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MS4 - Respiratory > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

Anatomic classification of pneumonia

A

Bronchopneumonia - patchy consolidation of different lobes

Lobar pneumonia - single lobe

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2
Q

Aetiological classification of pneumonia

A

CAP

HAP

Aspiration pneumonia

Immunocompromised pneumonia

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3
Q

Community Acquired Pneumonia causative agents

A

Pneumococcus

Mycoplasma

Haemophilus

S. aureus

Chlamydia

Legionella

Viruses 15%

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4
Q

Hospital Acquired Pneumonia

A

> 48 hrs after hospital admission

Gram negative enterobacteria

S. aureus

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5
Q

Aspiration pneumonia risk factors

A

Stroke

Bulbar palsy

GORD

Achalasia

Decreased GCS

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6
Q

Aspiration pneumonia causative agents

A

Anaerobes

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7
Q

Immunocompromised pneumonia causative agents

A

Usual organismsPCP (pneumocystis pneumonia)

TB

Fungi

CMV/HSV

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8
Q

Signs of pneumonia

A

Consolidation: Dull percussion

Bronchial breathing

Crackles

Pleural rub

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9
Q

Atypical pneumonias

A

Mycoplasma

Chlamydia

Legionella

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10
Q

Severity scoring for pneumonia

A

CURB 65

Confusion

Urea > 7mM

RR > 30

BP < 90/60

Age > 65

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11
Q

Interpretation of pneumonia severity score

A

< 2 - Home Rx

2 - Hospital Rx

3+ - Consider ITU

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12
Q

Mx of pneumonia

A

Abx

O2

Fluids

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13
Q

Mild CAP abx

A

Amoxicillin 500mg TDS

OR

Clarithromycin 500mg BD

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14
Q

Moderate CAP abx

A

Amoxicillin 500mg TDS

+Clarithromycin 500mg BD

Clarithro alone if penicillin allergic

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15
Q

Severe CAP abx

A

Co-amoxiclav 1.2g TDS / Cefuroxime 1.5g TDS

+Clarithromycin 500mg BD

(+ Flucloxacillin of staph suspected)

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16
Q

Chlamydia abx

A

Chlamydia - tetracycline

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17
Q

PCP abx

A

co-trimoxazole

18
Q

Legionella abx

A

Clarithro + rifampicin

19
Q

HAP severity

A

Mild - < 5 days

Severe - > 5 days

20
Q

Mild HAP abx

A

Co-amoxiclav 625 mg TDS

21
Q

Severe HAP abx

A

Tazocin +/- Vanc +/- Gent

22
Q

Aspiration pneumonia abx

A

Co-amoxilcav 625 mg TDS

23
Q

Pneumovax

A

Pneumonia vaccine

Revaccinate every 6 yrs

24
Q

Indications for Pneumovax

A

> 64 yrs

Chronic organ failure

DM

Immunocomprimised

25
Q

Types of respiratory failure

A

Type 1: Hypoxia

Type 2: Hypoxia + Hypercapnia

26
Q

Features of a lung abscess

A

Swinging fever

Cough - purulent sputum

Pleuritic pain

Clubbing

Empyema

27
Q

SIRS

A

Systemic Inflammatory Response Syndrome

2+ of:

  • Tachycardia > 90
  • Tachypnoea > 20
  • Temperature < 36 or > 38
  • WCC < 4 or > 12
  • BM > 6.6 in NON diabetic
28
Q

Sepsis definition

A

SIRS caused by infection

Clinical suspicion of infection

29
Q

Severe sepsis

A

Sepsis + organ hypoperfusion

Eg. hypotension, confusion

30
Q

Septic shock

A

Sepsis + persistent hypotension despite fluid resus

31
Q

Features of Mycoplasma pneumonia

A

Dry cough

Flu-like prodrome

32
Q

Features of legionella pneumonia

A

Dry cough

Bi-basal consolidation

33
Q

Features of PCP

A

Dry cough

Bilateral creps

CXR normal or bilateral perihilar interstitial shadowing

34
Q

Differntiating between exudate and transudate?

A
  • Effusion protein < 25g/L = transudate
  • Effusion protein >35g/L = exudate
  • Between 25-35g/L: apply Light’s Criteria
35
Q

Light’s criteria

A

An exudate has one of:

  • Effusion : serum protein ratio >0.5
  • Effusion : serum LDH ratio >0.6
  • Effusion LDH is 0.6 x ULN
36
Q

Cause of exudate?

A

↑ capillary permeability

37
Q

Cause of transudate?

A

↑ capillary hydrostatic or ↓ oncotic pressure

38
Q

3 conditions leading to transudate formation?

A

CCF

Renal failure

Reduced Albumin (eg due to liver failure)

39
Q

Signs of pleural effusion?

A
  • Tracheal deviation away from effusion
  • ↓ expansion
  • Stony dull percussion
  • ↓ air entry
  • Bronchial breathing just above effusion
40
Q

Pleural tap method?

A
  • Percuss upper boarder and go 1-2 spaces below
  • Infiltrate down to pleura ̄c lignocaine.
  • Aspirate ̄c 21G needle
41
Q

Mx of pleural effusion?

A
  • Rx underlying cause
  • May use drainage if symptomatic (≤2L/24h)

MS4 - Respiratory (11 decks)

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