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Year 6 Respiratory > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What causes Legionnaire’s disease?

A

Legionnaire’s disease is caused by the intracellular bacterium Legionella pneumophilia.

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2
Q

Where does Legionella typically colonize?

A

Legionella typically colonizes water tanks.

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3
Q

Is Legionnaire’s disease transmitted person-to-person?

A

Person-to-person transmission is not seen.

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4
Q

What are common features of Legionnaire’s disease?

A

Common features include flu-like symptoms, dry cough, relative bradycardia, confusion, lymphopaenia, hyponatraemia, deranged liver function tests, and pleural effusion.

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5
Q

What is the diagnostic test of choice for Legionnaire’s disease?

A

The diagnostic test of choice is urinary antigen.

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6
Q

What are the chest x-ray findings in Legionnaire’s disease?

A

Chest x-ray findings may include a mid-to-lower zone predominance of patchy consolidation and pleural effusions in around 30%.

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7
Q

What is the treatment for Legionnaire’s disease?

A

Treatment is with erythromycin or clarithromycin.

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8
Q

What is Mycoplasma pneumoniae?

A

Mycoplasma pneumoniae is a cause of atypical pneumonia which often affects younger patients.

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9
Q

What are some characteristic complications of Mycoplasma pneumoniae?

A

It is associated with complications such as erythema multiforme and cold autoimmune haemolytic anaemia.

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10
Q

How often do epidemics of Mycoplasma pneumoniae occur?

A

Epidemics of Mycoplasma pneumoniae classically occur every 4 years.

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11
Q

Why is it important to recognize atypical pneumonia?

A

Atypical pneumonia may not respond to penicillins or cephalosporins due to lacking a peptidoglycan cell wall.

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12
Q

What are the typical features of Mycoplasma pneumoniae infection?

A

The disease typically has a prolonged and gradual onset, with flu-like symptoms classically preceding a dry cough and bilateral consolidation on x-ray.

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13
Q

What are some complications of Mycoplasma pneumoniae?

A

Complications may include cold agglutins (IgM), erythema multiforme, meningoencephalitis, bullous myringitis, pericarditis/myocarditis, and gastrointestinal issues.

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14
Q

How is Mycoplasma pneumoniae diagnosed?

A

Diagnosis is generally by Mycoplasma serology and a positive cold agglutination test may show red blood cell agglutination.

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15
Q

What is the management for Mycoplasma pneumoniae infection?

A

Management includes doxycycline or a macrolide (e.g. erythromycin/clarithromycin).

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16
Q

What is pneumonia?

A

Pneumonia is an inflammatory condition affecting the alveoli of the lungs, commonly secondary to a bacterial infection.

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17
Q

What is the most common type of pneumonia?

A

Bacterial pneumonia is the most common type seen in clinical practice.

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18
Q

What are other infective causes of pneumonia?

A

Other causes include viral and fungal infections, such as Pneumocystis jiroveci.

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19
Q

Which organism accounts for 80% of pneumonia cases?

A

Streptococcus pneumoniae (pneumococcus) accounts for 80% of cases.

Particularly associated with high fever, rapid onset, and herpes labialis. A vaccine to pneumococcus is available.

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20
Q

What is a common pneumonia organism in patients with COPD?

A

Haemophilus influenzae is particularly common in patients with COPD.

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21
Q

What organism often occurs following influenza infection?

A

Staphylococcus aureus often occurs in patients following influenza infection.

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22
Q

What are the characteristics of Mycoplasma pneumoniae?

A

Mycoplasma pneumoniae is an atypical pneumonia that often presents with a dry cough and atypical chest signs/x-ray findings.

Autoimmune haemolytic anaemia and erythema multiforme may be seen.

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23
Q

What is Legionella pneumophilia associated with?

A

Legionella pneumophilia is another atypical pneumonia, classically seen secondary to infected air conditioning units.

Hyponatraemia and lymphopenia are common.

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24
Q

Which organism is classically seen in alcoholics?

A

Klebsiella pneumoniae is classically seen in alcoholics.

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25
Q

What is Pneumocystis jiroveci typically seen in?

A

Pneumocystis jiroveci is typically seen in patients with HIV.

Presents with a dry cough, exercise-induced desaturations, and the absence of chest signs.

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26
Q

What is idiopathic interstitial pneumonia?

A

Idiopathic interstitial pneumonia is a group of non-infective causes of pneumonia, such as cryptogenic organizing pneumonia.

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27
Q

What is the difference between community-acquired pneumonia and hospital-acquired pneumonia?

A

Community-acquired pneumonia (CAP) occurs outside of hospitals, while hospital-acquired pneumonia occurs 48 hours or more after admission.

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28
Q

What are common symptoms of pneumonia?

A

Common symptoms include cough, sputum, dyspnoea, chest pain (may be pleuritic), and fever.

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29
Q

What are common signs of pneumonia?

A

Common signs include fever, tachycardia, reduced oxygen saturations, reduced breath sounds, and bronchial breathing.

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30
Q

What is the classical x-ray finding in pneumonia?

A

The classical x-ray finding in pneumonia is consolidation.

31
Q

What does a full blood count typically show in bacterial infections?

A

A full blood count would usually show neutrophilia in bacterial infections.

32
Q

What is the CURB-65 scoring system used for?

A

The CURB-65 scoring system is used for risk stratification in patients with community-acquired pneumonia.

33
Q

What does the ‘C’ in CURB-65 stand for?

A

‘C’ stands for confusion, defined as an abbreviated mental test score <= 8/10.

34
Q

What does the ‘R’ in CURB-65 indicate?

A

‘R’ indicates a respiration rate >= 30/min.

35
Q

What does the ‘B’ in CURB-65 refer to?

A

‘B’ refers to blood pressure: systolic <= 90 mmHg and/or diastolic <= 60 mmHg.

36
Q

What does the ‘65’ in CURB-65 signify?

A

‘65’ signifies that the patient is aged >= 65 years.

37
Q

What is the recommended management for a CRB-65 score of 0?

A

NICE recommends home-based care for patients with a CRB-65 score of 0.

38
Q

What is the first-line treatment for pneumonia?

A

Oral amoxicillin is generally used as first-line treatment.

39
Q

What is the mortality risk associated with a CURB-65 score of 4?

A

Patients with a CURB-65 score of 4 approach a 30% mortality rate at 30 days.

40
Q

What criteria does NICE recommend for assessing pneumonia in primary care?

A

NICE recommends using the CRB65 criteria:

C: Confusion (abbreviated mental test score <= 8/10)
R: Respiration rate >= 30/min
B: Blood pressure: systolic <= 90 mmHg and/or diastolic <= 60 mmHg
65: Aged >= 65 years

41
Q

How are patients stratified for risk of death in pneumonia assessment?

A

Patients are stratified as follows:

0: low risk (less than 1% mortality risk)
1 or 2: intermediate risk (1-10% mortality risk)
3 or 4: high risk (more than 10% mortality risk)

42
Q

What is the recommendation for treatment based on risk level in primary care?

A

NICE recommends:

0: treatment at home should be considered
1 or 2: hospital assessment should be considered
3 or 4: urgent admission to hospital

43
Q

What does NICE recommend regarding the CRP test for antibiotic therapy?

A

CRP < 20 mg/L: do not routinely offer antibiotic therapy
CRP 20 - 100 mg/L: consider a delayed antibiotic prescription
CRP > 100 mg/L: offer antibiotic therapy

44
Q

What is the difference between CRB65 and CURB65 criteria?

A

In hospital, CURB65 is used instead of CRB65, adding the criterion:

U: urea > 7 mmol/L

45
Q

What are the recommendations for CURB65 scores in secondary care?

A

NICE recommends:

0 or 1: consider home-based care (low risk, < 3% mortality risk)
2 or more: consider hospital-based care (intermediate risk, 3-15% mortality risk)
3 or more: consider intensive care assessment (high risk, > 15% mortality risk)

46
Q

What investigations are recommended for pneumonia?

A

Investigations include:

Chest x-ray
Blood and sputum cultures for intermediate or high-risk patients
Pneumococcal and legionella urinary antigen tests
CRP monitoring for admitted patients

47
Q

What is the first-line management for low-severity community acquired pneumonia?

A

Amoxicillin is first-line. If penicillin allergic, use a macrolide or tetracycline.

NICE recommends a 5-day course of antibiotics.

48
Q

What is the management for moderate and high-severity community acquired pneumonia?

A

Dual antibiotic therapy is recommended with amoxicillin and a macrolide for 7-10 days.
NICE recommends considering beta-lactamase stable penicillins in high-severity cases.

49
Q

What are the discharge criteria for pneumonia patients?

A

Patients should not be routinely discharged if they have had 2 or more of the following in the past 24 hours:

  • Temperature > 37.5°C
  • Respiratory rate >= 24 breaths/min
  • Heart rate > 100 beats/min
  • Systolic BP <= 90 mmHg
  • Oxygen saturation < 90% on room air
  • Abnormal mental status
  • Inability to eat without assistance
50
Q

What post-discharge symptom resolution timeline does NICE recommend for pneumonia patients?

A

NICE recommends the following timelines:

1 week: Fever resolved
4 weeks: Chest pain and sputum production reduced
6 weeks: Cough and breathlessness reduced
3 months: Most symptoms resolved, fatigue may persist
6 months: Most feel back to normal

51
Q

What follow-up is recommended after pneumonia treatment?

A

All cases of pneumonia should have a repeat chest X-ray at 6 weeks after clinical resolution to ensure consolidation has resolved.

52
Q

What is the most common cause of community-acquired pneumonia?

A

Streptococcus pneumoniae (pneumococcus) accounts for around 80% of cases.

53
Q

What are some infectious agents that can cause community-acquired pneumonia (CAP)?

A
  1. Streptococcus pneumoniae
  2. Haemophilus influenzae
  3. Staphylococcus aureus (commonly after influenza infection)
  4. Atypical pneumonias (e.g. due to Mycoplasma pneumoniae)
  5. Viruses
54
Q

Which group of people is Klebsiella pneumoniae classically associated with?

A

Klebsiella pneumoniae is classically associated with alcoholics.

55
Q

What are the characteristic features of pneumococcal pneumonia?

A
  1. Rapid onset
  2. High fever
  3. Pleuritic chest pain
  4. Herpes labialis (cold sores)
56
Q

What is pneumonia?

A

Pneumonia is a common inflammatory condition affecting the alveoli in the lungs caused by pathogens entering the lower respiratory tract.

57
Q

What are common causative pathogens of pneumonia?

A

Causative pathogens include bacteria (e.g. Streptococcus pneumoniae), viruses, and fungi (e.g. Pneumocystis jiroveci).

58
Q

What initiates the inflammatory response in pneumonia?

A

Once a pathogen enters the lower respiratory tract, an inflammatory cascade begins with neutrophils migrating to the infected alveoli.

59
Q

What are the risk factors for pneumonia?

A

Risk factors include age under 5 or over 65, smoking, recent viral respiratory infection, chronic respiratory diseases, immunosuppression, aspiration risk, IV drug use, and other non-respiratory co-morbidities.

60
Q

What are the common symptoms of pneumonia?

A

Symptoms include a cough with purulent sputum, dyspnoea, chest pain, fever, and malaise.

61
Q

What are the signs of pneumonia?

A

Signs include high temperature, tachycardia, hypotension, confusion, tachypnoea, low oxygen saturation, reduced breath sounds, bronchial breathing, crepitations, and dullness on percussion.

62
Q

What is the CRB65 criteria for assessing pneumonia in primary care?

A

CRB65 criteria include: C - Confusion, R - Respiration rate >= 30/min, B - Blood pressure systolic <= 90 mmHg, 65 - Age >= 65 years.

63
Q

How are patients stratified for risk of death using CRB65?

A

Patients are stratified as follows: 0 - low risk (less than 1% mortality), 1 or 2 - intermediate risk (1-10% mortality), 3 or 4 - high risk (more than 10% mortality).

64
Q

What is the recommendation for patients with a CRB65 score of 0?

A

NICE recommends home-based care for patients with a CRB65 score of 0.

65
Q

What does a CRP level indicate in pneumonia assessment?

A

CRP < 20 mg/L - do not offer antibiotics; CRP 20 - 100 mg/L - consider delayed prescription; CRP > 100 mg/L - offer antibiotics.

66
Q

What is the CURB65 criteria used in secondary care?

A

CURB65 criteria include: C - Confusion, U - Urea > 7 mmol/L, R - Respiration rate >= 30/min, B - Blood pressure systolic <= 90 mmHg, 65 - Age >= 65 years.

67
Q

What are the recommendations for CURB65 scores in secondary care?

A

Consider home-based care for CURB65 score 0 or 1 (low risk), hospital care for score 2 (intermediate risk), and intensive care for score 3 or more (high risk).

68
Q

What is typically seen on a chest X-ray for pneumonia?

A

A chest X-ray typically shows consolidation (opacity) in the area of infection and may also show effusion.

69
Q

What does a raised white cell count in FBC indicate?

A

It indicates infection.

70
Q

What is urea used for in U&E?

A

It is used for the CURB-65 score.

71
Q

What does a raised CRP indicate?

A

It indicates inflammation.

Monitoring is recommended for admitted patients to help determine response to treatment.

72
Q

What are blood cultures used for?

A

They are used to identify infections.

73
Q

What is the purpose of a sputum sample?

A

It is used to diagnose the causative organism after culture.

74
Q

When are Legionella antibodies recommended?

A

They are recommended in intermediate or high-risk patients.

Year 6 Respiratory (23 decks)

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