Pneumonia**** Flashcards
4 types
Community-acquired (CAP)
Hospital-acquired
Aspiration
Atypical - immunocompromised patient
Pathophysiology
Inflammation of lung parenchyma distal to terminal bronchioles, which includes the respiratory bronchioles, alveolar ducts, and alveoli
Chest infection vs pneumonia:
What are the medical terms for common chest infection?
How can you tell it is not pneumonia?
Acute bronchitis
No focal chest signs and CXR is clear
Typical bacteria causing CAP? - 2
What percentage of CAP cases are caused by viruses?
Hospital-acquired pneumonia:
- When is it classed as hospital-acquired?
- Most common pathogens?
Strep pneumoniae
H. influenzae
48hrs after hospital admission
Similar to CAP early on
Later on, it’s enterobacteria and staph aureus (inc. MRSA)
Aspiration pneumonia:
Examples of a group of patients which may aspirate food or foreign bodies?
Which side of the lungs does aspiration usually occur?
Stroke/MG/Bulbar palsies
Reduced consciousness
Oesophageal disease
Right side - wide and straighter
Immunocompromised - most common causes?
Strep pneumoniae H. influenzae Strep aureus Other fungi Viruses - CMV, HSV Mycobacteria
Pneumocystis pneumonia (PCP) - remember HIV
Atypical pneumonia:
Why is this type of pneumonia called atypical?
What is walking pneumonia?
Mycoplasma tends to occur in epidemics. How often do they happen?
Refers to pneumonia not caused by the ‘typical’ pathogens
A patient is fairly well but there is a mild clinical picture
Every 4 yrs or so in schools, universities, or workplaces
Symptoms - just list some
SOB
Cough with purulent sputum, possibly blood-stained
Pleuritis pain
Fever and malaise - may be only symptom
Signs - just list some
Consolidation - how are they following effected:
- Percussion
- Vocal resonance
- Expansion
- What is the breath sounds described as?
Cyanosis
Confusion
Tachypnoea
Tachycardia - AF
Dull percussion
Increased vocal resonance
Reduced expansion
Bronchial breathing - Rhonchi occur when air tries to pass through bronchial tubes that contain fluid or mucus.
Crackles occur if the small air sacs in the lungs fill with fluid and there’s any air movement in the sacs, such as when you’re breathing. The air sacs fill with fluid when a person has pneumonia or heart failure.
Pneumonia and effusion can both cause dull percussion.
What can be used to distinguish between the 2 which can be worked out by a letter in their names?
P(n)eumonia = noisy (Increased VR and BS (bronchial))
Effu(s)ion = shhh (Reduced VR and BS)
Pathogen-specific features:
Strep. pneumoiae - what colour may the sputum be?
What type of patient is more likely to have H. influenzae and Moraxella pneumonia?
Which bacteria can cause pneumonia bilaterally?
Pneumocystis pneumonia (PCP):
- Main symptom
- Bi/unilateral
- What causes desaturation?
Rusty coloured sputum
COPD patients
Strep. aureus - especially post-flu --- Dry cough Bilateral Exertion causes desaturation
Pathogen-specific features:
Klebsiella - what colour may the sputum be?
Coxiella burnetii - what farm animal is this acquired from?
Current jelly sputum
Sheep mainly but can be from other farm animals
Investigations - CURB 65:
What does it stand for?
It is a score out of 5.
What score warrants hospital admission?
What score suggests it is very severe which may require ITU?
Bedside - 3
Bloods - 4
Confusion Urea RR BP Age >65
2 - hospital
>3 - ITU and severe
O2 SATS
ABG
BP
FBC
U&Es
LFT
CRP
Investigations - CURB 65:
Confusion - under what score on the mental test means the patient is confused?
Urea above what number?
RR above what?
BP under what?
<8 or the patient may just be disorientated
Urea > 7
RR >30
Systolic BP < 90
Age >65
Investigations - Community Tests;
What is used to check if the person has inflammation as a response to CAP at the GP?
What med is given to those with pneumonia in the community?
CRP - remember Chris in consultation with a lady with pneumonia
ABs
