pneumonia Flashcards
1
Q
what is pneumonia
A
Infection of the distal airspaces usually with inflammatory exudation (localised oedema)
2
Q
what does fluid filled airspaces lead to
A
consolidation
3
Q
what is lobar pneumonia
A
Confluent consolidation involving complete lung lobe
4
Q
what is lobar pneumonia usually due to
A
strep. pneumoniae, can be seen with klebsiella, legionella
5
Q
who gets lobar pneumonia
A
young healthy adults
6
Q
is lobar pneumonia usually CAP or HAP
A
CAP
7
Q
what is the complications of pneumonia
A
organisation (fibrous scarring) abscess bronchiectasis empyema Steven-johnson syndrome (RARE)
8
Q
pathology of lobar pneumonia
A
exudation of fibrin rich fluid
neutrophil infiltration
macrophage infiltration
resolution
9
Q
what is bronchopneumonia
A
infection starts in airways + spreads to adjacent alveolar lung
10
Q
a COPD patient comes and presents with pneumonia is it likely to be lobar or broncho
A
bronchopneumonia
caused by haemophilus influenza
11
Q
who gets bronchopneumonia
A
people with pre-existing disease: COPD, cardiac failure, viral infection, aspiration of gastric contrents
12
Q
is bronchopneumonia spread person-to-person
A
no
13
Q
what 3 organisms are likely to cause bronchopneumonia in a patient with aspiration of gastric contents
A
staphylococus
anaerobes
coliforms
14
Q
what is a typical organism that causes bronchopneumonia
A
strep pneumonia
15
Q
what can pneumonia especially if recurrent be an underlying symptom of
A
HIV
16
Q
name 4 organisms that cause CAP
A
strep pneumonia
viruses
H.influenzae
staph aureus
17
Q
pathology of CAP
A
organism in lung
immune activation + infiltration
fluid + celll build up in alveoli
impaired gas exchange
18
Q
who are at higher risk of CAP
A
Age <16, >65 Co-morbdities CF,COPD Lifestyle Immunocomprimised Iatrogenic: immunosuppressant therapy
19
Q
what organisms cause HAP
A
Gm -ve bacilli e.coli klebisella pneumoniae acinetobacter p.aeruginosa
Staph aureus - MRSA
(USUALLY NOT VIRAL)
20
Q
what do patients with HAP present with
A
New onset of cough with purulent sputum
X-ray showing consolidation in patients > 2 days of admission or in healthcare setting (nursing home) in last 3 months
21
Q
what is used to treat severe HAP
A
Piperacillin-tazobctam
22
Q
what patients are immunocomprimised
A
genetic defect
iatrogenic
immunosuppresant therapy
immunodeficiency: HIV
23
Q
name an opportunistic pathogen that could cause pneumonia in immunocompromised patients
A
Pneumocystis jiroveci (PCP) affects patients on immunosuppressant therapy
24
Q
a patient on long term corticosteroids presents with pneumonia what is the likely cause of the pneumonia
A
pneumocystis jiroveci (PCP)
25
name 4 immunosuppressant therapies
Long-term corticosteroids
Monoclonal antibody therapy
Methotrexate for autoimmune disease
Anti-rejection mediaction post-solid organ transplant
26
how is pneumocystis jiroveci (PCP) spread
in air
| re-infection (NOT reactivation)
27
what do patients with pneumocystis jiroveci (PCP) present with
```
Very hypoxic
Breathless very quickly
Dry cough – several weeks
Poor response to 1st line antibiotics
Cyanotic
```
28
if a patient is found to have pneumocystis jiroveci (PCP) what must you test them for
HIV
29
how is pneumocystis jiroveci (PCP) treated
high dose co-trimoxazole
| high dose steroids
30
what are the complications of pneumocystis jiroveci (PCP)
pneumothorax
resp failure
death
31
a patient presents not looking too sick, has little symptoms, symptoms aren't in the resp tract but their X-ray shows signs of pneumonia, they have arthritis and lots of bruises what is the likely cause of their pneumonia
mycoplasma pneumoniae
32
what type of pneumonia causes walking pneumonia
mycoplasma pneumoniae
| has a slower onset
33
3 signs of mycoplasma pneumoniae
bruises
autoimmune haemolytic anaemia
arthiritis
34
what treatment should not be given to patients with mycoplasma pneumoniae and why
Penicillin
| No cell wall, resistant to b-lactam antibiotics
35
what type of people present with mycoplasma pneumonia
students
| young adults/fit healthy
36
what type of pneumonia shows an epidemic once every 4 years
mycoplasma pneumonia
37
a young male who is a smoker and diabetic presents with pneumonia, they have recently came back from their holidays, what is they likely cause of their pneumonia
legionella (legionaries disease)
38
how is legionaries disease aquired
```
by inhaling water mist containing bateria/contaminated water droplets
lukewarm water
hot tubs
air conditioning
water cooler not working
```
39
what organism can cause necrotising bacteria
staph aureus
| post infleunzae
40
a patient presents they have a cardiovascular infection, CAP, and their X ray shows Pulmonary inflammation, consolidation, peripheral necrosis, multiple small cavities and Bilateral infiltrates. what is the cause of their pneumonia
staph aureus
41
what does MRSA strains produce
Panton Valentine Leucocidin (PVL)
42
what organism from bids that can be person to person spread causes pneumonia
chlamydrophilia psittaci
43
what organism that causes endocardidtis usually in young men can cause pneumonia
Coxiella burnetti (Q fever)
44
can legionella be transmitted from person to person
NO
45
a male presents with pneumonia. he drinks excessive alcohol, has poor dental hygiene, and diabetes and has admitted to sleeping rough sometimes what organism is causing his pneumonia
klebsiella pneumonia
| high mortality
46
a patient with an underlying lung disease presents with pneumonia what is a possible organism causing the pneumonia
Pseudomonas aeruginosa
47
a patient presents with avian flu (from poultry) what is the likely cause of their pneumonia
influenza A
48
what organism can cause pneumonia but doesn't usually affect humans and has a high mortality
influenza A
49
are elderly patients admitted to hospital if they have a respiratory virus that leads to pneumonia
NO
| as risk of MRSA
50
an adult smoker presents with chicken pox and pneumonia what organism is causing their pnuemonia
```
Varicella Zoster (only occurs in smokers)
Viral
```
51
what does respiratory viruses cause
pneumonitis
52
how does pneumonitis present on CT
heals leaving calcified and non-calcified nodules on CT
53
what is aspiration pneumonia
Acute aspiration of gastric contents into lungs
| Severe/fatal
54
where do gastric contents usually reside if enter the lungs
right middle lobe
| apical/posterior segments of right lower lobe
55
what can aspiration of gastric contents cause in pregnant women under anaesthesia
Mendelson's syndrome: bronchopulmonary reaction
56
what is medelsons syndrome treated with
abtacid eg. sodium citrate
| H2 antagonists eg. Ranitdine
57
symptoms of pneumonia
```
Pleuritic chest pain
Purulent sputum
Productive cough
breathlessness
Febrile (fever)
Anorexia
Sweats
Rigors
Pleurisy
Abdominal pain
Tachypnoea
Cyanosis
Hypotension
Preceeding URTI
Dyspnoea
haemoptysis
```
58
symptoms of pneumonia in elderly
diarrhoea
NO COUGH
confusion
59
a female patient presents with cough, fever, rust sputum, pleuritic chest pain, herpes what is the likely cause of their pneumonia
pneumococcal pneumonia (strep pneumonia)
60
what are the risk factors for strep. pnumoniae
more in females
COPD
diabetes
excess alcohol
61
wha tis the difference between non invasive and invasive pneumonia and give an example of each
non invasive: no pneumonia spread to blood eg. ear/sinus/upper resp tract infection
invasive: pneumonia with bloodstream spread eg meningitis
62
a patent presents with myalgia, arthralgia, malaise, (general aches and pains) non-productive cough, headache and aren't feeling great they also have a skin rash what is the likely cause of their pneumonia
mycoplasma pneumonia
63
what is the presentation of mycoplasma pneumonia
```
every 3/4 years
myalgia
arthralgia
malaise
myocarditis + pericarditis
non-productive cough
headache
not feeling great
skin rashes
```
64
what 2 skin rashes are associated with mycoplasma endocarditis
erythema multforma
| erythema nodosum
65
complications of mycoplasma pneumonia
hepatitis
| haemolytic anaemia
66
a patient presents with severe flu symptoms, chills, loss of appetite, lethargy, myalgia, arthalga, malaise and abdominal pain with vomiting and diarrhoea they are also confused what is the likely cause of their pneumonia
legionella
67
symptoms of legionella
```
Severe flu symptoms
Chills
Appetite loss
lethargy
Myalgia: muscle pain
Arthalgia: joint pain
Malaise: discomfort
Headache
Abdominal pain
Diarrhoea
Vomiting
Chest symptoms minimal
GI disturbance
Renal failure
Neurological eg. Confusion
Elevated creatine kinase
SOB
```
68
symptoms of coxiella burnetti (Q fever)
dry cough
| high fever
69
how would an x-ray of a patient with pseudomonas aerginosa look
cavitation
| abcess formation
70
a patent presents with fever, breathlessness, cough, diarrhoea, lymphopenia and thrombocytopenia what is the likely cause of their pneumonia
Influenza A
71
symptoms of pneumocystis jiroveci
high fever
breathlessness
dry cough
72
6 bacteria that causes pneumonia
```
Haemophilus influenzae
Streptococcus
Klebsiella
Staphylococci: MRSA/MSSA
Legionella
pseudomonas
```
73
patients with pneumonia usually have respiratory acidosis - true or false
true
74
how is hypoxia diagnosed
low PO2
| < 9.3 - 13.3 kPa
75
how is hypercapnia diagnosed
higher than 4.7-6 kPa
76
what do people with uncompensated respiratory acidosis have
high CO2, normal HCO3 (normal base excess)
77
how can pneumonia be diagnosed
```
blood culture +ve
serology
arterial gases
full blood count
urea (liver function)
sputum + Gm stain
chest Xray
```
78
high/low albumin is a sign of pneumonia
high
79
what indicates if a patient is cyanotic
PaOc < 8 kPa
80
what is checked in a full blood count to indicate pneumonia
high white cell count <4 or >30
81
if a patient has a white cell count of > 15 and elevated inflammatory markers what pneumonia may they have
strep pneumonia
82
in mycoplasma pneumonia the white cell count is high/low/normal
normal
83
in patient with legionella the white cell count is high/low/normal
low = lymphopenia
| without marked leucocytosis, hyponatraemia, hypoalbumineamia, high serum levels of lifer aminotransfereases
84
what does the bloods of a patient with legionaries disease show
lymphopenia
| deranged liver enzymes
85
a patient is found to have low platelet count and low white cell count what type of pneumonia could they have
klebsiella pneumonia
86
what organisms can be checked for in the sputum
```
strep pneumonia (gm +ve diplococci)
staph aureus (gm +ve clusters)
```
87
chest X-ray must be repeated 4 weeks after discharge of a pneumonia patient - true or false
false
| 6 weeks after
88
what does an X-ray of a patient with pneumonia look like
cavitation
masses/nodules
atelasis
may have a pleural effusion
89
a patients X-ray has air bronchograms, pleural effusion + collapse what type of pneumonia does this show
strep pneumonia
90
what type of pneumonia presents on a chest X ray as one lobe, can be bilateral and extensive
mycoplasma pneumonia
91
a patients X-ray is lobar with multi-lobed shadowing they also have a small pleural effusion what does this indicate
legionella pneumonia
92
a patients X-ray shows localised infiltration with nodules, cavitation and a pneumothorax. what type of pneumonia do they have
pneumocystis jiroveci
93
what test assesses the severity of CAP
curve 65 score
94
what does curve 65 mean
C- new onset CONFUSION
U - urea > 7 mmol/l
R - resp rate > 30/min
B - blood pressure systolic <90 or diastolic <61
65 - 65 or older
each is given a point
used to see if healthy patient should be admitted to hosptal
95
a urea conc of greater than 7 moll/l is a sign of pneumonia - true or false
TRUE
96
what curve 65 score would suggest a patient should be treated as an outpatientss
0-1
97
what curve 65 score would suggest a patient should be treated in hospital
2
98
what curve 65 score would suggest a patient should be treated in ICU
3+
99
in the curb 65 score how much greater mortality is a COPD patient likely to have
10% greater
100
who does the curve 65 score not apply to
children/young adults
101
when checking the young for pneumonia what does CURB stand for
C – good cerebral vasculature
U – good kidneys
R – can increase V1
B – inotropic, chronotropic, vascular responses
102
how does a patient with pneumonias lungs percuss
stoney dull in area of pneumonia
103
how may a pneumonia patient sound on auscultation
Wheeze
Course crackles
Bronchial breath
Pleural rub
104
a patient presents with rapid desaturation on exercise and their radiograph shows diffuse bilateral alveolar interstitial shadowing in perihilar regions which spreads out Butterfly Pattern there is also indirect immunofloesence on sputum/bronchoalveolar lavage what is condition do they have
pneumocystis jiroveci
| pneumonia
105
if you suspect a patient has strep pneumonia what tests should you carry out
counter-immunoelectrophoresis (CIE) of sputum, urine, serum if strep it will be 3/4 times more sensitive
urine antigen test
106
what is the benefits of carrying out a urineary antigen test to check for strep
```
C-polysaccharide
Rapid
Unaffected by antibiotics
Sensitivity 68-80%
Specificity 80%
```
107
if you suspect a patient has mycoplasma pneumonia what test should you carry out
PCR on resp tract samples eg. throat swab/sputum
Complemement Fixation Test (CFT): measure 10-14 days apart, rising tires/single level approx 7 days after illness onset
low sensitivity
low specificity
108
what has a higher detection rate for mycoplasma PCR or serological assays
PCR
109
if you suspect a patient has legionanaires disease what tests should you carry out
specific urinary antigen test (detects only serogroup 1, high sensitivity, high specificity)
direct immunofluroesent staining of organisms in pleural fluid/sputum
serum antibodies
culture: 3 weeks, antibiotic sensitivity, performed if urinary antigen +ve
sputum PCR
110
is legionella visible on Gm stain
NO
111
if you suspect a patient has chlamydophilia pneumoniae what tests should you carry out
paired serum antibodies (10-14 days apart)
antigen detections (DIF): throat swabs
CFT (not reliable, weakly +ve)
112
if you suspect a patient has chlamydophilia psittaci what tests should you carry out
paired serum antibodies (10-14 days apart)
| CFT: high sensitivity and high specificity
113
if you suspect a patient has coxiella burnetti (Q fever) what tests should you carry out
paired serum antibody
| titres 10-14 days apart
114
what test should you do to check for viruses eg. Influenza A or B
PCR of resp tract: throat swab, sputum, bronchoalveolar lavage
115
community treatment of strep pneumonia
Amoxicilin
Doxycycline
Co-trimoxazole
116
community treatment of H.influenzae
Avoid macrolides
Amoxicillin
Doxycycline
Co-trimoxazole
117
what is the first most common cause of pneumonia
strep pnumonia
118
what is the second most common cause of pneumonia
H. influenza
119
treatment of M. Caterrhalis
Co-amoxiclav
Doxycycline
Clarythromycin
Co-trimoxazole
120
if BP of patient is low what should be given
fluids by IV
121
what is Gm-ve HAP treatment with
antibiotics administered in first 4 hours
Amoxicillan
Gentamicin
Metronizaole
122
what is given to patients with HAP if they are allergic to amoxicillin
co-trimoxazole
123
if temperature settles in first 24 hours how should antibiotics be administered
from parental to oral
124
1st line HAP treatment for staph aureus
amoxicillin (5 day course)
| flucloxacillin
125
2nd line HAP treatment for staph aureus
doxycycline
| co-trimoxazole
126
why should treatment with cephalosporins be avoided
increase c. diff risk
127
what should be offered to patients with sputum retention issues
physiotherapy help
128
treatment of p.aeruginosa
ciprofloxin
129
treatment of analgesia
paracetamol
non-steroidal anti-inflammatory
treats pleuritic pain
130
treatment of aspiration pneumonia
anaerobic cover required
amoxicillin/co-amoxiclav for mild to moderate
metronidazole for more severe
131
treatment of legionella
```
QUINOLONES
• Levofloxacin
• Ciprofloxacin
• Moxi-floxin
• Gemifloxacin
• trovofloxin
Macrolides
• Azithromycin
• Clarithromycin
• Erythromycin
NO CO-AMOXICLAV
```
132
how can legionella be prevented
water supply systems cooled below 20 or above 60
133
treatment of mycoplasma pneumonia
```
NOT PENICILLIN
• Clarythromycin (1st line)
• Erythromycin
• Tetracycline
• Ciprolfloxin
```
134
first line treatment of mycoplasma pneumonia
carythromycin
135
treatment of chlamydrophilia pneumonia
macrolides eg. azithromycin
| tetracycline eg. doxycycline
136
1st line treatment of o Pneumocystis Jiroveci (PCP)
high dose co-trimoxazole
137
how can pneumonia be prevented
Influenza + pneumococcal vaccines: over 65, chronic chest/cardiac disease, diabetes, immunocompromised
138
how many serotypes does 1 pneumococcal vaccine cover
23
139
what is the mortality of pneumococcal pneumonia
5-10%
140
what is the mortality of a bacteraemic pneumonia
30%
141
mortality of legionaries disease
5-30%
142
complications of pneumonia
```
parapneumonic effusion
emphyema: fluid in pleural space
death
resp failure
sepsis
lung abscess
```
143
symptoms of emphyema
ongoing fever
| elevated inflammatory markers
144
what should be offered to high risk patients in hospitals for > 12 hours and are bed ridden
thromboprophylaxis
Subcutaneous low molecular wight heparin
TED (thromboembolus deterrent) eg Stockings
