Pneumonia Flashcards
What is pneumonia?
LRTI that causes inflammation/infection of the lung parenchyma /alveolar space
How does pneumonia present on a chest x-ray?
Consolidation
What is acute bronchitis?
Infection and inflammation in the in the bronchi bronchioles
What are the 4 types of pneumonia?
Community acquired pneumonia (CAP)
Hospital acquired pneumonia (HAP)
Ventilator acquired pneumonia (VAP)
Aspiration pneumonia
What is the definition of a hospital acquired pneumonia (HAP)?
More than 48hrs in the hospital where the organism wasn’t present before admission
How does a patient with a pneumonia typically present?
Productive cough
SOB
Fever
Rarely Haemoptysis
Pleuritic chest pain delirium
Dyspnoea
What are the signs on examination of a patient with pneumonia?
Bronchial breath sounds
Dull percussion
Coarse crackles
Wheeze
Reduced air entry
Increased vocal fremitus
How do you assess the severity of pneumonia?
CURB-65
What does CURB-65 stand for?
Confusion
Urea > 7mmol/L
Resp rate > 30
BP < 90 systolic < 60 diastolic
65 years +
What are the indications for managements of pneumonia depending on the CURB 65 score?
0-1 consider treatment at home
2-3 consider hospital admission
3+ consider intensive care
What are some common bacteria causes of pneumonia?
Streptococcus pneumonia
Haemophilus influenza
Moraxella catarrhalis
Pseudomonas aeruginosa
MRSA
What are some atypical causes of pneumonia?
Legionella pneumophila
Mycoplasma pneumonia
Chlamydopphila pneumonia
What are some fungal causes of pneumonia?
Pneumocycstic jiroveci
Aspergilus
What are some differentials for a patient that might present similarly to pneumonia?
Lung cancer
COPD / asthma exacerbation
Pleural effusion
Empyema
Pulmonary embolism
Pulmonary oedema
What investigations are done for pneumonia?
CXR
FBC
Renal profile
CRP
Sputum culture
Urinary antigen test for atypical. Causes of pneumonia
ABG
What antigens are tested for in the urine if suspecting an atypical cause of pneumonia?
Pneumococcal
Legionella antigen
What do you need to diagnose TB pneumonia?
3 TB positive blood cultures
What do you need to diagnose TB pneumonia?
3 TB positive blood cultures
What management besides antibiotics do you do for TB Pneumonia?
Broncheoalveolar lavage
How do you manage low severity curb-65 0-1 pneumonia?
Amoxicillin or Doxycycline
What is the management for a moderate/ CURB-65 1-2 pneumonia?
Amoxicillin + Doxycycline
What is the management for severe CURB-65 3+?
Co-amoxiclav + Clarithryomycin
What are some complications of pneumonia?
Sepsis
Pleural effusion
Lung abscess
Death
Acute respiratory distress syndrome
Lung fibrosis
What investigation is diagnostic for empyema/lung abscess?
Thoracentesis
Intercostal chest drain
ABG < 7.2
How do you prevent pneumonia?
Smoking cessation
Pneumococcal and influenza vaccine
Optimise co-morbidities
When should a follow up CXR be done on a patient with pneumonia?
4-6wks post diagnosis/commencing treatment
What is the first line management for allergic bronchopulmonary aspergillosis?
Oral Prednisolone
What is the second line management for allergic bronchopulmonary aspergillosis if oral Prednisolone fails?
Itraconazole
How is an aspergilloma managed?
Typically try itraconazole
If significant Haemoptysis needs definitive surgical removal
What type of pneumonia commonly produces consolidation and cavitation on CXR?
Klebsiella pneumonia
What type of patient is Klebsiella pneumonia most common in?
Diabetics
Alcoholics
