Respiratory Flashcards
What are the 3 features characterising Asthma
Reversible airway obstruction
Airway hyper-responsiveness
Bronchial inflammation
What are common triggers of Asthma
Dust mites Pollen Pets Cigarette smoke Viral respiratory tract infection Aspergillus fumigatus spores Occupational allergens
What are the signs and symptoms of Asthma
Wheeze
Breathlessness
Cough
Previous hospitalisations due to acute attacks
Tachypnoea Use of accessory muscles Prolonged wheeze Polyphonic wheeze Hyperinflated chest
What are the signs of a Severe and a life-threatening asthma attack
Severe: PEFR <50% Predicted Pulse >110 RR > 25 Inability to complete sentences
Life-threatening: PEFR <33% Silent chest Cyanosis Bradycardia Hypotension Confusion Coma
What are appropriate investigations in Asthma
PEF or FEV1 Monitoring - <60% Severe
O2 Sats - <90% Severe
CXR - Hyperinflation
Bloods - IgE, Eosinophilia, Aspergillus AntiB
How are acute exacerbations of Asthma treated
Moderate - Severe:
Oxygen + Inhaled Salbutamol + Oral Corticosteroid
A - Inhaled Anticholinergic (Atropine)
A - Mg
Potential ICU for mechanical ventilation this would be with an inhaled Anticholinergic with the salbutamol + Systemic Corticosteroids (Start with IV switch to oral ASAP)
A - Heliox
If sputum super thick (Antibiotics)
How is Asthma treated chronically
1 - Short Acting Beta agonist (SABA) - PRN
2 - Add Low-dose inhaled corticosteroid (ICS)/Leukotriene-receptor antagonist (LTRA)
3 - Either LABA with ICS OR increase ICS to medium dose OR combine ICS with LTRA
4 - LABA + Medium ICS OR Medium ICS + LTRA
5 - LABA + High ICS (A - Immunomodulator - Omalizumab)
6 - LABA + High ICS + Oral Corticosteroid (A - Immunomodulator - Omalizumab)
What is Bronchiectasis
Chronic bronchial dilation, impaired mucociliary clearance and frequent bacterial infections
What is Bronchiectasis caused by
Chronic, recurrent of severe infections secondary to an underlying disorder
H. Influenzas
S. Pneumoniae
S. Aureus
P. Aeruginosa
CF, Ciliary dyskinesia, Alpha 1 anti-trypsin deficiency
Foreign body, Connective tissue, Tumour
Immunosuppression, immunodeficiency
Childhood respiratory infection due to viruses
Mycobacteria infection or severe bacterial pneumonia
Exaggerated response to inhaled Aspergillus fumigatus
What are signs and symptoms of Bronchiectasis
Persistent cough (Worse lying down)
Mucopurulent sputum (Green/Rusty coloured)
SOB
Haemoptysis
Crackles on auscultation
Squeaks and pops on inspiration
Fever
What are the appropriate investigations for Bronchiectasis
O2 Sats
CXR - First line - Tram track sign
High resolution CT - Best/Most appropriate/Gold standard diagnostic - String of beads
FBC - Raised WCC, Eosinophilia
Sputum culture
PFT - Reduced FEV1
Other:
Alpha 1 anti-trypsin
Sweat NaCl - CF
Skin prick - Aspergillus
How is Bronchiectasis treated
- Exercise, improved nutrition
- Airway clearance therapy (Percussion and postural drainage)
- Inhaled bronchodilator (Salbutamol)
- Inhaled hyperosmolar agent
A - Antibiotics
What is COPD
Chronic obstruction of airflow that is not fully reversible. Encompassing both emphysema and chronic bronchitis
What is the primary cause of COPD
SMOKING!!
Air pollution and occupational pollutants
Alpha-1 antitrypsin (Autosomal dominant)
How is Chronic bronchitis clinically defined
Having a productive cough for more than 3 months each year for 2+ consecutive years
What are the symptoms of COPD
Productive cough
Wheeze
SOB (Exertional)
Fatigue due to nocturnal cough
Infectious exacerbation: Severe SOB Increase sputum volume and purulence Fever Chest pain
What are signs of COPD
GI:
Tar staining
Cyanosis
Barrel chest
Palpation:
Reduced expansion
Hyper-resonance
Auscultation:
Reduced air movement
Wheezing
Coarse crackles
Signs of RHF (Cor pulmonale):
- Raised JVP
- Peripheral Oedema
- Hepatomegaly
What is cor pulmonale
This is RVH secondary to pulmonary hypertension
How is COPD diagnosed
Spirometry is the first-line test and will show reduced FEV1 and FEV1/FVC ratio.
COPD is defined by a post-bronchodilator FEV1/FVC <0.7. If FVC can’t be achieved then FEV6 can be used.
In acute exacerbation O2 Sats and ABG precede any other tests
O2 Sats <92% = ABG
ABG = Low sats/FEV1 <35%/Respiratory depression
PaCO2 >50mmHg &/or
PaO2 <60mmHg
CXR - Hyperinflation
FBC - Raised Ht, Raised WCC
ECG - RVH
Other
- Alpha-1 antitrypsin (Early onset)
Outline the survival altering treatments for chronic COPD
Improved survival:
- Smoking cessation
- Annual Flu Vaccine
- Pneumococcal vaccination (once before 65 and once after)
- Long-term O2 therapy (at least 15hrs/day) - Aim is maintain between 88-92%
- Lung volume reduction surgery
Give O2 therapy to:
- O2 saturation <88% - ABG
- PaO2 <7.3kPa - ABG
If they have right heart failure or a raised hematocrit then O2 therapy is given when:
- O2 saturation <90% - ABG
- PaO2 <8kPa - ABG
Hypoxaemia is important to maintain as this is part of what stimulates the respiratory drive for people with CO2. It is also important because it helps blood get directed to places that will actually get good air supply. This helps explain why lung reduction surgery can be beneficial
Outline the symptom altering treatments for chronic COPD
- (80-100) SABA (Salbutamol) OR SAMA (Ipratropium bromide)
- (50-79) SABA + LABA (Salmeterol) OR SAMA + LAMA (Tiotropium)
- (30-49) LABA + LAMA OR LABA + ICS (Symbicort)
- (<30) LABA + LAMA + ICS
How is an acute exacerbation of COPD treated
24% O2 given through either a nasal cannula or Venturi mask (Blue) - Fraction of O2 can be precisely controlled
Inhaled bronchodilators are most effective - SABA & SAMA used simultaneously given through a nebuliser (Salbutamol 5mg, IB 0.5mg)
Oral or IV corticosteroids are given along side (IV hydrocortisone 200mg or oral prednisolone 40-50mg)
IV amoxicillin
BiPAP (T2 respiratory failure) (NIV)
What are the classifications for Pneumothoracies
Primary spontaneous - No underlying respiratory illness
Secondary spontaneous - Associated underlying respiratory pathology
Traumatic - After trauma
Tension - This is a complication of any type of pneumothorax
What are risk factors for Pneumothoracies
Primary: Smoking Marfan's syndrome Homocysteinuria FHx Tall Slender Young male
Secondary:
COPD
CF
TB
Pneumocystis jirovecii respiratory infection - HIV patients susceptible
Thoracic endometriosis - Catamenial pneumothorax (Usually right sided)
What are symptoms of Pneumothoracies
SOB
Chest pain
Usually occurring at rest
Tension:
- Laboured breathing
- Cyanosis
- Profuse sweating
- Tachycardia
What are signs of Pneumothoracies
Hyperinflation
Palpation + Percussion:
Reduced chest expansion
Hyper-resonant
Auscultation:
Reduced vocal resonance
Reduced breath sounds
Tension:
- Tracheal shifts to contralateral side
How is a Pneumothorax diagnosed
CXR would be first line
CT chest -
US - Absent pleural sliding
Bronchoscopy - Visualise the endobronchial obstruction
How is Pneumothorax treated
Primary and <50yo
<2cm - O2 + discharge
>2cm - O2 + Aspiration (Chest drain if unsuccessful)
Secondary of >55yo
<2cm - O2 + Aspiration
>2cm - O2 + Chest drain
Tension: Immediate needle decompression - 2nd ICS MCL + O2
Define Acute respiratory distress syndrome
Non-cardiogenic pulmonary oedema and diffuse lung inflammation syndrome
What are the diagnostic criteria for ARDS
Acute onset (<1 week)
Bilateral opacities on CXR
PaO2/FiO2 Ratio (Arterial/Inspired) <300 on PEEP OR on CPAP > 5cmH2O
If there are no risk factors for ARDs then acute pulmonary oedema as a result of HF should be ruled out
What are the causes of ARDs
Sepsis - Most common (Usually of pulmonary origin e.g. pneumonia)
Aspiration, inhalation injury, trauma, burns, pulmonary confusion
Acute pancreatitis, fat emboli, drug overdose (Smoking, alcohol)
Cardiopulmonary bypass, DIC
What are the signs and symptoms of ARDs
Acute onset SOB
Hypoxaemia -> Acute respiratory failure
Cough - Frothy pulmonary oedema sputum
Creps
Crackles
Increased RR
What are appropriate investigations for ARDs
- CXR - Bilateral infiltrates
- ABG - Decreased PaO2 (Allows for assessment of PaO2/FiO2 Ratio)
- Sputum/Blood/Urine Cultures - Source of infection
- Amylase and/or lipase - 3x more in acute pancreatitis
What are the different types of Lung carcinomas
Non-small cell (80% of all lung carcinomas)
- Adenocarcinoma (45%)
- Squamous cell carcinoma (25-30%, later mets)
- Large cell carcinoma (10%)
Small cell
Metastases
Mesothelioma
Outline features of the main types of lung cancer
Small cell:
- Strongest association with smoking
- Arise in central lung
- Fast growing, highly malignant
- May produce endocrine hormones (ACTH or ADH)
Adenocarcinomas:
- Most common type in never-smokers
- Most common type in women
- Arise in peripheral lung
- Most common type to have pleural involvement
Squamous cell:
- Most commonly occurs in male smokers
- Strong association with smoking
- Arise in central lung
- May produce PTHrP
Large cell:
- Can arise centrally or peripherally
- Poor prognosis
Metastatic:
- Most common sources are breast and colon carcinomas
- More common than primary tumours
What are the symptoms of Lung cancer
(f)LAW(s)
Cough - Haemoptysis
SOB
What are the signs of Lung cancer
Horner's syndrome Cachexia Anaemia Clubbing Paraneoplastic syndromes
Possible:
- Wheeze
- Crackles
- Dullness to percussion
- Reduced breath sounds
How is Lung cancer diagnosed
CXR - Identification of initial lesion
Contrast enhanced CT
Definitive diagnosis - Biopsy
Sputum cytology - Better for central tumours
What are causes of Pulmonary embolism (PE)
Stasis - COPD, Varicose, Age >40, Immobility (Long-haul/Paralysis), GA, MI/Stroke
Hyper-coagulability - Cancer, High oestrogen (OCP, Obesity, pregnancy), IBDs, Nephrotic syndrome, Sepsis
Vessel wall damage - Trauma, Previous DVT, Surgery, Central venous catheterisation
What are the signs and symptoms of PE
Acute onset:
- Pleuritic chest pain
- SOB
- Sense of apprehension
- Haemoptysis + syncope
Fever
Cough
Unilateral tenderness or swelling of calves
Tachycardia
How is PE diagnosed
Wells criteria/Geneva score Initial test
CTPA (V/Q scan if CTPA is contraindicated) - If high suspicion
D-dimer if low suspicion
Monitor:
- Coagulation studies
- U&Es
- FBC
ECG - Sinus tachycardia, right axis deviation, RBBB, ‘S1 Q3 T3’ - very uncommon
CXR - Pleural effusion, elevation of hemidiaphragm
How is PE treated
Conservative:
- Analgesia
- Oxygen - Aim Sat for >94%
- Fluids
Low - Intermediate + Haemodynamically stable - Anticoagulation (If giving a LMWH then give with warfarin)
Intermediate - High or Haemodynamically unstable - Add Thrombolysis (Alteplase)/Embolectomy
IVC Filter to be used if anticoagulation is contraindicated
What are complications of PE
Acute bleeding Recurrent VTE Pulmonary infarct Cardiac arrest Heparin-associated thrombocytopenia
What is Interstitial lung disease
This is an umbrella term for a large group of disorders that cause scarring (fibrosis) of the lungs. The scarring causes stiffness in the lungs which makes it difficult to breath.
What are causes of Idiopathic pulmonary fibrosis
Well it idiopathic but it is caused by over activation of fibroblasts due to recurrent alveolar damage
Drugs can produce a similar illness (bleomycin, methotrexate, amiodarone)
Risk factors:
- Advanced age
- Smoking
- Male
- Animal/Vegetable dusts
- Occupational exposure to metal or wood
What are the signs and symptoms of Idiopathic pulmonary fibrosis
Gradual onset Exertional dyspnoea
Dry cough
No wheeze
Potential constitutional symptoms - Fatigue + weight loss
Bibasal fine inspiratory crackles
Clubbing
RHF - In advanced disease
How is Idiopathic pulmonary fibrosis diagnosed
Bloods
- ABG - Normal in early disease, PO2 decreases with exercise, Normal PCO2, which rises in late stage disease
- ANA and RF - 1/3 of patients are positive for ANA or RF
CXR
- Usually normal at presentation
- Early disease may show ground glass shadowing
- Late disease shows reticulonodular shadowing, signs of cor pulmonale and eventually honeycombing
PFTs
- Restrictive features (Reduced FEV1 and FVC, with preserved or increased FEV1/FVC)
- Decreased lung volume
- Decreased lung compliance
- Decreased TLC
High resolution CT - Can be diagnostic
Lung Biopsy - Diagnostic gold standard
Histological patterns - Interstitial pneumonia
Bronchoalveolar lavage - Exclude infection and malignancy
Echo - PHTN
What are the causes of Extrinsic allergic alveolitis (Hypersensitivity pneumonitis)
It is caused by inhalation of antigenic dusts that induce a hypersensitivity response in susceptible individuals
Mainly due to occupational risk:
- Farmers - Mouldy hay with thermophilic actinomycetes
- Bird-keeper - Bloom of bird feathers
- Mushroom worker’s
- Humidifier - Plumbers
- Malt workers - Barley with aspergillum clavatus
What are the signs and symptoms of Extrinsic allergic alveolitis (Hypersensitivity pneumonitis)
Exposure to antigen will be in the history
Exertion dyspnoea
Dry cough
Fever
Constitutional symptoms - Fever, weight loss
Clubbing
Bibasal fine inspiratory crackles
How is Extrinsic allergic alveolitis (Hypersensitivity pneumonitis) diagnosed
Bloods
- FBC - Neutrophilia, leukocytosis, ACD
- ESR elevated
Immunological response to causative antigen - IgG to fungal or avian antigens
CXR
- Acute = Normal
- Chronic = Fibrosis
- Ground glass shadowing
PFTs
- Restrictive features (Reduced FEV1 and FVC, with preserved or increased FEV1/FVC)
- Decreased lung volume
- Decreased lung compliance
- Decreased TLC
High resolution CT - Can be diagnostic
Lung Biopsy - Occasionally performed to clear up doubt
Bronchoalveolar lavage - Increased cellularity - Lymphocytosis
What causes Pneumoconiosis
Chronic Inhalation of mineral dusts:
- Coal
- Silica
- Asbestos (Strong correlation to smoking)
Occupational exposure coal mining, quarrying, iron and steel foundries, stone cutting, sandblasting, insulation industry, plumbers, ship builders
Co-factors such as smoking and TB also contribute
What are the signs and symptoms of Pneumoconiosis
Incidental finding - Asymptomatic = Simple
Insidious onset SOB
Dry cough
Black sputum - Coalworker’s
Pleuritic chest pain - Asbestosis
Coalworker's and silicosis: - Decreased breath sounds Asbestosis: - End-inspiratory crepitations - Clubbing Both have signs of RHF
How is Pneumoconiosis diagnosed
CXR:
- Simple = micro-nodular mottling
- Complicated = bilateral lower zone reticulonodular shadowing and pleural plaques (asbestosis is fibrotic changes, not just plaques) and nodular opacities, micronodular shadowing; eggshell calcification (silicosis)
High resolution CT – fibrotic changes
PFTs
- Restrictive features (Reduced FEV1 and FVC, with preserved or increased FEV1/FVC)
- Decreased lung volume
- Decreased lung compliance
- Decreased TLC
What is Sarcoidosis
Multisystem granulomatous inflammatory disorder
What are causes Sarcoidosis
Unknown but link to Mycobacterium tuberculosis and Borrelia burgdorferi
What are the signs and symptoms of Sarcoidosis
General: Fever, malaise, weight loss, bilateral parotid swelling, lymphadenopathy, hepatosplenomegaly
Pulmonary (Most common symptoms): SOB, dry cough, chest discomfort, minimal clinical signs
MSK: Bone cysts, Polyarthritis, Myopathy
Eyes: Dry eyes (Keratoconjuctivitis sicca), uveitis, papilloedema
Skin: Lupus pernio, Erythema nodosum, Maculopapular eruptions
Neurological: Lymphocytic meningitis, SOL, Pituitary infiltration, Cerebellar ataxia, CN palsies, Peripheral neuropathy
Cardiac: Arrhythmia, BBB, Pericarditis, Cardiomyopathy, CHF
What are the signs and symptoms of Sarcoidosis
General: Fever, malaise, weight loss, bilateral parotid swelling, lymphadenopathy, hepatosplenomegaly
Pulmonary (Most common symptoms): SOB, dry cough, chest discomfort, minimal clinical signs
MSK: Bone cysts, Polyarthritis, Myopathy
Eyes: Dry eyes (Keratoconjuctivitis sicca), uveitis, papilloedema
Skin: Lupus pernio, Erythema nodosum, Maculopapular eruptions
Neurological: Lymphocytic meningitis, SOL, Pituitary infiltration, Cerebellar ataxia, CN palsies, Peripheral neuropathy
Cardiac: Arrhythmia, BBB, Pericarditis, Cardiomyopathy, CHF
How is Sarcoidosis diagnosed
Bloods:
High Ca –> Hypercalciuria
High serum ACE
High ESR
PFTs
Restrictive picture
CXR
Stage 0: Normal
Stage 1: Bilateral hilarity lymphadenopathy
Stage 2: + Pulmonary infiltrates
Stage 3: Pulmonary infiltrates only
Stage 4: Extensive fibrosis with distortion
High resolution CT
Ground glass appearance + features from CXR
Bronchoscopy + Lavage
Low sensitivity –> Lymphocytosis with CD4-CD8 ratio >3.5
Transbronchial lung biopsy - Diagnostic - Non-caseating granulomas
What is a Mesothelioma
This is an aggressive epithelial neoplasm arising from the lining of the lung, abdomen, pericardium, or tunica vaginalis
What causes Mesothelioma
Asbestos exposure is the main risk factor (80%). There is a weak correlation to smoking
There is a latency period of 20-40 yrs
What are signs and symptoms of Mesothelioma
Dry cough
SOB
Chest pain
Classic constitutional symptoms: Weight loss especially
Clubbing
Muffled breath sounds on auscultation - Pleural effusion
How is Mesothelioma diagnosed
CXR - Unilateral Pleural effusion, irregular thickening of the pleura, reduced lung volume, fibrosis
CT - Similar findings more accurate
Pleural biopsy is diagnostic
What is Obstructive sleep apnoea
Recurrent prolapse of the pharyngeal airway and apnoea (cessation of airflow for >10s) during sleep followed by arousal from sleep
What are causes of Obstructive sleep apnoea
Weight gain Smoking Alcohol Sedative use Enlarged tonsils and adenoids in children Macroglossia Marfan's syndrome Craniofacial abnormalities
Male more common
What are signs and symptoms of Obstructive sleep apnoea
Excessive daytime sleepiness Unrefreshing or restless sleep Morning headaches Dry mouth Difficulty concentrating Irritability and mood changes Partner reporting snoring, nocturnal apnoeic episodes or nocturnal choking
Large tongue Enlarged tonsils Long or thick uvula Retrognathia (Pulled back jaw) Neck circumference: More than 42 cm in males (40 in females) Obesity HTN
How is Obstructive sleep apnoea diagnosed
Sleep study: Polysomnography (airflow monitoring; respiratory effort; pulse oximetry and heart rate)
What are the 3 main Aspergillus lung diseases
Allergic bronchopulmonary aspergillosis (ABPA) - Hypersensitivity reaction to mould when bronchi become colonised by A. fumigatus
Invasive aspergillosis - Invasion of lung tissue and fungal dissemination mainly occurring in the immunosuppressed
Asperigilloma - Fungal ball growth in pre-existing lung cavity (Post-TB, Old infarct or abscess)
What are the signs and symptoms of ABPA
Hx of Asthma/CF/Atopy
SOB, wheeze, cough (mucus)
Fever
Weight loss
Clubbing & Cyanosis
Reduced breath sounds
Dullness in affected lung
How is ABPA diagnosed
Skin prick test - A. fumigatus
Serum IgE - Raised
Eosinophilia
Serum specific IgG/IgE to A. fumigatus
CXR - Not essential criterion - Transient patchy shadows, collapse, distended mucous-filled bronchi
PFT - Restrictive
What are the signs and symptoms of Aspergilloma
Asymptomatic
Potentially a massive haemoptysis
Tracheal deviation
Reduced breath sounds
Dullness in affected lung
How is Invasive aspergillosis diagnosed
Aspergillus is detected in cultures or by histological examination
Bronchoalveolar lavage fluid or sputum may be used diagnostically
Chest CT - Nodules surrounded by a ground-glass appearance (halo sign)
- This is caused by haemorrhage into the tissue surrounding the fungal invasion
serum Aspergillus galactomannan (GM) antigen by enzyme immunoassay (EIA)
How is Aspergilloma diagnosed
CXR - Sinlge upper lobe lesion
CT or MRI - CXR is unclear
Sputum culture
How is Aspergilloma diagnosed
CXR - Sinlge upper lobe lesion
CT or MRI - CXR is unclear
Sputum culture
What is Tuberculosis
An infectious disease caused by mycobacterium tuberculosis. in many causes becoming dormant before progressing to an active infection.
What are the risk factors for TB and what are the different disease states
Mycobacterium tuberculosis
Immunosuppression from medication for another disease, or from HIV infection.
Malnutrition is the main risk factor for people of no fixed abode (homeless).
Patients infected withM tuberculosiswho have no clinical, bacteriological, or radiographic evidence of active TB are said to have latent TB infection. Active TB may occur from re-activation of previously latent infection or from progression of primary infection.
Approximately 10% of individuals with latent infection will progress to active disease over their lifetime.
The likelihood of transmission depends on
- the infectivity of the source case (e.g., smear status and extent of cavitation on CXR),
- the degree of exposure to the case (e.g., proximity, ventilation, and the length of exposure)
- susceptibility of the person in contact with an infected case
What are signs and symptoms of TB
Cough - 2-3 week duration (Starts dry goes to productive)
Drenching night sweats
FLAWS
Haemoptysis <10%
Crackles, bronchial breathing
Erythema nodosum
Pleuritic chest pain Signs of pleural effusion Collapse Consolidation Fibrosis
What are the appropriate investigations for TB
FBC - Raised WCC, Low Hb
CXR - Fibronodular opacities on upper lobes. Atypical = Opacities in middle or lower lobe, hilar or paratracheal lymphadenopathy and/or pleural effusion
Sputum - acid-fast bacilli Positive, using Ziehl-Neelson staining, On Lowestein-Jensen agar
Sputum culture - Most sensitive and specific test - Positive (3 Samples at least 8 hrs apart)
NAAT - Positive for M tuberculosis
What is Pneumonia
Inflammation of the alveoli which can be caused by bacteria, viruses or fungi. Inflammation results in air sacs filling with fluid or pus.
What are the different types of Pneumonia
- Community Acquired Pneumonia
- Hospital Acquired Pneumonia
- Aspiration Pneumonia
- Atypical
What are the usual causative agents in CAP, HAP and Atypical pneumonia
CAP: Streptococcus pneumonia & Haemophilus influenzae
then
Staph. aureus or Group A strep
COPD - Moraxella catarrhalis
HAP: Pseudomonas aeruginosa, E. coli, Klebsiella pneumoniae, Acinetobacter species, Staph. aureus
Atypical: Mycoplasma pneum, Chlamydophila pneum, Legionella pneum, Coxiella burnetii
What are the signs and symptoms of Pneumonia
- Productive cough - Coloured sputum
- SOB
- Pleuritic chest pain
- Cough
Fever Confusion High HR and RR Hypotension Cyanosis Decreased chest expansion Dull percussion Increased resonance Bronchial breathing Coarse crackles Empyema - Clubbing
Atypical:
- Headache
- Myalgia
- Diarrhoea/abdominal pain
- Dry cough
How is Pneumonia diagnosed
Bloods
FBC - WCC raised
CRP - Raised
Sputum sample - MC&S
Blood cultures - (if severe)
CXR - Diagnostic
- Consolidation
- Alveolar opacification
- Air bronchograms
- Lobar or patchy shadowing
Atypical viral serology
How is Pneumonia treated
Assess severity using the British thoracic society guideline - CURB65 (1 Point each)
Confusion Urea >7 Resp rate >30 BP <90/60 >65
0-1 Treat at home if possible
2 Consider hospital treatment
3 or more Severe, consider ITU
Emirical antibiotics
- Low Severity – oral amoxicillin
- Moderate – oral/IV amoxicillin + macrolide
- High severity – IV Co-Amoxiclav + macrolide
Atypical
- Legionella - IV Ciprofloxacin or Clarythromicin
- Pneumocystis Jirovercii - High dose co-trimoxazole
- Pseudomonas aeruginosum - Piptazobactam (piperacillin + Tazobactam)
- Mycoplasma pneumonia - Erythromycin/Clarythromycin (Marcolide)
- Staph. Aureus - Flucloxacillin (Vancomycin if MRSA)
Outline features of Atypical pneumonias
Legionella
- Bacteria - Aqueous environments - Inhalation of contaminated water droplets
- Atypical pneumonia symptoms + N+V
Pneumocystis Jirovercii
- Opportunistic fungal infection and is an AIDS defining illness
Pseudomonas aeruginosum
- Bronchiectasis or CF
Mycoplasma pneumonia
- Seen in community setting (University)
- Red cell agglutinins and transverse myelitis
Staph. aureus
IVDU
What are complications of Pneumonia
- Septic shock
- C. difficile infection from antibiotic use
- Death from HF, RD in the elderly or severely unwell
