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
pen allergy for mild cap
doxycyline or clarithromycin
26
pen allergy for severe cap
ciprofloxacin and vancomycin
27
cap vaccines
23-valent pneumococcal polysaccharide vaccine and annual influenza vaccine
28
inx of parapneumonic effusion vs empyema
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
treatment of parapneum effusion
-resolves with treatment of pneumonia
30
treatment of empyema
- drains with US guidance | - surgical intervention if loculated
31
what are the complication of pneumonia
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
what causes lobar collapse in pneumonia
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
what causes lung abscess pathogens
s.aureus k.pneumoniae or fungi
34
how does pneumonia cause myocardial infarction
due to pro-inflammatory state it increases platelets which can cause dvt resulting in PE and MI
35
pathogens of HAP
gram positives and gram negatives
36
risk factors for hap
recent surgery | endotracheal intubation
37
diff dx of hap
- PE - decompensated chronic lung or cardiac disease - sub diaphargmatic source of infection - ventilator assoc. pneumonia - atelectasis: lung collapse - copd - infection - heart failure
38
HAP dx
- sputum - viral throat swab - blood cultures - MRSA screen
39
what pathogens is hao predominantly
e.coli p.aeruginosa ie gram negative bacilli
40
severity score for hap
``` temp <36 >39 rr>20 wbc <4 or >12 multi organ hr >100 ```
41
pneumonia within 5 days of being at hospital treatment
treat as cap
42
treatmnet of hap with only 1 severity score
doxycycline
43
treatment of hap with 2 or more
amoxicillin and gentamicin
44
pen allergy for hap
gentamicin and vancomycin
45
pneumona in immunocompromised host causes
pneumocystis jiroveci
46
empirical antibiotics for immunocompromised host
broad spec bacterial and fungal
47
what pathogens might be seen in a patient with a neutrophil dysfunction from chemo or malignancy
-s.aureus -p.aeruginosa fungus a.fumigatus
48
what pathogens might be seen in a patient with t-cell dysfunction from immunosuppressive drugs or hiv infection
viral (cmv,) mycobacteria ie tb or non tb pneumocystis jiroveci
49
what pathogens might be seen in a patient with antibody production dysfunction from hypogammaglobulinaemia
encapsulated bacteria - h.influenzae - s.pneumoniae
50
symptoms of pneumocystis jiroveci pneumonia
- Fever, non productive cough and dyspnoea are predominant with insidious onset - Exercise induced hypoxia (desaturate on walking)
51
what dx inx is needed for pneumocystis jiroveci
-high resolution more sensitive shows ground glass inflamamtory changes
52
treatment of p.jiroveci
co-trimoxazole and steroid if Pao2 <9.3 pka started within 72 hrs of co-trimox
53
aspiration pneum pathogens
aerobes and anaerobes
54
treatment aspiration pneum
-metronidazole and -amoxicillin