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ESA 3 - Respiratory System > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What are the common microorganisms found in the respiratory tract?

A
  • Viridans streptococci
  • Neisseria spp
  • Anaerobes
  • Candida spp
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2
Q

What are the less common microorganisms found in the respiratory tract?

A
  • Streptococcus pneumonia
  • Streptococcus pyogenes
  • Haemophillus influenza
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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
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4
Q

What are the muco-ciliary clearance mechanisms?

A
  • Ciliated columnar epithelium
  • Nasal hairs
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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
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6
Q

What are the main upper respiratory tract infections?

A
  • Rhinitis (common cold)​
  • Pharyngitis
  • Epiglottisitis
  • Laryngitis
  • Tracheitis
  • Sinusitis
  • Ottitis media
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7
Q

What is otitis media?

A

Inflammation of the middle/inner ear

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8
Q

What are URTs most commonly caused by?

A

Viruses

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9
Q

What viruses commonly cause URT infections?

A
  • Rhinovirus
  • Coronavirus
  • Influenza/parainfluenza
  • Respiratory syncytial virus (RSV)
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10
Q

Other than virally, what else can cause URTs?

A

Bacterial super-infection

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11
Q

What is bacterial super-infection common with?

A
  • Sinusitis
  • Otitis media
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12
Q

What can URTs caused by bacterial super-infection lead to?

A
  • Mastoiditis
  • Meningitis
  • Brain abscess
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13
Q

What is pneumonia?

A

General term denoting inflammation of gas-exchanging region of the lung

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14
Q

What is pneumonia usually due to?

A

Infection, bacterial or viral

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15
Q

What is pneumonia an infection of?

A

The lung parenchyma

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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

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17
Q

What is lobar pneumonia?

A

Pneumonia localised to a particular lobe(s) of the lung

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18
Q

What is lobar pneumonia most often due to?

A

Streptococcus pneumoniae

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19
Q

What is bronchopneumonia?

A

Pneumonia that is diffuse and patchy

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20
Q

What path does infection take in bronchopneumonia?

A

It starts in the airways, and spreads to adjacent alveoli and lung tissue

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21
Q

What causes bronchopneumonia?

A
  • Streptococcus pneumoniae
  • Haemophilus influenza
  • Staphylococcus aureus
  • Anaerobes
  • Coliforms
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22
Q

What is aspiration pneumonia?

A

Aspiration of food, drink, saliva, or vomit that leads to pneumonia

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23
Q

Who is more likely to develop aspiration pneumonia?

A
  • Individuals with altered levels of consciousness
  • Individuals with problems swallowing
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24
Q

Why may individuals have an altered level of consciousness?

A
  • Anaesthesia
  • Drug or alcohol abuse
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25
Q

Why may an individual have problems swallowing?

A

Nerve or oesophageal damage

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26
Q

What organisms are involved in aspiration pneumonia?

A
  • Oral flora
  • Anaerobes
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27
Q

What is interstital pnuemonia?

A

Inflammation of the intersticium of the lung

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28
Q

What becomes inflamed in interstitial pneumonia?

A
  • Alveolar epithelium
  • Pulmonary capillary endothelium
  • Basement membrane
  • Perivascular and perilymphatic tissues
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29
Q

What is chronic pneumonia?

A

Inflammation of the lungs that persists for an extended period of time

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30
Q

What common bacteria cause pneumonia?

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Klebsiella pneumoniae
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31
Q

What atypical bacteria cause pneumonia?

A
  • Chlamydia pneumophilia
  • Mycoplasma pneumoniae
  • Legionella pneumophila
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32
Q

What hospital acquired bacteria cause pneumonia?

A
  • Gram negative enteric bacteria
  • Pseudomonas
  • Staphylococcus aureus
  • MRSA
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33
Q

What % of pneumonia is caused by Streptococcus pneumoniae?

A

30%

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34
Q

What % of pneumonia is caused by Haemophilus influenza?

A

13%

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35
Q

What % of pneumonia is caused by Chlamydia pneumophilia?

A

10%

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36
Q

What % of pneumonia is caused by gram negative enteric bacteria?

A

10%

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37
Q

What are the common respiratory tract pathogens?

A
  • S. pneumoniae
  • H. influenza
  • Legionella
  • Mycoplasma
  • S. aureus
  • Chlamydia
  • Coxiella
  • Klebsiella
  • S. mirelli
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38
Q

What features are associated with respiratory tract infections caused by S. pneumoniae?

A
  • Elderly
  • Co-morbidities
  • Acute onset
  • High fever
  • Pleuritic chest pain
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39
Q

What features are associated with respiratory tract infections caused by H. influenza?

A

COPD

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40
Q

What features are associated with respiratory tract infections caused by Legionella?

A
  • Recent travel
  • Younger patient
  • Smoker
  • Illness
  • Multi-system involvement
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41
Q

What are the features associated with respiratory tract infections caused by Mycoplasma?

A
  • Young
  • Prior antibiotics
  • Extra-pulmonary involvement
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42
Q

What extra-pulmonary involvement is seen in respiratory tract infections caused by Mycoplasma?

A
  • Haemolysis
  • Skin
  • Joint
43
Q

What features are associated with respiratory tract infections caused by S. aureus?

A
  • Post-viral
  • Intra-venous drug user
44
Q

What features are associated with respiratory tract infections caused by Chlamydia?

A

Contact with birds

45
Q

What features are associated with respiratory tract infections caused by Coxiella?

A

Animal contact (sheep)

46
Q

What features are associated with respiratory tract infections caused by Klebsiella?

A
  • Thrombocytopenia
  • Leucopenia
47
Q

What features are associated with respiratory tract infections caused by S. milleri?

A
  • Dental infections
  • Abdominal source
  • Aspiration
48
Q

What can make pneumonia hard to diagnose?

A

The presentation can be variable

49
Q

What does pneumonia almost always present with?

A
  • Malaise
  • Fever
  • Productive cough
50
Q

What are the characteristics of the sputum in pneumonia?

A

May be purulent, or rusty coloured (little blood), or stained with lots of blood

51
Q

What kind of pain commonly present in pneumonia?

A

Plureitic chest pain

52
Q

How fast is the onset of pnuemonia?

A

May be very rapid onset

53
Q

When is pneumonia likely to have a rapid onset?

A

When pneumococcal or staphylococcal

54
Q

What is the prognosis of rapid onset pneumonia?

A

Can have fatal outcome in short period of time

55
Q

What are the symptoms of pneumonia?

A
  • Fever
  • Chills
  • Sweats
  • Rigors
  • Cough
  • Sputum
  • Dyspnoea
  • Pleuritic chest pain
  • Malaise
  • Anorexia
  • Vomiting
  • Headache
  • Diarrhoea
  • Chest signs
56
Q

What chest signs are present in pneumonia?

A
  • Bronchial breath sounds
  • Crackles
  • Wheeze
  • Dullness to percussion
  • Reduced vocal resonance
57
Q

What is classified as hospital acquired pneumonia?

A

Pneumonia occuring 48 hours after hospital admission

58
Q

What % of hospital acquired infections does pneumonia constitute?

A

˜15%

59
Q

Who is hospital acquired pneumonia common in?

A

Ventilated and post-surgical patients

60
Q

How can the severity of pneumonia be assessed?

A

Using the CURB 65 score

61
Q

How is the CURB 65 score interpreted?

A
  • Presence of two or more of the features is an indiciation for hospital treatment
  • Patients with high scoles may require ICU treatment
62
Q

What does C in CURB represent?

A

New mental confusion

63
Q

What does U in CURB represent?

A

Urea >7mmol/L

64
Q

What does R in CURB represent?

A

Respiratory rate >30 per minute

65
Q

What does B in CURB represent?

A

Blood pressure - systolic < 90 or diastolic < 60 mmHg

66
Q

What samples are collected to investigate pneumonia?

A
  • Sputum
  • Nose and throat swabs
  • Endotracheal aspirates
  • Broncho Alveolar Lavage fluid (BAL)
  • Open Lung Biopsy
  • Blood culture
  • Urine
  • Serum
67
Q

When should a blood culture be taken to investigate pneumonia?

A

Preferably before antibiotics

68
Q

What is the purpose of a urine sample in the investigation of pneumonia?

A

Detect the antigens of legionella/pneumococcus

69
Q

What is the purpose of a serum sample in the investigation of pneumonia?

A

Antibody detection

70
Q

What are the microbiological investigations of pneumonia?

A
  • Macroscopic
  • Microscopy
  • Culture
  • PCR
  • Antigen detection
  • Antibody detection
71
Q

What aspects of pneumonia can be examined macroscopically?

A

Sputum, if it is purulent or blood stained

72
Q

What stains are used to examine pneumonia microscopically?

A
  • Gram staining
  • Acid fast
73
Q

What is being looked for when a culture is grown to investigate pneumonia?

A
  • Bacteria
  • Viruses
74
Q

What can PCR detect when investigating pneumonia?

A

Respiratory viruses

75
Q

What can antigen detection detect when investigating pneumonia?

A

Legionella

76
Q

What can pathogens infecting immunosuppressed hosts be?

A
  • Virulent infection with common organism
  • Infection with opportunistic pathogen
77
Q

What kinds of opportunistic pathogens can infect immunosupressed hosts?

A
  • Viruses
  • Bacteria
  • Fungi
  • Protozoa
78
Q

Give an example of an opportunistic virus

A

Cytomegalovirus (CMV)

79
Q

Give an example of an opportunistic bacteria

A

Mycobacterium avium intracellulare

80
Q

Give 3 examples of opportunistic fungi

A
  • Aspergillus
  • Candida
  • Pneumocystis jiroveci
81
Q

Give two examples of opportunistic protozoa

A
  • Cryptosporidia
  • Toxoplasma
82
Q

How is pneumonia managed?

A
  • Oral fluids (IV if severe)
  • Anti-pyretic drugs
  • Stronger analgesics
  • Oxygen
  • Antibiotics
83
Q

What is the purpose of providing fluids in pneumonia?

A

Avoid dehydration

84
Q

What is the purpose of anti-pyretic drugs in pneumonia?

A

Reduce fever and malaise

85
Q

Give an example of an anti-pyretic drug given in pneumonia

A

Paracetamol

86
Q

When is oxygen given in pneumonia?

A

If there is cyanosis

87
Q

What antibiotics are given to treat pneumonia?

A

Varies with the type of pneumonia

88
Q

What is the target organism when treating community acquired pneumonia?

A

Normally, Pneumococcus

89
Q

What is Pneumococcus usually sensitive to?

A

Penicillin, or related antibiotics

90
Q

What is the target organism in management of hospital aquired pneumonia?

A

More likely to be gram -ve

91
Q

What antibiotic must be used in treating hospital acquired pneumonia?

A

Antibiotics that cover gram -ve organisms, e.g. IV Co-Amoxiclav

92
Q

What are the potential outcomes of pneumonia?

A
  • Resolution
  • Complications
93
Q

What happens in resolution of pneumonia?

A

Organisations and fibrous scarring

94
Q

What are the potential complications of pneumonia?

A
  • Lung abscess
  • Bronchiectasis
  • Empyema
95
Q

What is empyema?

A

Pus in the pleural cavity

96
Q

How is pneumonia prevented?

A
  • Immunisation
  • Chemoprophylaxis
97
Q

How is pneumonia immunised against?

A
  • Flu vaccine
  • Pneumococcal vaccine
98
Q

How often is the flu vaccine given?

A

Annually

99
Q

Who is the flu vaccine given to?

A

High risk patients

100
Q

What does the pneumococcal vaccine consist of?

A

Two vaccines

101
Q

What is given in chemoprophylaxis for pneumonia?

A

Oral penicillin or erythromycin

102
Q

When is chemoprophylaxis given?

A

When patients have higher risk of lower respiratory tract infections

103
Q

What conditions can mean that patients have a higher risk of lower respiratory tract infections?

A
  • Asplenia
  • Dysfunctional spleen
  • Immunodeficiency

ESA 3 - Respiratory System (14 decks)

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