Pneumonia Flashcards

1
Q

What is pneumonia?

A

Inflammation of the lower respiratory tract involving infection of the AIR SPACES eg oedema and consolidation

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2
Q

How can pneumonia be classifed?

A

Setting eg hospital or community
Organism
Morphology eg Lobar or bronchopneumonia

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3
Q

What is the difference between lobar and bronchopneumonia?

A

Lobar- on or two distinct lobes

Broncho- Begins in the airways and can spread diffusely to adjacent alveolar lung

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4
Q

What is the most common causes of lobar pneumonia?

A

Strep.pneumonia

Legionella, Klebsiella

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5
Q

Who is likely to get lobar pneumonia?

A

In community

Smokers, alcoholics, COPD

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6
Q

What does the acute inflammatory response involve?

A
Exudation of fibrin rich fluid
Neutrophils infiltrate
Macrophages infiltrate
Resolution
Red hepatisation
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7
Q

Who is likely to get bronchopneumonia?

A
Those with existing disease
CF
COPD
bronchiectasis
cardiac failure
aspiration
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8
Q

Where does bronchopneumonia usually affect?

A

Lower lobes

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9
Q

What organisms cause bronchopneumonia?

A
Strep.pneumonia
H. influenza
Staph aureus
Anaerobes 
Coliforms
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10
Q

What are the possible complications of pneumonia?

A
Bronchiectasis
Absesses- inhaled foregin bodies
Empyema
Organisation eg scarring
Respiratory failure
Pleural effusion
Death
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11
Q

What are atypical causes of pneumonia?

A
Mycoplasma
Coxiella burnetti- sheep and goats
Chlamidia psittaci- birds
Legionella- water
Pneumocysitis carinii- HIV 
Fungal- Aspergillus- Immunocompromised
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12
Q

What are the common causes of nosocomial pneumonia?

A

Gram negatives eg pseudomonas
Coliforms
Anaerobes- aspiration

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13
Q

What cause of pneumonia is common in patients with CF or bronchiectasis?

A

PSeudomonas

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14
Q

Which cause is responsible for epidemics?

A

Mycoplasma

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15
Q

What are the symptoms of pneumonia?

A
cough- dry or productive
Rusty sputum
Haemoptysis
Breathless
Fever
Pleuricy 
Malaise
Anorexia
Arthralgia
GI symptoms and confusion, renal failure= legionella
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16
Q

What are the signs of pneumonia?

A
Herpes labialis 
Tachycardia
Hypotension
Diminished expansion
Dull percusion
increased tactile vocal fremetis
bronchial breathing
PLeural rub
Crackles
17
Q

How do you measure the severity of pneumonia?

A
CURB 65
OxygenPaO2 less than 8kPa
Temp 40
Multi lobe 
WBC 30
18
Q

What is curb 65?

A

Confusion 7mmol/L
Respiratory rate >30/min
BP <60 dyastolic

19
Q

What is the treatment for community acquired pneumonia CURB less than 2?

A

Amoxicillin 1g 3 x daily 7 days oral or IV
Allergic? - Doxycycline 200mg 2 x daily I day
100 mg 2 x daily 6 days
If need IV- Clarithromycin

20
Q

What is the treatment for CAP with CURB 3+?

A

IV Co- amoxiclav + IV Clarithromycin or Oral Doxycycline 2 x daily
Allergy? IV Levofloxacin
Step down to Doxycycline (10 days total)

21
Q

How do you treat severe hospital acquired pneumonia?

A

Amoxicillin IV + Gentamicin + Metronidazole

Step down to Co-amoxiclav (7- 10 days)

22
Q

How do you treat non severe hospital aquired pneumonia?

A

Amoxicillin and metronidazole (7 days)

23
Q

How do you treat legionella?

A

Clarithromycin/ Erythromycin

Fluroquinolone eg levofloxacin

24
Q

How do you treat Pneumocysitis?

A

Pentamidine

Cotrimidazole

25
Q

How do you treat fungal pneumonia?

A

IV Ampheterecin