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Respiratory > Pneumonia and Bronchitis > Flashcards

Pneumonia and Bronchitis Flashcards

1
Q

What are risk factors/aetiology for pneumonia?

A

Immunosuppressed

Smoking

Chronic lung disease: COPD

>Age

Associated conditions: Diabetes, alcoholism

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2
Q

What organisms can cause pneumonia?

A

Streptococci Pneumoniae

Staphylococcus aureus

Haemophilus Influenzae

Legionella: Younger patients, poorly maintained air conditioning systems

Mycoplasma Pneumoniae

Chlamydia Psittaci

Coxiella Burnetii

Klebsiella pneumoniae

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3
Q

Describe the presentation of pneumonia

A

Cough with purulent green sputum

Reduced chest expansion

Pleuritic chest pain (sharp chest pain worse on inspiration)

Myalgia

Stony dull percussion

Crepitations on auscultation/coarse crackles

Fever

Tachycardia

Tachypnoea

Bronchial breathing

  • Harsh breath sounds equal on inspiration and expiration caused by consolidation of lung tissue

Pleural rub

>Vocal resonance

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4
Q

What investigations are used in pneumonia diagnosis?

A

CXR

Sputum Culture and gram stain

FBC

  • >WCC

>CRP

U&E for urea

ABG

  • Hypoxia

Urinary Legionella antigen

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5
Q

What is the CURB-65 classification?

A

Determines risk of mortality of pneumonia

C: Confusion

U: Urea>7 mmoles/l

R: RR>30/min

B: <90/60mmHg

>65

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6
Q

What does a CURB-65 score of 0 suggest?

A

Low risk of death, no need for admission

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7
Q

What does a CURB-65 score of 1-2 suggest?

A

Increased risk, should be admitted

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8
Q

What does a CURB-65 score of >3 suggest?

A

Urgent hospital admission, consider intensive care assessment

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9
Q

What is the management of pneumonia?

A

Non-severe

  • 5 days of treatment
  • Amoxicillin

Severe

  • 7 days of treatment
  • Amoxicillin + Clarithromycin
  • Co-Amoxiclav

Supportive

  • IV fluids
  • Oxygen
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10
Q

What are the possible complications of pneumonia?

A

Sepsis

Lung abscess

Respiratory failure

Empyema

Death

Bronchiectasis

Exudate pleural effusion

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11
Q

What investigation is used to monitor response to treatment in pneumonia?

A

CRP

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12
Q

What area of the lung is aspiration pneumonia most common in?

A

Right lower lobe

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13
Q

What organism is associated with pneumonia in diabetics and alcoholics?

A

Klebsiella Pneumoniae

Associated with red currant sputum

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14
Q

What organism is associated with pneumonia in bird owners?

A

Chlamydia Psittaci

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15
Q

What organism is associated with younger patients and a target rash?

A

Mycoplasma pneumoniae

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16
Q

What organism causes fungal pneumonia in severely immunocompromised patients/HIV?

A

Pneumocystis jiroveci

17
Q

What organism is associated with. pneumonia post influenza infection?

A

Staph aureus

18
Q

What organism is associated with pneumonia in patients exposed to infected water supplies and poor air ventilation?

A

Legionella pneumophila

Also causes hyponatraemia

19
Q

What organism is associated with pneumonia in farmers/exposure to animals?

A

Coxiella burnetii

20
Q

What is important to remember about CRP when monitoring pneumonia?

A

Shows a lag in decreasing compared to WCC in treatment of acute bacterial infection

21
Q

Give risk factors for aspiration pneumonia

A

Poor dental hygiene

Swallowing difficulties

Prolonged hospitalization or surgical procedures

Impaired consciousness

Impaired mucociliary clearance

Intubation

22
Q

What are the classes of pneumonia?

A

Community aquired

Hospital aquired, developed more tha 48 hours after hospital admission

Aspiration

23
Q

What is the difference between CURB-65 outside and inside hospital?

A

Outside hospital does not count urea

24
Q

Describe the prognosis of pneumonia at 1 week?

A

Fever should have resolved

25
Q

Describe the prognosis of pneumonia at 4 weeks

A

Chest pain and sputum culture should have substantially reduced

26
Q

Describe the prognosis of pneumonia at 6 weeks

A

Cough and breathlessness should have substantially resolved

27
Q

Describe the prognosis of pneumonia at 3 months

A

Most symptoms should have resolved but fatigue may be present

28
Q

What is the prognosis of pneumonia at 6 months?

A

Most patients should be back to normal

29
Q

How is pneumocystis jiroveci pneumonia managed?

A

Co-trimoxazole and steroids

30
Q

What is acute bronchitis?

A

Self limiting chest infection caused by inflammation of the trachea and major bronchi and therefore associated with oedematous large airways and the production of sputum

31
Q

What is the prognosis of bronchitis?

A

The disease course usually resolves before 3 weeks, however 25% of patients will still have a cough beyond this time

32
Q

What organisms cause bronchitis?

A

Viral

33
Q

How does bronchitis present?

A

Cough that may or may not be productive

Sore throat

Rhinorrhoea

Wheeze, no other focal chest signs

Low grade fever

34
Q

How is bronchitis managed?

A

Analgesia

Good fluid intake

Consider antibiotic therapy if patients:

  • Are systemically very unwell
  • Have pre-existing co-morbidities
  • Have a CRP of 20-100mg/L (offer delayed prescription) or a CRP >100mg/L (offer antibiotics immediately)
  • Doxycycline or amoxicillin for children/pregnant women
35
Q

What antibiotic is used in aspiration pneumonia?

A

Metronidazole

36
Q

What is gold standard in diagnosing pneumocystitis pneumonia?

A

Bronchoalveolar lavage

Respiratory (14 decks)

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