pneumonia

Question 1

pathophysiology of pneumonia

Answer 1

• infection of the lower respiratory tract

- consolidation in lower lungs

Question 2

what is consolidation

Answer 2

alveoli filled with exudative inflammatory fluid and pus

Question 3

what is a parapneumonic effusion

Answer 3

effusion of the pleural space

Question 4

what is empyema

Answer 4

when parapneumonic effusion becomes infected and pus filled

Question 5

what is shunting

Answer 5

blood passing through alveoli without the exchange of co2 and o2

Question 6

what is the compensatory response to shunting

Answer 6

increase respiratory rate to increase ventialation to alveoli

Question 7

difference between type 1 and type 2 resp failure

Answer 7

type 1=o2 low but co2 normal

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

Question 8

what is uncomplicated pneumonia and o2

Answer 8

type 1 resp failure

give supplemental o2 in venturi mask

Question 9

what is extensive consolidated pneumonia and o2

Answer 9

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

Question 10

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

Answer 10

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

Question 11

what is chronic decompensated t2rf and treatmnet

Answer 11

decompensated get acidosis due to o2

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

Question 12

exam of a consolidated lung

Answer 12

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

Question 13

exam of parapneumonic effusion

Answer 13

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

Question 14

diff dx of hypoxia and crackles

Answer 14

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

Question 15

cap dx

Answer 15

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

Question 16

CURB-65 scoring and treatment

Answer 16

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

Question 17

main pathogens of cap

Answer 17

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

Question 18

viruses that cause cap

Answer 18

• Influenza a
• Influenza b
• Rhinovirus
• Adenovirus
• Respiratory syncytical virus RSV

Question 19

where is chlamydia psittaci cap normally acquired

Answer 19

birds

Question 20

complication m.pneumonia

Answer 20

haemolytic anaemia with cold agglutinins

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

Question 21

where is leigionella pneum found

Answer 21

contaminated water

Question 22

where is leigonella longbeachae found

Answer 22

contaminated soil

Question 23

where is coxiella burnetti found

Answer 23

reservoir of bacteria in farm animals

Question 24

complications s.aureus causing cap

Answer 24

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

Question 25

pen allergy for mild cap

Answer 25

doxycyline or clarithromycin

Question 26

pen allergy for severe cap

Answer 26

ciprofloxacin and vancomycin

Question 27

cap vaccines

Answer 27

23-valent pneumococcal polysaccharide vaccine and annual influenza vaccine

Question 28

inx of parapneumonic effusion vs empyema

Answer 28

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 ```

Question 29

treatment of parapneum effusion

Answer 29

-resolves with treatment of pneumonia

Question 30

treatment of empyema

Answer 30

- drains with US guidance | - surgical intervention if loculated

Question 31

what are the complication of pneumonia

Answer 31

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

Question 32

what causes lobar collapse in pneumonia

Answer 32

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

Question 33

what causes lung abscess pathogens

Answer 33

s.aureus k.pneumoniae or fungi

Question 34

how does pneumonia cause myocardial infarction

Answer 34

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

Question 35

pathogens of HAP

Answer 35

gram positives and gram negatives

Question 36

risk factors for hap

Answer 36

recent surgery | endotracheal intubation

Question 37

diff dx of hap

Answer 37

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

Question 38

HAP dx

Answer 38

- sputum - viral throat swab - blood cultures - MRSA screen

Question 39

what pathogens is hao predominantly

Answer 39

e.coli p.aeruginosa ie gram negative bacilli

Question 40

severity score for hap

Answer 40

``` temp <36 >39 rr>20 wbc <4 or >12 multi organ hr >100 ```

Question 41

pneumonia within 5 days of being at hospital treatment

Answer 41

treat as cap

Question 42

treatmnet of hap with only 1 severity score

Answer 42

doxycycline

Question 43

treatment of hap with 2 or more

Answer 43

amoxicillin and gentamicin

Question 44

pen allergy for hap

Answer 44

gentamicin and vancomycin

Question 45

pneumona in immunocompromised host causes

Answer 45

pneumocystis jiroveci

Question 46

empirical antibiotics for immunocompromised host

Answer 46

broad spec bacterial and fungal

Question 47

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

Answer 47

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

Question 48

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

Answer 48

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

Question 49

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

Answer 49

encapsulated bacteria - h.influenzae - s.pneumoniae

Question 50

symptoms of pneumocystis jiroveci pneumonia

Answer 50

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

Question 51

what dx inx is needed for pneumocystis jiroveci

Answer 51

-high resolution more sensitive shows ground glass inflamamtory changes

Question 52

treatment of p.jiroveci

Answer 52

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

Question 53

aspiration pneum pathogens

Answer 53

aerobes and anaerobes

Question 54

treatment aspiration pneum

Answer 54

-metronidazole and -amoxicillin