Pneumonia Flashcards
1
Q
What are the common microorganisms found in the respiratory tract?
A
- Viridans streptococci
- Neisseria spp
- Anaerobes
- Candida spp
2
Q
What are the less common microorganisms found in the respiratory tract?
A
- Streptococcus pneumonia
- Streptococcus pyogenes
- Haemophillus influenza
3
Q
What natural defences does the respiratory tract have to protect against infection?
A
- Cough and sneezing reflex
- Muco-ciliary clearance mechanisms
- Respiratory mucosal immune system
4
Q
What are the muco-ciliary clearance mechanisms?
A
- Ciliated columnar epithelium
- Nasal hairs
5
Q
What are the components of the respiratory mucosal immune system?
A
- Lymphoid follicles of the pharynx and tonsils
- Alveolar macrophages
- Secretory IgA and IgG
6
Q
What are the main upper respiratory tract infections?
A
- Rhinitis (common cold)
- Pharyngitis
- Epiglottisitis
- Laryngitis
- Tracheitis
- Sinusitis
- Ottitis media
7
Q
What is otitis media?
A
Inflammation of the middle/inner ear
8
Q
What are URTs most commonly caused by?
A
Viruses
9
Q
What viruses commonly cause URT infections?
A
- Rhinovirus
- Coronavirus
- Influenza/parainfluenza
- Respiratory syncytial virus (RSV)
10
Q
Other than virally, what else can cause URTs?
A
Bacterial super-infection
11
Q
What is bacterial super-infection common with?
A
- Sinusitis
- Otitis media
12
Q
What can URTs caused by bacterial super-infection lead to?
A
- Mastoiditis
- Meningitis
- Brain abscess
13
Q
What is pneumonia?
A
General term denoting inflammation of gas-exchanging region of the lung
14
Q
What is pneumonia usually due to?
A
Infection, bacterial or viral
15
Q
What is pneumonia an infection of?
A
The lung parenchyma
16
Q
What is pneumonitis?
A
Inflammation of the gas-exchanging region of the lung due to causes other than infection, such as physical or chemical damage
17
Q
What is lobar pneumonia?
A
Pneumonia localised to a particular lobe(s) of the lung
18
Q
What is lobar pneumonia most often due to?
A
Streptococcus pneumoniae
19
Q
What is bronchopneumonia?
A
Pneumonia that is diffuse and patchy
20
Q
What path does infection take in bronchopneumonia?
A
It starts in the airways, and spreads to adjacent alveoli and lung tissue
21
Q
What causes bronchopneumonia?
A
- Streptococcus pneumoniae
- Haemophilus influenza
- Staphylococcus aureus
- Anaerobes
- Coliforms
22
Q
What is aspiration pneumonia?
A
Aspiration of food, drink, saliva, or vomit that leads to pneumonia
23
Q
Who is more likely to develop aspiration pneumonia?
A
- Individuals with altered levels of consciousness
- Individuals with problems swallowing
24
Q
Why may individuals have an altered level of consciousness?
A
- Anaesthesia
- Drug or alcohol abuse
25
Why may an individual have problems swallowing?
Nerve or oesophageal damage
26
What organisms are involved in aspiration pneumonia?
* Oral flora
* Anaerobes
27
What is interstital pnuemonia?
Inflammation of the intersticium of the lung
28
What becomes inflamed in interstitial pneumonia?
* Alveolar epithelium
* Pulmonary capillary endothelium
* Basement membrane
* Perivascular and perilymphatic tissues
29
What is chronic pneumonia?
Inflammation of the lungs that persists for an extended period of time
30
What common bacteria cause pneumonia?
* *Streptococcus* *pneumoniae*
* *Haemophilus influenzae*
* *Klebsiella pneumoniae*
31
What atypical bacteria cause pneumonia?
* *Chlamydia pneumophilia*
* *Mycoplasma pneumoniae*
* *Legionella pneumophila*
32
What hospital acquired bacteria cause pneumonia?
* Gram negative enteric bacteria
* *Pseudomonas*
* *Staphylococcus aureus*
* MRSA
33
What % of pneumonia is caused by *Streptococcus pneumoniae*?
30%
34
What % of pneumonia is caused by *Haemophilus influenza*?
13%
35
What % of pneumonia is caused by *Chlamydia pneumophilia*?
10%
36
What % of pneumonia is caused by gram negative enteric bacteria?
10%
37
What are the common respiratory tract pathogens?
* *S. pneumoniae*
* *H. influenza*
* *Legionella*
* *Mycoplasma*
* *S. aureus*
* *Chlamydia*
* *Coxiella*
* *Klebsiella*
* *S. mirelli*
38
What features are associated with respiratory tract infections caused by *S. pneumoniae*?
* Elderly
* Co-morbidities
* Acute onset
* High fever
* Pleuritic chest pain
39
What features are associated with respiratory tract infections caused by *H. influenza*?
COPD
40
What features are associated with respiratory tract infections caused by *Legionella*?
* Recent travel
* Younger patient
* Smoker
* Illness
* Multi-system involvement
41
What are the features associated with respiratory tract infections caused by *Mycoplasma*?
* Young
* Prior antibiotics
* Extra-pulmonary involvement
42
What extra-pulmonary involvement is seen in respiratory tract infections caused by *Mycoplasma*?
* Haemolysis
* Skin
* Joint
43
What features are associated with respiratory tract infections caused by *S. aureus*?
* Post-viral
* Intra-venous drug user
44
What features are associated with respiratory tract infections caused by *Chlamydia*?
Contact with birds
45
What features are associated with respiratory tract infections caused by *Coxiella*?
Animal contact *(sheep)*
46
What features are associated with respiratory tract infections caused by *Klebsiella*?
* Thrombocytopenia
* Leucopenia
47
What features are associated with respiratory tract infections caused by *S. milleri*?
* Dental infections
* Abdominal source
* Aspiration
48
What can make pneumonia hard to diagnose?
The presentation can be variable
49
What does pneumonia almost always present with?
* Malaise
* Fever
* Productive cough
50
What are the characteristics of the sputum in pneumonia?
May be purulent, or rusty coloured *(little blood)*, or stained with lots of blood
51
What kind of pain commonly present in pneumonia?
Plureitic chest pain
52
How fast is the onset of pnuemonia?
May be very rapid onset
53
When is pneumonia likely to have a rapid onset?
When pneumococcal or staphylococcal
54
What is the prognosis of rapid onset pneumonia?
Can have fatal outcome in short period of time
55
What are the symptoms of pneumonia?
* Fever
* Chills
* Sweats
* Rigors
* Cough
* Sputum
* Dyspnoea
* Pleuritic chest pain
* Malaise
* Anorexia
* Vomiting
* Headache
* Diarrhoea
* Chest signs
56
What chest signs are present in pneumonia?
* Bronchial breath sounds
* Crackles
* Wheeze
* Dullness to percussion
* Reduced vocal resonance
57
What is classified as hospital acquired pneumonia?
Pneumonia occuring 48 hours after hospital admission
58
What % of hospital acquired infections does pneumonia constitute?
˜15%
59
Who is hospital acquired pneumonia common in?
Ventilated and post-surgical patients
60
How can the severity of pneumonia be assessed?
Using the CURB 65 score
61
How is the CURB 65 score interpreted?
* Presence of two or more of the features is an indiciation for hospital treatment
* Patients with high scoles may require ICU treatment
62
What does C in CURB represent?
New mental confusion
63
What does U in CURB represent?
Urea \>7mmol/L
64
What does R in CURB represent?
Respiratory rate \>30 per minute
65
What does B in CURB represent?
Blood pressure - systolic \< 90 or diastolic \< 60 mmHg
66
What samples are collected to investigate pneumonia?
* Sputum
* Nose and throat swabs
* Endotracheal aspirates
* Broncho Alveolar Lavage fluid (BAL)
* Open Lung Biopsy
* Blood culture
* Urine
* Serum
67
When should a blood culture be taken to investigate pneumonia?
Preferably before antibiotics
68
What is the purpose of a urine sample in the investigation of pneumonia?
Detect the antigens of legionella/pneumococcus
69
What is the purpose of a serum sample in the investigation of pneumonia?
Antibody detection
70
What are the microbiological investigations of pneumonia?
* Macroscopic
* Microscopy
* Culture
* PCR
* Antigen detection
* Antibody detection
71
What aspects of pneumonia can be examined macroscopically?
Sputum, *if it is purulent or blood stained*
72
What stains are used to examine pneumonia microscopically?
* Gram staining
* Acid fast
73
What is being looked for when a culture is grown to investigate pneumonia?
* Bacteria
* Viruses
74
What can PCR detect when investigating pneumonia?
Respiratory viruses
75
What can antigen detection detect when investigating pneumonia?
Legionella
76
What can pathogens infecting immunosuppressed hosts be?
* Virulent infection with common organism
* Infection with opportunistic pathogen
77
What kinds of opportunistic pathogens can infect immunosupressed hosts?
* Viruses
* Bacteria
* Fungi
* Protozoa
78
Give an example of an opportunistic virus
Cytomegalovirus (CMV)
79
Give an example of an opportunistic bacteria
*Mycobacterium avium intracellulare*
80
Give 3 examples of opportunistic fungi
* *Aspergillus*
* *Candida*
* *Pneumocystis jiroveci*
81
Give two examples of opportunistic protozoa
* Cryptosporidia
* Toxoplasma
82
How is pneumonia managed?
* Oral fluids *(IV if severe)*
* Anti-pyretic drugs
* Stronger analgesics
* Oxygen
* Antibiotics
83
What is the purpose of providing fluids in pneumonia?
Avoid dehydration
84
What is the purpose of anti-pyretic drugs in pneumonia?
Reduce fever and malaise
85
Give an example of an anti-pyretic drug given in pneumonia
Paracetamol
86
When is oxygen given in pneumonia?
If there is cyanosis
87
What antibiotics are given to treat pneumonia?
Varies with the type of pneumonia
88
What is the target organism when treating community acquired pneumonia?
Normally, *Pneumococcus*
89
What is *Pneumococcus* usually sensitive to?
Penicillin, or related antibiotics
90
What is the target organism in management of hospital aquired pneumonia?
More likely to be gram -ve
91
What antibiotic must be used in treating hospital acquired pneumonia?
Antibiotics that cover gram -ve organisms, e.g. IV Co-Amoxiclav
92
What are the potential outcomes of pneumonia?
* Resolution
* Complications
93
What happens in resolution of pneumonia?
Organisations and fibrous scarring
94
What are the potential complications of pneumonia?
* Lung abscess
* Bronchiectasis
* Empyema
95
What is empyema?
Pus in the pleural cavity
96
How is pneumonia prevented?
* Immunisation
* Chemoprophylaxis
97
How is pneumonia immunised against?
* Flu vaccine
* Pneumococcal vaccine
98
How often is the flu vaccine given?
Annually
99
Who is the flu vaccine given to?
High risk patients
100
What does the pneumococcal vaccine consist of?
Two vaccines
101
What is given in chemoprophylaxis for pneumonia?
Oral penicillin or erythromycin
102
When is chemoprophylaxis given?
When patients have higher risk of lower respiratory tract infections
103
What conditions can mean that patients have a higher risk of lower respiratory tract infections?
* Asplenia
* Dysfunctional spleen
* Immunodeficiency
