some symptoms of HAP.

9

A
  • Fever
  • Rigor
  • Malaise
  • Anorexia
  • Dyspnoea
  • Cough
  • Purulent sputum
  • Haemoptysis
  • Pleuritic chest pain
19
Q

Pneumonia

Name some signs of HAP.

8

A
  • Pyrexia
  • Cyanosis
  • Confusion
  • Tachypnoea
  • Tachycardia
  • Hypotension
  • Signs of consolidation
  • Pleural rub

the elderly may also be hypothermic, not pyrexial
confusions may be the only sign in the elderly

20
Q

Pneumonia

Name some signs of consolidation.

4

A
  • diminished expansion
  • dull percussion note
  • increased tactile vocal fremitus/vocal resonance
  • bronchial breathing
21
Q

Pneumonia

What are the risk factors for HAP?

7

A
  • Poor infection control/hand hygiene (of treating healthcare workers)
  • Head of bed at <30° angle
  • Intubation and mechanical ventilation; endotracheal cuff pressure <20cm H2O
  • H2 antagonist and antacid use
  • Poor oral hygiene
  • No interruption in sedation
  • Reintubation
22
Q

Pneumonia

What are the 1st line investigations for HAP?

A
  • Chest X-ray
  • CT scanning
  • WBC count with differential
  • Pulse Oximetry
  • Sputum Sample
23
Q

Pneumonia

What other investigations might we do for HAP after 1st line?

A
  • Arterial Blood Gas
  • CT chest
24
Q

Pneumonia

Which view is prefered in CXR?

A

PA and lateral views are preferred over AP

25
Q

Pneumonia

Why might a CT be ordered?

A

to diagnose an opacity and clarify whether a procedure is indicated

26
Q

Pneumonia

What are some risk factors for MDR pathogens?

multidrug-resistant (MDR) pathogens

A
  • ABx in the past 90 days
  • Septic shock at the time of ventilator-associated pneumonia
  • ARDS preceding ventilator-associated pneumonia
  • > 5 days hospitalisation prior to the occurrence of ventilator-associated pneumonia
  • Acute renal replacement therapy prior to ventilator-associated pneumonia
27
Q

Pneumonia

NICE guildlines for ABx prescription in over 18s.

  • 1st choice oral, non-severe clinical features, not at high risk of resistance

with and without penicillin allergy

A
  • Co-amoxiclav

(allergy)
- Doxycycline, Co-trimoxazole, Levofloxacin

28
Q

Pneumonia

NICE guildlines for ABx prescription in over 18s.

  • 1st choice severe symptoms or signs (e.g. those of sepsis) or if the patient is at a higher risk of resistance
A

Piperacillin + tazobactam is recommended

alternative: ceftriaxone

29
Q

Pneumonia

NICE guildlines for ABx prescription in over 18s.

  • 1st choice if the patient has a suspected or confirmed MRSA infection, then ____ is recommended. For example…
A

dual IV therapy

Piperacillin / Ceftriaxone
+
Vancomycin / Teicoplanin / Linezolid

30
Q

Pneumonia

What management is indicated indicated in cases of respiratory failure, where non-invasive ventilation fails to maintain adequate oxygenation?

A

Intubation and invasive ventilation

31
Q

Pneumonia

When might a bronchoscopy or a thoracentesis need to be performed?

A

the patient is not recovering despite treatment and where an alternative diagnosis is being sought

32
Q

Pneumonia

What is Bronchopneumonia?

A

a subtype of pneumonia

characterised by inflammation of the bronchi, bronchioles and alveoli.

33
Q

Pneumonia

What is broncho pneumonia aka and why?

A

lobular pneumonia

Inflammatory patchy consolidations may be present in lobules, mainly in a basal location in the lungs

34
Q

Pneumonia

Name the pathogen:

____ is a gram-negative bacillus, often responsible for pneumonia in heavy alcoholics and causes cavitating lesions in the lungs.

A

Klebsiella pneumoniae

35
Q

Pneumonia

Name the pathogen:

____ is a gram-positive coccus responsible for bacterial pneumonia in the general population.

It usually causes lobar pneumonia and is not typically associated with cavitating lesions.

A

Streptococcus pneumoniae

36
Q

Pneumonia

Name the pathogen:

____ is a gram-negative bacillus commonly implicated in infective exacerbations of chronic obstructive pulmonary disease.

It is often associated with smoking, but is not typically associated with cavitating lesions.

A

Haemophilus influenzae

37
Q

Pneumonia

Name the pathogen:

____ is a gram-negative bacillus that causes atypical pneumonia, specifically called ____ disease.

Classically, it presents following exposure to contaminated droplets e.g. in poorly maintained air-conditioning systems.

Other characteristic features include hyponatraemia and deranged LFTs.

A

Legionella pneumophila

Legionnaires disease.

Diagnosis is usually with urinary legionella antigen detection.

38
Q

Pneumonia

Name the pathogen:

____ is a fungi-like bacteria that causes atypical pneumonia with dry cough.

Characteristic features include erythema multiforme (a target-shaped lesion) and cold-agglutinin disease.

A

Mycoplasma pneumoniae

Diagnosis is with mycoplasma serology tests.

Y3 Conditions (55 decks)

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