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Resp Revision > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What are the most common causes of acute bacterial pneumonia?

A 
S. pneumoniae (most common)
H. influenzae
Staph
Klebsiella spp.
Legionella spp.
TB
Chlamydophila
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2
Q

What are the common causes of atypical pneumonia?

A 
Mycoplasma pneumoniae
Chlamydia pneumoniae
Coxiella burnetti
Legionella spp.
M. catarrhalis
Viral (RSV, influenza, adenovirus)
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3
Q

What are some other less common causes of pneumonia?

A

Histoplasma
Aspergillus
Pneumocystis

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4
Q

How is sputum collected for a laboratory diagnosis of pneumonia?

A 
Transtracheal aspirate
Aspiration via tracheostomy, endotracheal tube or bronchoscope
Pleural tap to sample effusion
Blood culture and serology
Rarely lung biopsy
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5
Q

When is serological diagnosis of pneumonia useful (with what causative organisms)?

A

Mycoplasma pneumoniae
Legionella pneumophilia
Chlamydophila and Chlamydia spaces
Coxiella burnetii

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6
Q

List 5 “must-know” pathogens in the diagnosis of pneumonia

A 
SARS, MERS, etc
Influenza (e.g. avian flu)
Legionella spp.
Bioterrorism agents
Community-acquired MRSA
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7
Q

List 2 “should-know” pathogens in the diagnosis of pneumonia

A

Penicillin G-resistant S. pneumoniae

Gram- rods (e.g. Pseudomonas)

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8
Q

How is community-acquired pneumonia treated?

A

Usually empirical antibiotics (B-lactam, e.g. penicillin G/amoxycillin, + doxycycline/macrolide)

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9
Q

What vaccines are available to prevent pneumonia?

A

Influenza (flu is a risk factor for pneumonia)

Pneumococcal (23v for adults, 13v for children)

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10
Q

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

A

> 50% S. pneumoniae

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11
Q

What are the common pathogens causing nosocomial pneumonias?

A

Gram-

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12
Q

What pathogens are important in pneumonia in the immune compromised host?

A

Bacteria (low virulence)
Fungi
Protozoa (e.g. Pneumocystis jiroveci)

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13
Q

What are the 4 possible routes of entry in infective pneumonia?

A

Inhalation
Aspiration of infected secretions from URT
Aspiration of infected particles
Haematogenous spread

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14
Q

What are the 3 possible microbial aetiologies underlying infective pneumonia?

A

URT flora
Enteric saprophytes (contaminate airways or via blood)
Environmental pathogens

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15
Q

What are the 2 patterns of infective pneumonia?

A

Alveolar inflammation

Interstitial inflammation

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16
Q

What causes a pattern of alveolar inflammation in infective pneumonia?

A

Bacterial pathogens

17
Q

What causes a pattern of interstitial inflammation in infective pneumonia?

A

Viruses

Bacterial causes of atypical pneumonia (e.g. mycoplasma)

18
Q

What is the distinguishing feature of alveolar pneumonia?

A

Consolidation, a condition in which lung tissue becomes firm and solid due to the accumulation of neutrophils within the alveolar spaces

19
Q

What are the 2 patterns of consolidation in alveolar pneumonias?

A

Lobar pneumonia: whole lobe affected +/- inflammation of adjacent pleura
Bronchopneumonia: centered on bronchi or bronchioles and spreads to surrounding alveoli with patchy, multifocal consolidation, often bilateral and affecting >1 lobe
N.B. Patterns can overlap

20
Q

What causes lobar pneumonia vs. bronchopneumonia?

A

Bacteria can produce either pattern depending on the virulence of the organism and the state of the host defences

21
Q

What is the most common cause of lobar pneumonia?

A

S. pneumoniae

22
Q

What are the symptoms and signs of lobar pneumonia?

A 
Abrupt onset
Fever with chills
Raised WCC
Cough with sputum and haemoptysis
Pleuritic chest pain
Gram+ diplococci in sputum
Bacteraemia
23
Q

What are the 4 stages of lobar pneumonia?

A

Congestion: inflammatory exudate (with fibrin) in alveoli
Red hepatisation: diapedesis of RBCs into alveoli
Grey hepatisation: macrophages invade and remove RBCs and other debris
Resolution

24
Q

What is the most common pattern of bacterial pneumonia?

A

Bronchopneumonia

25
Q

What patients are at risk of acute bronchopneumonia?

A

Very young and very old
Usually secondary to pre-existing chronic cardiorespiratory disease
Common in hospital patients (frequent post-operative complication)

26
Q

List 6 possible complications of pneumonia

A 
Pleural fibrosis
Empyema
Abscess
Bronchiectasis
Interstitial fibrosis
Cysts
27
Q

What are the common causes of interstitial pneumonia?

A

Viral

Bacterial, producing an atypical pneumonia

28
Q

Describe the underlying pathogenesis of interstitial pneumonia

A

Alveolar septa are widened and infiltrated by lymphocytes, plasma cells and macrophages
Produces bronchiolitis
May be alveolar oedema or haemorrhage but not neutrophils (i.e. there is no consolidation)

29
Q

What is the presentation of atypical pneumonia?

A

Systemic symptoms predominant over respiratory (malaise, headaches, diarrhoea)
Dry non-productive cough
Reticulonodular infiltrate on CXR

Resp Revision (28 decks)

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