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Pneumonia flash revision flashcards

1
Q

Classify pneumonia under these three headings:

  • Source classification
  • Infective agent
  • Anatomic site
A

SOURCE CLASSIFICATION

  • Community acquired
  • Nosocomial (hospital)
  • Aspiration
  • Immunocompromised

INFECTIVE AGENT

  • Bacterial (most common)
  • Atypical
  • Viral
  • Non-infective (e.g. radiation)

ANATOMIC SITE

  • Lobar
  • Bronchopneumonia
  • Interstitia
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2
Q

List factors that predispose to pneumonia

A
  1. Loss of respiratory defense mechanisms
  2. Smoking and Alcoholism
  3. Pulmonary congestion
  4. Cystic fibrosis
  5. Immunocompromised
  6. IV drug use (S. aureus)
  7. Hospitalization (nosocomial)
  8. Chronic illness
  9. upper respiratory tract infections
  10. old age
  11. HIV
  12. preexisting lung disease
  13. indoor air pollution
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3
Q

List eight (8) causes of organizing pneumonia

A

Causes of Pneumonia:

  1. Infection (viral, bacterial, fungal)
  2. Inhaled toxins
  3. Drugs
  4. Rheumatoid arthritis, SLE
  5. Bronchial obstruction
  6. Wegener’s granulomatosis
  7. Hypersensitivity pneumonitis
  8. Neoplasms
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4
Q

List six (6) defense mechanisms of the respiratory system

A
  1. Humidification
  2. Mucociliary escalator
  3. Cough / sneeze reflex
  4. Immune cells
  5. Turbulent air flow
  6. Secretory IgA
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5
Q

Outline the four stage inflammatory response to lobar pneumonia. Include time frames)

A
  1. Congestion (2-6 hrs): alveoli fill with serous fluid.
  2. Red hepatisation (12 hrs): exudate + RBCs
  3. Grey hepatisation (1-10 days): RBCs lysed, exudate persists
  4. Resolution: enzymatic digestion of exudate by macrophages
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6
Q

List four (4) potential complications of pneumonia

A
  1. Abscess formation
  2. Empyema (pus in pleural space)
  3. Organisation (fibrous)
  4. Bacteraemia > endocarditis, meningitis, etc
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7
Q

List eight (8) common symptoms of pneumonia

A

Common symptoms of pneumonia:

  • Fever
  • Cough
  • Purulent sputum
  • Malaise
  • Rigors
  • Haemoptysis
  • Pleuritic chest pain
  • Dyspnoea
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8
Q

Describe the defining feature(s) of Atypical Pneumonia

A

Atypical pneumonia:

  • No evidence of consolidation
  • No alveolar exudate
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9
Q

What are the most common pathogens in the following types of pneumonia?

  • Community acquired (typical)
  • Community acquired (atypical)
  • Nosocomial
  • Immunosuppressed
A

COMMUNITY ACQUIRED
Typical - S. pneumoniae
Atypical - Influenza A

NOSOCOMIAL
- Pseudomonas aeruginosa

IMMUNOSUPPRESSED:

  • Fungal
  • CMV
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10
Q

Outline the prognostic measures for pneumonia

A

CURB score:

  • Confusion (GCS <8)
  • Urea (>7 mmol/L)
  • Respiratory rate (>30)
  • BP (<90/60)
  • Age > 65 years

Or, pneumonia severity index

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11
Q

List the differential diagnosis of pneumonia

A
  • Pulmonary infarction
  • Pulmonary/pleural tuberculosis
  • Pulmonary oedema (can be unilateral)
  • Pulmonary eosinophilia
  • Malignancy: bronchoalveolar cell carcinoma
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12
Q

what are the recommended diagnostic methods for pneumonia

A
  • Blood test
  • Sputum test
  • Oropharynx swab
  • Urine test
  • Chest x-ray
  • Pleural fluid analysis
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13
Q

what are the possible chest x-ray findings in a patient with pneumonia

A

LOBAR PNEUMONIA
• Patchy opacification evolves into homogeneous consolidation of affected lobe
• Air bronchogram (air-filled bronchi appear lucent against consolidated lung tissue) may be present

BRONCHOPNEUMONIA
• Typically patchy and segmental shadowing

COMPLICATIONS
• Para-pneumonic effusion, intrapulmonary abscess or empyema

STAPHYLOCOCCUS AUREUS
• Suggested by multilobar shadowing, cavitation, pneumatoceles and abscesses

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14
Q

List six (6) indications for referral to ITU

A
  • CURB score of 4–5, failing to respond rapidly to initial management
  • Persisting hypoxia (PaO2 < 8 kPa (60 mmHg)), despite high concentrations of oxygen
  • Progressive hypercapnia
  • Severe acidosis
  • Circulatory shock
  • Reduced conscious level
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15
Q

List six (6) preventative measures against community acquired pneumonia

A

CAP prevention measures:
- stop smoking
- Influenza and pneumococcal vaccination should be
considered in patients at highest risk
- improve nutrition
- eliminate indoor air pollution
- immunisation against measles, pertussis and
haemophilus influenzae type b.
- investigation and elimination of potential Legionella
pneumophila sources

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16
Q

List few preventative measures against hospital acquired pneumonia

A

HAP prevention measures

  • good hygiene
  • minimise the chances of aspiration and to limit the use of stress ulcer prophylaxis with proton pump inhibitors.
  • Oral antiseptics may be used to decontaminate the upper airway and the digestive tract.
17
Q

what antibiotics should be considered If Staphylococcus is cultured or suspected?

A
  • Flucloxacillin 1–2 g 4 times daily IV plus

* Clarithromycin 500 mg twice daily IV

18
Q

what antibiotics should be considered If Mycoplasma or Legionella is suspected

A
  • Clarithromycin 500 mg twice daily orally or IV or Erythromycin 500 mg 4 times daily orally IV plus
  • Rifampicin 600 mg twice daily IV in severe cases
19
Q

what antibiotics are recommended for a patient with uncomplicated CAP?

A

• Amoxicillin 500 mg 3 times daily orally

If patient is allergic to penicillin
• Clarithromycin 500 mg twice daily orally or Erythromycin 500 mg 4 times daily orally

20
Q

What antibiotics are indicated for a patient with Severe CAP?

A
  • Clarithromycin 500 mg twice daily IV or Erythromycin 500 mg 4 times daily IV plus
  • Co-amoxiclav 1.2 g 3 times daily IV or Ceftriaxone 1–2 g daily IV or Cefuroxime 1.5 g 3 times daily IV or
  • Amoxicillin 1 g 4 times daily IV plus flucloxacillin 2 g 4 times daily IV
21
Q

what pathogens are more often attributed to late-onset HAP?

A

Late-onset HAP is more often attributable to Gram-negative bacteria (e.g. Escherichia coli, Pseudomonas aeruginosa, Klebsiella spp. and Acinetobacter baumannii), Staph. aureus (including meticillin-resistant Staph. aureus (MRSA)) and anaerobes, and the choice of antibiotics ought to cover these possibilities.

Pneumonia (1 decks)

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