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Respiratory > Pneumonia - Full summary > Flashcards

Pneumonia - Full summary Flashcards

1
Q

What is pneumonia?

A

A form of acute lower respiratory tract infection that leads to inflammation and a build up of pus and fluid in the alveolar sacs

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2
Q

What are the 2 types of pneumonia?

A

Lobar pneumonia
Bronchopneumonia

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3
Q

What is meant by lobar pneumonia?

A

Pneumonia in which there is confluent consolidation involving a complete lung lobe

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4
Q

What is meant by bronchopneumonia?

A

Pneumonia in which the infection starts in the airways and spreads to the adjacent alveolar lung

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5
Q

What are some symptoms of pneumonia?

A

Malaise
Anorexia
Sweating
Rigors
Myalgia and arthralgia
Headache
Cough
Pleurisy and abdominal pain
Haemoptysis
Dyspnoea
Diarrhoea

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6
Q

What are some common clinical signs of pneumonia?

A

Pyrexia
Herpes labialis (Cold sores)
Tachypnoea
Crackles
Sternal rub
Cyanosis
Hypotension

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7
Q

How is the severity of pneumonia scored?

A

CURB65
C - Confusion (New onset)
U - Urea >7mmol
R - Respiratory rate >30 per minute
B - Blood pressure < 90/61mmHg
65 - Over 65 years old

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8
Q

Why should the CURB65 score be used with caution in younger people?

A

They have very good cerebral vascularisation, kidney function, can increase tidal volume instead of respiratory rate and have very good inotropic and chronotropic responses to changes in blood pressure
This means that younger patients will have to be much sicker before they register a high score on the CURB65 scale

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9
Q

Which bacteria are those with an alcohol addiction more likely to contract in pneumonia?

A

Streptococcus pneumoniae
Oral anaerobes
Klebsiella pneumonia
Acinetobacter sp
Mycobacterium tuberculosis

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10
Q

Which bacteria are those with COPD who smoke more at risk of contracting in pneumonia?

A

Haemophilus influenza
Pseudomonas aeruginosa
Legionella sp
Streptococcus pneumoniae
Moraxella catarrhalis
Chlamydophila pneumoniae

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11
Q

Which bacteria are those with lung abscesses more likely to have as a pneumonia?

A

Oral anaerobes
Atypical mycobacteria
Mycobacterium tuberculosis

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12
Q

Which bacteria is someone who has had recent contact with a bird (e.g. parrot) at risk of contracting as a pneumonia?

A

Chlamydophila psittaci (Avian influenza)

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13
Q

Which bacteria is someone who has had recent contact with farm animals at risk of contracting as a pneumonia?

A

Coxiella burnetti (Q fever)

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14
Q

Which bacteria is someone who has had recent contact with rabbits or rodents at risk of contracting as a pneumonia?

A

Francisella tularensis (Tularemia)

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15
Q

In an influenza epidemic, what are some more common bacteria that people will contract as a pneumonia?

A

Influenza virus
Streptococcus pneumoniae
Haemophilus influenza
Staphylococcus aureus

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16
Q

What bacteria would be suspected if a pneumonia patient was coughing after vomiting or had long term vomiting?

A

Bordatella pertussis (Whooping cough)

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17
Q

What are some common bacteria found in those with structural abnormalities of the lungs as a pneumonia?

A

Pseudomonas aeruginosa
Staphylococcus aureus
Burkholderia cepacia

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18
Q

What are some common bacterial pneumonias in IV drug or medication users?

A

Staphylococcus aureus
Anaerobes
Mycoplasma tuberculosis
Streptococcus pneumoniae

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19
Q

What organism would cause production of rust coloured sputum in pneumonia?

A

Streptococcus pneumoniae

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20
Q

What organisms would cause production of green sputum in pneumonia?

A

Pseudomonas and Haemophilus

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21
Q

What organism would cause production of red currant-jelly sputum in pneumonia?

A

Klebsiella

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22
Q

What type of organism would cause production of found smelling and bad tasting sputum?

A

Foul smelling and bad tasting sputum

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23
Q

What are the main types of management of pneumonia?

A

Antibiotics
Oxygen therapy
Bed rest
Smoking cessation

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24
Q

Why can mycoplasma pneumoniae not be gram stained?

A

It has no cell wall

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25
Q

How long does mycoplasma pneumoniae take to culture?

A

2-3 weeks

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26
Q

What are some pathologies that can be caused by mycoplasma pneumoniae?

A

Pneumonia
Hepatitis
Immune thrombocytopenia purpura
Autoimmune haemolytic anaemia
Arthritis

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27
Q

Describe the epidemiology of mycoplasma pneumoniae?

A

Mycoplasma infections come in waves every 4 years with a small peak in cases the year before

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28
Q

How can mycoplasma be tested for?

A

Via PCR swabbing
It also shows a tree and bud sign on CT

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29
Q

How does mycoplasma pneumoniae cause a paroxysmal cough?

A

It causes ciliary dysfunction and produces H2O2, which damages respiratory membranes and erythrocytes

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30
Q

What antibiotics should be used to treat pneumonia caused by mycoplasma pneumoniae?

A

Doxycycline or a macrolide such as clarithromycin or erythromycin

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31
Q

How may a person present with mycoplasma pneumoniae?

A

It can cause a paroxysmal cough and often affects the upper airways causing symptoms such as myringitis (ear ache)

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32
Q

How should a non-severe hospital acquired pneumonia first be treated normally?

A

Oral amoxicillin

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33
Q

How should a non-severe hospital acquired pneumoniae first be treated in a patient with a penicillin allergy?

A

Orał doxycycline

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34
Q

How should a severe hospital acquired pneumonia first be treated normally?

A

IV amoxicillin + IV Gentamicin

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35
Q

How should a severe hospital acquired pneumonia first be treated in a patient with a penicillin allergy?

A

Orał doxycycline + IV gentamicin

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36
Q

What are some common bacteria in community acquired pneumonia (CAP)?

A

Streptococcus pneumoniae
Haemophilus influenza
Mycoplasma pneumoniae
Chlamydia pneumoniae
Legionella sp
Moraxella catarrhalis

37
Q

What does treatment of community acquired pneumonia (Streptococcus pneumoniae) depend upon?

A

The patients CURB65 score

38
Q

How should a patient with a CURB65 score of 0-2 be treated for CAP (Pneumococcal) normally?

A

Oral amoxicillin

39
Q

How should a patient with a CURB65 score of 0-2 be treated for CAP (Pneumococcal) if they have a penicillin allergy?

A

Doxycycline on day 1 and then a full course of doxycycline or IV clarithromycin

40
Q

How should a patient with a CURB65 score of 3-5 be treated for CAP (Pneumococcal) normally?

A

Co-amoxiclav IV + Doxycycline IV

41
Q

How should a patient with a CURB65 score of 3-5 be treated for CAP (Pneumococcal) if they have a penicillin allergy?

A

IV Levofloxacin

42
Q

How should a patient in ICU be treated for CAP (Pneumococcal) normally?

A

Co-amoxiclav IV + Clarithromycin

43
Q

How should a patient in ICU be treated for CAP (Pneumococcal) if they have a penicillin allergy?

A

IV Levofloxacin

44
Q

How is aspiration pneumonia usually treated?

A

This requires anaerobic cover
Amoxicillin + Metronidazole

45
Q

How is Chlamydophila pneumoniae tested and cultured?

A

Gram staining is not used, instead, micro-immunofluorescent testing is performed
It is usually only cultured on HEp-2 cells

46
Q

Where is Legionella pneumophila usually found?

A

It is an obligate intracellular organisms that lives in warm water, so is commonly contracting in warm countries such as Spain and can be found in the air-conditioning units of poorly maintained hotels

47
Q

What is pneumonia caused by a legionella species known as?

A

Legionnaires disease

48
Q

How is legionnaires disease diagnosed?

A

It shows no growth on selective media
Diagnosis is made using Legionella urinary antigens

49
Q

What treatment is used in Legionnaires disease?

A

Levofloxacin (Quinolones) +/- rifampicin
Macrolide such as clarithromycin could also be used

50
Q

What are some classical presentations of legionnaires disease?

A

Pneumonia
Confusion
Diarrhoea
Recent traveller

51
Q

What is a common symptom of Coxiella burnetti pneumonia that is uncommon in pneumonias?

A

A non-productive cough

52
Q

Who is at risk of infection from Pneumocystis jiroveci?

A

It only affects those with a CD4 count of less than 200, so usually affects those with HIV or frequent steroid takers

53
Q

How will pneumocystis jiroveci present on CT scan?

A

It will show a ground glass appearance

54
Q

What is pneumocystis and how is it diagnosed?

A

It is a yeast like fungus
It can be diagnosed by PCR testing or blood testing to find ßD-Glucan

55
Q

What is the treatment for pneumocystis jiroveci?

A

Co-trimoxazole +/- steroids

56
Q

What can cause necrotising properties in Staphylococcus aureus?

A

Panton Valentine Leukocidin

57
Q

How does Haemophilus influenza normally present on CT scan?

A

Tree and bud sign

58
Q

What can arise due to Haemophulus influenza infection?

A

Increased risk of bronchiectasis and is common in younger patients with bronchiectasis or who have an influenza infection

59
Q

What is the treatment of Haemophilus influenza pneumonia?

A

Doxycycline and azithromycin

60
Q

What is the most common cause of pneumonia?

A

Streptococcus pneumoniae

61
Q

What are some pathologies associated with Streptococcus pneumoniae?

A

Otitis media
Pneumonia
Meningitis

62
Q

Who is more at risk from invasive disease in Streptococcus pneumoniae?

A

Coeliacs
Those with no spleen
Those with a T cell deficiency

63
Q

How can Streptococcus pneumoniae be prevented?

A

There are 2 forms of pneumococcal vaccines, one for adults and one for children

64
Q

What virus is the cause of chicken pox?

A

Varicella zoster

65
Q

What virus is the cause of Herpes Simplex Virus?

A

Herpes viridae

66
Q

How can Varicella zoster and Herpes viridae cause pneumonia?

A

They can hide from the immune system in neurones and non-neuronal cells and persist for many years
When the host has a lowered immune resistance, they emerge and can cause a viral form of pneumonia

67
Q

What are some possible complications of pneumonia?

A

Empyema
Pulmonary abscesses
Septic embolism

68
Q

What is empyema?

A

A build up of pus in the pleural cavity

69
Q

What is the prognosis of empyema?

A

20% of people with empyema will die

70
Q

What causes empyema?

A

Bacteria can erode through the lung wall and visceral pleura

71
Q

What is the most common type of organism responsible for empyema?

A

Aerobic organisms

72
Q

What are some examples of gram positive causes of empyema?

A

Streptococcus milleri
Staphylococcus aureus
Streptococcus pneumoniae

73
Q

What are some examples of gram negative causes of empyema?

A

Eschericiae coli
Pseudomonas sp
Klebsiella sp

74
Q

When is anaerobic empyema most common?

A

In severe pneumonia or in those with bad oral hygiene

75
Q

In which patients is testing for empyema usually carried out?

A

In those with a slow to resolve pneumonia or a pneumonia which gets worse after getting better

76
Q

What are some tests that can show an empyema?

A

Chest X-ray
Ultrasound scanning
High resolution CT

77
Q

What will usually be shown by an empyema on x-ray?

A

A meniscus or D-sign (Split pleural sign)

78
Q

What are the advantages of ultrasound in empyema diagnosis?

A

They are simple, non-invasive and can be done bedside, as well as giving a clue on severity

79
Q

What are the advantages of High Resolution CT scanning in empyema diagnosis?

A

It is useful in differentiating between empyema and pulmonary abscesses

80
Q

What is the difference between empyema and pulmonary abscess on high resolution CT?

A

Abscesses will often have an acute angle between the grey mass and the chest wall
Empyema will often show an obtuse angle between the grey mass and the chest wall

81
Q

Which IV antibiotics can be used in an empyema of unknown bacteriology?

A

Broad spectrum antibiotics, amoxicillin and metronidazole or co-amoxiclav

82
Q

What oral antibiotic is usually given in cultured empyema?

A

5 weeks of oral amoxicillin

83
Q

What is an intrapulmonary abscess?

A

A circumscribed necrotic infection within the lung tissue

84
Q

What are some common clinical presentations of intrapulmonary abscesses?

A

Weight loss
Lethargy
Tiredness
Weakness
Cough that suddenly gets worse

85
Q

What are the most common organisms responsible for intrapulmonary abscesses?

A

Streptococcus sp
Staphylococcus sp
Eschericiae coli
Gram negatives
Aspergillus

86
Q

How are intrapulmonary abscesses usually treated?

A

They are treated with prolonged antibiotics and a possible chest drain

87
Q

What is a septic embolus?

A

Occlusion of a blood vessel by a cluster of bacteria in the blood stream

88
Q

What are some common conditions that can cause septic emboli?

A

Pneumonia, Right sided endocarditis, infected DVT and IV drug use

Respiratory (23 decks)

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