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Respiratory Medicine > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What are the calssifications of pnuemonia

A
  • Community-acquired pneomonia (CAP)
  • Hospital - acquired pneumonia (HAP)
    • new lung parenchyma infection >48hrs after admission
  • Aspiration pneumonia
    • after inhaling foreign material
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2
Q

What organisms infect CAP?

A
  • Strep pneumonia
  • H Influenza
  • Moraxella catarrhalis
  • Atypical
    • mycoplasma pneuomonia
    • Legionella pneumophila
    • Chlamydophila pneumoniae
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3
Q

What organisms infect HAP?

A
  • Gram neg enterobacteria
    • Pseudomonas aeruginosa
    • E.coli
    • Klebsiella
  • Strep pneumonia
  • staph aureus
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4
Q

What organisms affect immunocompromised patients?

A
  • Same like CAP +
  • Pneumocystis jirovecii
  • Cytomegalovirus
  • Herpes Simplex Virus
  • Mycobacteria
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5
Q

Which patients are at risk of contracting aspiration pneumonia?

A
  • stroke
  • myasthenia
  • bulbar palsies
  • loss of conciousness
  • oesophageal disease - achalasia
  • poor dental hygiene
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6
Q

What are the Sx of pneumonia?

A
  • Fever, rigors
  • malaise
  • dyspnoea
  • productive cough - purulent
  • haemoptysis
  • pleuritic chest pain
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7
Q

What are the signs of pneumonia?

A
  • Pyrexia
  • cyanosis
  • confusion
  • tachypnoea
  • tachycardia
  • hypotension
  • signs of consolidation
  • pleural rub
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8
Q

What are the signs of consolidation?

A
  • reduced chest expansion
  • dull percussion
  • crepitations
  • bronchial breathing - peripheral of lungs
  • focal coarse crackles
  • tachycardia
  • hypotension
  • confusion
  • cyanosis
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9
Q

What scoring system would you use to assess severity of pneumonia?

A
  • CURB-65
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10
Q

What does the CURB 65 predicts?

A
  • Mortality
    • 1 = <5%
    • 3 = 15%
    • 4/5 = >25%
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11
Q

What does CURB 65 stand for

A
  • Confusion (AMTS <8)
  • Urea > 7
  • Resp rate equal or >30
  • BP <90 systolic, equal to or <60 diastolic
  • equal or >65
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12
Q

What does the different total scores indicate?

A
  • Score 0/1: Consider treatment at home
  • Score 2: Consider hospital admission
  • Score ≥ 3: Consider intensive care assessment
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13
Q

What scoring system is used for out of hospital?

A
  • CRB-65
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14
Q

What CRB-65 score will you send someone to hospital?

A
  • 0
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15
Q

What Ix would you order for pneumonia?

A
  • 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
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16
Q

What are the differentials for consolidations?

A
  • Pneumonia
  • TB (upper lungs)
  • Lung cancer
  • Lobar collapse
  • Haemorrhage
17
Q

How would you Mx CAP?

A

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
18
Q

How would you mx HAP?

A
  • Check hospital guidelines
  • Mild infections
    • Co-amoxiclav 625mg TDS
  • Severe infections
    • Tazocin (piperacillin/tazobactam) 4.5g IV TDS
19
Q

What abx would you use for atypical pneumonia?

A
  • Legionella
    • fluoroquinolone + clarithromycin
  • Chlamydophila
    • Tetracycline
  • Pneumocystis jirovecii
    • co-trimoxazole
20
Q

What is atypical pneumonia?

A
  • 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).
21
Q

What organisms causes Atypical Pneumonia?

*Legions of psittaci MCQs

A
  • Legionella pneumophila
  • Chlamydia psittaci
  • Mycoplasma pneumoniae
  • Chlamydophila pneumoniae
  • Q fever (coxiella burnetti)
22
Q

What are the features of Mycoplasma Pneumoniae

A
  • Mild pneumonia
  • slow onset
  • erythema multiform (target lesions)
  • neurological sx in young pt
  • Macrolides, tetracyclines
23
Q

What are the features of Legionella?

A
  • Caused by infected water supply/air conditioning
  • Causes SIADH - hyponatraemia
  • levofloxacin
24
Q

What are the features of Chlamydophila Pneumoniae?

A
  • school agedchild with mild-moderate pneumonia
25
Q

What are the Cx of pneumonia?

A
  • Septic shock
  • ARDS
  • Pleural effusion
  • Lung abscess
  • Empyema
  • Death

Respiratory Medicine (12 decks)

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