Pneumonia Flashcards
What are the calssifications of pnuemonia
- Community-acquired pneomonia (CAP)
- Hospital - acquired pneumonia (HAP)
- new lung parenchyma infection >48hrs after admission
- Aspiration pneumonia
- after inhaling foreign material
What organisms infect CAP?
- Strep pneumonia
- H Influenza
- Moraxella catarrhalis
- Atypical
- mycoplasma pneuomonia
- Legionella pneumophila
- Chlamydophila pneumoniae
What organisms infect HAP?
- Gram neg enterobacteria
- Pseudomonas aeruginosa
- E.coli
- Klebsiella
- Strep pneumonia
- staph aureus
What organisms affect immunocompromised patients?
- Same like CAP +
- Pneumocystis jirovecii
- Cytomegalovirus
- Herpes Simplex Virus
- Mycobacteria
Which patients are at risk of contracting aspiration pneumonia?
- stroke
- myasthenia
- bulbar palsies
- loss of conciousness
- oesophageal disease - achalasia
- poor dental hygiene
What are the Sx of pneumonia?
- Fever, rigors
- malaise
- dyspnoea
- productive cough - purulent
- haemoptysis
- pleuritic chest pain
What are the signs of pneumonia?
- Pyrexia
- cyanosis
- confusion
- tachypnoea
- tachycardia
- hypotension
- signs of consolidation
- pleural rub
What are the signs of consolidation?
- reduced chest expansion
- dull percussion
- crepitations
- bronchial breathing - peripheral of lungs
- focal coarse crackles
- tachycardia
- hypotension
- confusion
- cyanosis
What scoring system would you use to assess severity of pneumonia?
- CURB-65
What does the CURB 65 predicts?
- Mortality
- 1 = <5%
- 3 = 15%
- 4/5 = >25%
What does CURB 65 stand for
- Confusion (AMTS <8)
- Urea > 7
- Resp rate equal or >30
- BP <90 systolic, equal to or <60 diastolic
- equal or >65
What does the different total scores indicate?
- Score 0/1: Consider treatment at home
- Score 2: Consider hospital admission
- Score ≥ 3: Consider intensive care assessment
What scoring system is used for out of hospital?
- CRB-65
What CRB-65 score will you send someone to hospital?
- 0
What Ix would you order for pneumonia?
- Bedside
- O2 sats
- Sputum culture
- Urine antigen - Legionella/Pneumococcal
- PCR sputum - viral serology
- Bloods
- FBC, U&E, LFT, CRP
- Imaging
- CXR
- Special test
- Pleural fluid aspiration
- bronchoscopy
- bronchoalveolar lavage
What are the differentials for consolidations?
- Pneumonia
- TB (upper lungs)
- Lung cancer
- Lobar collapse
- Haemorrhage
How would you Mx CAP?
1. Oxygen
- aim 94-98% (normal lungs) 88-92% (COPD)
2. IV fluids
3. Analgesia
4. ABX
- Low severity (5-7days)
- Amoxicillin
- Doxycycline or Clarithromycin (if penicillin allergy)
- Intermediate severity (7-10 days)
- Amoxicillin + Clarithromycin
- replace amox with doxy if pen allery
- High severity (14-21 days)
- IV co-amoxiclav and IV clarithromycin
How would you mx HAP?
- Check hospital guidelines
-
Mild infections
- Co-amoxiclav 625mg TDS
-
Severe infections
- Tazocin (piperacillin/tazobactam) 4.5g IV TDS
What abx would you use for atypical pneumonia?
- Legionella
- fluoroquinolone + clarithromycin
- Chlamydophila
- Tetracycline
- Pneumocystis jirovecii
- co-trimoxazole
What is atypical pneumonia?
- pneumonia caused by an organism that cannot be cultured in the normal way or detected using a gram stain
- don’t respond to penicillins and can be treated with macrolides (e.g. clarithomycin), fluoroquinolones (e.g. levofloxacin) or tetracyclines (e.g. doxycycline).
What organisms causes Atypical Pneumonia?
*Legions of psittaci MCQs
- Legionella pneumophila
- Chlamydia psittaci
- Mycoplasma pneumoniae
- Chlamydophila pneumoniae
- Q fever (coxiella burnetti)
What are the features of Mycoplasma Pneumoniae
- Mild pneumonia
- slow onset
- erythema multiform (target lesions)
- neurological sx in young pt
- Macrolides, tetracyclines
What are the features of Legionella?
- Caused by infected water supply/air conditioning
- Causes SIADH - hyponatraemia
- levofloxacin
What are the features of Chlamydophila Pneumoniae?
- school agedchild with mild-moderate pneumonia
What are the Cx of pneumonia?
- Septic shock
- ARDS
- Pleural effusion
- Lung abscess
- Empyema
- Death
