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401 - Content > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What makes up the lower respiratory tract

A

• larynx
• bronchi
• bronchioles
• alveoli

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2
Q

What are the characteristics of pneumonia?

A

• consolidation of lung tissue
• filling of alveoli, with fluid, inflam cells and fibrin

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3
Q

< that occurs due to

A

• bacteria or virus
• damage to the chest wall
• inhalation of chemicals

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4
Q

Which part of the lungs is inflamed in CAP and HAP

A

Lung parenchyma

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5
Q

Facts

A

• most symptomatic human disease in children and adults
• more common in children

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6
Q

Which virus causes viral pneumonia

A

• COVID
• influenza
• parainfluenza
• swine flu
• SARS
• herpes

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7
Q

Symptoms

A

• gradual flu like
• fever
• chills
• muscle pain
• upper respiratory symptoms (runny nose)

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8
Q

Treatment

A

• oxygen
• antipyretics
• analgesics
• nutrition
• vaccine
• antivirals

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9
Q

Which bacteria cause CAP

A

• h. Influenza
• s.pneumonia (streptococcus) (mst cmmn)
• myocoplasama
• chalmydophila

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10
Q

Which bacteria cause HAP

A

• staphylococcus aureus - MRSA
• pseudomonas aeruginosa
• klebisella
• E.coli

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11
Q

How do the bacteria enter the lower respiratory tract?

A

3 ways:

• inhalation of infected aerosol particles
• entry to lungs via blood stream from infected location outside the lungs
• aspiration of oropharyngeal contents (can occur during sleep)

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12
Q

What 2 models are used for risk stratification, used before treatment to determine level of care? (For CAP only)

A

CURB-65 & PSI

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13
Q

CURB-65?

A

Determines site of care
One point is given to each factor:

• confusion
• respiratory rate - 30 and above
• Uremia
• hypotension
• 65>

Score
• 0-1 = outpatient treatment
• 2 = admit to medical ward
• 3+ = ICU

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14
Q

PSI

A

Assess risk of mortality

Uses:
• age
• gender
• co morbidities
• physical exam
• lab findings

Scores
• 1-2 = outpatient
• 3 = short hospital stay
• 4+ = impatient

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15
Q

What is considered CAP

A

• it is developed in the community
• <48 hrs in hospital

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16
Q

Risk of CAP

A

• old age
• respiratory conditions
• contact with influenza
• contact with infected birds
• farm environment
• immune compromised
• smoking
• alcoholism

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17
Q

Symptoms of CAP

A

• cough with rusted colours sputum
• headache
• confusion
• loss of appetite
• pleuritic chest pain
• fever
• dysponea
• hypoxemia, tachycardia, hypotension, tachypnoea
• decreased breathing sounds

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18
Q

Tests and investigations for CAP

A

• x-ray (to confirm consolidation in lungs
• sputum
• RBC
• ABG
• C-reactive protein

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19
Q

When should oxygen be give

A

• hypoxemia
• high levels of CO2 in blood

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20
Q

What are the options for empirical treatment for outpatients

A

One of the following:
• macrolides (mycins)
• doxycycline
• fluoroquinolone (cefalaxin- first gen)

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21
Q

What are the options for empirical treatment for inpatients (not ICU)

A

• extended spectrum cephalosporin + macrolide

OR
• b-lactam inhibitor + macrolide or fluoroquinolone

22
Q

What are the options for empirical treatment for ICU patients

A

ESC or b-lactamse inhibitor + macrolide or fluoroquinolone

23
Q

How long after cap diagnosis should abx treatment begin?

A

<4

24
Q

Treatment is based on what score?

A

CURB-65

25
Q

Treatment for CURB-65 score of 0-1/low severity

A

• amoxicillin 500mg, TDS - 5 days

Alternatives:
• doxycycline, 200mg on first day, next four days 100mg OD

• clarithromycin 500mg BD - 5 days

• erythromycin (pregnancy) 500mg QDS - 5 days

(All doses repeated are the same)

26
Q

Treatment for moderate severity

CURB - 2

A

Amoxicillin + clarythromycin or Erythromycin (if typical pathogen is suspected) - 5 days

Alternative:
• doxycycline - 5 days
• erythromycin (pregnancy) - 5 days

27
Q

Treatment for severe?

A

Co-amoxiclav 500/125mg TDS (or IV 1.2g) + clarythromycin or erythromycin (if atypical bacteria is suspected)

Alternative
• levofloxacin 500mg TDS or IV 500mg

28
Q

HAP is considered when?

A

Occurring in hospital >48 hours of admission

29
Q

Is the common causative organism gram negative or positive

A

Negative e

30
Q

What are the risk factors of HAP

A

• in hospital >5 days
• on ventilator
• in ICU
• have an immunosuppressive conditions
• chronic respiratory condition
• HIV/AIDS
• high frequency on abx resistance in the hospital or community

31
Q

Which investigation or labs would you do

A

• Clincal symptoms
• sputum culture
• WBC
• FBC
• ABG
• C-reactive protein
• urjnary antigen test
• chest x ray (cloudy spaces in the lungs)
• chest CT scan

32
Q

What is the treatment for non severe or not a risk of abx resistance

A

• co-amoxiclav

Alternative
• doxycycline
• co-trimoxazole (960mg BD)

33
Q

Treatment of HAP with severe symptoms (sepsis) or high risk of resistance

A

• piperacillin + tazobactam 4.5mg TDS

Alternative
• ceftriaxone 2mg OD

34
Q

What is the add on IV therapy if MRSA is suspected/confirmed

A

Vancomycin 15-20mg/kg TDS

or linezolid 600mg BD

(5 days for all treatment)

35
Q

For oral Abx when should treatment be reviewed

A

5 days

36
Q

Or IV abx when should treatment be reviewed

A

After 48 hours, then consider switching to oral

37
Q

What is aspiration pneumonia

A

Occurs when aspiration of oropharyngeal contents

38
Q

Who is at risk of this?

A

• unconscious patients
• swallowing difficulties
• weak immune system
• GI conditions

39
Q

Test/investgations

A

Similar to CAP/HAP

+ broncoscopy

40
Q

Treatment?

A

• piperacillin + tazobactam

41
Q

What are the end complications of pneumonia

A

• respiratory failure
• death
• bronchitis
• emphysema
• destruction of lung paranchyme
• ventilations dependency

42
Q

Drug related questions

A
43
Q

What other drug is in co-trimoxazole

A

Sulfamethoxazole (used together for their synergic activity and prevents drug resistance)

44
Q

Is co-trimoxazole licenced in HAP

A

No

45
Q

Common ADR of co-trimoxazole

A

• diarrhoea
• fungal overgrowth
• electrolyte imbalance

46
Q

Monitoring for co-trimoxazole

A

Serium K and Na

47
Q

Amoxicillin ADR

A

• GI disturbances
• thrombocytopenia
• hypersensitivity (rash or anaphylactic)

48
Q

How many lobes does the right vs left lung have

A

Right - 3
Left -2

49
Q

What is the main symptoms difference in CAP and HAP

A

Onset
• quicker in cap

Sputum
• cap - yellow green
• hap - foul smelling (common in anaerobic organisms)

Pleuritic chest pain
• more common in cap

50
Q

What is the normal oxygen saturation

A

95-100%

51
Q

What are the body’s natural defence mechanisms against infections

A

• mucus
• coughing reflex
• mucus
• cillary movement
• T lymohocytes
• iGA
• sneezing

401 - Content (17 decks)

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