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Respiratory > Pneumonia > Flashcards

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
Q

how to treat CAP with CURB65 = 3-5 in the hospital

A

Co-amoxiclav IV 1.2g tds + Doxycycline PO 100mg bd

26
Q

how to treat CAP in ICU/HDU

A

Co-amoxiclav IV 1.2g tds + Clarithromycin* IV 500mg bd

27
Q

step down treatment of severe CAP in the hospital

A

Doxycycline 100mg bd for ALL patients with severe CAP TOT AL IV/PO 7 days

28
Q

treatment of non severe HAP in the hospital

A

PO Amoxicillin

29
Q

treatment of severe HAP in hospital

A

IV Amoxicillin + Gentamicin

Step down: PO Co-trimoxazole TOTAL IV/PO 7 days

30
Q

treatment of non severe aspiration pneumonia

A

PO Amoxicillin + Metronidazole

31
Q

treatment of severe aspiration pneumonia

A

IV Amoxicillin + Metronidazole + Gentamicin

32
Q

step down treatment of aspiration pneumonia

A

PO Amoxicillin + Metronidazole

33
Q

treatment of penicillin allergic CURB65 0 in primary care

A

doxycycline 200mg day 1 then 100mg daily (5 days total)

34
Q

treatment of penicillin allergic CURB65 = 0-2 CAP in the hospital

A

:Doxycycline PO 200mg on day 1 then 100mg od or IV Clarithromycin* if NBM

35
Q

treatment of penicillin allergic CURB65 = 3-5 CAP in the hospital

A

IV Levofloxacin 500mg bd monotherapy

36
Q

treatment of penicillin allergic ICU/HDU CAP

A

IV Levofloxacin 500mg bd monotherapy

37
Q

treatment of penicillin allergic non severe HAP in the hospital

A

Doxycycline 100mg bd (5 days)

38
Q

treatment of penicillin allergic severe HAP in the hospital

A

IV Co-trimoxazole + Gentamicin) Step down: PO Co-trimoxazole TOTAL IV/PO 7 days

39
Q

treatment of penicillin allergic non severe aspiration pneumonia

A

PO Doxycycline 100mg bd + Metronidazole) TOTAL 5 days

40
Q

treatment of penicillin allergic severe aspiration pneumonia

A

(PO Doxycycline or IV Clarithrimycin) + Metronidazole + Gentamicin

41
Q

potential complications of pneumonia

A

Respiratory failure, Hypotension, Atrial fibrillation, Pleural effusion, Emphyemal Lung Abscess, Septicaemia, Pericarditis and myocarditis, Jaundice, Death

42
Q

key features of streptococcus pneumoniae

A

80% of cases, High fever, rapid onset, herpes labialsis, “rust colour”

43
Q

key features of haemophilius influenza

A

Common in patients with COPD, secondary (opportunisitic) Productive cough

44
Q

key features of staphylococcus aureus

A

often found following influenza

45
Q

key features of mycoplasma pneumoniae

A

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
Q

key features of legionella pneumophila

A

Atypical. Urine antigen Haemonatreaemia

Lymphopenia Cooling towers, air condition untils, typically people get when going abroad or work with those listed above

47
Q

key features of pneumocystits jirveci

A

alcoholics and diabetes

48
Q

key features of coxiella burnetti

A

Found in patients with HIV or immunosuppressed, Drug users

Dry cough, Exercise induced desaturations, Absent chest signs (bat wings)

49
Q

key features of chlamydophil psittaci

A

Mucoid sputum (grey) Presents as pneumonia Birds

50
Q

key features of mycobacterium tuberculosis

A

TB, asymptomatic latent or active, systemic symptoms, sputum+/-haemoptysis

51
Q

how do you differ pneumonia to a LRTI?

A

pneumonia requires presence on xray

52
Q

what supportive management do you consider for CAP?

A

o2

fluids

53
Q

Bonus points in pneumonia treatment

A 
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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