Pneumonia Flashcards
what are the classifications of pneumonia?
community acquired hospital acquired atypical aspiration pneumonia recurrent pneumonia pneumonia in the immunocompromised
what are the different patterns of pneumonia
bronchopneumonia segmental pneumonia lobar pneumonia aspiration pneumonia hypostatic pneumonia obstructive retention endogenous lipid
what organism is the most common cause of pneumonia?
streptococcus pneumoniae
describe the difference in bronchopneumonia and lobar pneumonia.
bronchopnuemonia has a focal nature of consolidation with bilateral opacification.
lobar pneumonia is the consolidation of the entire lung
describe what opacification of the lung is.
opacification is a decrease in the gas to lung tissue ratio. this represents that there an increase in the density of the lung. this is usually due to infiltrate of fluid.
list some of the complications of pneumonia.
pleurisy pleural effusion empyema lung abcess bronchiectasis organisation (mass lesion, Cryptogenic organising pneumonia or constructive bronchiolitis). Acute kidney injury ARDS Haemolytic anaemia Septicaemia
how can a lung abcess develop as a complication of pneumonia?
bronchial obstruction by an endoluminal tumour
apiration pnuemonia complication
partial organisation i.e. staph aureus, pneumococci and klebsiella
transdiaphragmatic spread of liver abcess
necrotic lung
Metastatic empyema
what is bronchiectasis (complication of pneumonia)
dilation of the bronchi which have been ripped and pulled apart
what causes bronchiectasis as a complication of pneumonia?
severe infection
recurrent infection
proximal bronchial obstruction
lung parenchymal destruction
what is the treatment for bronchiectasis?
Antibiotics, Physiotherapy to get rid of trapped mucous, Surgery, Postural drainage
May need inhaled therapy I.e. b2 agonist + corticosteroid
what is hypoxaemia due to?
ventillation/perfusion mismatch
shun
diffusion impatiemment
hypoventillation
how can hypoxaemia occur with pneumonia?
ventillation perfusion mismatch -
caused by bronchiectasis / bronchopneumonia
low ventilation/perfusion V/Q ratio
due to hypoventillation
shunt-
caused by severe bronchopneumonia
lobar pattern of a large area of consolidation
in pneumonia with hypoxaemia, does V/Q mismatch and shunt respond well to an increase in FL02?
V/Q mismatch responds well to even a small increase
shunt doesn’t respond
what are the symptoms of pneumonia?
symptoms varied with the immune state of the patient and the organism it is caused by.
cough (productive or dry, rust coloured sputum is caused by pneumococcus)
breathlessness
Fever
chest pain
apart from the common clinical presentation of pneumonia, what other symptoms may be experienced by the patient?
Haemolysis (mycoplasma pneumonia)
thombocytopenia (low platelet count)
Community acquired pneumonia (CAP) in the elderly can present with confusion or non specific recurrent symptoms such as falls.
What are the clinical signs of pneumonia?
Tachycardia , tachypnoea, Pyrexia, cyanosis
Increased vocal resonance
Band of bronchial breathing over area of consolidation on auscultation
Crackles over area of consolidation on auscultation
Dullness on percussion
Decreased chest expansion
What is the initial treatment for a patient who has pneumonia?
Oxygen IV fluids Antibiotics (beta lactam and macrolide) Analgesia Anti-pyretics May need intubation and ventilation May need continuous positive airway pressure
How is pneumonia severity assessed?
Using CURB 65 score: C - confusion U - blood urea (<7.2) R - respiratory rate (>30) B - blood pressure diastolic (<60) 65 - age >65
0 = low risk and community treatment 1-2 = higher risk therefore hospital treatment is required 3-5 = risk of death therefore require ITU
What would be the treatment for a patient who has scored a 3 in the CURB65 score?
Co-amoxiclav + clarithromycin (or levoflaxin if they are penicillin allergic)
What would the treatment be if a patient scored 1 on the CURB 65 score?
Amoxicillin or clarithromycin (doxycycline if allergic)
Several months after being diagnosed with pneumonia and not recovering a patient presents with a liver abscess as a complication of the pneumonia. What organism Is the likely cause?
Strep. Aureus
Pseudomonas
Anaerobes such as klebsiella.
A patient presents with empyema as a complication of her previous pneumonia that hasn’t fully healed. What are the most likely organisms to cause empyema?
Staph. Aureus
Streptococcus
Anaerobes
What complication can arise due to pneumonia caused by klebsiella?
Lung abscess
Name a complication of pneumonia due to aspiration pneumonia.
Lung abcess
What are the symptoms of pneumonia?
Productive cough Haemoptysis Pyrexia Chest pain Dyspnoea Confusion
What are the signs of pneumonia?
Pyrexia Decreased chest expansion Decreased breath sounds on auscultation Band of bronchial breathing on auscultation over area of consolidation Crackles on auscultation Increased vocal resonance Tachycardia & tachypnoea Cyanosis Thrombocytopenia Haemolysis
What are the investigations for pneumonia?
CXR Sputum culture Full blood count Atypical serology Mycoplasm IgG CRP Serum biochemistry Urinary legionella Antigen (Ag)
