respiratory 2 Flashcards
what are the different classifications of pneumonia?
If the pneumonia developed outside of hospital it is labeled labelled “community acquired pneumonia”. If it develops more than 48h after hospital admission it is labelled “hospital acquired pneumonia”. If it develops as a result of aspiration, meaning after inhaling foreign material such as food, then it is labelled “aspiration pneumonia”
how does pneumonia present?
presentation: Shortness of breath Cough productive of sputum Fever Haemoptysis (coughing up blood) Pleuritic chest pain (sharp chest pain worse on inspiration) Delirium (acute confusion associated with infection) Sepsis
Signs - deranged basic observations - they may indicate sepsis secondary to pneumonia
Tachypnoea, Tachycardia, Hypoxia, Hypotension, Fever, Confusion
what are the three characteristic chest signs of pneumonia?
- Bronchial breath sounds. These are harsh breath sounds equally loud on inspiration and expiration. These are caused by consolidation of the lung tissue around the airway.
- Focal coarse crackles. These are air passing through sputum in the airways similar to using a straw to blow in to a drink.
- Dullness to percussion due to lung tissue collapse and/or consolidation.
how is the severity of pneumonia assessed?
NICE recommend using the scoring system CRB-65 out of hospital and CURB-65 in hospital. The only difference is that out of hospital you do not count urea.
When you see someone out of hospital with a CRB-65 score of anything other than 0 NICE suggest considering referring to the hospital.
C – Confusion (new disorientation in person, place or time)
U – Urea > 7
R – Respiratory rate ≥ 30
B – Blood pressure < 90 systolic or ≤ 60 diastolic.
65 – Age ≥ 65
The CURB 65 score predicts mortality (score 1 = under 5%, score 3 = 15%, score 4/5 = over 25%). The scoring system is there to help guide whether to admit the patient to hospital:
Score 0/1: Consider treatment at home
Score ≥ 2: Consider hospital admission
Score ≥ 3: Consider intensive care assessment
what are the common causes of CAP?
streptococcus pneumoniae - aka pneumococcus
also haemophilus influenza
what are the common causes of HAP?
gram negative bacilli, staph aureus
what is the most common cause of pneumonia in those with COPD?
H.influenzae
who is moraxella catarrhalis pneumonia common in?
Moraxella catarrhalis in immunocompromised patients or those with chronic pulmonary disease
what is a common cause of pneumonia in those with cystic fibrosis?
pseudomonas aeruginosa
staph aureus
what is atypical pneumonia ?
The definition of atypical pneumonia is pneumonia caused by an organism that cannot be cultured in the normal way or detected using a gram stain. They don’t respond to penicillins and can be treated with macrolides (e.g. clarithomycin), fluoroquinolones (e.g. levofloxacin) or tetracyclines (e.g. doxycycline).
what are the different types of atypical pneumonia?
- Legionella pneumophila
- mycoplasma pneumoniae
- chlamydophila pneumoniae
- coxiella brunettii - aka Q fever
- chlamidya psittaci
how does legionella pneumonia present?
Legionella pneumophila (Legionnaires’ disease). This is typically caused by infected water supplies or air conditioning units. It can cause hyponatraemia (low sodium) by causing an SIADH. The typical exam patient has recently had a cheap hotel holiday and presents with hyponatraemia.
how does mycoplasma pneumoniae present?
This causes a milder pneumonia and can cause a rash called erythema multiforme characterised by varying sized “target lesions” formed by pink rings with pale centres. It can also cause neurological symptoms in young patient in the exams.
how does chlamydophila pneumoniae present?
Chlamydophila pneumoniae. The presentation might be a school aged child with a mild to moderate chronic pneumonia and wheeze. Be cautious though as this presentation is very common without chlamydophilia pneumoniae infection.
how does coxiella burnetii present?
Coxiella burnetii AKA “Q fever”. This is linked to exposure to animals and their bodily fluids. The MCQ patient is a farmer with a flu like illness.
how does chlamydia psittaci present?
Chlamydia psittaci. This is typically contracted from contact with infected birds. The MCQ patient is a from parrot owner.
what is a common cause of fungal pneumonia?
Pneumocystis jiroveci (PCP) pneumonia occurs in patients that are immunocompromised. It is particularly important in patients with poorly controlled or new HIV with a low CD4 count. It usually presents subtly with a dry cough without sputum, shortness of breath on exertion and night sweats. Treatment is with co-trimoxazole (trimethoprim/sulfamethoxazole) known by the brand name “Septrin”. Patients with low CD4 counts are prescribed prophylactic oral co-trimoxazole to protect against PCP.
what is a common cause of pneumonia in alcoholics?
klebsiella pneumoniae
this is also seen often in diabetics
and commonly causes lung abscess formation and empyema
what investigations would you perform for pneumonia?
CXR - will show a new shadowing (consolidation)
FBC - raised WCC
U&E’s - for urea - assess for severity of disease
CRP - for inflammation and infection
ABG
in patients with moderate/severe:
sputum cultures
blood cultures
legionella and pneumococcal urinary antigens
how is CAP managed?
low severity
1st line - amoxicillin (if allergic to penicillin use either a macrolide (clarithromycin) or tetracycline (doxycycline) - give Abx for 5 days
high severity
dual antibiotic therapy is recommended with amoxicillin and a macrolide
what are the complication of pneumonia?
sepsis pleural effusion empyema lung abscess death
how is HAP managed?
within 5 days of admission: co-amoxiclav or cefuroxime
more than 5 days after admission: piperacillin with tazobactam or a broad spectrum caphalosporin e,g, ceftazidime or a quinolone e.g. ciprofloxacin
where is the most common place of lung cancer?
95% are carcinoma of the bronchus
2% are alveolar tumours
what can cause secondary lung cancer?
breast kidney uterus ovary testes thyroid