Pneumonia Flashcards
What is pneumonia?
Acute inflammation of the lung parenchyma distal to the terminal bronchiole, including the alveoli.
What is the epidemiology of pneumonia in Kenya?
The leading cause of in-hospital death, with high mortality rates especially in ICU patients.
What are the primary risk factors for pneumonia?
Extremes of age, anatomic respiratory defects, immunodeficiency, altered consciousness, and underlying lung diseases.
Describe the lung defense mechanisms.
Nasopharyngeal filtering, gag and cough reflex, mucociliary action, phagocytosing alveolar macrophages, and immunoglobulins.
What are the routes of infection for pneumonia?
Aspiration, inhalation of infectious aerosols, hematogenous dissemination, and direct inoculation.
What is community-acquired pneumonia (CAP)?
Pneumonia acquired outside of hospitals or within 48 hours after admission, without recent healthcare facility exposure.
What are the typical causative organisms of CAP?
Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Legionella, viruses like Influenza.
What is the pathophysiology of pneumonia?
Impaired host defenses, microbial invasion, inflammatory response, and cytokine release leading to lung tissue consolidation.
What are the pathophysiological causes of pneumonia?
Impaired defense mechanisms, virulent pathogens, and defects in host responses like reduced cough reflex and mucociliary clearance.
What are the typical symptoms of bacterial pneumonia?
Productive cough with rusty sputum, fever, chills, pleuritic chest pain, and dyspnea.
Describe the clinical presentation of pneumonia.
Acute cough, fever, chills, dyspnea, pleuritic chest pain, headache, altered mental status, and respiratory distress.
What investigations are used to diagnose pneumonia?
Full hemogram, UECs, CRP, imaging (chest X-ray), sputum cultures, and blood tests.
What is the role of imaging in pneumonia diagnosis?
To confirm the presence of infiltrates, assess the extent of lung involvement, and identify possible complications.
How is the CURB-65 score used in pneumonia?
It assesses severity and guides management; includes confusion, urea level, respiratory rate, BP, and age >65.
Why is CURB-65 important in pneumonia management?
It helps to stratify risk and decide whether a patient can be managed outpatient or requires hospitalization.
What are key components of managing CAP?
Oxygen therapy, IV fluids, antibiotics, antipyretics, and chest physiotherapy.
What is the treatment duration for CAP?
Typically 5-7 days, extended if complications like lung abscesses or empyema occur.
What is the primary treatment for community-acquired atypical pneumonia?
Macrolides (azithromycin) or tetracyclines.
What defines hospital-acquired pneumonia (HAP)?
Pneumonia developing 48 hours or more after hospital admission, not present at the time of admission.
What is healthcare-associated pneumonia (HCAP)?
Pneumonia in non-hospitalized patients who have frequent contact with healthcare environments, such as dialysis or nursing homes.
What is the common treatment approach for HAP?
Broad-spectrum antibiotics with empiric coverage, tailored after pathogen identification.
Describe ventilator-associated pneumonia (VAP).
Pneumonia occurring 48 hours after intubation; treated with empirical broad-spectrum antibiotics.
What are common causes of healthcare-associated pneumonia (HCAP)?
Frequent exposure to healthcare environments, recent hospitalization, long-term care, and immunosuppression.
How does aspiration pneumonia differ from typical pneumonia?
It involves inhalation of gastric contents, often causing a chemical pneumonitis or infection by anaerobic bacteria.
What is aspiration pneumonia?
Pneumonia caused by inhalation of oropharyngeal contents into the lungs, common in patients with impaired gag reflex.
What are common pathogens in aspiration pneumonia?
Anaerobes like Bacteroides, Streptococcus pneumoniae.
What are common pathogens in viral pneumonia?
Influenza, Respiratory Syncytial Virus (RSV), and SARS-CoV-2.
What is the role of procalcitonin in pneumonia management?
Guides the duration of antibiotic therapy and helps in reducing unnecessary use.
What are the benefits of using shorter antibiotic courses in pneumonia?
Reduces resistance, side effects, and the overall duration of therapy if the patient shows improvement within 3 days.
How does hypostatic pneumonia develop?
From prolonged immobility leading to pooling of fluids in dependent lung areas, commonly seen in elderly or bedbound patients.
What is hypostatic pneumonia?
Pneumonia in immobile patients due to fluid pooling in dependent lung areas, treated with mobilization and chest physiotherapy.
What are the signs of severe pneumonia?
Fever, tachypnea, hypoxemia, hypotension, confusion, and decreased breath sounds on auscultation.
What are common complications of pneumonia?
Para-pneumonic effusion, empyema, lung abscess, ARDS, and sepsis.
What factors increase the risk of pneumonia in immunocompromised patients?
Conditions like HIV/AIDS, cancer, organ transplants, and the use of immunosuppressive drugs.
How is pneumonia managed in patients with structural lung disease?
Using broader spectrum antibiotics, including carbapenems or fluoroquinolones.
How is pneumonia prevented in high-risk groups?
Vaccination, good hygiene, managing chronic conditions, and avoiding crowded places during flu season.
What are the preventive measures for pneumonia?
Vaccination, smoking cessation, hand hygiene, and managing chronic conditions.
