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Y1 - Respiratory > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What is pneumonia?

A

Infection of the lung tissue causing inflammation and exudation (oedema)

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2
Q

What are the symptoms of pneumonia?

A 
Shortness of breath
Purulent cough
Haemoptysis
Pleuritic chest pain
Malaise
Rigors (spiking change in temperature)
Myalgia
Confusion
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3
Q

What are the signs of pneumonia?

A 
Fever
Tachypnoea
Tachycardia
Hypoxia 
Hypotension
Crackles
Bronchial breath sounds (harsh breath sounds on insp and exp)
Dullness to percussion
Pleural rub
Cyanosis
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4
Q

What investigations are done for pneumonia?

A 
CXR
Sputum culture
Viral PCR
Blood culture
Serology
ABGs
FBC
CRP
U&Es
LFTs
Legionella and pneumococcal urinary antigens
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5
Q

What is the assessment criteria for pneumonia?

A

CURB65

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6
Q

What is the most common cause of pneumonia?

A

Streptococcus pneumoniae

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7
Q

What is a common cause pneumonia in COPD patients?

A

Haemophilus influenzae

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8
Q

What is a common cause of pneumonia in PWIDs, the young or elderly, or often following influenza?

A

Staphylococcus aureus

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9
Q

Which atypical pneumonia organism is associated with birds?

A

Chlamydophila psittaci

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10
Q

Which atypical pneumonia organism is associated with sheep and goats, and farming?

A

Coxiella burnetti

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11
Q

Which atypical pneumonia organism is associated with water tanks/ air con and holiday to Spain?

A

Legionella pneumophilia

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12
Q

Which atypical pneumonia organism is associated with alcoholism and aspiration pneumonia?

A

Klebsiella/mixed anaerobbes

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13
Q

Which atypical pneumonia organism is associated with the immunocompromised?

A

Pneumocystis jiroveci

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14
Q

Which atypical pneumonia organism causes erythema multiforme (target lesions) and neurological symptoms in a young patient?

A

Mycoplasma pneumoniae

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15
Q

How does strep pneumonia appear on gram staining?

A

Gram positive (purple) cocci in strips

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16
Q

How does haemophilia influenzae appear on gram staining?

A

Gram negative (pink) coccobacilli

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17
Q

How does staph aureus appear on gram staining?

A

Gram positive coccus, ‘grape-like’ clusters

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18
Q

What is community acquired pneumonia?

A

Pneumonia acquired outside hospital or healthcare facilities

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19
Q

What is the pathology of pneumonia?

A
  1. Organism reaches the lungs
  2. Immune activation and infiltration of neutrophils, macrophages
  3. Fluid and cellular build up in alveoli
  4. Impaired gas exchange
20
Q

What are risk factors for community acquired pneumonia?

A 
Increasing age
Immunocompromised/suppressed patients
Smoking 
COPD
Alcohol abuse
Drugs that reduce stomach acid production - H2 antagonist, antacids
21
Q

In what way can atypical pathogens present differently to other pathogens?

A

Can present sub-acutely with gradual onset of symptoms

22
Q

When should you suspect community acquired pneumonia?

A

In patients with symptoms and signs of a lower respiratory tract infection, and when there is new radiographic consolidation for which there is no other explanation

23
Q

What are some differentials for pneumonia?

A 
Acute bronchitis
Congestive heart failure
Bronchiectasis exacerbation
TB
Lung cancer
Pulmonary embolism
Pneumothorax
24
Q

How does the assessment criteria for pneumonia assess severity?

A 
Confusion
Urea >7
Resp rate >30
BP <90 systolic or <60 diastolic 
65+
One point for each of the above that they exhibit
0 points is low risk
1-2 is moderate
3+ is high risk
25
Q

What is the treatment for mild/moderate community acquired pneumonia?

A

Oral amoxicillin/doxycycline 5 days

26
Q

What is the treatment for severe community acquired pneumonia?

A

Co-amoxiclav + doxycycline
If penicillin allergic then levofloxacin only
If high risk of atypical organism: co-amoxiclav + clarithromycin

27
Q

What are the supportive measures used for pneumonia?

A

Oxygen if <94%
IV fluids
Bed rest

28
Q

Who are pneumonia vaccines given to?

A 
Over 65 year olds
Patients with chronic chest or cardiac disease
Patients with diabetes
Immunocompromised
Health care workers
29
Q

What are some complications of pneumonia?

A 
Septic shock
ARDS
C diff associated colitis (pseudomembranous)
Heart failure
Pleural effusion
Empyema
Lung abscess
30
Q

What is hospital acquired pneumonia?

A

An acute lower respiratory tract infection that is acquired after at least 48 hours of admission to hospital

31
Q

What is early onset hospital acquired pneumonia often caused by?

A

Strep pneumoniae

32
Q

What are risk factors for hospital acquired pneumonia?

A

ICU
Major surgery
Patients who have been in hospital a long time
Endotracheal intubation with mechanical ventilation
Sedation
Immunosuppression
Head of the bead at <30 degree angle

33
Q

What is the treatment for non-severe hospital acquired pnuemonia?

A

Amoxicillin/doxycycline PO 5 days

34
Q

What is the treatment for severe hospital acquired pneumonia?

A

IV Amoxicillin + gentamicin

If penicillin allergic then co-trimoxazole + gentamicin

35
Q

What are the most common organisms causing community acquired pneumonia?

A

Strep pneumoniae
Atypicals
Haemophilus influenza
Staph aureus

36
Q

What are the atypical bacteria causing pneumonia?

A 
Legionella pneumophilia
Mycoplasma
Chlamydia pneumonia
Coxiella burnetti
Chlamydia psittaci
37
Q

What fungus can cause pneumonia?

A

Pneumocystis jiroveci

38
Q

How does pneumocystis jiroveci (pneumocystis pneumonia) present?

A

Subtly with dry cough without sputum, shortness of breath on exertion and night sweats

39
Q

How is pneumocystis pneumonia treated?

A

Co-trimoxazole

40
Q

What are the most common organisms causing hospital acquired pneumonia?

A

E. coli
Klebsiella
Pseudomonas aeruginosa

41
Q

What is lobar pneumonia?

A

Consolidation involving a complete lobe

42
Q

What is bronchopneumonia?

A

Infection starting int he airways and spreading to adjacent alveolar lung

43
Q

What is the onset of pneumonia?

A

Subacute - days

44
Q

What is the treatment for non-severe aspiration pneumonia?

A

Amoxicillin/doxycycline + metronidazole PO 5 days

45
Q

What is the treatment for severe aspiration pneumonia?

A

IV amoxicillin/clarithromycin + metronidazole + gentamicin

46
Q

What is the treatment for atypical pneumonia?

A

If it’s not legionella - doxycycline

If it’s legionella - clarithromycin/erythromycin or levofloxine

Y1 - Respiratory (12 decks)

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