Pneumonia Flashcards

1
Q

Pneumonia

A

This patient has been acutely unwell for 3 days, with shortness of breath and a productive cough.
Please examine his chest.

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2
Q

Clinical signs of Pneumonia

A
  • Tachypnoea, O2 mask, sputum pot (rusty sputum associated with pneumococcus)
  • Reduced expansion
  • Dull percussion note
  • Focal coarse crackles, increased vocal resonance and bronchial breathing
  • Ask for the temperature chart
  • If dull percussion note with absent tactile vocal fremitus, think parapneumonic effusion/ empyema
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3
Q

Investigation

A
  • CXR: consolidation (air bronchogram), abscess and effusion
  • Bloods: WCC, CRP, urea, atypical serology (on admission and at day 10) and immunoglobulins
  • Blood (25% positive) and sputum cultures
  • Urine:
    ⚬⚬ Legionella antigen (in severe cases)
    ⚬⚬ Pneumococcal antigen
    ⚬⚬ Haemoglobinuria (mycoplasma causes cold agglutinins → haemolysis)
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4
Q

Community acquired pneumonia (CAP)

* Common organisms:

A

⚬⚬ Streptococcus pneumoniae 50%
⚬⚬ Mycoplasma pneumoniae 6%
⚬⚬ Haemophilus influenzae (especially if COPD)
⚬⚬ Chlamydia pneumoniae.

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5
Q

Community acquired pneumonia (CAP)

* Antibiotics:

A

⚬⚬ 1st line: penicillin or cephalosporin + macrolide

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6
Q

Special considerations in pneumonia
* Immunosuppressed:
* Aspiration
* Post‐influenza:

A
  • Immunosuppressed:
    ⚬⚬ Fungal Rx Amphotericin
    ⚬⚬ Multi‐resistant mycobacteria
    ⚬⚬ Pneumocystis carinii Rx Cotrimoxazole/Pentamidine
    ⚬⚬ CMV Rx Ganciclovir
  • Aspiration (commonly posterior segment of right lower lobe):
    ⚬⚬ Anaerobes Rx + Metronidazole
  • Post‐influenza:
    ⚬⚬ Staph. aureus Rx + Flucloxacillin
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7
Q

Severity score for pneumonia:

A
CURB‐65 (2/5 is severe)
* Confusion
* Urea >7
* Respiratory rate >30
* BP systolic <90 mm Hg or diastolic <60 mm Hg
* Age >65

Severe CAP should receive high‐dose IV antibiotics initially plus level 2 care (HDU/ITU)

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8
Q

Prevention of pneumonia

A

Pneumovax II® to high‐risk groups, e.g. chronic disease (especially nephrotic and asplenic patients) and the elderly

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9
Q

Complications of pneumonia

A
  • Lung abscess (Staph. aureus, Klebsiella, anaerobes)
  • Para‐pneumonic effusion/empyema
  • Haemoptysis
  • Septic shock and multi‐organ failure
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