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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
What should be tested in a patient with suspected pneumonia
Sputum cultures | serology samples
26
What are the general investigations performed for suspected pneumonia
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
27
What PO2 is aimed for
>8kPa
28
Who is chest physiotherapy useful for
Those with COPD with copious secretions
29
What is the treatment for community acquired pneumonia
500mg tds amoxicillin orally
30
What is the alternative for those allergic to penicillin
Doxycycline or clarithromycin
31
For severe pneumonia, what is the initial antibiotic treatment
IV Coamoxiclav 1.2g tds and clarithromycin 500mg bd
32
What is an appropriate alternative to co-amoxiclav
Cefuroxime
33
What is the appropriate treatment for hospital acquired pneumonia
combination of aminoglycoside (tobramycin) and a third generation cephalosporin (ceftazidime)
34
When should patient be switched from IV to oral antibiotics
When they are improving
35
When should patient be switched from IV to oral antibiotics
When they are improving
36
What are asplenic patients usually given
Pneumococcal vaccination and long term prophylactic phenoxymethylpenicillin
37
Who are advised to get the pneumococcal vaccination
``` Those 65 and above chronic lung disease diabetics renal and cardiac disease immunodeficient ```
38
What causes bronchopneumonia
Spread of infection into the lung parenchyma
39
What type of organism often occurs as a sequel to influenza
Staph aureus
40
Who is affected by Klesbiella pneumonia
Those who have imparied resistance to infection (alcohol misuse, malnutrition, diabetes) or underlying lung disease
41
What does Klesbiella pneumonia often show on an Xray
Lung tissue | Cavitation and abscess formation
42
Where does pseudomonas aeruginosa pneumonia come from
Endotracheal ventilation in ITU
43
How is the diagnosis made for organisms which are difficult to culture in the laboratory
Through rising antibody titre on serological tests
44
What is the treatment for organisms which are not sensitive to penicillins
Tetracycline or macrolide (clarithromycin)
45
How is mycoplasm pneumoniae spread
Infection through person to person by infected respiratory droplets
46
What are the 3 chlamydial species that cause respiratory disease
Chlamydophila psittaci Chlamydophila pneumoniae Chlamydia trachomatis
47
What are other symptoms of legionella pneymophila
``` Prostration confusion diarrhoea abdominal pain respiratory failure ```
48
How can we diagnose legionella
Antigen in urine
49
How do we treat legionella pneumonia
Combination of clarithromycin or a fluoroquinolone and rifampicin
50
How did the SARS coronavirus spread so quickly
Through airplane travel
51
Who should be offered HIV testing
Patients with a wide range of conditions, pneumonia, bronchiectasis, TB
52
What fungus can cause disease in immunocompromised individuals
Pneumocystis jirovecci
53
How does PCP typically present
As a subacute illness over a few weeks with cough, dyspnoea, fever, hypoxaemia, bilateral perihilar interstitial infiltrates on CXR
54
How is penumocystis pneumonia usually diagnosed
Confirmed by detecting Pneumocysstis jirovecii using a monoclonal antibody immynofluorescent technique on specimens obtained by sputum induction or by bronchoscopy and bronchoalveolar lavage
55
What is the treatment of PCP
High dose IV co-trimoxazole for 3 weeks
56
What do patients with moderate or severe PCP benefit from
THe addition of corticosteroids to reduce the pulmonary inflammation response
57
What are patients with HIV infection and impaired CD4 lymphocyte function highly susceptible to?
Developing reactivation of previously axquired latent TB and to contracting the disease from an exogenous source with rapid progression to active disease
58
Who does mycobacterium avium-intracellulare complex usually infect
Patients with advanced AIDS
59
What viruses might cause pneumonia in AIDS patients
Epstein-Barr, adenovirus , influenzae and herpes simplex
60
What is the commonest malignancy in HIV infected patients
Kaposi's sarcoma
61
What is Pulmonary Kaposi's sarcoma nearly always accompanised by
lesions in the skin or buccal mucosa
62
What do Kaposi's sarcoma apeear as at bronchoscopy
Red or purple lesions
63
What is the treatment of Kaposi's sarcoma
ANti-retroviral therapy (HAART) but also anti-neoplastic chemotherapy is needed
64
What presents as episodes of dyspnoea with pulmonary infiltrates, reduced gas diffusion and hypoxaemia
Interstitial pneumonitis
65
Who is lymphoid interstitial pneumonitis most commonly seen in
Children with HIV infection
66
How should patients be reviewed with pneumonia
Arrange a clinical review and chest X rays 6 weeks after discharge from hospital
67
Opportunistic infections develop when the CD4 count falls below what?
200/mm3

Respiratory (LECTURE NOTES) (19 decks)

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