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pneumonia Flashcards

1
Q

pathophysiology of pneumonia

A
  • infection of the lower respiratory tract

- consolidation in lower lungs

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2
Q

what is consolidation

A

alveoli filled with exudative inflammatory fluid and pus

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3
Q

what is a parapneumonic effusion

A

effusion of the pleural space

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4
Q

what is empyema

A

when parapneumonic effusion becomes infected and pus filled

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5
Q

what is shunting

A

blood passing through alveoli without the exchange of co2 and o2

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6
Q

what is the compensatory response to shunting

A

increase respiratory rate to increase ventialation to alveoli

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7
Q

difference between type 1 and type 2 resp failure

A

type 1=o2 low but co2 normal

type 2 =both o2 and co2 affeceted as rr drops so cant compensate anymore

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8
Q

what is uncomplicated pneumonia and o2

A

type 1 resp failure

give supplemental o2 in venturi mask

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9
Q

what is extensive consolidated pneumonia and o2

A

oxygenation compromised
profound type 1 rf
-deliver high o2 through high flow nasal cannulae or mechanical vent

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10
Q

what is prolonged hypoxic and tachypnoea to maintain o2 and o2 treatmnet

A
  • patient starts to tire decreasing RR so switch to type 2 RF
  • anaesthetist intubation and mechanical ventilation
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11
Q

what is chronic decompensated t2rf and treatmnet

A

decompensated get acidosis due to o2

  • beware o2 desensitise so non invasive ventilation
  • BIPAP controlled o2 not high flow anymore
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12
Q

exam of a consolidated lung

A 
palpation
-reduced expansion
-dull percussion
auscultation
-bronchial or reduced breath sounds
-inspiratory crackle
-increased vocal resonance
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13
Q

exam of parapneumonic effusion

A 
palpation
-reduced expansion
percussion
-stony dull
auscultation
-decreased breath sounds
-bronchial above
-decrease vocal resonance
-pleural rub rough crackly hoarse sound
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14
Q

diff dx of hypoxia and crackles

A
  • Pulmonary oedema
  • Emphysema and copd
  • Atelectasis
  • Fibrosis or intersitial lung disease
  • Airway secretions
  • Pulmonary haemorrhage
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15
Q

cap dx

A

clinical signs

  • chest x-ray
  • ct if suspcicion of abscess or complication
  • follow up Chest x-ray in 6-8 weeks for resolution
  • labs inflammatory markers,WCC and crp
  • U and E as eGFR influences
  • antimicrobials and urea guides the severity of the score
  • arterial blood gases
  • sputum culture
  • pcr viral throat swab
  • bronchoalveolar lavage or tracheal aspirate if intubated and ventilated
  • pleural tap if effusion present
  • legionella urine antigen
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16
Q

CURB-65 scoring and treatment

A

0-1 give oral amoxicillin and keep at home
2=give oral amoxicillin and clarithromycin and admit to hospital
3= give co-amoxiclav and clarithromycin iv at hospital

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17
Q

main pathogens of cap

A

s. pneum
m. pnum
s. aureus
h. infl

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18
Q

viruses that cause cap

A
  • Influenza a
  • Influenza b
  • Rhinovirus
  • Adenovirus
  • Respiratory syncytical virus RSV
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19
Q

where is chlamydia psittaci cap normally acquired

A

birds

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20
Q

complication m.pneumonia

A

haemolytic anaemia with cold agglutinins

  • steven Johnson syndrome
  • erythema nodosum
  • pericarditis
  • meningoencephalitis
  • guillain barre syndrome
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21
Q

where is leigionella pneum found

A

contaminated water

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22
Q

where is leigonella longbeachae found

A

contaminated soil

23
Q

where is coxiella burnetti found

A

reservoir of bacteria in farm animals

24
Q

complications s.aureus causing cap

A

may cause lung abscess
-beware bacteraemia and haematogenous dissemination
OR
-pneumonia may be secondary bacteramia eg infective endocarditis due to septic emboli
-get cavity lesions

25
Q

pen allergy for mild cap

A

doxycyline or clarithromycin

26
Q

pen allergy for severe cap

A

ciprofloxacin and vancomycin

27
Q

cap vaccines

A

23-valent pneumococcal polysaccharide vaccine
and
annual influenza vaccine

28
Q

inx of parapneumonic effusion vs empyema

A

parapneum

  • clear
  • pH >7.2
  • exudate proteins
  • increased LDH
  • sterile
empyema
-pus filled
pH<7.2
-exudate and increased LDH
-gram stain or culture positive
29
Q

treatment of parapneum effusion

A

-resolves with treatment of pneumonia

30
Q

treatment of empyema

A
  • drains with US guidance

- surgical intervention if loculated

31
Q

what are the complication of pneumonia

A
  1. parapneum
  2. empyema
  3. lobar collapse
  4. lung abscess or cavity
  5. myocardial infarction
  6. atrial fibrillation
  7. resp failure
  8. sepsis (organ failure)
  9. ARDS
32
Q

what causes lobar collapse in pneumonia

A

can be due to mucous plugging starts to move up the way and blocks smaller airways resulting in collapse of lung further down
-need chest physiotherapy

33
Q

what causes lung abscess pathogens

A

s.aureus
k.pneumoniae
or fungi

34
Q

how does pneumonia cause myocardial infarction

A

due to pro-inflammatory state it increases platelets which can cause dvt resulting in PE and MI

35
Q

pathogens of HAP

A

gram positives and gram negatives

36
Q

risk factors for hap

A

recent surgery

endotracheal intubation

37
Q

diff dx of hap

A
  • PE
  • decompensated chronic lung or cardiac disease
  • sub diaphargmatic source of infection
  • ventilator assoc. pneumonia
  • atelectasis: lung collapse
  • copd
  • infection
  • heart failure
38
Q

HAP dx

A
  • sputum
  • viral throat swab
  • blood cultures
  • MRSA screen
39
Q

what pathogens is hao predominantly

A

e.coli
p.aeruginosa
ie gram negative bacilli

40
Q

severity score for hap

A 
temp <36 >39
rr>20
wbc <4 or >12
multi organ
hr >100
41
Q

pneumonia within 5 days of being at hospital treatment

A

treat as cap

42
Q

treatmnet of hap with only 1 severity score

A

doxycycline

43
Q

treatment of hap with 2 or more

A

amoxicillin and gentamicin

44
Q

pen allergy for hap

A

gentamicin and vancomycin

45
Q

pneumona in immunocompromised host causes

A

pneumocystis jiroveci

46
Q

empirical antibiotics for immunocompromised host

A

broad spec bacterial and fungal

47
Q

what pathogens might be seen in a patient with a neutrophil dysfunction from chemo or malignancy

A

-s.aureus
-p.aeruginosa
fungus
a.fumigatus

48
Q

what pathogens might be seen in a patient with t-cell dysfunction from immunosuppressive drugs or hiv infection

A

viral (cmv,)
mycobacteria ie tb or non tb
pneumocystis jiroveci

49
Q

what pathogens might be seen in a patient with antibody production dysfunction from hypogammaglobulinaemia

A

encapsulated bacteria

  • h.influenzae
  • s.pneumoniae
50
Q

symptoms of pneumocystis jiroveci pneumonia

A
  • Fever, non productive cough and dyspnoea are predominant with insidious onset
  • Exercise induced hypoxia (desaturate on walking)
51
Q

what dx inx is needed for pneumocystis jiroveci

A

-high resolution more sensitive shows ground glass inflamamtory changes

52
Q

treatment of p.jiroveci

A

co-trimoxazole
and
steroid if Pao2 <9.3 pka started within 72 hrs of co-trimox

53
Q

aspiration pneum pathogens

A

aerobes and anaerobes

54
Q

treatment aspiration pneum

A

-metronidazole
and
-amoxicillin

infection (15 decks)

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