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Respiratory (LECTURE NOTES) > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What part of the respiratory tract is usually sterile

A

The lower respiratory tract (below the larynx)

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2
Q

How can infections reach the lungs

A

Inhalation, aspiration, direct inoculations and blood borne

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3
Q

Define pneumonia

A

A general term denoting inflammation of the gas exchange region of the lung. Usually it implies parenchymal lung inflammation caused by infection

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4
Q

Who can get pneumonia

A

All age groups

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5
Q

What do the circumstances of the illness include

A 
Site of infection in the respiratroy tract
Age of the patient 
community or hospital acquired
Concurrent disease 
environemental and geographical factors 
severity of the illness
microbiology of the pneumonia
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6
Q

What is the most common cause of primary pneumonia

A

Streptococcus pneumoniae

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7
Q

What is the most common cause of pneumonia in children under 2

A

Viruses (RSV)

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8
Q

What is the causative organism for the majority of cases in community acquired pneumonia

A

Streptococcus pneumonia

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9
Q

Define hospital acquired pneumonia

A

Pneumonia that develops 2 or more days after admission to hospital for some other reason

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10
Q

Are gram negative or gram positive organisms usually the causative organisms in hospital acquired pneumonia

A

Gram negative

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11
Q

Are gram negative or gram positive organisms usually the causative organisms in hospital acquired pneumonia

A

Gram negative

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12
Q

What 4 things can predispose to pneumonia and are associated with a greatly increased mortality

A

Alcohol misuse
Malnutrition
Diabetes
Underlying cardiorespiratory disease

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13
Q

Who is likely to develop aspiration pneumonia

A

Those with impaired swallowing or in patients with impaired consciousness

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14
Q

What organism is found in birds

A

Chlamydophila psittaci

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15
Q

What organism is found in farm animals

A

Coxiella burnetti

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16
Q

What organism is found in farm animals

A

Coxiella burnetti

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17
Q

What organism is found in contaminated water sources

A

Legionella pneumophila

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18
Q

What occurs in outbreaks every 4 years

A

Mycoplasma pneumoniae

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19
Q

How do we assess the severity of pneumonia

A 
CURB 65 
Confusion - new onset 
Urea >7
Respiratory Rate >30 
BP systolic
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20
Q

What are the typical clinical features of pneumonia

A 
Cough
Purulent sputum
Fever 
Pleuritic pain 
SOB
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21
Q

What are the typical clinical features of pneumonia

A 
Cough
Purulent sputum
Fever 
Pleuritic pain 
SOB
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22
Q

What is often auscultated in the chest?

A

Crackles
Dullness
Bronchial breathing

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23
Q

If the CURB65 score is 2 where should the patient be treated

A

Hospital ward

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24
Q

When should the patient be treated in ITU

A

When the CURB 65 score is 3 or more

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25
Q

What should be tested in a patient with suspected pneumonia

A

Sputum cultures

serology samples

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26
Q

What are the general investigations performed for suspected pneumonia

A

CXR - confirms diagnosis form consolidation
Haematology and biochemistry - helpful in assessing the severity of the disease
Oxygenation - pulse oximetry. Those lower than 94% should have ABGs done

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27
Q

What PO2 is aimed for

A

> 8kPa

28
Q

Who is chest physiotherapy useful for

A

Those with COPD with copious secretions

29
Q

What is the treatment for community acquired pneumonia

A

500mg tds amoxicillin orally

30
Q

What is the alternative for those allergic to penicillin

A

Doxycycline or clarithromycin

31
Q

For severe pneumonia, what is the initial antibiotic treatment

A

IV Coamoxiclav 1.2g tds and clarithromycin 500mg bd

32
Q

What is an appropriate alternative to co-amoxiclav

A

Cefuroxime

33
Q

What is the appropriate treatment for hospital acquired pneumonia

A

combination of aminoglycoside (tobramycin) and a third generation cephalosporin (ceftazidime)

34
Q

When should patient be switched from IV to oral antibiotics

A

When they are improving

35
Q

When should patient be switched from IV to oral antibiotics

A

When they are improving

36
Q

What are asplenic patients usually given

A

Pneumococcal vaccination and long term prophylactic phenoxymethylpenicillin

37
Q

Who are advised to get the pneumococcal vaccination

A 
Those 65 and above 
chronic lung disease 
diabetics 
renal and cardiac disease 
immunodeficient
38
Q

What causes bronchopneumonia

A

Spread of infection into the lung parenchyma

39
Q

What type of organism often occurs as a sequel to influenza

A

Staph aureus

40
Q

Who is affected by Klesbiella pneumonia

A

Those who have imparied resistance to infection (alcohol misuse, malnutrition, diabetes) or underlying lung disease

41
Q

What does Klesbiella pneumonia often show on an Xray

A

Lung tissue

Cavitation and abscess formation

42
Q

Where does pseudomonas aeruginosa pneumonia come from

A

Endotracheal ventilation in ITU

43
Q

How is the diagnosis made for organisms which are difficult to culture in the laboratory

A

Through rising antibody titre on serological tests

44
Q

What is the treatment for organisms which are not sensitive to penicillins

A

Tetracycline or macrolide (clarithromycin)

45
Q

How is mycoplasm pneumoniae spread

A

Infection through person to person by infected respiratory droplets

46
Q

What are the 3 chlamydial species that cause respiratory disease

A

Chlamydophila psittaci
Chlamydophila pneumoniae
Chlamydia trachomatis

47
Q

What are other symptoms of legionella pneymophila

A 
Prostration
confusion
diarrhoea
abdominal pain 
respiratory failure
48
Q

How can we diagnose legionella

A

Antigen in urine

49
Q

How do we treat legionella pneumonia

A

Combination of clarithromycin or a fluoroquinolone and rifampicin

50
Q

How did the SARS coronavirus spread so quickly

A

Through airplane travel

51
Q

Who should be offered HIV testing

A

Patients with a wide range of conditions, pneumonia, bronchiectasis, TB

52
Q

What fungus can cause disease in immunocompromised individuals

A

Pneumocystis jirovecci

53
Q

How does PCP typically present

A

As a subacute illness over a few weeks with cough, dyspnoea, fever, hypoxaemia, bilateral perihilar interstitial infiltrates on CXR

54
Q

How is penumocystis pneumonia usually diagnosed

A

Confirmed by detecting Pneumocysstis jirovecii using a monoclonal antibody immynofluorescent technique on specimens obtained by sputum induction or by bronchoscopy and bronchoalveolar lavage

55
Q

What is the treatment of PCP

A

High dose IV co-trimoxazole for 3 weeks

56
Q

What do patients with moderate or severe PCP benefit from

A

THe addition of corticosteroids to reduce the pulmonary inflammation response

57
Q

What are patients with HIV infection and impaired CD4 lymphocyte function highly susceptible to?

A

Developing reactivation of previously axquired latent TB and to contracting the disease from an exogenous source with rapid progression to active disease

58
Q

Who does mycobacterium avium-intracellulare complex usually infect

A

Patients with advanced AIDS

59
Q

What viruses might cause pneumonia in AIDS patients

A

Epstein-Barr, adenovirus , influenzae and herpes simplex

60
Q

What is the commonest malignancy in HIV infected patients

A

Kaposi’s sarcoma

61
Q

What is Pulmonary Kaposi’s sarcoma nearly always accompanised by

A

lesions in the skin or buccal mucosa

62
Q

What do Kaposi’s sarcoma apeear as at bronchoscopy

A

Red or purple lesions

63
Q

What is the treatment of Kaposi’s sarcoma

A

ANti-retroviral therapy (HAART) but also anti-neoplastic chemotherapy is needed

64
Q

What presents as episodes of dyspnoea with pulmonary infiltrates, reduced gas diffusion and hypoxaemia

A

Interstitial pneumonitis

65
Q

Who is lymphoid interstitial pneumonitis most commonly seen in

A

Children with HIV infection

66
Q

How should patients be reviewed with pneumonia

A

Arrange a clinical review and chest X rays 6 weeks after discharge from hospital

67
Q

Opportunistic infections develop when the CD4 count falls below what?

A

200/mm3

Respiratory (LECTURE NOTES) (19 decks)

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