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Medicine > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

define pneumonia?

(+ clinical definition?)

A

inflammation of lung parenchyma distal to the terminal bronchioles, which includes the respiratory bronchioles, alveolar ducts, and alveoli

LRTI Sx
+ focal Sx (crackles), systemic Sx (fever) OR {unexplained CXR shadowing}

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2
Q

what is a chest infection?

A
  • non-specific term for LRTIs
  • tends to be used for milder presentations – i.e. acute bronchitis – rather than pneumonia
  • acute bronchitis +/- productive cough and fever, but no focal chest signs and CXR is clear
  • unlike pneumonia, Abx not routinely indicated
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3
Q

common causes CAP?

ordered from most to least likely

A

• BACTERIA

  • Strep. pneumoniae (50)
  • H. influenzae (7)
  • Staph. aureus (2)
  • Moraxella catarrhalis (2)

• ‘ATYPICALS’:

  • Chlamydophila pneumoniae (10)
  • Mycoplasma pneumoniae (5-15)
  • Legionella pneumophila (3)

• VIRAL:

  • COVID :(
  • influenza A+B
  • RSV

• IMMUNO↓:

  • Pneumocystis jirovecii (Pneumocystis pneumonia, PCP)
  • CMV
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4
Q

definition and causes of HAP?

A

• develops >48h post-admission
• pathogens similar to CAP in the first 4 days
• later
- Gram -ve enterobacteria (Klebsiella, E. coli)
- Staph. aureus (inc. MRSA)
- Legionella
- Pseudomonas

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5
Q

causes aspiration pneumonia? bugs?

A
  • NM (stroke, myasthenia gravis)
  • ↓consciousness (anaesthesia, alcohol intoxication)

• similar to HAP

  • Klebsiella in alcoholism
  • anaerobes like Peptostreptococcus, Fusobacterium, and Prevotella

Commonly affects right lower lobe**

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6
Q

causes and clinical picture of atypical pneumonia?

A
  • either bugs that aren’t common, or bugs that can’t be gram stained (Mycoplasma, Chlamydophila)
  • generally “walking well” (mild clinical picture, but mostly in M+C)
  • also caused by Legionella from stagnant water, and that can be nasty
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7
Q

Sx + Ex to expect in pneumonia?

A
  • SOB
  • cough with purulent sputum +/- possibly blood
  • pleuritic pain
  • fever, malaise
  • cyanosis, confusion
  • ↑RR, ↑HR, AF
  • consolidation leads to dull percussion
  • ↑vocal resonance (VR)
  • bronchial breathing (i.e. ↑breath sounds, BS)
  • **both pneumonia and effusion cause dull percussion, but pneumonia is noisy (↑VR, ↑BS) while effusion goes shhh (↓VR, ↓BS).
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8
Q

what may cause a lobar pneumonia with rusty sputum, 10 percent have oral herpes?

A

Strep. pneumo

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9
Q

cause more common in COPD patients?

A

H. influenzae and Moraxella

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10
Q

cause if it may be bilateral, and can occur post-influenza?

A

S. aureus

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11
Q

persistent dry cough, mild fever, malaise, headache, and myalgia, but usually self-resolves over weeks?

(peaks in 4-yearly epidemics)

immunological complications include erythema multiforme and haemolytic anaemia

A

Mycoplasma pneumo (atypical)

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12
Q

gradual onset, initial pharyngitis/URTI symptoms, and headache. Usually self-resolves, but may take months?

A

Chlamydophila pneumo (atypical)

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13
Q

flu-like prodrome followed by cough (dry then productive or bloody), SOB, + D,V. Bilateral in severe cases?

A

Legionella

“Pontiac fever” is infection without lung involvement

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14
Q

dry cough, bilateral pneumonia, desaturation on exertion, HIV+?

A

PCP

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15
Q

“currant jelly sputum”?

A

Klebsiella

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16
Q

acquired from sheep and other farm animals. Part of Q fever, which includes flu-like symptoms, hepatitis, and endocarditis?

A

Coxiella burnetii

17
Q

acquired from birds. Causes fever, dry cough, headache, splenomegaly, and arthritis?

A

Chlamydophila psittaci

“P”igeon = “P”sittaci

18
Q

Ix pneumonia?

A

• CURB-65 to score severity. 1 for each of:

  • Confusion: abbreviated mental test ≤8 or disoriented
  • Urea >7 (in the community, this is optional, use CRB-65 instead)
  • RR ≥30
  • BP: SBP <90 or DBP ≤60
  • Age ≥65

0-1 is mild
2 may require hospitalisation
≥3 is severe and may require ITU

19
Q

How to Ix/Tx a mild CAP in the community?

A
  • 70 percent of patients with mild CAP are managed in the community
  • they require few, if any, Ix beyond obs
  • if the diagnosis is unclear, get a CRP
  • **Diagnose pneumonia and give Abx if CRP >100 mg/L. Consider diagnosis if CRP 20-100.
20
Q

inpatient Ix of pneumonia?

A

BEDSIDE
• O2 sats. ABG if <92% or severely unwell
• ECG if tachy
• Sputum culture
• Strep. pneumo and Legionella urine antigen tests. 75 percent sensitive

BLOODS
• FBC
• U+E (Legionella ↑urea and ↑creatinine, ↓Na+ due to SIADH) (Mycoplasma: ↓Na+)
• LFT (↑LFTs commoner in Legionella)
• CRP (↑↑CRP suggests Strep. pneumo)
• blood culture
• Mycoplasma - +ve cold agglutinin test

IMAGING
• CXR (also arrange follow up CXR 6 weeks later to check if clear and rule out underlying lung disease)
• High-res CT for PCP may show ground glass opacities

21
Q

Tx CAP?

A

• Mild-moderate: amoxicillin PO

  • Clarithromycin or doxycycline if allergic
  • Clarithromycin if atypical suspected (monotherapy if mild, added to amoxicillin if moderate)

• Severe: co-amoxiclav, cefuroxime, or cefotaxime IV (or levofloxacin if allergic), plus clarithromycin IV

  • If hospitalised, start within 4 hours
  • Monitor response to treatment with CRP
22
Q

Tx HAP?

A
  • piperacillin/tazobactam, 3rd generation cephalosporin, meropenem, or levofloxacin IV
  • Co-amoxiclav is a PO alternative or stepdown
  • Add vancomycin or teicoplanin or linezolid if MRSA suspected
23
Q

Tx aspiration pneumonia?

A

• clindamycin, levofloxacin, or piperacillin/tazobactam

24
Q

Tx PCP?

A
  • co-trimoxazole

* add steroids if moderate or severe: prednisolone PO or hydrocortisone IV

25
Q

general Tx of pneumonia?

A
  • 5 days Abx (longer if remains febrile or unstable, or for certain pathogens)
  • if starting IV, review after 48 hours for possible PO stepdown
  • O2
  • Fluids
  • Paracetamol
26
Q

complications of pneumonia?

A
  • fever should resolve within 1 week
  • cough and SOB may take up to 6 weeks to resolve, and fatigue may persist up to 3 months
  • respiratory failure
  • sepsis and septic shock
  • uncomplicated parapneumonic pleural effusion, empyema (purulent, colonized pleural effusion)
  • lung abscess
27
Q

pathophysiology of lung abscess?

A
  • necrotic tissue leaves pus-filled cavity

* may follow pneumonia, aspiration, or lung tissue damage (infarct, tumour, trauma)

28
Q

Sx of lung abscess?

A
  • non-specific respiratory and systemic symptoms
  • dullness to percussion
  • clubbing
29
Q

Ix lung abscess?

A
  • Blood and sputum cultures
  • Bloods: FBC, U+E, LFT, CRP
  • CXR shows cavitation with fluid level
  • Consider CT
  • Culture fluid from abscess via bronchoscopy or trans-thoracic aspiration
30
Q

Tx lung abscess?

A
  • 8 weeks antibiotics, initially IV for 2-3 weeks
  • chest physio to help drain it
  • 10 percent will require CT-guided or open drainage

Medicine (28 decks)

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