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Pneumonia Flashcards

1
Q

What are the two main classifications of pneumonia?

A

Community-acquired pneumonia and hospital-acquired pneumonia

Pneumonia can also occur in immunocompromised hosts.

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2
Q

What is lobar pneumonia?

A

A radiological and pathological term referring to homogeneous consolidation of one or more lung lobes, often with associated pleural inflammation.

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3
Q

What does bronchopneumonia refer to?

A

More patchy alveolar consolidation associated with bronchial and bronchiolar inflammation, often affecting both lower lobes.

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4
Q

What percentage of adults in the UK are estimated to suffer from community-acquired pneumonia (CAP) each year?

A

5-11 per 1000 adults, accounting for around 5%-12% of all lower respiratory tract infections.

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5
Q

What is the most common infecting agent in community-acquired pneumonia?

A

Streptococcus pneumoniae.

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6
Q

What are some factors that may impair local defenses and predispose individuals to community-acquired pneumonia?

A
  • Cigarette smoking
  • Upper respiratory tract infections
  • Alcohol
  • Glucocorticoid therapy
  • Old age
  • Recent influenza infection
  • Pre-existing lung disease
  • HIV
  • Indoor air pollution.
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7
Q

What are the typical systemic features of pneumonia?

A
  • Fever
  • Rigors
  • Shivering
  • Malaise
  • Delirium may be present.
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8
Q

What pulmonary symptoms are commonly associated with pneumonia?

A
  • Cough (initially short, painful, and dry)
  • Expectoration of mucopurulent sputum
  • Rust-colored sputum in Streptococcus pneumoniae infection
  • Pleuritic chest pain.
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9
Q

Which organism is more common in young people with pneumonia?

A

Mycoplasma pneumoniae.

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10
Q

What is the CURB-65 score used for?

A

To assess the severity of pneumonia based on examination and investigation findings.

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11
Q

What are the most important aspects of managing pneumonia?

A
  • Oxygenation
  • Fluid balance
  • Antibiotic therapy
  • Nutritional support may be required in severe cases.
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12
Q

What are some common causative organisms of community-acquired pneumonia?

A
  • Streptococcus pneumoniae
  • Mycoplasma pneumoniae
  • Legionella pneumophila
  • Chlamydia pneumoniae
  • Haemophilus influenzae
  • Influenza
  • Parainfluenza.
  • Viruses like adenovirus and coronaviruses.
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13
Q

What is the differential diagnosis of pneumonia?

A
  • Pulmonary infarction
  • Pulmonary/pleural tuberculosis
  • Pulmonary edema
  • Pulmonary eosinophilia
  • Malignancy (bronchoalveolar cell carcinoma)
  • Cryptogenic organizing pneumonia.
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14
Q

Fill in the blank: The presence of herpes labialis may point to _______ infection.

A

streptococcal.

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15
Q

True or False: Legionella pneumophila occurs in local outbreaks centered on contaminated cooling towers.

A

True.

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16
Q

What can a chest examination reveal in a patient with pneumonia?

A
  • Dullness to percussion
  • Bronchial breathing
  • Whispering pectoriloquy
  • Crackles heard throughout.
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17
Q
A
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18
Q

What does CURB-65 score assess?

A

Severity of pneumonia

CURB-65 score includes: Confusion, Urea > 7 mmol/L, Respiratory rate > 30/min, Blood pressure (systolic < 90 mmHg or diastolic < 60 mmHg), Age > 65 years.

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19
Q

What are the indications for referral to an intensive care unit?

A

Score of 4 or 5 on CURB-65

Indicates severe pneumonia requiring higher-level care.

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20
Q

What should be administered to all patients with tachypnoea or hypoxemia?

A

Oxygen therapy

Target oxygen saturations must be maintained.

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21
Q

What is the role of CPAP in pneumonia management?

A

Consider in hypoxic patients despite high-concentration oxygen therapy

Requires management in a high-dependency or intensive care environment.

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22
Q

When should intravenous fluids be considered?

A

In severe illness, older patients, or those with vomiting

Adequate oral fluid intake should be encouraged otherwise.

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23
Q

What is the typical duration of antibiotic treatment for uncomplicated pneumonia?

A

5 days

Longer treatment may be needed for pneumonia due to specific pathogens.

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24
Q

What is the definition of hospital-acquired pneumonia (HAP)?

A

Pneumonia presenting at least 48 hours after hospital admission

Not incubating at the time of admission.

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25
Q

What is the leading cause of healthcare-associated infection (HAI)-associated death?

A

Hospital-acquired pneumonia (HAP)

It is the second most common HAI after surgical-site infections.

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26
Q

What are common features indicating pneumonia in hospitalized patients?

A

Purulent sputum, new radiological infiltrates, unexplained increase in oxygen requirement, core temperature >38.3°C, leucocytosis or leucopenia

These features warrant consideration of pneumonia diagnosis.

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27
Q

What should be done for patients with pleural pain?

A

Relieve pain for normal breathing and efficient coughing

Simple analgesia is usually sufficient.

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28
Q

What is the mortality rate of adults with non-severe pneumonia?

A

<1%

Hospital death rates for severe illness can be between 5% and 10%, and may reach 50%.

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29
Q

What should be arranged for patients upon discharge after pneumonia treatment?

A

Clinical review in 6 weeks

A chest X-ray should be obtained if there are persistent symptoms.

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30
Q

Fill in the blank: The initial choice of antibiotic is guided by clinical context, ______, local knowledge of antibiotic resistance patterns, and antibiotic guidelines.

A

Severity assessment

31
Q

True or False: Physiotherapy is usually indicated in patients with community-acquired pneumonia (CAP).

A

False

It may assist in expectoration for patients who suppress cough due to pleural pain.

32
Q

What vaccination should be offered to patients at highest risk of pneumonia?

A

Influenza and pneumococcal vaccination

Particularly for those over 65 or with chronic health conditions.

33
Q

What is the recommended approach for managing patients with shock?

A

Vasopressor support may be required

Especially in cases of severe illness.

34
Q

What is the common outcome of antibiotic therapy in pneumonia patients?

A

Most patients respond promptly

Fever may persist for several days, and chest X-ray resolution can take weeks or months.

36
Q

What is a very high white cell count indicative of?

A

Marker of severity

Very high (>20 x 10^9) or low (<4 x 10^9) white cell count can indicate severity of conditions.

37
Q

What does neutrophil leucocytosis > 15 x 10^9 suggest?

A

Bacterial aetiology

Neutrophil leucocytosis is often used to indicate a bacterial infection.

38
Q

What urea level is considered a marker of severity?

A

Urea >7 mmol/L (-20 mg/dL)

High urea levels can indicate more severe cases.

39
Q

What is hyponatraemia a marker of?

A

Marker of severity

Low sodium levels can indicate more severe conditions.

40
Q

What indicates abnormal liver function tests in pneumonia?

A

Basal pneumonia inflames liver

Liver function may be affected during pneumonia.

41
Q

What does hypoalbuminaemia indicate?

A

Marker of severity

Low albumin levels can suggest more severe illness.

42
Q

What does a high procalcitonin level suggest?

A

Bacterial rather than viral infection

Procalcitonin is a biomarker that helps differentiate between types of infections.

43
Q

What do C-reactive protein and erythrocyte sedimentation rate indicate?

A

Non-specifically elevated

These markers can indicate inflammation but are not specific.

44
Q

What is the purpose of blood culture in pneumonia investigations?

A

To identify bacteraemia

Blood cultures can reveal the presence of bacteria in the bloodstream.

45
Q

What should sputum samples be measured for?

A

Ventilatory failure or acidosis

Sputum samples are assessed when SpO2 <93% or with severe clinical features.

46
Q

What does a Gram stain of sputum help identify?

A

Presence of bacteria

Gram staining is used to categorize bacteria based on their cell wall properties.

47
Q

What is NAAT used to detect?

A

Respiratory viruses and bacteria

NAAT stands for nucleic acid amplification test.

48
Q

What does chest X-ray show in lobar pneumonia?

A

Patchy opacification evolving into homogeneous consolidation

Air bronchograms may also be present in lobar pneumonia.

49
Q

What does bronchopneumonia typically show on a chest X-ray?

A

Patchy and segmental shadowing

This pattern is characteristic of bronchopneumonia.

50
Q

What complications can arise from pneumonia?

A

Para-pneumonic effusion, intrapulmonary abscess, empyema

These are potential complications associated with pneumonia.

51
Q

What suggests Staphylococcus aureus infection in pneumonia?

A

Multilobar shadowing, cavitation, pneumatoceles, abscesses

These findings can indicate a Staphylococcus aureus infection.

52
Q

When should pleural fluid be aspirated and cultured?

A

When present in more than trivial amounts

Ultrasound guidance is preferred for aspiration.

53
Q

What is the CURB score used for?

A

Indications for referral to intensive care

A CURB score of 4-5 indicates severe illness requiring intensive care.

54
Q

What are indications for intensive care referral?

A
  • CURB score of 4-5
  • Failing to respond rapidly to initial management
  • Progressive hypercapnia
  • Severe acidosis
  • Persisting hypoxia (PaO2 < 8 kPa)
  • Circulatory shock
  • Reduced conscious level

These criteria help assess severity and need for intensive care.

55
Q

What is a key principle of pneumonia management?

A

Adequate oxygenation, appropriate fluid balance, antibiotics

Management principles focus on stabilizing the patient.

56
Q

What is the challenge in choosing empirical antibiotic therapy for pneumonia?

A

Diversity of pathogens and potential drug resistance

Local patterns of microbiology and resistance should guide therapy.

57
Q

What is the initial choice of antibiotic agents guided by?

A

Knowledge of local patterns of microbiology and antibiotic resistance

Understanding local infections helps tailor treatment.

58
Q

What is the importance of physiotherapy in pneumonia management?

A

Aids expectoration in less mobile patients

Physiotherapy helps clear secretions from the lungs.

59
Q

What is the most appropriate duration of antibiotic therapy based on?

A

Clinical judgement

There is no established standard for duration.

60
Q

What is the antibiotic treatment for low severity community-acquired pneumonia (CAP) with a CURB-65 score of 0-1?

A

Amoxicillin 500 mg 3 times daily orally (or IV if necessary)

If allergic to penicillin: Doxycycline 200 mg loading dose then 100 mg/day orally or clarithromycin 500 mg twice daily orally.

61
Q

What is the antibiotic treatment for moderate severity community-acquired pneumonia (CAP) with a CURB-65 score of 2?

A

Amoxicillin 500 mg-1g 3 times daily orally (or IV if oral medication not possible) or benzylpenicillin 1.2g 4 times daily IV plus clarithromycin 500 mg twice daily orally/IV

If allergic to penicillin: Doxycycline 200 mg loading dose then 100 mg/day orally or levofloxacin 500 mg/day orally.

62
Q

What is the antibiotic treatment for severe community-acquired pneumonia (CAP) with a CURB-65 score of 3-5?

A

Co-amoxiclav 1.2g 3 times daily IV or cefuroxime 1.5g 3 times daily IV or ceftriaxone 1-2g daily IV plus clarithromycin 500 mg twice daily IV

If Legionella is suspected, consider adding levofloxacin 500 mg twice daily IV.

63
Q

What factors should be considered when using antibiotics in individual patients?

A

Local guidance and antibiotic sensitivity patterns

Reasons include impaired consciousness, impaired swallowing reflex, and functional or anatomical reasons for malabsorption.

64
Q

What is the approximate mortality rate from hospital-acquired pneumonia (HAP)?

A

Approximately 30%

Thus, prevention is crucial.

65
Q

What are key prevention strategies for hospital-acquired pneumonia?

A
  • Good hygiene, particularly hand-washing
  • Minimising chances of aspiration
  • Limiting use of stress ulcer prophylaxis with proton pump inhibitors
  • Oral antiseptic (chlorhexidine 2%) for upper airway decontamination
  • Selective decontamination of the digestive tract in intensive care units
66
Q

How is suppurative pneumonia characterized?

A

Destruction of lung parenchyma by the inflammatory process

Micro-abscess formation is a characteristic histological feature.

67
Q

What are the common infectious agents in suppurative pneumonia and pulmonary abscess?

A
  • Staph. aureus
  • K. pneumoniae
  • Actinomyces spp.
  • Prevotella melaninogenica
  • Fusobacterium necrophorum
  • Bacteroides fragilis
68
Q

What are the complications of pneumonia?

A
  • Para-pneumonic effusion
  • Empyema
  • Retention of sputum causing lobar collapse
  • Deep vein thrombosis and pulmonary embolism
  • Pneumothorax
  • ARDS, renal failure, multi-organ failure
69
Q

What factors predispose individuals to hospital-acquired pneumonia?

A
  • Reduced cough reflex
  • Reduced immune defences
  • Disordered mucociliary clearance
  • Aspiration of nasopharyngeal or gastric secretions
  • Bacteria introduced into the lower respiratory tract
70
Q

What is a common cause of pulmonary abscesses associated with Lemièrre syndrome?

A

Fusobacterium necrophorum

Illness typically starts with a sore throat and progresses to severe symptoms.

71
Q

What is exogenous lipid pneumonia?

A

A non-infective form of aspiration pneumonia due to aspiration of animal, vegetable, or mineral oils.

72
Q

What are the radiological features of suppurative pneumonia?

A

Homogeneous lobar or segmental opacity consistent with consolidation or collapse, cavitation, and fluid levels in abscesses.

Medicine Theory (2 decks)

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