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Pneumonia TCD Flashcards

1
Q

Which patients with respiratory infection should be referred to hospital for treatment?

A

The patients who have suspected pneumonia and need further investigations / interventions. Usually they will have signs of severe respiratory infection (high fever, or low blood pressure/ high respiratory rate / with confusion). Also if it is felt that the patient would not be able to manage at home.

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2
Q

CAP could be defined simply as…

A

‘Signs of lower respiratory tract infection (fever/cough/phlegm/crepitations or bronchial breathing) + CXR changes.’

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3
Q

How do you assess CAP severity and treatment?

A

CURB65 score, 1 mild, 2 moderate, 3 severe

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4
Q

Which patients does CURB65 not work well in?

A

Patietns younger than 65 as they will not score highly even if ill, and they compensate. Patients with bad renal function so high urea when well.

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5
Q

What six domains is NEWS2 based on?

A 
respiration rate
oxygen saturation
systolic blood pressure
pulse rate
level of consciousness or new confusion*
temperature
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6
Q

Why would Clarithromycin be prescribed alongside wide range antibiotics in pneumonia?

A

Clarithromycin was needed to cover for the atypical, intracellular causes of pneumonia

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7
Q

What are CD4 and CD8 lymphocytes?

A

CD4 are T helper, CD8 are cytotoxic T cells

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8
Q

Types of URTI?

A

Common cold (Coryxa
Sinusitis
Laryngitis
Pharyngitis

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9
Q

Types of LRTI?

A 
acute bronchitis 
Pneumonia 
COPD infection 
Lung abscess 
Empyema 
Acute exacerbation of bronchiectasis
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10
Q

What part of the respiratory tract does influenza infect?

A

All parts

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11
Q

Are upper respiratory tract infections mainly viral or bacterial?

A

Mainly viral

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12
Q

Are lower respiratory tract infections mainly viral or bacterial?

A

Mainly bacterial

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13
Q

Is influenza bacterial or viral?

A

Viral

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14
Q

In LRTI COPD how do you work out if it is pneumonia and not simple exacerbation?

A

CXR

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15
Q

In Simple infection of COPD what is the most common cause of bacterial infection?

A

Half and half bacterial/viral. Most of bacteria is H influenzae

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16
Q

Bronchiectasis

A

Structural damage of airway where there is both narrowing and dilatation - Large volume of sputum production. the wide parts are constantly colonised. DIAGNOSE VIA CT normally H. Influenzea. Sample sputum regularly as this will help when exacerbation

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17
Q

How do we classify pneumonias now?

A

Based on how they are caused - help guide treatment

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18
Q

Commonest causes of CAP

A

Gram positive bacteria
s. pneumoniae
Mycoplasma
Influenza

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19
Q

Commonest causes of hospital acquired pneumonia

A

Gram negative bacteria

MRSA

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20
Q

Commonest cause of aspiration pneumonia

A

Chemical or anaerobe

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21
Q

What is rigors?

A

a sudden feeling of cold with shivering accompanied by a rise in temperature, often with copious sweating, especially at the onset or height of a fever.

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22
Q

nosocomial pneumonia

A

Hospital acquired

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23
Q

What does CRUB65 stand for?

A 
Confusion
Respiratory rate 
Urea high 
Blood pressure 
Over 65
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24
Q

Investigations for CAP on admission

A

Gas exchange SaO2, arterial blood gases
Fluid balance U & Es
Diagnosis WCC, C-reactive protein, chest radiograph
Cause sputum Gram stain + culture & sensitivity
blood culture
urine pneumococcal and legionella antigen
(during influenza season throat swab for viral PCR)

25
CURB65 0-1 treatment?
amoxicillin oral
26
CURB65 2 treatment?
amoxicillin and clarithromycin oral
27
CURB 3+ treatment?
Co-amoxiclav and clarithromycin I.V
28
Name for infected plural effusion?
empyema
29
Sputum in pneumococcal pneumonia is characteristically
Rust/red coloured
30
Myalgia and arthralgia is also common especially in infections with
Legionella or Mycoplasma
31
If the patient presenting with pneumonia is under the age of 60 an --- test should be offered as this is a common presentation of --- in an undiagnosed individual (testing as indicator illness).
HIV
32
Cocci are... in shape
Round
33
Bacilli are... in shape
Rod
34
Two examples of gram +ve cocci
staphilococci | Streptococci
35
types of fungi
Yeasts, moulds dimorphic - travellers and histoplasmosis
36
Two classifications of parasites
ectoparasites and endoparasites
37
Likely type of bacteria in UTI and gut bio
Gram negative bacilli
38
Common cause of external otitis
P. aeruginosa - gram negative bacilli
39
What are coliforms?
Gram negative gut rods that ferment lactose
40
Pseudomonas aeruginosa facts
Gram negative non fermenter, aerobe
41
Streptococcus pneumoniae type
gram positive diplococci
42
How can streptococci be classified?
Via their haemolysis, Beta, alpha, gamma (Beta worse)
43
What group of bacteria often infect the upper resp track?
Streptococci
44
UTI bacteria
Entrococci, Group B streptococci
45
Staph vs Strep
Staph grapes strep pairs or alone (Stripped)
46
Likely cause of old lady cellulitis
staphylococci
47
Staphylococcus aureus coagulate positive or negative?
Positive - if systemic give I.V flucoxacillin
48
Coagulase negative staphylococci live
On skin
49
All staphylococci form ... films
Bio films
50
MSSA treatment
Flucloxacillin
51
Think fungi if...
a septic patient is not responding to broad spectrum antibiotics.
52
Haemophilus influenzae classification
Gram negative bacillus
53
Legionella pneumophilia aka Legionnaire’s disease
Think of this in patients who have recently been on holiday Tends to affect males (2:1 ratio) and smokers Prodromal syndrome of high fevers before a dry cough develops Can be diagnosed with urinary antigen testing Treat with macrolides
54
Klebsiella pneumoniae
Gram negative bacillus Elderly patients and people with comorbidities at increased risk, alcohol excess also risk factor Clinically tends to affect upper lobes Inherently resistant to penicillins, cephalosporins recommended, penicillin combined with a betalactamase inhibitor may be an option.
55
The commonest viruses to cause pneumonia in adults are
influenza A and B
56
In the UK, ... ... is the most common cause of fungal pneumonia
Pneumocystis jirovecii
57
What common organisms should be considered when dealing with a hospital acquired pneumonia?
Staphylococci (including MRSA) Enterococci Gram negative bacilli (such as E-Coli or pseudomonas) or a mixed flora if aspiration pneumonia is suspected
58
Which lobe of the lung is most often effected in aspiration pneumonia?
Right lobe as straighter from the trachea

Year 3 (26 decks)

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