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Pneumonia Flashcards

1
Q

state two LRTIs?

A

bronchial infection

pneumonia

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2
Q

what two anatomical types of pneumonia is there?

A

lobar

bronchopneumonia

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3
Q

what does lobar pneumonia look like?

A

Fibrosuppurative consolidation of a single lobe

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4
Q

does bronchopneumonia affect one lobe?

A

no

- patchy consolidation of different lobes

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5
Q

what are the etiological classification of pneumonia?

A

community acquired
hospital acquired
aspiration
immunocompromised

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6
Q

what organisms cause community acquired pneumonia ?

A

Pneumococcus, mycoplasma, haemophilus

S. aureus, Moraxella, Chlamydia, Legionella

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7
Q

after how long in hospital does hospital acquired pneumonia occur?

A

> 48hrs

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8
Q

what organisms cause hospital acquired pneumonia ?

A

Gm-ve enterobacteria, S. aureus

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9
Q

what conditions increase the risk of aspiration pneumonia ?

A

stroke, bulbar palsy, ↓GCS, GORD, achalasia

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10
Q

what organisms cause aspiration pneumonia ?

A

Anaerobes

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11
Q

what organisms can immunocompromised pneumonia ?

A

PCP, TB, fungi, CMV/HSV

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12
Q

how is severity determined for pneumonia ?

A

CURB65

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13
Q

what special investigation can be done for PCP (pneumocystis jiorveci pneumonia)

A

Immunofluorescence

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14
Q

what investigations should be done for pneumonia ?

A

Bloods: FBC, U+E, LFT, CRP, culture, ABG (if ↓SpO2)

Urine: Ag tests (Pneumococcal, Legionella)

Sputum: MC&S

Imaging: CXR

Paired sera Abs for atypicals
- Mycoplasma, Chlamydia, Legionella

pleural tap

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15
Q

what does a score of 1,2,3 mean for where the patient can be treated with the CURB65 score ?

A

0-1 → home Rx

2 → hospital Rx

≥3 → consider ITU

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16
Q

what is the treatment for mild pneumonia ?

A

amoxicillin 500mg three times daily PO for 5d
or
clarithro 500mg twice daily PO for 7d

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17
Q

what is the treatment for moderate pneumonia ?

A

amoxicillin 500mg TDS
and
clarithro 500mg BD PO/IV (clarithro alone if pen allergy) for 7d

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18
Q

what is the treatment for severe pneumonia ?

A

Co-amoxiclav 1.2g TDS IV / cefuroxime 1.5g TDS IV
and
clarithro 500mg BD IV for 7-10d

Add fluclox if staph suspected. (hospital acquired) Add vancomycin if MRSA is suspected

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19
Q

what is the treatment for atypical pneumonia ?

A

Chlamydia: tetracycline

PCP: Co-trimoxazole

Legionella: Clarithro + rifampicin

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20
Q

what is the treatment for hospital acquired pneumonia?

A

Mild / <5d: Co-amoxiclav 625mg PO TDS for 7d

Severe / >5d: Tazocin ± vanc ± gent for 7d

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21
Q

what is the treatment for aspiration pneumonia?

A

Co-amoxiclav 625mg PO TDS for 7d

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22
Q

what is pneumovax 23 used for?

A

It is used for the prevention of pneumonia caused by the 23 different types of pneumococci bacteria that are contained in the vaccine.

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23
Q

what are the indications of pneumovax 23?

A

≥65yrs
Chronic heart, lungs, liver and renal (nephrosis, post transplant) failure or conditions
DM
Immunosuppression: hyposplenism (splenectomy, asplenia, sickle cell, coeliac disease), chemo, HIV

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24
Q

what are the contraindications of pneumovax 23?

A

Pregnancy
breast feeding
fever

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25
Q

when should pneumonia be followed up?

A

6 weeks

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26
Q

state what type 1 and type 2 resp failure is ?

A

Type 1: PaO2 <8kPa + PaCO2 <6kPa (low o2)

Type 2: PaO2 <8kPa + PaCO2 >6kPa (low O2 and high CO2)

27
Q

state some complications of pneumonia ?

A 
resp failure 
hypotension 
AF
pleural effusion 
empyema 
lung abscess 
sepsis 
pericarditis 
jaundice
28
Q

what is the Tx for acute AF caused by infection?

A

Digoxin or β-B for rate control

29
Q

what will pleural tap of empyema show?

A

turbid, pH<7.2, ↓glucose, ↑LDH

30
Q

what is the Tx for empyema?

A

US guided chest drain + Abx

31
Q

what are the symptoms of lung abscess?

A 
Swinging fever
􏰀 Cough, foul purulent sputum, haemoptysis
􏰀 Malaise, wt. loss
􏰀 Pleuritic pain
􏰀 Clubbing
􏰀 Empyema
32
Q

what will a CXR for lung abscess show?

A

cavity ̄c fluid level

33
Q

what is augmentin?

A

oral antibacterial combination consisting of amoxicillin and the beta lactamase inhibitor, clavulanate potassium

co-amoxiclav!!

34
Q

what two antibiotics used to treat pneumonia can cause jaundice?

A

flucloxacillin

co-amoxiclav

35
Q

SIRS (Systemic Inflammatory Response Syndrome) requires 2 out of 4 criteria for a diagnosis. what are the 4 criteria?

A

Temperature: >38°C or <36°C

Heart rate: >90

Respiratory rate: >20 or PaCO2 <4.6 KPa

WCC: >12x109/L or <4 x109/L or >10% bands

36
Q

what is severe sepsis?

A

Sepsis ̄c at least 1 organ dysfunction or hypoperfusion

37
Q

what is septic shock?

A

Severe sepsis with refractory hypotension

38
Q

what is Multiple organ dysfunction syndrome (MODS)

A

Impairment of ≥2 organ systems

39
Q

what are risk factors of S aureus pneumonia ?

A

Influenza infection
IVDU
Co-morbidities

40
Q

what are risk factors of pseudomonas pneumonia ?

A

Bronchiectasis CF

41
Q

what are risk factors of legionella pneumonia ?

A

Travel

Air conditioning

42
Q

what are risk factors of chlamydia psittaci pneumonia ?

43
Q

what types of atypical pneumonia cause a dry cough?

A

mycoplasma
legionella
chalmydia psittaci
PCP

44
Q

what organism causes PCP?

A

pneumocystis jiroveci

45
Q

what CXR findings are there with PCP ?

A

normal or bilateral perihilar interstitial shadowing

46
Q

what CXR findings are there with pneumococcus?

A

lobar consolidation

47
Q

what CXR findings are there with s aureus?

A

Bilateral cavitating bronchopneumonia

48
Q

what CXR findings are there with legionella ?

A

bilateral consolidation

49
Q

what CXR findings are there with chlamydia psittaci ?

A

patchy consolidation

50
Q

what CXR findings are there with Klebsiella?

A

cavitating pneumonia

51
Q

what is the treatment for pseudomonas pneumonia ?

A

tazobactam

52
Q

how is a diagnosis of legionella made?

A

Urinary Ag or serology

53
Q

what is the treatment of legionella?

A

clarithromycin plus rifampicin

54
Q

what is the treatment of chalmydia psittaci?

A

clarithromycin

55
Q

how is a diagnosis of PCP made?

A

visualisation from BAL (Bronchoalveolar lavage), sputum, biopsy

56
Q

what is the treatment for PCP?

A

High dose co- trimoxazole or pentamidine

57
Q

when is prophylaxis for PCP given?

A

Prophylaxis if CD4<200 or after 1st attack

58
Q

what are extra pulmonary signs of clamydia psittaci?

A

Horder’s spots ~ rose spots Splenomegaly
Epistaxis
Hepatitis, nephritis Meningo-encephalitis

59
Q

what pneumonia can cause SIADH and confusion?

A

legionella

60
Q

what medication can be given to reduce the morbidity of influenza A?

A

oseltamivir

61
Q

what precautions can be taken to reduce the spread of influenza A?

A

appropriate hand hygiene
don’t spare utensils
avoid face to face contact
wear high efficiency masks and eye protection

62
Q

what is severe acute respiratory syndrome caused by?

A

SARS-CoV virus

63
Q

is there any medication available for severe acute respiratory syndrome?

A

no

- because it is viral

64
Q

what are the features of severe acute respiratory syndrome ?

A 
fever
rigors 
myalgia 
dry cough 
headache 
SOB
diarrhoea

Y4 Resp (17 decks)

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