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Y1 Respiratory > Pneumonia and its complications + Fibrosis > Flashcards

Pneumonia and its complications + Fibrosis Flashcards

1
Q

Pathogens causing pneumonia

A

Viruses - influenza / haemophilus influenza / coronavirus / parainfluenza
Bacteria
Fungus - aspergillus / pneumocystis

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2
Q

Clinical settings of pneumonia

A

Community acquired pneumonia

Hospital acquired pneumonia

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3
Q

Hospital acquired pneumonia is defined as

A

development of pneumonia 48hrs or more after hospitalization and there is no sign of incubation when admitted

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4
Q

What is aspiration pneumonia

A

Pneumonia caused by inhaled substances such as vomit / saliva / liquid / food / foreign substances

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5
Q

What is pneumonia

A

Infection of the alveoli

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6
Q

Most common pathogen causing CAP

A

Streptococcus pneumoniae

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7
Q

Most common pathogen causing HAP

A

Staphylococcus aureus

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8
Q

Treatment of CAP

A

Oral Amoxicillin is the first line treatment
- if allergic: oral doxycyline
Review choice of drug if the patient is still unwell or if the microbiological results came back

Co-amoxicillin if severe

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9
Q

Treatment of CAP (suspect atypical organisms)

A

Macrolide

Oral clarithromycin / oral erythromycin

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10
Q

Treatment of HAP

A

Mild severity or within 5 days : co-amoxiclav

Severe or after 5 days : piperacillin + tazobactam / cefuroxime / ciprofloxacin

Consider gentamicin if caused by gram negative

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11
Q

Herpes Liabilis is most associated with which pathogen

A

Streptococcus Pneumoniae

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12
Q

Symptoms of pneumonia caused by streptococcus pneumoniae

A

Herpes liabilis
high fever
pleuritic chest pain
productive cough

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13
Q

What symptoms are commonly seen in Legionella pneumonia

A

Hyponatraemia

Lymphopenia

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14
Q

Common pathogens causing HAP

A

Staphylococcus a.
Pseudomonas a.
Klebsiella p.
e. coli

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15
Q

Complications of pneumonia

A

Fibrosis
Bronchiectasis
Abscesses
Empyema

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16
Q

Which group of patients does pneumocystis jiroveci commonly affect

A

common in HIV patients

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17
Q

Which pathogen is most commonly associated with alcoholics

A

Klebsiella

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18
Q

Which pathogen is most commonly associated with pneumonia after influenza infection

A

staphylococcus aureus

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19
Q

Features of pneumonia caused by Klebsiella

A

Mainly affects upper lobe
Causes cavitating pneumonia
produce red sputum
increase in risk of complications

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20
Q

Complications of mycoplasma pneumoniae

A

Guillain Barre’s syndrome - nerve damage causing muscle paralysis/ weakness
Erythema multiforme
Steven’s-Johnson syndrome
Autoimmune haemolytic anaemia

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21
Q

What is normally shown on CXR for mycoplasma pneumonia

A

Nodular opacity

Lower lobe

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22
Q

What are the atypical pathogens of pneumonia

A

Legionella
Mycoplasma
Chlamydia

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23
Q

Symptoms caused by mycoplasma pneumoniae

A

Dry cough
myalgia
headache

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24
Q

Which bronchi is most likely to be affected by aspiration pneumonia

A

Right bronchus

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25
Which lung lobe is most likely to be affected by aspiration pneumonia
Right lower lobe or right middle lobe
26
Which groups of people are more at risk of pneumonia due to Klebsiella
Elderly Alcoholics Diabetics people with long term steroid use
27
What are the clinical findings of pneumonia
Dull percussion Bronchial breathing Increased vocal resonance
28
Which GI condition is associated with greater risk of aspiration pneumoniae
GORD
29
What are patients with aspiration pneumonia more at risk of developing
Lung abscess
30
Which pathogen produces red sputum
Klebsiella
31
What type of microorganism is pneumocystis jiroveci
Fungus
32
Symptoms caused by pneumocystis jiroveci
Dry cough dyspnea fever
33
Diagnosis of pneumonia
``` ABG Blood tests Blood culture Sputum culture CURB65 (or CRB65 in primary setting) CXR ```
34
What would blood tests show in pneumonia
Increased CRP Raised WCC Neutrophilia
35
What is CURB65 score for
Assess mortality risk of pneumonia
36
What does CURB65 stand for
``` Confusion Urea Raised respiratory rate Blood pressure (low) Age 65 years or more ```
37
Why should you be careful about using CURB 65 score
Because young patients normally develop those symptoms at very late stage so young patients with 0 CURB65 score does not mean that they are well Elderly also automatically gains one point but doesn't mean they are unwell
38
Initial management of pneumonia
IV fluids Oxygen Analgesia
39
Management for CAP
``` Low severity: - amoxicillin or levofloxacin Intermediate - amoxicillin + clarithromycin Severe: - co amoxiclav + clarithromycin ```
40
What drug is used if the patient is penicillin allergic
Doxycycline or clarithromycin
41
Which group of drug does clarithromycin belong to
Macrolide, a broad spectrum bacteriostatic antibiotic
42
What type of drug is amoxicillin
Penicillin; Broad spectrum Beta lactam
43
Beta lactam mechanism of action
Blocks peptidoglycan cross linking during cell wall synthesis, creating a hole in wall so the bacteria lyses and dies
44
Management of HAP
Within 5 days - co amoxiclav After 5 days - piperacillin + tazobactam / ciprofloxacin / cefuroxime
45
Management of aspiration pneumonia
Low severity: - Oral metronidazole + oral co-amoxiclav High severity: - IV metronidazole + IV gentamicin + IV amoxicillin
46
What type of drug is doxycycline
Tetracycline- broac spectrum Bacteriostatic drug
47
Mechanism of action of bacteriostatic drugs
Stops the growth of bacteria by interfering with protein production or cellular metabolism. It does not kill the bacteria
48
Which group of drug is clarithromycin part of
Macrolides
49
Which group of drug is doxycycline part of
Tetracycline antibiotics
50
Mechanism of action of macrolides
Bacteriostatic
51
What pathogens commonly cause lung abscesses to form
Streptococcus Staph. aureus E.coli Aspergillus
52
What causes abscesses
Infection causes necrosis of tissue, creating a hole then dead pathogens or cells form pus which fills in the hole
53
Symptoms of abscesses
Malaise Weight loss Cough Fever
54
Are the symptoms of abscesses acute or chronic
Chronic
55
What can be seen on CXR in a patient with lung abscess
Opacity with clear edges. | No shift in mediastinum
56
What is empyema
Pus in pleural cavity
57
What are the complications of pneumonia
``` Fibrosis Abscesses Empyema Bronchiectasis Bacteriaemia ```
58
How will pleuritic chest pain be described as
Sharp, stabbing, worse on inspiration
59
Symptoms of empyema
``` Dyspnea Fever Pleuritic chest pain Cough Weight loss ```
60
Diagnosis of empyema
CXR Ultrasound Thoracocentesis CT scan
61
What would CXR show for empyema
Opacity | Normally collect at costophrenic angle, no clear angles, not diffuse
62
What is thoracocentesis
Ultrasound guided | Remove pus fluid from the pleural cavity for microbiological assessment
63
What would the pH and glucose level be if the fluid from pleural cavity was pus
pH < 7 | glucose < 40
64
Management of empyema
Chest drain | Antibiotics
65
Where is the interstitial space in lungs
Space between the capillaries and alveoli
66
What is interstitial lung disease (pulmonary fibrosis)
Large group of diseases that causes scarring of the lungs hence thickening of the interstitial space, reducing rate of diffusion and making breathing difficult
67
Examples of interstitial lung disease
Idiopathic interstitial pneumonia Sarcoidosis asbestos / silica exposure related Rheumatoid arthiritis
68
What is the most common example of idiopathic interstitial pneumonia
Idiopathic pulmonary fibrosis
69
What are the factors related to ILD
``` Autoimmune disease (rheumatoid arthritis / lupus) Sarcoidosis Idiopathic interstitial pneumonia Long term exposure related (asbestos/ silica) ```
70
What drugs may cause idiopathic pulmonary fibrosis
Long term use of Amiodarone (used in arrhythmias) Methotrexate (used in Crohn's) Nitrofurantoin
71
What is nitrofurantoin used for
Commonly given to elderly patients with recurrent urinary tract infection
72
Symptoms of idiopathic pulmonary fibrosis
Progressive breathlessness (on exertion) dry cough Bilateral inspiratory crackles Clubbing
73
Is interstitial lung disease restrictive or obstructive
Restrictive lung disease
74
What will the spirometry results be for pulmonary fibrosis
FEV1/FVC = normal ( >80%) BUT FEV1 < 70% and FVC < 70% Both FEV1 and FVC decrease but the ratio is normal
75
Diagnosis of Idiopathic pulmonary fibrosis
Blood tests Spirometery / TLCO / lung volumes Imaging - CXR / CT
76
What is TLCO
Transfer factor for carbon monoxide; measures how good the transfer of inspired gas to RBC is (measures how good diffusion is)
77
What would TLCO be for interstitial lung disease
decreased
78
What would imaging show for idiopathic pulmonary fibrosis
bilateral infiltrates Net-like shadowing at peripheries of lung , more prominent at lung base Heart edges less distinct
79
What conditions can be caused by pulmonary fibrosis
bronchiectasis | Atelectasis
80
What would CT scan show in pulmonary fibrosis
Honeycombing (clusters of air) traction bronchiectasis reticular (net like) opacities Most prominent at bases
81
Management of IPF
Palliative, supportive Oxygen if hypoxic Pirfenidone + nintendanib Lung transplant for young patients
82
What are pirfenidone and nintedanib
Antifibrotic drugs; they do not reverse fibrosis, only slows progression
83
Which condition do patients with IPF ultimately progress into
Respiratory failure
84
What type of hypersensitivity is sarcoidosis
Type IV hypersensitivity
85
What is type IV hypersensitivity
Delayed hypersensitivity; cell mediated
86
Describe type IV hypersensitivity mechanism (sensitization stage)
Sensitization phase 1) Antigen engulfed by dendritic cells and presented on MHC II 2) Dendritic cell moves into lymph node. Specific T cell binds to the antigen on MHC II 3) Co-stimulatory molecules on dendritic cells interact with receptors on T cells, causing the T cell to be fully activated 4) activated T cell proliferates and differentiates into Th1 cell. 5) Th1 cell secretes TNF-gamma and IL-2
87
Describe type IV hypersensitivity effector phase
re-encounter of same antigen causes recruitment of the specific Th1 cells and cause inflammation
88
Why is type IV hypersensitivity called delayed hypersensitivity
Because the signs and symptoms only develop 48-72 hours after encountering the antigen; this is because it takes time to recruit the Th1 cells
89
What proinflammatory cytokines do macrophages release
TNF, IL-1 , IL-6
90
What cytokines do Th1 cells release
IL-2, TNF-gamma
91
Function of IL-2
Helps Th1 cells and other cells to proliferate
92
What systems can be affected by sarcoidosis
``` Lungs - alveolitis -> pulmonary sarcoidosis Eyes - uveitis Skin - erythema nodosum / lupus pernio Joint - arthritis Hypercalcaemia ```
93
What causes hypercalcaemia
Increase in level of calcitrol -> Increase in activated vitamin D -> increase in Ca2+
94
What histopathological feature does sarcoidosis cause
Non-caseating granuloma
95
Which lung condition causes caseating granuloma
TB
96
Diagnosis of pulmonary sarcoidosis
``` ABG Blood tests Spirometry CXR CT Tissue biopsy ```
97
What would be seen in spirometry for pulmonary sarcoidosis
Restrictive pattern | Reduced FEV1 and FVC but normal FEV1/FVC ratio
98
What would be seen on CXR for sarcoidosis
Bilateral hilar lymphadenopathy | reticulonodular opacities
99
Management of mild sarcoidosis
No treatment bc it often resolves by itself | Monitor spirometry and CXR over several years bc it may recur
100
Management of severe sarcoidosis
Steroids Immunosuppressants Biologics
101
What immunosuppressants are used against sarcoidosis
Azathioprine / methotrexate
102
What biologic is used for sarcoidosis
anti-TNF
103
Why should patients be screened for TB before using anti-TNF
Because it may trigger latent TB
104
Which lung fibrosis is most likely to occur at upper lobe
Sarcoidosis
105
Which lung lobe does pneumonia caused by klebsiella usually affect
Upper lobes
106
What is a characteristic feature caused by klebsiella pneumoniae
Red current jelly sputum
107
Which pathogen increases risk of developing complications of pneumonia
Klebsiella
108
Which age group does mycoplasma pneumoniae usually affect
Young
109
Feature of pneumonia caused by legionella pneumoniae
Hyponatraemia Lymphopenia Deranged LFT
110
Symptoms caused by streptococcus pneumoniae
Symptoms are rapid onset Herpes liabilis High fever
111
What is the most common pathogen causing pneumonia in patients after influenza infection
Staphylococcus aureus
112
What is the most common pathogen causing pneumonia in patents with COPD
Haemophilus influenza
113
What are the most common pathogens causing COPD exacerbations
Haemophilus influenza Streptococcus pneumonia Rhinovirus
114
Management of acute exacerbation of COPD
Consider giving bronchodilator through nebuliser Oral prednisolone for 5 days Amoxicillin / doxycyline / clarythromycin if the sputum is purulent
115
Why should you use nebuliser in acute exacerbations of COPD
because nebulisers turn the liquid drug into fine mist so can deliver high doses very quickly

Y1 Respiratory (4 decks)

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