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Respiratory > Pneumonia > Flashcards

Pneumonia Flashcards

0
Q

What are some common flora of the respiratory tract?

A

Viridans streptococci
Neisseria spp
Anaerobes
Candida spp

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1
Q

What are the natural defences of the respiratory tract?

A

Muco-ciliary clearance mechanisms

  • nasal hair
  • ciliated columnar epithelium

Cough and sneezing reflex

Respiratory mucosal immune system

  • lymphoid follicles of pharynx
  • alveolar macrophage
  • secretory IgA and IgG
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2
Q

Less common flora of the respiratory tract?

A 
Streptococcus pneumoniae
Streptococcus pyogenes
Haemophillus influenza 
Pseudomonas 
E. coli
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3
Q

What are the main infections of the upper respiratory tract?

A 
Rhinitis
Pharyngitis
Epiglottis
Laryngitis
Tranchesitis
Sinusitis
Otitis media
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4
Q

What are the main pathogens that cause upper resp tract infection?

A

Viruses

  • rhinovirus
  • coronavirus
  • influenza
  • parainfluenza
  • respiratory syncytial virus
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5
Q

What is pneumonia?

A

Inflammation of pulmonary parenchyma with consolidation, usually due to an infection.

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6
Q

What is inflammation of the pulmonary parenchyma due to from a cause other than infection? What can these causes be?

A

Pneumonitis

Physical or chemical

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7
Q

In pneumonia, what causes the consolidation?

A

Accumulation of inflammatory exudate in the alveoli and adjoining ducts
Alveolar space contains liquid instead of gas

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8
Q

What is lobar pneumonia?

A

Confluent consolidation involving a complete lung lobe.

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9
Q

What is lobar pneumonia usually caused by?

A

Streptococcus pneumoniae
Community acquired
Acute onset

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10
Q

Pathology of lobar pneumonia?

A

Typical acute inflammatory response
Exudation of fibrin-rich fluid
Get neutrophil and macrophage infiltration

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11
Q

How does the immune system help in the clearance of lobar pneumonia?

A

Antibodies lead to opsonisation and phagocytosis of bacteria

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12
Q

What is broncho-pneumonia?

A

Infection starting in the airways and spreading to adjacent alveoli and lung tissue

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13
Q

When is broncho-pneumonia normally seen?

A

In the context of a pre-existing disease

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14
Q

What is broncho-pneumonia normally caused by?

A 
Streptococcus pneumoniae
Haemophilus influenzae
Staph aureus
Anaerobes
Coliforms
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15
Q

How does bronchopneumonia appear on an X ray?

A

Diffuse and patchy

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16
Q

Who is aspiration pneumonia common in?

A

Patients with neurological dysphagia - strokes
Epilepsy
Alcoholics
Drowning
Patients with a lower level of consciousness eg anaesthesia

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17
Q

What can be aspired to cause aspiration pneumonia?

A

Food
Drink
Saliva
Vomit

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18
Q

What organisms can cause aspiration pneumonia?

A

Oral flora

Anaerobes

19
Q

What is interstitial pneumonia?

A 
Inflammation of the interstitium of the lungs
Includes
-alveolar epithelium
-pulmonary capillary endothelium
-basement membrane
-perivascular and perilymphatic tissue
20
Q

What is chronic pneumonia?

A

Inflammation of lungs that persists for an extended period of time

21
Q

Common causative organisms of community-acquired pneumonia?

A

Streptococcus pneumoniae
Haemophilus influenzae
Klebsiella pneumoniae

Rare:
Chlamydia pneumophilia
Mycoplasma pneumoniae
Legionella pneumophilia

22
Q

Causative organisms of hospital acquired pneumonia?

A 
Gram negative bacilli
Staphylococcus aureus
Pseudomonas
MRSA
Drug resistant organisms are more common
23
Q

What would make you suspect that pneumonia is caused by Streptococcus pneumoniae?

A 
Community acquired
More common in elderly
Commonly preceded by viral infection
Rapid temperature - 39.5*C
Pleuritic pain
Dry cough becoming increasingly productive
Rust-coloured sputum
Breathing becomes more rapid and shallow with decreased chest expansion on side of infection
24
Q

What would make you suspect the organism is H influenzae?

A

Common in elderly
COPD patients
Community acquired

25
Q

What would make you suspect Legionella pneumophilia the causative organism?

A

Recent travel
Young person or a smoker
Illness
Multi-system involvement

26
Q

What would make you suspect Mycoplasma pneumoniae as the causative organism?

A

Young people
Prior antibiotics
Extra-pulmonary involvement - haemolysis, skin and joints

27
Q

What would make you suspect Staph aureus as the most common causative pathogen of pneumonia?

A

IV drug user

Occurred after influenza

28
Q

What would make you suspect Chlamydia pneumophilia to be the causative organism of pneumonia?

A

Contact with birds

29
Q

What would make you suspect coxiella to be the causative organism of pneumonia?

A

Animal contact - sheep

30
Q

What would make you suspect S milleri to be the causative organism of pneumonia?

A

Dental infection
Abdominal source
Aspiration

31
Q

Presentation of pneumonia?

A

Almost always

  • malaise
  • fever
  • productive cough
  • sputum may be purulent/rust coloured/stained with lots of blood
  • fever, chills, sweats, rigors
  • cough, dry in infants and elderly
  • vomiting
  • headache
  • loss of appetite
  • haemoptysis
  • pleuritic chest pain
  • upper abdominal tenderness
32
Q

What might you find on examination of a patient with pneumonia?

A

Signs of consolidation

  • bronchial breath sounds
  • crackles
  • wheeze
  • dullness to percussion
  • reduced vocal resonance
  • seen on CXR

Tachypnoea
Tachycardia
Diarrhoea

33
Q

When is pneumonia classed as hospital acquired?

A

48hrs after hospital admission

Very common, 15% of hospital acquired infections

34
Q

Who is hospital acquired pneumonia common in?

A

Ventilated and post-surgical patients

35
Q

What is the scoring system used to assess chance of mortality from pneumonia?

A 
C - confusion
U - urea >7mmol/L
R - resp rate >30/min
B - blood pressure, systolic <60
65 - aged over 65
36
Q

What specimens can be used for lab diagnosis of pneumonia?

A 
Sputum
Nose and throat swabs
Endotracheal aspirates
Bronchoalveolar lavage fluid
Open lung biopsy
Blood culture
Urine - detects legionella and pneumococcus antigens
Serum - antibody detection
37
Q

Microbiological investigations for pneumonia?

A 
Microscopy - Gram staining and acid fast
Culture bacteria and viruses
PCR of respiratory viruses
Antigen detection for legionella
Serology - Antibody detection
38
Q

Common pathogens which cause pneumonia in the immunosuppressed?

A

Cytomegalovirus (CMV)
Mycobacterium avium intracellulare
Aspergillus, candida, pneumocystis, jiroveci
Crytosporidia, toxoplasma

39
Q

Supportive treatment of pneumonia

A

Fluids (oral/IV)
Anti-pyretic drugs - reduce fever and malaise
Strong analgesics for pleural pain
Oxygen if cyanosed

40
Q

Antibiotics for community acquired pneumonia?

A

Target organism is normally pneumococcus

Penicillin - amoxycillin

41
Q

Antibiotics for hospital-acquired pneumonia?

A

More likely to be Gram negative

IV co-amoxiclav

42
Q

Treatment of legionella pneumonia?

A

Levofloxacin

43
Q

Antibiotics for atypical pathogens of pneumonia?

A

Tetracyclines

Macrolides

44
Q

Possible outcomes of pneumonia?

A 
Resolution
Organisation (scarring)
Complications
-lung abscess
-bronchiectasis
-empyema
-respiratory failure
-hypotension
-septicaemia
45
Q

How to prevent pneumonia?

A

Flu vaccine for high risk patients
Pneumococcal vaccine

Chemoprophylaxis
-oral penicillin/erythromycin

46
Q

When is chemoprophylaxis for pneumonia given?

A

Asplenic patients

Immunosuppressed

Respiratory (17 decks)

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