Pneumonia flash revision flashcards

Question 1

Classify pneumonia under these three headings:

• Source classification
• Infective agent
• Anatomic site

Answer 1

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

Question 2

List factors that predispose to pneumonia

Answer 2

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

Question 3

List eight (8) causes of organizing pneumonia

Answer 3

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

Question 4

List six (6) defense mechanisms of the respiratory system

Answer 4

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

Question 5

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

Answer 5

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

Question 6

List four (4) potential complications of pneumonia

Answer 6

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

Question 7

List eight (8) common symptoms of pneumonia

Answer 7

Common symptoms of pneumonia:

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

Question 8

Describe the defining feature(s) of Atypical Pneumonia

Answer 8

Atypical pneumonia:

• No evidence of consolidation
• No alveolar exudate

Question 9

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

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

Answer 9

COMMUNITY ACQUIRED
Typical - S. pneumoniae
Atypical - Influenza A

NOSOCOMIAL
- Pseudomonas aeruginosa

IMMUNOSUPPRESSED:

• Fungal
• CMV

Question 10

Outline the prognostic measures for pneumonia

Answer 10

CURB score:

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

Or, pneumonia severity index

Question 11

List the differential diagnosis of pneumonia

Answer 11

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

Question 12

what are the recommended diagnostic methods for pneumonia

Answer 12

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

Question 13

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

Answer 13

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

Question 14

List six (6) indications for referral to ITU

Answer 14

• 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

Question 15

List six (6) preventative measures against community acquired pneumonia

Answer 15

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

Question 16

List few preventative measures against hospital acquired pneumonia

Answer 16

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.

Question 17

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

Answer 17

• Flucloxacillin 1–2 g 4 times daily IV plus

* Clarithromycin 500 mg twice daily IV

Question 18

what antibiotics should be considered If Mycoplasma or Legionella is suspected

Answer 18

• 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

Question 19

what antibiotics are recommended for a patient with uncomplicated CAP?

Answer 19

• 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

Question 20

What antibiotics are indicated for a patient with Severe CAP?

Answer 20

• 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

Question 21

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

Answer 21

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.