Pneumonie

Question 1

Wat is een shunt?

Answer 1

Perfusie zonder ventilatie

Question 2

Wat is de dode ruimte?

Answer 2

Ventilatie zonder perfusie

Question 3

Wat is de definitie van pneumonie?

Answer 3

Acute abnormal inflammatory condition of the lungs characterized by inflammation of the parenchym (Alveoli) and abnormal alveolar filling with fluid (Exudate -> Pus)

Question 4

Wanneer is er sprake van CAP?

Answer 4

CAP if:
- Acute abnormal inflammatory condition of the lungs
- Associated with symptoms of acute infection
- Radiological or auscultatory abnormalities (Or ultrasound)
- Not hospitalized in previous 3 months

Question 5

Wat zijn de risico’s voor pneumonie?

Answer 5

Co-morbiditeiten:
- COPD
- Astma
- Bronchiectasis
- Diabetes Mellitus
- Cystic Fibrose

Lifestyle:
- Alcohol
- Roken
- Homeless
- Overcrowded living

Patiënt:
- Extreme leeftijden
- Immuungecomprimenteerd

Question 6

Waarop duidt een oreo en bat sign?

Answer 6

Oreo sign -> Duidt op pericardinfusie
Bat sign -> Pneumocysten of acuut hartfalen met longoedeem

Question 7

Wanneer is het typisch of atypische cap?

Answer 7

Typical is usually caused by common bacterial pathogens:
- Typical i associated with sudden onset symptoms -> Inclusive fever, pleuritic chestpain or productive cough
- Typical laboratory results shows raised inflammatory parameters
- Typical has a lobar infiltrate on chest X-ray

So -> With all 4 present, one is certain of a typical CAP
With each criterium less present, atypical CAP becomes more likely

Question 8

Hoe kan de ernst van pneumonie worden bepaald?

Answer 8

CURB-65:
- Verwarheid
- Ureum >7 mmol/L
- Ademhalingsfrequentie >30/min
- Bloeddruk systolisch <90 mmHg en/of diastolisch <60 mmHg
- Leeftijd >65 jaar

CURB-65 2: Amoxicilline IV
CURB-65 3-5: Cefuroxim met/of ciprofloxacine

Legionella sneltest bij risicofactoren zoals buitenlandbezoek, legionella epidemie, onvoldoende verbetering op beta lactam AB