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Respiratory > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

what is the commonest cause of CAP

A

streptococcus pneumoniae

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2
Q

organisms of CAP

A

strep pneumonia, haemophilus influenza, mycoplasma pneumonia. staph aureus, Legionella, Moraxella catarrhalis, chlymadia.

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3
Q

what are rarer in CAP gram positive or negative

A

gram negative bailli are rarer. caxiella burntii and anaerobes rare

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4
Q

what % are made up by viruses CAP

A

15%

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5
Q

what may flu be complicated by

A

community acquired MRSA pneumonia

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6
Q

how many hours after admission is pneumonia hospital acquired

A

> 48 hours after (nosocomial)

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7
Q

what are the most common organisms Hospital acquired

A

gram negative enterobacteria or staph aureus. also pseudomonas, klebsiella, bacteroides, clostridia

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8
Q

who are at risk of aspirating oropharyngeal anaerobes

A

those with stroke, myasthenia, bulbar palsies, decr consciousness, oesophageal disease, poor dental hygiene

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9
Q

symptoms

A

fever, malaise, rigors, anorexia, dyspnoea, cough, purulent sputum, haemoptysis, pleuritic pain

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10
Q

signs

A

pyrexia, cyanosis, confusion, tachypnoea, tachycardia, hypotension, signs of consolidation, pleural rub

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11
Q

tests

A

CXR- lobar/multi lobar infiltrates, cavitation or pleural effusion. assess oxygenation- sats, bp. bloods- FBC, U&E, LFT, CRP, cultures. sputum MC&S. in severe cases check for legionella (urine antigen). pneumococcal antigen in urine. pleural fluid aspiration.

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12
Q

if immunocompromised what tests can be done

A

bronchoscopy, and bronchoalveolar lavage

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13
Q

what score is used to assess severity

A

CURB65 confusion, urea >7, RR >30, BP 65.

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14
Q

what score indicates severe and to consider ITU

A

score 3 or above

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15
Q

management

A

antibiotics. oxygen keep O2>8 and sats >94. IV fluids and VTE prophylaxis. analgesia if pleurisy eg paracetemol 1g/6h. follow up at 6 weeks

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16
Q

complications

A

pleural effusion, empyema, lung abscess, resp failure, septicaemia, brain abscess, pericarditis, myocarditis, cholestatic jaundice

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17
Q

what vaccine and who to give it to

A

pneumococcal. at risk groups- >65, chronic heart/liver, renal, lung conditions, DM, immunosuppression, AIDS, on chemo.

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18
Q

antibiotics in CAP mild not previously acquired

A

strep and haem- amoxicillin or clarithromycin or doxycycline

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19
Q

antibiotics in CAP moderate

A

strep, haem, myco- oral amoxicillin, clarithromycin, doxycycline. if IV required- amoxicillin or clarithromycin

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20
Q

antibiotics in CAP severe

A

co amoxiclav or cephalosporin IV and clarithromycin. add flucloxacillin and rifampicin if staph, vancomycin if MRSA.

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21
Q

atypical CAP antibiotics

A

legionella- fluoroquinolone, combined with clarithromycin or rifampicin. chlamydophila- tetracycline.

22
Q

hospital acquired antibiotics

A

gram negative, pseudomonas, anaerobes- aminoglycosides and antipseudomonal penicillin. cephalosporin

23
Q

aspiration pneumonia antibiotics

A

cephalosporin, metronidazole

24
Q

neutropenic pts

A

aminoglycoside, penicillin, cephalosporin

25
Q

what does CXR show in pneumococcal

A

lobar consolidation

26
Q

features pneumococcal

A

fever, pleurisy, herpes labialis

27
Q

what occurs with staph infection

A

may complicate influenza infection, young, elerly, IVDU, or patients with underlying disease

28
Q

when does klebsiella ccur

A

elderly, diabetics, alcoholics

29
Q

what does CXR show with staph

A

bilateral cavitating bronchopneumonia

30
Q

what does CXR show klebsiella

A

cavitating pneumonia, particularly of the upper lobes, often drug resistant

31
Q

treatment klebsiella

A

cefotaxime, imipenem

32
Q

what organism is common in bronchiectasis and CF

A

pseudomonas. also causes HAP

33
Q

how does infection with mycoplasma present

A

flu like symptoms- followed by a dry cough

34
Q

what does the CXR show in mycoplasma

A

reticular nodular shadowing or patchy consolidation often of 1 lower lobe

35
Q

diagnosis mycoplasma

A

PCR sputum or serology

36
Q

complications mycoplasma

A

skin rash, steven johnsons syndrome, meningoencephalitis, myelitis, GBS

37
Q

when is legionella common

A

colonises water tanks kept at

38
Q

symptoms legionella

A

flu like sx, dry cough, dyspnoea, anorexia, d+v, hepatitis, renal failure, confusion, coma

39
Q

what does the CXR show legionella

A

bi basal consolidation.

40
Q

diagnosis legionalla

A

urine antigen/serology

41
Q

complications of pneumonia

A

resp failure, hypotension, AF, pleural effusion, empyema, lung abscess, septicaemia, pericarditis and myocarditis, jaundice

42
Q

what is an empyema

A

pus in the pleural space

43
Q

features empyema

A

CXR indicates pleural effusion, aspirated pleural effusion is typically yellow and turbid with low ph, low glucose, high LDH.

44
Q

how to treat empyema

A

chest drain.

45
Q

what is a lung abscess

A

cavitating area of localised suppurative infection within the lung

46
Q

causes lung abscess

A

inadequately treated pneumonia, aspiration, bronchial obstruction, pulmonary infarction, septic emboli, subphrenic or hepatic abscess

47
Q

clinical features lung abscess

A

swinging fever, cough, purulent foul smelling sputum, pleuritic chest pain, haemoptysis, malaise, weight loss

48
Q

signs lung abscess

A

finger clubbing, anaemia, creps. empyema in 20-30%

49
Q

tests lung abscess

A

FBC- anaemia, neutrophilia, ESR, CRP, cultures. sputum microscopy, culture, cytology. CXR- walled cavity often with a fluid lvevel. CT, bronchoscopy

50
Q

treatment lung abscess

A

antibiotics indicated by sensitivities, postural drainage, repeated aspiration, surgical excision

Respiratory (17 decks)

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