Pneumonia symposium - pneumonia and lower resp tract infections Flashcards

Question

What does CURB65 stand for?

Answer 1

``` Confusion Urea ≥7mmol/L Respiratory rate≥ 30/min Blood pressure; low systolic < 90mm/Hg or diastolic ≤60mm/Hg Age ≥ 65 ```

Answer 2

expensive adverse effects IV - so harder to give promotes resistance

Answer 3

Strep. pneumoniae

Answer 4

``` S. pneumoniae 40% Mycoplasma 11% Chlamydophila pneumoniae 13% Legionella sp. 4% H. influenzae 5% Klebsiella pneumoniae (rare; homeless and in hospital) Staphylococcus aureus (low % in community but increased after influenza and in hospital especially) Viruses 13% ```

Answer 5

S. pneumoniae (as it is most common) S. aureus Legionella sp.

Answer 6

``` Mycoplasma pneumoniae (~10% peaks in epidemic seasons) Chlamydophila pneumoniae (~10%) Legionella pneumophila and other spp.(<5%) (also Chlamydophila psittaci and Coxiella burnetti ‘Q fever’) ```

Answer 7

Gram positive cocci | so purpule cocci

Answer 8

alpha haemolysis

Answer 9

optochin sensitive

Answer 10

amoxicillin or Cefuroxime/cefotaxime (both cephalosporins and good to use if the pt is allergic to penicillin) an alternative is a macrolide eg Clarithromycin

Answer 11

Gram negative cocobacillus

Answer 12

H. influenzae (hence the name) | S. aureus

Answer 13

Gram negative bacillus | one of the Enterobacteriaceae

Answer 14

Co-amoxiclav (amoxicillin + clavulanic) | Tetracyclines ie doxycycline

Answer 15

Macroclides eg clarythromycin

Answer 16

beta lactams eg flucloxacillin or cefuroxime (cephalosporin) if its MRSA - Vancomycin or Linezolid

Answer 17

Beta lactams: co-amoxiclav or cephalosporins

Answer 18

they won't grow on blood agar, so need to make the diagnosis by other methods eg serology - like looking for the legionella urinary antigen need different antibiotics ie not the beta lactams

Answer 19

Macrolides (erythromycin / clarithromycin) or fluorquinolones (ciprofloxacin) or tetracyclines (doxycycline)

Answer 20

``` haemolytic anaemia raynauds erythema multiforme bullous myringitis (blisters on the tympanic membrane) encephalitis due to cold agglutinins ```

Answer 21

cross reactive antibodies (IgM) against red blood cells. These cross-reactive antibodies are specific (and diagnostic) for Mycoplasmas infection and some other diseases. antibodies form and coalesce in areas which are a bit colder like the skin. It is a form of autoimmune haemolytic anaemia, specifically one in which antibodies only bind red blood cells at low body temperatures

Answer 22

``` diarrhoea, abnormal liver function tests, hyponatremia, myalgia, raised creatinine kinase, interstitial nephritis, encephailitis, confusion ```

Answer 23

Draughtsman colonies

Answer 24

PO Amoxicillin - if penicillin allergic use clarythromycin

Answer 25

PO amxocillin + clarythromycin

Answer 26

as it promotes antibiotic associated diarrhoea and has the side effect of nausea

Answer 27

IV co-amoxiclav AND claryhtromycin | alternatively if penicllin allergic would give IV cefuroxime and clarythromycin

Answer 28

5 days if mild to moderate and more than 5 days if severe | 14-21 days if S. aureus or G- bacteria or Legionella

Answer 29

= Panton–Valentine leukocidin (PVL) is a cytotoxin produced by some aggressive strains of S. aureus that cause a fulminant necrotising pneumonia

Answer 30

PPV - polysaccharide penumococcal vaccine given to >65's, people with splenic dysfunction, the immunocompromised, people with chronic medical conditions eg heart, lung, kidney disease, diabetes influenza vaccine smoking cessation PCV - pneumococcal conjugate vaccine in children

Answer 31

invasive pneumococcal disease but not pneumonia

Answer 32

parapneumonic effusion - a type of pleural effusion that can be infected ie become an empyema- the infection would not be treatable with antibiotics so the pt gets worse despite antibiotics

Answer 33

failure of fever or markers of inflammation (WBC/CRP) to settle on antibiotics pain on deep inspiration signs of pleural collection (stony dull to percussion, reduced air entry)

Answer 34

diagnostic thoracocentesis to identify bacteria, cloudy fluid, pus, low pH will also find out whether it is a transudate or exudate so if pneumonia, we would be looking for an exudate ie high protein

Answer 35

needs draining by therapeutic thoracocentesis (chest tube) or cardiothroacic surgery and decortication may not need to change antimicrobials but would need to give them for longer about 3 weeks eg Co-amoxiclav, meropenam or piperacillin-tazobactam

Answer 36

criteria that help to identify whether an effusion needs draining, ie will need draining if there is an infection in the fluid eg empyema

Answer 37

s. aureus eg with an IVDU - comes from the skin Strep. milleri from the mouth - dental work anaerobes and Klebsiella pneumonia from aspiration of vomit and other gram -ve bacteria Furosobacteria from Lemierre's syndrome which is infectious thrombophelbitis of the IJV as a complication of sore throat infection - infection gets into RHS of the heart and causes infection in the lungs

Answer 38

There is an infected DVT in the leg and the embolus from the DVT goes to the lungs and causes an infection and PE in the lungs. The infection is invasive and erodes into the pleura

Answer 39

prolonged antibiotics for 6 weeks may need surgical drainage [most are treated successfully with antibiotics even without drainage, drainage is second line]

Answer 40

development of pneumonia at least 48 hours after admission

Answer 41

the elderly ventilated post-operative

Answer 42

``` new fever purulent secretions New radiological infiltrates New leukocytosis / CRP increase plus increasing O2 requirements ```

Answer 43

start broad and then focus with the antibiotics as the bacteria in hospital are more resistant

Answer 44

the organisms are likely to be similar to the ones acquired in the commnity, with anerobes being a possibility as well so give Metronidazole OR beta lactam with a beta-lactamse inhibitor such as Co-amoxiclav or piperacilllin-tazobactam

Answer 45

First line is Piperacillin-tazobactam IV MRSA (vancomycin) Pseudomonas aeruginosa (give piperacillin-tazobactam) Acinetobacter baumanii Klebsiella pneumoniae

Answer 46

IV colistin

Answer 47

Mild: amoxicillin PO (clarythromycin if allergic) moderate: amoxicillin PO (clarythromycin if allergic) if not responding to amoxicillin after 2 days give co-amoxiclav PO severe: co-amoxiclav IV PLUS clarythrocmycin (PO/IV) if allergic to penicillin give Cefuroxime IV PLUS Clarythromycin

Answer 48

Bacterial - Pseudomonas aeruginosa Fungal - Pneumocystis pneumonia (PCP) due to the yeast-like fungus Pneumocystis jirovecii - Moulds e.g. Aspergillus spp. Viruses - Cytomegalovirus (CMV) - Adenovirus - Respiratory syncytial virus (RSV)

Answer 49

``` bacteria fungi parasites malignancy vasculitis drugs eosinophils ```

Answer 50

Infections due to Respiratory syncytial virus Inflammation of bronchioles and mucus production cause airway obstruction happens in young babies esp those born prematurely

Answer 51

low O2 sats respiratory retractions widespread crackles and wheeze severe resp distress

Answer 52

severe acute respiratory syndrome associated coronavirus | Severe respiratory illness with respiratory failure

Answer 53

Middle East Respiratory Syndrome novel Coronavirus | similar to SARS

Answer 54

self-limited inflammation of the epithelia of the bronchi due to upper airway infection

Answer 55

majority caused by viral infection but can rarely be caused by bacteria eg Mycoplasma pneumoniae, Chlamydia pneumoniae, Bordatella pertussis so similar organisms to CAP

Answer 56

``` cough either productive or not SOB wheeze no signs of focal consolidation fever and systemic features are unusual and suggest influenza or pneumonia ```

Answer 57

- CXR to exclude pneumonia - so the CXR is normal - viral and bacterial throat swabs - serology for mycoplasma and chlamydia pneumoniae

Answer 58

usually none if viral