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Respiratory System > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

Why is C - confusion part of the CURB65?

A

Because elderly patients can present with atypical presentation, so confusion or atypical falls should always consider pneumonia.

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2
Q

What is bronchoalveolar lavage?

A
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3
Q

Which are the two Gram-negative organisms?

A

Klebsiella pneumonia

Pseudomonas aeruginosa

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4
Q

What are two common complications of pneumonia?

A

effusions and empyema (marked by ongoing fever, persistent inflammatory markers).

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5
Q

What is Sepsis Six?

A
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6
Q

Why are Parkinson’s patients at risk of pneumonia?

A

Poor swallowing mechanisms (>> aspiration)

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7
Q

What are the most common organisms for CAP?

A

streptococcus pneumoniae (20-75%)

Haemophilus influenzae

(these are the typical organisms)

+ atypical organisms

Remember HAP: pseudomonas, and straphlococcus aureus

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8
Q

Common antibiotic for CAP

A

amoxicillin 500mg tds (low severity pneumonia)

If parenteral then amoxicillin or benzylpenicillin, or clarithromycin

High severity; Co-amoxiclav + clarithromycin

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9
Q

How is CAP spread?

A

respiratory droplets

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10
Q

What signs, symptoms, investigations would suggest pleural effusion due to a bacterial pneumonia?

A

purulent, cloudy, coloured exudate

sputum analysis

consolidation on CXR

fever, rigors

Blood test : >> WBC & CRP +

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11
Q

What is one of the most defining symptoms of Pneumocystis jiroveci?

A

Rapid desaturation on exercise/ exertion.

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12
Q

Salient clinical features of pneumonia (5)

A
  • cough
  • purulent sputum
  • fever
  • pleuritis pain
  • breathlessness
  • Confusion (in the elderly)
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13
Q

What is the cause of chest pain with pneumonia?

A

inflammation of the pleura. Maybe a pleural rub can be auscultated.

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14
Q

Community-acquired pneumonia

common organism?

sputum colour?

associated symptoms?

A

Streptococcus pneumoniae (20-75%).

RUST-coloured sputum.

Often preceded by flu-like symptoms.

High fever and pleuritic pain common.

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15
Q

What drug can you give for CAP with pencillian allergy?

A

clarithromycin

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16
Q

What investigations would you do for pneumonia? and why?

A

FBC: raised WBC and neutrophils confirm infection

CRP snd erythrocyte sedimentation rate: confirm infection

Urea and electrolytes : dehydration common (raised urea and creatinine)

Liver function tests (can become deranged in atypical pneumonia)

ABG: indentify respiratory failure

ECG: AF common with pneumonia, rule out cardiac causes

CXR: consolidation/ effusion evidence?

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17
Q

What is A-a gradient?

A

It is a measure of the difference between the alveolar concentration (A) of oxygen

and the arterial (a) concentration of oxygen. It is used in diagnosing the source of hypoxemia.

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18
Q

What are course crackles a diagnostic sign of?

A
  • Consolidation
  • COPD
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19
Q

Which bacteria gives rust-coloured sputum?

A

Steptococcus pneumoniae

(pneumococcal pneumonia)

(CAP type pneumonia)

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20
Q

What is CURB-65? and the associated red flags?

A

Confusion (mental test score <8)

Urea >7 mmol/L

Respiratory rate >35/min

BP Systolic < 90mmHg Diastolic < 60mmHg

21
Q

Name the common organisms in CAP (3)

A
  • streptococcus pneumoniae
  • haemophilus influenzae
  • moraxella catarrhalis
22
Q

What is Flail chest?

A
23
Q

What is lactate a marker for? And why is this important?

A

Anerobic respiration

24
Q

What are some possible respiratory complications of pneumonia?

A

pleural effusion

empyema

lung abscess

25
Q

What is pneumocystis jiroveci associated with?

A

immuno-compromised patients (eg. HIV +)

26
Q

Management of pneumonia (4)

A
  • depends on CURB-65 score
  • maintain O2 sats >94%
  • intravenous fluids if dehyrated
  • antibiotics (IV or oral)
27
Q

Community-acquired atypical pneumonia organisms (2)

A

Mycoplasma pneumoniae,

Legionella pneumophilia

28
Q

How long is the treatment window for sepsis?

A

one hour to get antibiotics and fluids in

29
Q

Recent flu and rusty sputum; which organism?

A

streptococcus pneumonia

30
Q

Do you give oxygen therapy with pneumonia?

A

Yes, to keep Sats within 94-98%, unless patient as risk of CO2 retention.

31
Q

Who gets Staphylococcus aureus?

A

Alcoholic, diabetic and nursing home patients, also head traumas, and ICU patients.

On the increase, also find in hospitals.

32
Q

CRB65 severity score

1 point each for which features? (4)

A
  • Confusion
  • Respiratory rate >30/min
  • Blood pressure (SBP <90 or DBP < 60mmHg)
  • Age >65
33
Q

Who gets klebsiella pneumonia? (gram –ve)

A

more common in men, and with excessive alcohol consumption. Also those with poor dental hygiene, diabetes, other co-morbidities.

34
Q

What would you hear on auscultation when pneumonia is present?

A
  • increased vocal resonance (99)
  • bronchial breathing
  • course crackles (consolidation)
  • possibly pleural rub
35
Q

With consolidation, what would you find with:

  1. mediastinal shift and trachea?
  2. chest wall escursion?
  3. percussion note?
  4. breath sounds?
  5. added sounds?
  6. vocal resonance?
A
  1. mediastinal shift and trachea - none
  2. chest wall escursion - normal or decreased on affected side
  3. percussion note - dull
  4. breath sounds - increased (bronchial)
  5. added sounds - crackles
  6. vocal resonance - increased
36
Q

Which TWO pneumonal organisms are associated with COPD exacerbations, and also with the elderly. (as risk factors)

A

Haemophilus influenza

Moraxella catarrhalis

37
Q

What is the cardinal sign for pneumonia?

A

Consolidation

38
Q

Aspiration pneumonia organisms

A

Usually gram-negative and anerobic bacteria.

39
Q

What is ‘empyema’?

A

A collection of pus within a naturally existing anatomical cavity. eg. pleural empyema.

NB. an abscess is a collection of pus in a newly formed cavity.

40
Q

Who gets Pseudomonas aeruginosa (gram –ve)

A

infection associated with underlying lung diseases eg. Cystic fibrosis, bronchiectasis, COPD, or immune suppression.

CXR – cavitation and abscess.

41
Q

Bacterial infections (typical) that can cause CAP (5)

A

Streptococcus pneumoniae (50-60%)

Haemaphilus influenzae (5%)

Klebsiella pneumoniae

Pseudomonas aeruginosa

Gram-negative (E.Coli)

42
Q

Hospital-acquired (nosocomial) pneumonia organisms

A

Gram-negative bacilli (70%),

pseudomonas aeruginosa

staphylococcus aureus (15%)

43
Q

What are some of the risk factors for CAP?

A

Age >65, <5 years old

Chronic disease (eg. renal or lung)

Diabetes mellitus

Immunosuppression (eg. drugs and HIV)

Alcohol dependency

aspiration (eg. Parkinson’s, epilepsy)

Recent Viral illness (eg. influenza)

Obesity, smoking, malnutrition

travel/ air conditioning (Legionella)

44
Q

Who gets Legionella pneumophila ?

A

Leginnaire’s disease (carried in water mist). More common in smokers, males, and in young people with no co-morbidities.

Headache is common.

Neurological symptoms common + GI involvement and deranged liver enzymes.

45
Q

If pneumonia is in the right lung, what do you need to think about?

A

Aspiration pneumonia, esp. If Px has associated risk factors.

46
Q

What organisms can cause aspiration pneumonia?

A

Anerobes from the mouth.

Gram negative bacteria; klebsiella and pseudomonas

47
Q

What would be a good antibiotic to treat HAP?

A

Must cover gram negative organisms (e.g. pseudomonas), and staphylococcus aureus

cefotaxime (cephalosporin)

  • always given parenterally as oral preparations are not absorbed.

Rem: if oxygen therapy is needed, HUMIDIFY it to prevent further insensible losses (esp. if pyrexic).

48
Q

If treating a HAP patient with pseudomonas and using ceftazidime, and px develops diarrhoea and is deterioating, what must you consider?

A

Possibly another source of infection (C. Diff) combined with pneumonia.

49
Q

What antibiotic would you use for aspiration pneumonia or abscess?

A

metronidazole

  • remember; must avoid alcohol with this antibiotic.

Respiratory System (7 decks)

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