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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
Q

Which lung lobe is most likely to be affected by aspiration pneumonia

A

Right lower lobe or right middle lobe

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26
Q

Which groups of people are more at risk of pneumonia due to Klebsiella

A

Elderly
Alcoholics
Diabetics
people with long term steroid use

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27
Q

What are the clinical findings of pneumonia

A

Dull percussion
Bronchial breathing
Increased vocal resonance

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28
Q

Which GI condition is associated with greater risk of aspiration pneumoniae

A

GORD

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29
Q

What are patients with aspiration pneumonia more at risk of developing

A

Lung abscess

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30
Q

Which pathogen produces red sputum

A

Klebsiella

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31
Q

What type of microorganism is pneumocystis jiroveci

A

Fungus

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32
Q

Symptoms caused by pneumocystis jiroveci

A

Dry cough
dyspnea
fever

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33
Q

Diagnosis of pneumonia

A 
ABG
Blood tests 
Blood culture
Sputum culture
CURB65 (or CRB65 in primary setting) 
CXR
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34
Q

What would blood tests show in pneumonia

A

Increased CRP
Raised WCC
Neutrophilia

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35
Q

What is CURB65 score for

A

Assess mortality risk of pneumonia

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36
Q

What does CURB65 stand for

A 
Confusion
Urea
Raised respiratory rate
Blood pressure (low) 
Age 65 years or more
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37
Q

Why should you be careful about using CURB 65 score

A

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

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38
Q

Initial management of pneumonia

A

IV fluids
Oxygen
Analgesia

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39
Q

Management for CAP

A 
Low severity:
- amoxicillin or levofloxacin 
Intermediate
- amoxicillin + clarithromycin
Severe:
- co amoxiclav + clarithromycin
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40
Q

What drug is used if the patient is penicillin allergic

A

Doxycycline or clarithromycin

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41
Q

Which group of drug does clarithromycin belong to

A

Macrolide, a broad spectrum bacteriostatic antibiotic

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42
Q

What type of drug is amoxicillin

A

Penicillin; Broad spectrum Beta lactam

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43
Q

Beta lactam mechanism of action

A

Blocks peptidoglycan cross linking during cell wall synthesis, creating a hole in wall so the bacteria lyses and dies

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44
Q

Management of HAP

A

Within 5 days
- co amoxiclav
After 5 days
- piperacillin + tazobactam / ciprofloxacin / cefuroxime

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45
Q

Management of aspiration pneumonia

A

Low severity:
- Oral metronidazole + oral co-amoxiclav
High severity:
- IV metronidazole + IV gentamicin + IV amoxicillin

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46
Q

What type of drug is doxycycline

A

Tetracycline- broac spectrum Bacteriostatic drug

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47
Q

Mechanism of action of bacteriostatic drugs

A

Stops the growth of bacteria by interfering with protein production or cellular metabolism. It does not kill the bacteria

48
Q

Which group of drug is clarithromycin part of

A

Macrolides

49
Q

Which group of drug is doxycycline part of

A

Tetracycline antibiotics

50
Q

Mechanism of action of macrolides

A

Bacteriostatic

51
Q

What pathogens commonly cause lung abscesses to form

A

Streptococcus
Staph. aureus
E.coli
Aspergillus

52
Q

What causes abscesses

A

Infection causes necrosis of tissue, creating a hole then dead pathogens or cells form pus which fills in the hole

53
Q

Symptoms of abscesses

A

Malaise
Weight loss
Cough
Fever

54
Q

Are the symptoms of abscesses acute or chronic

A

Chronic

55
Q

What can be seen on CXR in a patient with lung abscess

A

Opacity with clear edges.

No shift in mediastinum

56
Q

What is empyema

A

Pus in pleural cavity

57
Q

What are the complications of pneumonia

A 
Fibrosis 
Abscesses
Empyema
Bronchiectasis
Bacteriaemia
58
Q

How will pleuritic chest pain be described as

A

Sharp, stabbing, worse on inspiration

59
Q

Symptoms of empyema

A 
Dyspnea
Fever
Pleuritic chest pain
Cough
Weight loss
60
Q

Diagnosis of empyema

A

CXR
Ultrasound
Thoracocentesis
CT scan

61
Q

What would CXR show for empyema

A

Opacity

Normally collect at costophrenic angle, no clear angles, not diffuse

62
Q

What is thoracocentesis

A

Ultrasound guided

Remove pus fluid from the pleural cavity for microbiological assessment

63
Q

What would the pH and glucose level be if the fluid from pleural cavity was pus

A

pH < 7

glucose < 40

64
Q

Management of empyema

A

Chest drain

Antibiotics

65
Q

Where is the interstitial space in lungs

A

Space between the capillaries and alveoli

66
Q

What is interstitial lung disease (pulmonary fibrosis)

A

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
Q

Examples of interstitial lung disease

A

Idiopathic interstitial pneumonia
Sarcoidosis
asbestos / silica exposure related
Rheumatoid arthiritis

68
Q

What is the most common example of idiopathic interstitial pneumonia

A

Idiopathic pulmonary fibrosis

69
Q

What are the factors related to ILD

A 
Autoimmune disease (rheumatoid arthritis / lupus) 
Sarcoidosis 
Idiopathic interstitial pneumonia
Long term exposure related (asbestos/ silica)
70
Q

What drugs may cause idiopathic pulmonary fibrosis

A

Long term use of Amiodarone (used in arrhythmias)
Methotrexate (used in Crohn’s)
Nitrofurantoin

71
Q

What is nitrofurantoin used for

A

Commonly given to elderly patients with recurrent urinary tract infection

72
Q

Symptoms of idiopathic pulmonary fibrosis

A

Progressive breathlessness (on exertion)
dry cough
Bilateral inspiratory crackles
Clubbing

73
Q

Is interstitial lung disease restrictive or obstructive

A

Restrictive lung disease

74
Q

What will the spirometry results be for pulmonary fibrosis

A

FEV1/FVC = normal ( >80%)
BUT
FEV1 < 70% and FVC < 70%
Both FEV1 and FVC decrease but the ratio is normal

75
Q

Diagnosis of Idiopathic pulmonary fibrosis

A

Blood tests
Spirometery / TLCO / lung volumes
Imaging - CXR / CT

76
Q

What is TLCO

A

Transfer factor for carbon monoxide; measures how good the transfer of inspired gas to RBC is (measures how good diffusion is)

77
Q

What would TLCO be for interstitial lung disease

A

decreased

78
Q

What would imaging show for idiopathic pulmonary fibrosis

A

bilateral infiltrates
Net-like shadowing at peripheries of lung , more prominent at lung base
Heart edges less distinct

79
Q

What conditions can be caused by pulmonary fibrosis

A

bronchiectasis

Atelectasis

80
Q

What would CT scan show in pulmonary fibrosis

A

Honeycombing (clusters of air)
traction bronchiectasis
reticular (net like) opacities
Most prominent at bases

81
Q

Management of IPF

A

Palliative, supportive
Oxygen if hypoxic
Pirfenidone + nintendanib
Lung transplant for young patients

82
Q

What are pirfenidone and nintedanib

A

Antifibrotic drugs; they do not reverse fibrosis, only slows progression

83
Q

Which condition do patients with IPF ultimately progress into

A

Respiratory failure

84
Q

What type of hypersensitivity is sarcoidosis

A

Type IV hypersensitivity

85
Q

What is type IV hypersensitivity

A

Delayed hypersensitivity; cell mediated

86
Q

Describe type IV hypersensitivity mechanism (sensitization stage)

A

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
Q

Describe type IV hypersensitivity effector phase

A

re-encounter of same antigen causes recruitment of the specific Th1 cells and cause inflammation

88
Q

Why is type IV hypersensitivity called delayed hypersensitivity

A

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
Q

What proinflammatory cytokines do macrophages release

A

TNF, IL-1 , IL-6

90
Q

What cytokines do Th1 cells release

A

IL-2, TNF-gamma

91
Q

Function of IL-2

A

Helps Th1 cells and other cells to proliferate

92
Q

What systems can be affected by sarcoidosis

A 
Lungs - alveolitis -> pulmonary sarcoidosis 
Eyes - uveitis
Skin - erythema nodosum / lupus pernio 
Joint - arthritis 
Hypercalcaemia
93
Q

What causes hypercalcaemia

A

Increase in level of calcitrol -> Increase in activated vitamin D -> increase in Ca2+

94
Q

What histopathological feature does sarcoidosis cause

A

Non-caseating granuloma

95
Q

Which lung condition causes caseating granuloma

A

TB

96
Q

Diagnosis of pulmonary sarcoidosis

A 
ABG
Blood tests 
Spirometry
CXR 
CT
Tissue biopsy
97
Q

What would be seen in spirometry for pulmonary sarcoidosis

A

Restrictive pattern

Reduced FEV1 and FVC but normal FEV1/FVC ratio

98
Q

What would be seen on CXR for sarcoidosis

A

Bilateral hilar lymphadenopathy

reticulonodular opacities

99
Q

Management of mild sarcoidosis

A

No treatment bc it often resolves by itself

Monitor spirometry and CXR over several years bc it may recur

100
Q

Management of severe sarcoidosis

A

Steroids
Immunosuppressants
Biologics

101
Q

What immunosuppressants are used against sarcoidosis

A

Azathioprine / methotrexate

102
Q

What biologic is used for sarcoidosis

A

anti-TNF

103
Q

Why should patients be screened for TB before using anti-TNF

A

Because it may trigger latent TB

104
Q

Which lung fibrosis is most likely to occur at upper lobe

A

Sarcoidosis

105
Q

Which lung lobe does pneumonia caused by klebsiella usually affect

A

Upper lobes

106
Q

What is a characteristic feature caused by klebsiella pneumoniae

A

Red current jelly sputum

107
Q

Which pathogen increases risk of developing complications of pneumonia

A

Klebsiella

108
Q

Which age group does mycoplasma pneumoniae usually affect

A

Young

109
Q

Feature of pneumonia caused by legionella pneumoniae

A

Hyponatraemia
Lymphopenia
Deranged LFT

110
Q

Symptoms caused by streptococcus pneumoniae

A

Symptoms are rapid onset
Herpes liabilis
High fever

111
Q

What is the most common pathogen causing pneumonia in patients after influenza infection

A

Staphylococcus aureus

112
Q

What is the most common pathogen causing pneumonia in patents with COPD

A

Haemophilus influenza

113
Q

What are the most common pathogens causing COPD exacerbations

A

Haemophilus influenza
Streptococcus pneumonia
Rhinovirus

114
Q

Management of acute exacerbation of COPD

A

Consider giving bronchodilator through nebuliser
Oral prednisolone for 5 days

Amoxicillin / doxycyline / clarythromycin if the sputum is purulent

115
Q

Why should you use nebuliser in acute exacerbations of COPD

A

because nebulisers turn the liquid drug into fine mist so can deliver high doses very quickly

Y1 Respiratory (4 decks)

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