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RESPIRATORY > pneumonia > Flashcards

pneumonia Flashcards

1
Q

what is pneumonia

A

Infection of the distal airspaces usually with inflammatory exudation (localised oedema)

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2
Q

what does fluid filled airspaces lead to

A

consolidation

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3
Q

what is lobar pneumonia

A

Confluent consolidation involving complete lung lobe

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4
Q

what is lobar pneumonia usually due to

A

strep. pneumoniae, can be seen with klebsiella, legionella

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5
Q

who gets lobar pneumonia

A

young healthy adults

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6
Q

is lobar pneumonia usually CAP or HAP

A

CAP

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7
Q

what is the complications of pneumonia

A 
organisation (fibrous scarring)
abscess
bronchiectasis
empyema
Steven-johnson syndrome (RARE)
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8
Q

pathology of lobar pneumonia

A

exudation of fibrin rich fluid
neutrophil infiltration
macrophage infiltration
resolution

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9
Q

what is bronchopneumonia

A

infection starts in airways + spreads to adjacent alveolar lung

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10
Q

a COPD patient comes and presents with pneumonia is it likely to be lobar or broncho

A

bronchopneumonia

caused by haemophilus influenza

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11
Q

who gets bronchopneumonia

A

people with pre-existing disease: COPD, cardiac failure, viral infection, aspiration of gastric contrents

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12
Q

is bronchopneumonia spread person-to-person

A

no

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13
Q

what 3 organisms are likely to cause bronchopneumonia in a patient with aspiration of gastric contents

A

staphylococus
anaerobes
coliforms

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14
Q

what is a typical organism that causes bronchopneumonia

A

strep pneumonia

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15
Q

what can pneumonia especially if recurrent be an underlying symptom of

A

HIV

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16
Q

name 4 organisms that cause CAP

A

strep pneumonia
viruses
H.influenzae
staph aureus

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17
Q

pathology of CAP

A

organism in lung
immune activation + infiltration
fluid + celll build up in alveoli
impaired gas exchange

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18
Q

who are at higher risk of CAP

A 
Age <16, >65
Co-morbdities 
CF,COPD
Lifestyle
Immunocomprimised 
Iatrogenic: immunosuppressant therapy
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19
Q

what organisms cause HAP

A 
Gm -ve bacilli
e.coli
klebisella pneumoniae
acinetobacter
p.aeruginosa

Staph aureus - MRSA
(USUALLY NOT VIRAL)

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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

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21
Q

what is used to treat severe HAP

A

Piperacillin-tazobctam

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22
Q

what patients are immunocomprimised

A

genetic defect
iatrogenic
immunosuppresant therapy
immunodeficiency: HIV

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23
Q

name an opportunistic pathogen that could cause pneumonia in immunocompromised patients

A 
Pneumocystis jiroveci (PCP)
affects patients on immunosuppressant therapy
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24
Q

a patient on long term corticosteroids presents with pneumonia what is the likely cause of the pneumonia

A

pneumocystis jiroveci (PCP)

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25
Q

name 4 immunosuppressant therapies

A

Long-term corticosteroids
Monoclonal antibody therapy
Methotrexate for autoimmune disease
Anti-rejection mediaction post-solid organ transplant

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26
Q

how is pneumocystis jiroveci (PCP) spread

A

in air

re-infection (NOT reactivation)

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27
Q

what do patients with pneumocystis jiroveci (PCP) present with

A 
Very hypoxic
Breathless very quickly
Dry cough – several weeks
Poor response to 1st line antibiotics 
Cyanotic
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28
Q

if a patient is found to have pneumocystis jiroveci (PCP) what must you test them for

A

HIV

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29
Q

how is pneumocystis jiroveci (PCP) treated

A

high dose co-trimoxazole

high dose steroids

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30
Q

what are the complications of pneumocystis jiroveci (PCP)

A

pneumothorax
resp failure
death

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31
Q

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

A

mycoplasma pneumoniae

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32
Q

what type of pneumonia causes walking pneumonia

A

mycoplasma pneumoniae

has a slower onset

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33
Q

3 signs of mycoplasma pneumoniae

A

bruises
autoimmune haemolytic anaemia
arthiritis

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34
Q

what treatment should not be given to patients with mycoplasma pneumoniae and why

A

Penicillin

No cell wall, resistant to b-lactam antibiotics

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35
Q

what type of people present with mycoplasma pneumonia

A

students

young adults/fit healthy

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36
Q

what type of pneumonia shows an epidemic once every 4 years

A

mycoplasma pneumonia

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37
Q

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

A

legionella (legionaries disease)

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38
Q

how is legionaries disease aquired

A 
by inhaling water mist containing bateria/contaminated water droplets 
lukewarm water
hot tubs
air conditioning
water cooler not working
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39
Q

what organism can cause necrotising bacteria

A

staph aureus

post infleunzae

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40
Q

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

A

staph aureus

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41
Q

what does MRSA strains produce

A

Panton Valentine Leucocidin (PVL)

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42
Q

what organism from bids that can be person to person spread causes pneumonia

A

chlamydrophilia psittaci

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43
Q

what organism that causes endocardidtis usually in young men can cause pneumonia

A

Coxiella burnetti (Q fever)

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44
Q

can legionella be transmitted from person to person

A

NO

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45
Q

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

A

klebsiella pneumonia

high mortality

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46
Q

a patient with an underlying lung disease presents with pneumonia what is a possible organism causing the pneumonia

A

Pseudomonas aeruginosa

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47
Q

a patient presents with avian flu (from poultry) what is the likely cause of their pneumonia

A

influenza A

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48
Q

what organism can cause pneumonia but doesn’t usually affect humans and has a high mortality

A

influenza A

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49
Q

are elderly patients admitted to hospital if they have a respiratory virus that leads to pneumonia

A

NO

as risk of MRSA

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50
Q

an adult smoker presents with chicken pox and pneumonia what organism is causing their pnuemonia

A 
Varicella Zoster (only occurs in smokers)
Viral
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51
Q

what does respiratory viruses cause

A

pneumonitis

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52
Q

how does pneumonitis present on CT

A

heals leaving calcified and non-calcified nodules on CT

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53
Q

what is aspiration pneumonia

A

Acute aspiration of gastric contents into lungs

Severe/fatal

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54
Q

where do gastric contents usually reside if enter the lungs

A

right middle lobe

apical/posterior segments of right lower lobe

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55
Q

what can aspiration of gastric contents cause in pregnant women under anaesthesia

A

Mendelson’s syndrome: bronchopulmonary reaction

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56
Q

what is medelsons syndrome treated with

A

abtacid eg. sodium citrate

H2 antagonists eg. Ranitdine

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57
Q

symptoms of pneumonia

A 
Pleuritic chest pain
Purulent sputum
Productive cough
breathlessness
Febrile (fever)
Anorexia
Sweats
Rigors
Pleurisy
Abdominal pain 
Tachypnoea
Cyanosis
Hypotension
Preceeding URTI
Dyspnoea
haemoptysis
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58
Q

symptoms of pneumonia in elderly

A

diarrhoea
NO COUGH
confusion

59
Q

a female patient presents with cough, fever, rust sputum, pleuritic chest pain, herpes what is the likely cause of their pneumonia

A

pneumococcal pneumonia (strep pneumonia)

60
Q

what are the risk factors for strep. pnumoniae

A

more in females
COPD
diabetes
excess alcohol

61
Q

wha tis the difference between non invasive and invasive pneumonia and give an example of each

A

non invasive: no pneumonia spread to blood eg. ear/sinus/upper resp tract infection
invasive: pneumonia with bloodstream spread eg meningitis

62
Q

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

A

mycoplasma pneumonia

63
Q

what is the presentation of mycoplasma pneumonia

A 
every 3/4 years
myalgia
arthralgia
malaise
myocarditis + pericarditis
non-productive cough
headache
not feeling great
skin rashes
64
Q

what 2 skin rashes are associated with mycoplasma endocarditis

A

erythema multforma

erythema nodosum

65
Q

complications of mycoplasma pneumonia

A

hepatitis

haemolytic anaemia

66
Q

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

A

legionella

67
Q

symptoms of legionella

A 
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
Q

symptoms of coxiella burnetti (Q fever)

A

dry cough

high fever

69
Q

how would an x-ray of a patient with pseudomonas aerginosa look

A

cavitation

abcess formation

70
Q

a patent presents with fever, breathlessness, cough, diarrhoea, lymphopenia and thrombocytopenia what is the likely cause of their pneumonia

A

Influenza A

71
Q

symptoms of pneumocystis jiroveci

A

high fever
breathlessness
dry cough

72
Q

6 bacteria that causes pneumonia

A 
Haemophilus influenzae
Streptococcus
Klebsiella
Staphylococci: MRSA/MSSA
Legionella
pseudomonas
73
Q

patients with pneumonia usually have respiratory acidosis - true or false

A

true

74
Q

how is hypoxia diagnosed

A

low PO2

< 9.3 - 13.3 kPa

75
Q

how is hypercapnia diagnosed

A

higher than 4.7-6 kPa

76
Q

what do people with uncompensated respiratory acidosis have

A

high CO2, normal HCO3 (normal base excess)

77
Q

how can pneumonia be diagnosed

A 
blood culture +ve
serology
arterial gases
full blood count
urea (liver function)
sputum + Gm stain
chest Xray
78
Q

high/low albumin is a sign of pneumonia

A

high

79
Q

what indicates if a patient is cyanotic

A

PaOc < 8 kPa

80
Q

what is checked in a full blood count to indicate pneumonia

A

high white cell count <4 or >30

81
Q

if a patient has a white cell count of > 15 and elevated inflammatory markers what pneumonia may they have

A

strep pneumonia

82
Q

in mycoplasma pneumonia the white cell count is high/low/normal

A

normal

83
Q

in patient with legionella the white cell count is high/low/normal

A

low = lymphopenia

without marked leucocytosis, hyponatraemia, hypoalbumineamia, high serum levels of lifer aminotransfereases

84
Q

what does the bloods of a patient with legionaries disease show

A

lymphopenia

deranged liver enzymes

85
Q

a patient is found to have low platelet count and low white cell count what type of pneumonia could they have

A

klebsiella pneumonia

86
Q

what organisms can be checked for in the sputum

A 
strep pneumonia (gm +ve diplococci)
staph aureus (gm +ve clusters)
87
Q

chest X-ray must be repeated 4 weeks after discharge of a pneumonia patient - true or false

A

false

6 weeks after

88
Q

what does an X-ray of a patient with pneumonia look like

A

cavitation
masses/nodules
atelasis
may have a pleural effusion

89
Q

a patients X-ray has air bronchograms, pleural effusion + collapse what type of pneumonia does this show

A

strep pneumonia

90
Q

what type of pneumonia presents on a chest X ray as one lobe, can be bilateral and extensive

A

mycoplasma pneumonia

91
Q

a patients X-ray is lobar with multi-lobed shadowing they also have a small pleural effusion what does this indicate

A

legionella pneumonia

92
Q

a patients X-ray shows localised infiltration with nodules, cavitation and a pneumothorax. what type of pneumonia do they have

A

pneumocystis jiroveci

93
Q

what test assesses the severity of CAP

A

curve 65 score

94
Q

what does curve 65 mean

A

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
Q

a urea conc of greater than 7 moll/l is a sign of pneumonia - true or false

A

TRUE

96
Q

what curve 65 score would suggest a patient should be treated as an outpatientss

A

0-1

97
Q

what curve 65 score would suggest a patient should be treated in hospital

A

2

98
Q

what curve 65 score would suggest a patient should be treated in ICU

A

3+

99
Q

in the curb 65 score how much greater mortality is a COPD patient likely to have

A

10% greater

100
Q

who does the curve 65 score not apply to

A

children/young adults

101
Q

when checking the young for pneumonia what does CURB stand for

A

C – good cerebral vasculature
U – good kidneys
R – can increase V1
B – inotropic, chronotropic, vascular responses

102
Q

how does a patient with pneumonias lungs percuss

A

stoney dull in area of pneumonia

103
Q

how may a pneumonia patient sound on auscultation

A

Wheeze
Course crackles
Bronchial breath
Pleural rub

104
Q

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

A

pneumocystis jiroveci

pneumonia

105
Q

if you suspect a patient has strep pneumonia what tests should you carry out

A

counter-immunoelectrophoresis (CIE) of sputum, urine, serum if strep it will be 3/4 times more sensitive

urine antigen test

106
Q

what is the benefits of carrying out a urineary antigen test to check for strep

A 
C-polysaccharide
Rapid
Unaffected by antibiotics 
Sensitivity 68-80%
Specificity 80%
107
Q

if you suspect a patient has mycoplasma pneumonia what test should you carry out

A

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
Q

what has a higher detection rate for mycoplasma PCR or serological assays

A

PCR

109
Q

if you suspect a patient has legionanaires disease what tests should you carry out

A

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
Q

is legionella visible on Gm stain

A

NO

111
Q

if you suspect a patient has chlamydophilia pneumoniae what tests should you carry out

A

paired serum antibodies (10-14 days apart)
antigen detections (DIF): throat swabs
CFT (not reliable, weakly +ve)

112
Q

if you suspect a patient has chlamydophilia psittaci what tests should you carry out

A

paired serum antibodies (10-14 days apart)

CFT: high sensitivity and high specificity

113
Q

if you suspect a patient has coxiella burnetti (Q fever) what tests should you carry out

A

paired serum antibody

titres 10-14 days apart

114
Q

what test should you do to check for viruses eg. Influenza A or B

A

PCR of resp tract: throat swab, sputum, bronchoalveolar lavage

115
Q

community treatment of strep pneumonia

A

Amoxicilin
Doxycycline
Co-trimoxazole

116
Q

community treatment of H.influenzae

A

Avoid macrolides
Amoxicillin
Doxycycline
Co-trimoxazole

117
Q

what is the first most common cause of pneumonia

A

strep pnumonia

118
Q

what is the second most common cause of pneumonia

A

H. influenza

119
Q

treatment of M. Caterrhalis

A

Co-amoxiclav
Doxycycline
Clarythromycin
Co-trimoxazole

120
Q

if BP of patient is low what should be given

A

fluids by IV

121
Q

what is Gm-ve HAP treatment with

A

antibiotics administered in first 4 hours
Amoxicillan
Gentamicin
Metronizaole

122
Q

what is given to patients with HAP if they are allergic to amoxicillin

A

co-trimoxazole

123
Q

if temperature settles in first 24 hours how should antibiotics be administered

A

from parental to oral

124
Q

1st line HAP treatment for staph aureus

A

amoxicillin (5 day course)

flucloxacillin

125
Q

2nd line HAP treatment for staph aureus

A

doxycycline

co-trimoxazole

126
Q

why should treatment with cephalosporins be avoided

A

increase c. diff risk

127
Q

what should be offered to patients with sputum retention issues

A

physiotherapy help

128
Q

treatment of p.aeruginosa

A

ciprofloxin

129
Q

treatment of analgesia

A

paracetamol
non-steroidal anti-inflammatory
treats pleuritic pain

130
Q

treatment of aspiration pneumonia

A

anaerobic cover required
amoxicillin/co-amoxiclav for mild to moderate
metronidazole for more severe

131
Q

treatment of legionella

A 
QUINOLONES 
•	Levofloxacin
•	Ciprofloxacin
•	Moxi-floxin
•	Gemifloxacin
•	trovofloxin
Macrolides
•	Azithromycin
•	Clarithromycin
•	Erythromycin
NO CO-AMOXICLAV
132
Q

how can legionella be prevented

A

water supply systems cooled below 20 or above 60

133
Q

treatment of mycoplasma pneumonia

A 
NOT PENICILLIN
•	Clarythromycin (1st line)
•	Erythromycin
•	Tetracycline
•	Ciprolfloxin
134
Q

first line treatment of mycoplasma pneumonia

A

carythromycin

135
Q

treatment of chlamydrophilia pneumonia

A

macrolides eg. azithromycin

tetracycline eg. doxycycline

136
Q

1st line treatment of o Pneumocystis Jiroveci (PCP)

A

high dose co-trimoxazole

137
Q

how can pneumonia be prevented

A

Influenza + pneumococcal vaccines: over 65, chronic chest/cardiac disease, diabetes, immunocompromised

138
Q

how many serotypes does 1 pneumococcal vaccine cover

A

23

139
Q

what is the mortality of pneumococcal pneumonia

A

5-10%

140
Q

what is the mortality of a bacteraemic pneumonia

A

30%

141
Q

mortality of legionaries disease

A

5-30%

142
Q

complications of pneumonia

A 
parapneumonic effusion
emphyema: fluid in pleural space
death
resp failure
sepsis
lung abscess
143
Q

symptoms of emphyema

A

ongoing fever

elevated inflammatory markers

144
Q

what should be offered to high risk patients in hospitals for > 12 hours and are bed ridden

A

thromboprophylaxis
Subcutaneous low molecular wight heparin
TED (thromboembolus deterrent) eg Stockings

RESPIRATORY (12 decks)

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