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Year 3 > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What is pneumonia?

A

Inflammation of the lung tissue, characterised by a loss of silhouette signs on CXR, indicating the location of infection.

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2
Q

What increases the risk of aspiration pneumonia?

A

Decreased gag reflex, coughing and swallowing reflex due to CNS diseases such as seizures and Parkinson’s disease, and CNS depression from alcohol, opiates, or anaesthetics.

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3
Q

Name three pathogens involved in aspiration pneumonia.

A
  • Klebsiella pneumonia
  • Anaerobic bacteria from the GI tract such as E.Coli, Lactobaccilus and bifidobacteria
  • Staphylococcus aureus
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4
Q

What are common causes of inhalation pneumonia?

A
  • Streptococcus pneumonia
  • Mycoplasma pneumonia
  • Chlamydia pneumonia
  • Influenza pneumonia
  • Legionella pneumonia
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5
Q

Which fungi are associated with pneumonia?

A
  • Coccidioidomycosis
  • Histoplasmosis
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6
Q

What conditions increase the risk of pneumonia?

A

Impaired mucociliary clearance with:
* Cystic fibrosis
* Primary ciliary dyskinesia
* Bronchiectasis
* COPD
* Smoking (destroys cilia)
* post-viral state

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7
Q

Which agent puts elderly and smokers at risk of pneumonia?

A

Leigonella pneumonia, a gram negative aerobic bacteria commonly found in hot tubs.

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8
Q

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

A

Streptococcus pneumonia.

It typically occurs when there is a defect in normal host defence mechanism or virulent pathogen overwhelms the immune response. Alveolar macrophages release cytokines like TNF-alpha and IL-8 and GCSF- which promotes neutrophil chemotaxis. Leakage of alveolar-capillary membrane causes decreased lung compliance and dyspnoea.

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9
Q

What are the features of streptococcus pneumonia?

A

Streptococcus pneumonia has a polysaccharide capsule which inhibits complement binding to cell surface and therefore inhibits phagocytosis. It contains virulent proteins such as neuraminidase, pneumolysins and autolysin to counteract the host immune response.

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10
Q

What are the features of bronchopneumonia?

A

Bronchopneumonia: descending infection from the upper respiratory tract which spreads locally into the lungs, creating patchy areas of consolidation where neutrophils have collected in the alveoli and bronchi

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11
Q

What are the features of ventilation pneumonia?

A

Ventilation pneumonia should be suspected in patinets with new onset dyspnoea, fall in oxygen saturation with same ventilator settings, fevers with chills. They should receive a CXR or CT scan if CXR is inconclusive with invasive sampling techqneus like broncho-alveolar lavage

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12
Q

What are the most common causes of pneumonia in patients with immunocompromisaiton (CKD, diabetes and HIV)

A

-> pseudomonas aeuroginoas
-> liegonella penumonia
-> pneumocystis jirovecci for patients with CD4 count less than 200
-> cytomegalovirus

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13
Q

What pathogens cause hospital-acquired pneumonia?

A
  • MRSA
  • Pseudomonas aeruginosa
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14
Q

What pathogens cause atypical pneumonia?

A

:MCL
mycoplasma pneumonia, chlamydia pneumonia and legionella pneumonia

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15
Q

What is the CURB-65 criteria used for?

A

To assess the severity of pneumonia and determine the need for hospitalization.

Confusion
->Uraemia over 20
->Rate of respiration over 30
->Blood pressure less than either 90 systolic or 60 diastolic
65 years old: likely to have other co-morbidities for higher risk, impaired kmucociliary clearance

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16
Q

What does a CURB-65 score of 0-1 indicate?

A

Managed as an outpatient.

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17
Q

What does a CURB-65 score of 2 indicate?

A

non ICU admission

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18
Q

What are the symptoms of atypical pneumonia?

A

It typically presents with upper respiratory tract infection symptoms such as:
* Headaches
* Nasal congestion
* Sore throat
* Ear aches
* Low-grade fever
* Rigors

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19
Q

What does a CURB-65 score of 3 indicate?

A

iCU admission

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20
Q

How does pneumonia cause a V/Q mismatch?

A

Pneumonia results in a V/Q mismatch due to consolidation of the lobes which reduces alvoeli available for gas exchange, resulting in respiratory failure in extreme cases of consolidation.

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21
Q

What is the presentation of pneumonia?

A

Patients typically have tachycardia, tachypnoea, hypoxaemia with fever and rigors?
There may be inflammation of the bronchioles, causing a productive cough. Inflammation of the lung parenchyma may occur, that may irritate the pleura and cause pleuritic type chest pain

22
Q

What can excess inflammatory mediators in pneumonia result in?

A

Multi-organ failure.

23
Q

What clinical signs indicate pneumonia due to consolidation?

A
  • Bronchial breath sounds
  • Dullness to percussion
  • Enhanced vocal and tactile fremitus
  • Chest crackles
  • Hollow breath sounds which is harsh and unjoined up
24
Q

What are constitutional symptoms of pneumonia?

A

Constitutional symptoms are non-specific symptoms which indicate generalised illness.
* Fatigue
* Headache
* Myalgia
* Arthralgia

These are more common with viral pneumonia, where there is watery or rarely mucopurulent sputum production. Bacterial penumonia can cause purulent or blood-tinged sputum.

25
Q

True or False: Fever in pneumonia occurs due to IL-1 and IL-6 acting on the hypothalamus.

A

True.

26
Q

What is a common complication of pneumonia?

A
  • Parapneumonic effusion
  • empyema
  • Lung abscess
  • Acute respiratory distress
  • Sepsis
    *dissemniated intravascular coagualtion
27
Q

Which type of pneumonia is a lung abscess more common?

A

bronchopneumpioa

28
Q

What is empyema?

A

build up of pus in the pleural space

29
Q

What diagnostic tests help differentiate between community and hospital-acquired pneumonia?

A
  • Respiratory viral panel
  • FBC
  • BUN and creatinine
  • U & Es
  • Urine culture
  • LFTs
  • Sputum culture
30
Q

What is low sodium levels assoicated with?

A

leigonella pneumoina

31
Q

What is an increase in LFTs assoicated with?

A

Leigonella pneumonia

32
Q

What does an air bronchogram on CXR indicate?

A

Air within bronchi which is associated with pneumonia.

33
Q

What imaging is used to differentiate between lobar pneumonia and bronchopneumonia?

A

CXR -> bronchopneumonia shows patchy bilateral opacities

34
Q

What causes ground glass opacities on CXR?

A

interstitial pneumonia: affects the interstitial spaces with mycoplasma pneumonia, chlamydia and legionella and viruses like infleunza and rhinovirus, caused by ground glass opacities from the hilum outwards

35
Q

What can be used to differentiate between viral and bacterial pneumonia?

A

procalcitonin which is released with bacterial infection and especially high in sepsis.

36
Q

What is the first-line antibiotic treatment for outpatient community-acquired pneumonia?

A
  • Macrolide antibiotics (e.g., azithromycin)
  • Alternative: Doxycycline
37
Q

What is the second-line antibiotic treatment for outpatient community-acquired pneumonia?

A

fluroquinolone due to high resistance, unless they have had co-morbidities or antibiotics in the last 90 days

38
Q

What is the first-line antibiotic treatment for pneumonia in non-ICU ward?

A

Macrolide antibiotic
doxycline with beta lactam antibiotic, preferably ceftriazone

39
Q

What is the second-line antibiotic treatment for pneumonia in non-ICU ward?

A

Fluoroquinolone

40
Q

What is the first-line antibiotic treatment for pneumonia in ICU ward?

A

Macrolide antibiotic with beta lactam

41
Q

What is the second-line antibiotic treatment for pneumonia in ICU ward?

A

fluoroquinolone with beta-lactate antibiotic

42
Q

What is the antibitoic treatment for pneumonia caused by MRSA?

A

MRSA is treated with vancomycin

Liniezolid, a synthetic oxazolidinone antimicrobial drug which acts on the 50s ribosomal subunit to inhibit the 70s ribosome

43
Q

What is the antibiotic treatment for pneumocystis jirovecci?

A

trimethoprim with sulphamethazole

44
Q

What is the antibiotic treatment for pneumonia caused by pseudomonas aeruginosa

A

Combination medication piperacillin and beta-lac tam tazobactam.

Beta-lac tam antibiotic with aminoglycosides

45
Q

What are the treatment options for MRSA in hospital-acquired pneumonia?

A
  • Vancomycin
  • Linezolid
46
Q

What is the treatment for aspiration pneumonia?

A

antibiotics like clindamycin
Augmentin (amoxicillin and clav)
Metronidazole and beta-lactam

Typically lung is very aerated, so anaerobic won’t survive well and is treated with the same regimen as HAP or ICU CAP, unless lung abscess occur.

47
Q

How is ventilator pneumonia managed?

A

Management of ventilator pneumonia requires broad-spectrum antibiotics to cover for staphylococcus auerus, pseudomonas aueroginoas and gram negative bacilli.

48
Q

What is hypersensitivity pneumonitis?

A

An interstitial lung disease characterised by an immunological reaction of the lung parenchyma in response to repetitive inhalation of a sensitised allergen.

49
Q

What are clinical features of acute hypersensitivity pneumonitis?

A

following a short period of exposure to antigen which is reversible and affects the airways and bronchi, due to the inhalational nature with poorly-formed non-caesating granuloma and inflammatory cell infiltrates.

  • Breathlessness
  • Dry cough
  • Systemic symptoms (fever, chills)
  • Crackles on auscultation

Typically resolves in 1-3 days

50
Q

What distinguishes chronic hypersensitivity pneumonitis from acute?

A

Chronic exposure leads to fibrosis and is less reversible, mediate by CD8+ T cells. Clinical features include progressive exertional breathlessness, dry cough, systemic symptoms like weight loss, with crackles and squeaks on auscultation. There is typically upper and mid-zone reticulation with centrilobular nodules.

51
Q

What is the management of chronic hypersensitivity pneumonitis?

A

Management is based on antigen avoidance, but if necessary, corticosteroids are required

52
Q

What is the management for hypersensitivity pneumonitis?

A

Antigen avoidance and corticosteroids if necessary.

Year 3 (47 decks)

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