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Pneumonia Flashcards

1
Q

Pathophysiology of pneumonia

A

Organism reaches lungs > immune activation & infiltration (systemic response) > fluid & cellular build up in alveoli leads impaired gas exchange

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2
Q

common organisms in community acquired pneumonia

A

Streptococcus pneumoniae
Haemophilus Influenzae
Mycoplasma pneumoniae

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3
Q

less common causes of community acquired pneumonia

A

staphylococcus aureus, legionella species, Moraxella catarrhalis and chlamydia

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4
Q

rare causes of community acquired pneumonia

A

gram negative bacilli, Coxiella Burnetii and anaerobes

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5
Q

common causes of hospital acquired pneumonia

A

Gram negative bacteria enterobacteria or Staph aureus

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6
Q

less common causes of hospital acquired pneumonia

A

pseudomonas, Klebsiella, Bacteroides and Clostridia

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7
Q

risk factors for aspiration pneumonia

A

stroke, myasthenia, bulbar palsies, reduced consciousness, oesophageal disease or poor dental hygiene

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8
Q

which anaerobes cause aspiration pneumonia

A

oesophageal

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9
Q

which pneumonia has HIV as a buzzword

A

pneumocystis jirvoveci

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10
Q

causative organisms of immunocompromised pneumonia

A

o Strep pneumoniae, h. Influenzae, staph aureus, m. catarrhalis, m. pneumoniae, gram -ve bacilli and pneumocystis jirvoveci

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11
Q

organisms of atypical pneumonia

A

Mycoplasma pneumoniae
Coxiella
Chlamydophila
Legionella?

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12
Q

classifications of pneumonia based on regions affected

A

Lobar
Bronchopneumonia
Atypical/Interstitial

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13
Q

Common symptoms of pneumonia (10)

A

Fever, Rigors, Malaise, Anorexia, Dyspnoea, Cough, Purulent sputum, Haemoptysis, Pleuritic pains

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14
Q

Common signs of pneumonia (8)

A

Pyrexia, Cyanosis, Confusion, Tachypnoea, Tachycardia, Hypotension, Consolidation, Pleural rub

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15
Q

what does signs indicate consolidation of lung

A

diminished expansion, dull percussion, tactile vocal fremitus, bronchial breathing

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16
Q

what is the main method of diagnosis of pneumonia?

A

sputum: for microscopy and culture

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17
Q

in severe cases of pneumonia, what other tests could you consider?

A

Legionella (sputum culture, urine antigen)
Atypical organism/viral serology: PCR sputum/BAL, complement fixation tests acutely, paired serology
Check pneumococcal antigen in urine
Pleural fluid aspiration for culture
Consider bronchoscopy and bronchoalveolar lavage if patient is immunocompromised or on ITU

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18
Q

What does CURB65 stand for?

A 
C 	new onset of confusion
U	urea > 7
R	respiratory rate >30/min
B	blood pressure systolic <90 OR diastolic <61
65	age 65 years or older
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19
Q

what does the CURB65 score represent?

A

increased score = increased mortality

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20
Q

treatment of CURB65 = 0 in primary care

A

Usually treat at home amoxicillin 1g tds

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21
Q

treatment of CURB65 = 1 in primary care

A

Usually treat at home Consider hospital referral if major co morbidity

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22
Q

treatment of CURB65 = 2 in primary care

A

Consider hospital referral

23
Q

treatment of CURB65 = 3-4 in primary care

A

Urgent hospital admission Give amoxicillin 1g oral or benzylpenicillin 1.2g IV before transfer (withhold if known anaphylaxis)

24
Q

how to treat CAP with CURB65 = 0-2 in the hospital

A

Amoxicillin 1g tds IV/PO (total 5days)

25
how to treat CAP with CURB65 = 3-5 in the hospital
Co-amoxiclav IV 1.2g tds + Doxycycline PO 100mg bd
26
how to treat CAP in ICU/HDU
Co-amoxiclav IV 1.2g tds + Clarithromycin* IV 500mg bd
27
step down treatment of severe CAP in the hospital
Doxycycline 100mg bd for ALL patients with severe CAP TOT AL IV/PO 7 days
28
treatment of non severe HAP in the hospital
PO Amoxicillin
29
treatment of severe HAP in hospital
IV Amoxicillin + Gentamicin | Step down: PO Co-trimoxazole TOTAL IV/PO 7 days
30
treatment of non severe aspiration pneumonia
PO Amoxicillin + Metronidazole
31
treatment of severe aspiration pneumonia
IV Amoxicillin + Metronidazole + Gentamicin
32
step down treatment of aspiration pneumonia
PO Amoxicillin + Metronidazole
33
treatment of penicillin allergic CURB65 0 in primary care
doxycycline 200mg day 1 then 100mg daily (5 days total)
34
treatment of penicillin allergic CURB65 = 0-2 CAP in the hospital
:Doxycycline PO 200mg on day 1 then 100mg od or IV Clarithromycin* if NBM
35
treatment of penicillin allergic CURB65 = 3-5 CAP in the hospital
IV Levofloxacin 500mg bd monotherapy
36
treatment of penicillin allergic ICU/HDU CAP
IV Levofloxacin 500mg bd monotherapy
37
treatment of penicillin allergic non severe HAP in the hospital
Doxycycline 100mg bd (5 days)
38
treatment of penicillin allergic severe HAP in the hospital
IV Co-trimoxazole + Gentamicin) Step down: PO Co-trimoxazole TOTAL IV/PO 7 days
39
treatment of penicillin allergic non severe aspiration pneumonia
PO Doxycycline 100mg bd + Metronidazole) TOTAL 5 days
40
treatment of penicillin allergic severe aspiration pneumonia
(PO Doxycycline or IV Clarithrimycin) + Metronidazole + Gentamicin
41
potential complications of pneumonia
Respiratory failure, Hypotension, Atrial fibrillation, Pleural effusion, Emphyemal Lung Abscess, Septicaemia, Pericarditis and myocarditis, Jaundice, Death
42
key features of streptococcus pneumoniae
80% of cases, High fever, rapid onset, herpes labialsis, “rust colour”
43
key features of haemophilius influenza
Common in patients with COPD, secondary (opportunisitic) Productive cough
44
key features of staphylococcus aureus
often found following influenza
45
key features of mycoplasma pneumoniae
Atypical. Has autoimmune haemolytic anaemia and erythema multiform may be seen. Young person. Ulcers/ oral dusting Dry cough and atyoical chest/xray signs. Consolidation of lower lobe.
46
key features of legionella pneumophila
Atypical. Urine antigen Haemonatreaemia | Lymphopenia Cooling towers, air condition untils, typically people get when going abroad or work with those listed above
47
key features of pneumocystits jirveci
alcoholics and diabetes
48
key features of coxiella burnetti
Found in patients with HIV or immunosuppressed, Drug users | Dry cough, Exercise induced desaturations, Absent chest signs (bat wings)
49
key features of chlamydophil psittaci
Mucoid sputum (grey) Presents as pneumonia Birds
50
key features of mycobacterium tuberculosis
TB, asymptomatic latent or active, systemic symptoms, sputum+/-haemoptysis
51
how do you differ pneumonia to a LRTI?
pneumonia requires presence on xray
52
what supportive management do you consider for CAP?
o2 | fluids
53
Bonus points in pneumonia treatment
``` recognise need CXR give antibiotics within 6 hours stop simvastatin (with clarithromycin) Prophylactic LWMH Think about level of care (DNAR) ```

Respiratory (12 decks)

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