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Respiratory > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

Common upper respiratory tract conditions

A

Coryza, pharyngitis, sinusitis, epiglottis

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2
Q

Common lower respiratory tract conditions

A

Acute bronchitis, acute exacerbations of chronic bronchitis, pneumonia, influenza

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3
Q

What is Coryza

A

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

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4
Q

What is acute sinusitis

A

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

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5
Q

What is Quinsy

A

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

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6
Q

What is Diptheria

A

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

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7
Q

What is acute epiglottitis

A

Inflammation of epiglottis and tissues around that may lead to blockage of airway and impairing breathing process

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8
Q

What is also known as chest cold

A

Acute bronchitis - Inflammation of bronchi

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9
Q

Chest examination and x-ray of acute bronchitis

A

Normal. Is usually self limiting and antibiotics aren’t indication. Can lead to morbidity in patients with COPD

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10
Q

What is acopia

A

Inability to cope with activites of daily living

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11
Q

When should COPD patients be referred to hospital

A

If there’s evidence of respiratory failure or not coping at home

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12
Q

What is red hepatisation

A

Consolidation due to pneumonia causing resemblance to live tissue rather than lung

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13
Q

What are rigors

A

Sudden feeling of cold with shivering accompanied by a rise in temperature often with sweating

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14
Q

Signs of pneumoniae

A

Fever, rigors, herpes labialis, tachypnoea, crackles, pleural rub, cyanosis, hypotension

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15
Q

Investigating pneumoniae

A

Blood culture, serology, arterial gases, full blood count, urea, liver function test, chest x-ray

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16
Q

What can be used to assess pneumoniae severity

A

CURB65

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17
Q

How does CURB 65 work

A

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

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18
Q

What factor in CURB 65 rarely makes difference to management

A

Urea

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19
Q

Markers for pneumoniae severity other than CURB65

A

Temperature < 35 or > 40
Cyanosis, PaO2 < 8 kPa
WBC < 4 or > 30
Multi lobar involvement

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20
Q

Most common cause of pneumoniae (community and hospital)

A

Streptococcus pneumoniae
2nd most common for community acquired pneumoniae is Haemophilus influenzae and for hospital acquired is Mycoplasma pneumoniae

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21
Q

Adult smoker presents with pneumoniae and chicken pox in primary care setting. Next step?

A

Admit to hospital as varicella pneumoniae can be fatal

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22
Q

Bird keepers are bound to get what type of pneumoniae

A

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

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23
Q

Management of community acquired pneumoniae

A

Antibiotics, oxygen, fluids, bed rest, no smoking

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24
Q

Complications of Pneumoniae

A

Respiratory failure, pleural effusion, empyema and death

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25
Q

Extra steps in hospital acquired pneumoniae

A

Extended gram negative cover

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26
Q

Extra steps in aspiration pneumonia

A

Anaerobic cover

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27
Q

How can pneumonia be prevented

A

Giving an influenza and pneumococcal vaccine to -

> 65, immunocompromised, diabetics, chronic chest or cardiac disease, health care workers

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28
Q

Clinical presentation of influenza

A 
Fever - High, abrupt onset
Malaise
Myalgia
Headache
Cough
Prostration - Extremely unwel
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29
Q

Haemophilus influenzae and influenza

A

Not the primary cause of influenza but was believed to be. May be a secondary invader. Common cause is influenza A and B virus

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30
Q

How in influenza transmitted

A

Droplets or direct contact with secretions of someone with infections

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31
Q

Complications of flu

A

Primary influenzal pneumonia, secondary bacterial pneumonia, bronchitis, otitis media

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32
Q

Influenza during pregnancy

A

Associated with perinatal mortality, prematurity, smaller neonatal size, lower birth weight

33
Q

Therapy for flu

A

Symptomatic - bed rest, fluids, paracetamol, antivirals such as Oseltamivir and Zanamivir, mostly during pandemics.

34
Q

Endemic vs epidemic vs pandemic

A

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

35
Q

What influenza virus causes pandemics

A

Influenza A due to antigenic shift, segmented genome and animal reservoir/mixing vessel

36
Q

What is antigenic drift

A

Minor mutation in surface proteins of virus

37
Q

Diagnosing influenza

A

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

38
Q

Prevention of flu

A

Vaccination -
Killed: 2 different influenza A viruses and 1 influenza B
Live attenuated: More effective than killed vaccine, administered intra-nasally

39
Q

What vaccine is given annually to adults at risk of complications, health care workers, children aged 6 months to 2 years

A

Killed vaccine

40
Q

What vaccine is given to children aged 2 to 17

A

Live attenuated

41
Q

Are antivirals used a prophylaxis

42
Q

What bacteria cause atypical pneumonia

A

Mycoplasma pneumoniae, Coxiella burnetti and Chlamydohila psittaci

43
Q

Lab confirmation of atypical pneumonia

A

Serology and PCR

44
Q

Highest incidence of Mycoplasma pneumonia is in

A

Children and young adults, common CAP

45
Q

What causes pyrexia of unknown origin

A

Coxiella burnetti - Q fever
From domestic animals such as sheep and goats
Can cause culture negative endocarditis

46
Q

Cause of walking pneumoniae

A

Pneumonia that can spread from one lung to another, Mycoplasma pneumoniae

47
Q

Cardiology condition caused by pneumonia

A

Culture-negative endocarditis due to Q fever by Coxiella burnetti

48
Q

What pneumonia can be acquired from pet birds

A

Psittacosis by Chlamydophilia psittaci

49
Q

Cases presents in Dec to Jan with asthma like symptoms

A

Might be bronchiolitis

50
Q

What suspects you to bronchiolitis

A

Previous resp or cardiac disease

51
Q

Common cause of bronchiolitis

A

Human Respiratory Syncytial Virus

52
Q

Why isn’t passive immunisation given for Respiratory Syncytial Virus

A

Due to poor efficacy and cost-effectiveness

53
Q

Major cause of lower respiratory tract infection in infancy and childhood

A

Human Respiratory Syncytial Virus

54
Q

Second most common cause of LRTI in young children

A

Metapneumovirus

55
Q

How are viral samples for PCR collected

A

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.

56
Q

STI that can cause infantile pneumonia

A

Chlamydia trachomatis, diagnosed by PCR on urine of mother or throat/pernasal swab of child

57
Q

What organism that causes mild pneumoniae may be picked up on the test for psittacosis

A

Chlamydophila pneumoniae

58
Q

Virus most prevalent in Saudi Arabia with a resovoir in dromedary camels known to cause pneumonia

A

Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

59
Q

Patient presents with pneumonia, confusion and diarrhoea after travel to Spain

A

Legionella pneumoniae

60
Q

Treatment for Legionella pneumonia

A

Levofloxacin IV - 14 days

61
Q

What Legionella causes epidemics

A

Legionella longbeachii

62
Q

Pathogen has no cell wall, possible antibiotics?

A

Macrolides - Azithromycin, Clarithromycin, Erythromycin

Quinolones - Levofloxacin, Ciprofloxacin

63
Q

How does Mycoplasma pneumonia show symptoms

A

Young patient with predominant cough for weeks. No effect from penicillins such as Amoxicillin. Use PCR to detect

64
Q

Common pathogen in younger patients with bronchiectasis and pneumonia

A

Haemophilus influenzae. Must rule out cystic fibrosis if bronchiectasis under 40

65
Q

Causes of cavitating pneumonia

A

Mycobacterium tuberculosis, Klebsiella, Enterobacteria

66
Q

Excess consumptions of what can cause reoccurence of TB in the elderly

67
Q

The fastest laboratory method for identifying Legionella

A

PCR (1-2 days), serology takes 1-2 weeks and routine sputum culture takes 10 days

68
Q

What colour is haemoptysis in pnuemococcal pneumoniae

A

Rusty coloured

69
Q

What is bronchial breathing

A

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

70
Q

What to give if allergic to penicillin

A

Doxycycline

71
Q

What CURB65 score indicates severe pnemonia

A

Score of 3 or more. Admit patient into hospital

72
Q

Treatment of severe pneumonia

A

IV Co-amoxiclav + Clarithromycin

73
Q

Mild pneumonia treatment

A

Oral amoxicillin (gram-positive and anaerobes) + Clarithromycin (non-culturable organisms)

74
Q

Mild pneumonia without admission

A

Oral Amoxicillin only, alternatives are Levofloxacin/Moxifloxacin

75
Q

Water lily sign on chest x-ray

A

Hydatid infection - Small tapeworm parasite

76
Q

Main organism causing chest abscess vs empyema

A

Chest abscess - Staphylococcus spp.

Empyema - Streptococcus spp.

77
Q

21 year old medical student with symptoms of pneumonia

A

Mycoplasma pneumonia

78
Q

Alcoholic with pneumonia symptoms

A

Unusual organism such as Klebsiella

Respiratory (26 decks)

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