Pneumonia Flashcards
Common upper respiratory tract conditions
Coryza, pharyngitis, sinusitis, epiglottis
Common lower respiratory tract conditions
Acute bronchitis, acute exacerbations of chronic bronchitis, pneumonia, influenza
What is Coryza
Common cold, acute inflammation of mucous membranes lining nasal cavity. Causes a runny nose, nasal congestion, often sore throat with fever. Viral cause such as Adenovirus, Rhinovirus, Respiratory Syncytial virus
What is acute sinusitis
Acute infection or inflammation of membranes that line your sinuses preventing mucus drainage from nose. Preceded by common cold. Resolves in 10 days on its own, rarely requires antibiotics
What is Quinsy
Potentially serious complication of tonsillitis. Abscess forms between tonsils and wall of throat. This is due to bacterial spread from infected tonsil to surrounding area
What is Diptheria
Infection caused by Corynebacterium diptheriae. Toxin are produced which may be life threatening. Symptoms are sore throat, fever, characteristic barking cough and pseudomembrane formation which may block airway
What is acute epiglottitis
Inflammation of epiglottis and tissues around that may lead to blockage of airway and impairing breathing process
What is also known as chest cold
Acute bronchitis - Inflammation of bronchi
Chest examination and x-ray of acute bronchitis
Normal. Is usually self limiting and antibiotics aren’t indication. Can lead to morbidity in patients with COPD
What is acopia
Inability to cope with activites of daily living
When should COPD patients be referred to hospital
If there’s evidence of respiratory failure or not coping at home
What is red hepatisation
Consolidation due to pneumonia causing resemblance to live tissue rather than lung
What are rigors
Sudden feeling of cold with shivering accompanied by a rise in temperature often with sweating
Signs of pneumoniae
Fever, rigors, herpes labialis, tachypnoea, crackles, pleural rub, cyanosis, hypotension
Investigating pneumoniae
Blood culture, serology, arterial gases, full blood count, urea, liver function test, chest x-ray
What can be used to assess pneumoniae severity
CURB65
How does CURB 65 work
C - New onset of confusion
U - Urea > 7
R - Respiratory rate > 30 / min
B - Blooc pressure systolic < 90 or diastolic < 61
65 - More than 65 years of age
1 points fore each
Increase in CURB65 score increases mortality
What factor in CURB 65 rarely makes difference to management
Urea
Markers for pneumoniae severity other than CURB65
Temperature < 35 or > 40
Cyanosis, PaO2 < 8 kPa
WBC < 4 or > 30
Multi lobar involvement
Most common cause of pneumoniae (community and hospital)
Streptococcus pneumoniae
2nd most common for community acquired pneumoniae is Haemophilus influenzae and for hospital acquired is Mycoplasma pneumoniae
Adult smoker presents with pneumoniae and chicken pox in primary care setting. Next step?
Admit to hospital as varicella pneumoniae can be fatal
Bird keepers are bound to get what type of pneumoniae
Psittacosis - Known as parrot fever or ornithosis. Caused by bacteria known as Chlamydia psittaci. Contracted from birds such as parrots, macaws, pigeons, sparrows, ducks, hens etc
Management of community acquired pneumoniae
Antibiotics, oxygen, fluids, bed rest, no smoking
Complications of Pneumoniae
Respiratory failure, pleural effusion, empyema and death
Extra steps in hospital acquired pneumoniae
Extended gram negative cover
Extra steps in aspiration pneumonia
Anaerobic cover
How can pneumonia be prevented
Giving an influenza and pneumococcal vaccine to -
> 65, immunocompromised, diabetics, chronic chest or cardiac disease, health care workers
Clinical presentation of influenza
Fever - High, abrupt onset Malaise Myalgia Headache Cough Prostration - Extremely unwel
Haemophilus influenzae and influenza
Not the primary cause of influenza but was believed to be. May be a secondary invader. Common cause is influenza A and B virus
How in influenza transmitted
Droplets or direct contact with secretions of someone with infections
Complications of flu
Primary influenzal pneumonia, secondary bacterial pneumonia, bronchitis, otitis media
Influenza during pregnancy
Associated with perinatal mortality, prematurity, smaller neonatal size, lower birth weight
Therapy for flu
Symptomatic - bed rest, fluids, paracetamol, antivirals such as Oseltamivir and Zanamivir, mostly during pandemics.
Endemic vs epidemic vs pandemic
Endemic - Disease permanently affecting a particular region
Epidemic - Outbreak of disease affecting one or many communities at the same time
Pandemic - Epidemic spreads throughout the world
What influenza virus causes pandemics
Influenza A due to antigenic shift, segmented genome and animal reservoir/mixing vessel
What is antigenic drift
Minor mutation in surface proteins of virus
Diagnosing influenza
PCR - Nasopharyngeal swab, throat swab in virus transport medium, other respiratory samples
Antibody detection - Requires blood and takes a while for antibodies to be formed
Prevention of flu
Vaccination -
Killed: 2 different influenza A viruses and 1 influenza B
Live attenuated: More effective than killed vaccine, administered intra-nasally
What vaccine is given annually to adults at risk of complications, health care workers, children aged 6 months to 2 years
Killed vaccine
What vaccine is given to children aged 2 to 17
Live attenuated
Are antivirals used a prophylaxis
Rarely
What bacteria cause atypical pneumonia
Mycoplasma pneumoniae, Coxiella burnetti and Chlamydohila psittaci
Lab confirmation of atypical pneumonia
Serology and PCR
Highest incidence of Mycoplasma pneumonia is in
Children and young adults, common CAP
What causes pyrexia of unknown origin
Coxiella burnetti - Q fever
From domestic animals such as sheep and goats
Can cause culture negative endocarditis
Cause of walking pneumoniae
Pneumonia that can spread from one lung to another, Mycoplasma pneumoniae
Cardiology condition caused by pneumonia
Culture-negative endocarditis due to Q fever by Coxiella burnetti
What pneumonia can be acquired from pet birds
Psittacosis by Chlamydophilia psittaci
Cases presents in Dec to Jan with asthma like symptoms
Might be bronchiolitis
What suspects you to bronchiolitis
Previous resp or cardiac disease
Common cause of bronchiolitis
Human Respiratory Syncytial Virus
Why isn’t passive immunisation given for Respiratory Syncytial Virus
Due to poor efficacy and cost-effectiveness
Major cause of lower respiratory tract infection in infancy and childhood
Human Respiratory Syncytial Virus
Second most common cause of LRTI in young children
Metapneumovirus
How are viral samples for PCR collected
Throat swab in viral transport medium, bronchoalveolar lavage (BAL) in which bronchoscope is passed through the mouth or nose into lungs and fluid is squirted into small part of the lungs and then collected for examination.
STI that can cause infantile pneumonia
Chlamydia trachomatis, diagnosed by PCR on urine of mother or throat/pernasal swab of child
What organism that causes mild pneumoniae may be picked up on the test for psittacosis
Chlamydophila pneumoniae
Virus most prevalent in Saudi Arabia with a resovoir in dromedary camels known to cause pneumonia
Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
Patient presents with pneumonia, confusion and diarrhoea after travel to Spain
Legionella pneumoniae
Treatment for Legionella pneumonia
Levofloxacin IV - 14 days
What Legionella causes epidemics
Legionella longbeachii
Pathogen has no cell wall, possible antibiotics?
Macrolides - Azithromycin, Clarithromycin, Erythromycin
Quinolones - Levofloxacin, Ciprofloxacin
How does Mycoplasma pneumonia show symptoms
Young patient with predominant cough for weeks. No effect from penicillins such as Amoxicillin. Use PCR to detect
Common pathogen in younger patients with bronchiectasis and pneumonia
Haemophilus influenzae. Must rule out cystic fibrosis if bronchiectasis under 40
Causes of cavitating pneumonia
Mycobacterium tuberculosis, Klebsiella, Enterobacteria
Excess consumptions of what can cause reoccurence of TB in the elderly
Alcohol
The fastest laboratory method for identifying Legionella
PCR (1-2 days), serology takes 1-2 weeks and routine sputum culture takes 10 days
What colour is haemoptysis in pnuemococcal pneumoniae
Rusty coloured
What is bronchial breathing
Louder and higher pitched in nature. Unlike normal vesicular breath sounds, there is an audible gap between inspiration and expiration. They are abnormal if heard in the chest and suggest consolidation or fibrosis
What to give if allergic to penicillin
Doxycycline
What CURB65 score indicates severe pnemonia
Score of 3 or more. Admit patient into hospital
Treatment of severe pneumonia
IV Co-amoxiclav + Clarithromycin
Mild pneumonia treatment
Oral amoxicillin (gram-positive and anaerobes) + Clarithromycin (non-culturable organisms)
Mild pneumonia without admission
Oral Amoxicillin only, alternatives are Levofloxacin/Moxifloxacin
Water lily sign on chest x-ray
Hydatid infection - Small tapeworm parasite
Main organism causing chest abscess vs empyema
Chest abscess - Staphylococcus spp.
Empyema - Streptococcus spp.
21 year old medical student with symptoms of pneumonia
Mycoplasma pneumonia
Alcoholic with pneumonia symptoms
Unusual organism such as Klebsiella
