Respiratory - Pneumonia Flashcards

1
Q

pneumonia

A

a syndrome caused by infection
inflammation of the lung parenchyma
consolidation- new lung shadowing on cxr

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2
Q

how is pneumonia classified

A

by source of infection

community acquired
hospital acquired
aspiration pneumonia

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3
Q

symptoms of pneumonia

A

fever, purulent cough,SOB, pleuritic chest pain

signs: increased resp, increased HR, coarse crep and decreased air entry, hypotension

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4
Q

auscultation sounds in pneumonia

a.coarse crepitations
b.fine inspiratory crackles
c.pleural rub

A

a.coarse crepitations

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5
Q

new radiographic infiltrate in prescence of infection with onset at least 48 hrs after hospital admission (or within 2 weeks of discharge)

A

hospital acquired pneumonia

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6
Q

aspiration pneumonia occurs at the upper airway when it is colonised with gram……..

a.positives
b.negatives

A

b.negatives

esp if prev antibitoics

enteric bacilli
pseudomonas
MRSA

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7
Q

Which bacteria usually present in hopsital acquired pneumona

a.enteric bacilli, pseudomonas,MRSA

b.strep pneum, haem influenzae

A

a.enteric bacilli, pseudomonas,MRSA

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8
Q

risk factors for hopsital acquired pneumonia

A

> 70
comorbidities
surgery
NG tube

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9
Q

gram……… are the main cause of community acquired pneumonia

a.positives
b.negatives

A

a.positives

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10
Q

which gram positive cause of community acquired pneumonia is more common in copd

a.strep pneum
b.haemophillus influenzae
c.moraxella catarrhalis
d.pseudomonas

A

c.moraxella catarrhalis

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11
Q

which bacteria cause atypical pneumonia

A

legionella
mycoplasma
chlamydia

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12
Q

first line investigation for community acquired pneumonia

a.o2 assessment
b.cxr
c.bloods
d.microbiology

A

a.o2 assessment

check if can go home

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13
Q

second line investigation for community acquired pneumonia

a.o2 assessment
b.cxr
c.bloods
d.microbiology

A

b.cxr

shows consolidation in lower lobes (patchy changes cant make out border of diaphragm)

if consolidation is upper consider other causes …
TB, aspirated, tumour (if tumour occludes bronchus then can cause pneumonia)

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14
Q

which blood test is deranged if pneumonia is caused by mycoplasma or legionella

a.wcc
b.crp
c.u and e
d.lft

A

d.lft

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15
Q

poor prognosis factors

A

> 65 yrs
rr >30
confusion
hypotension
urea >7
albumin <35

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16
Q

what grading system is used for pneumonia

a.GOLD
b.CURB 65
c.GRACE
d.Hinshey

A

b.CURB 65

C- NEW confusion
u- urea >7 mmol
r- resp rate >/= 30
b- systolic <90 or diastolic <= 60

65 - age 65+

each letter = 1 point
>2 = hospital admission

17
Q

first line management for pneumonia

a. antibiotics
b.oxygen
c.VTE prophylaxis
d.critical care
e.CT chest

A

a. antibiotics

within 4 hrs of hospital admission

and oxygen,fluids,analgesia,nutrition,physio,VTE prophylaxis

18
Q

pneumonia with paO2 <8kpa
tiring with CO2 increase
increasing metabolic acidosis despite antibiotics and fluids
hypotension

what should be done ?

a. antibiotics
b.oxygen
c.VTE prophylaxis
d.critical care
e.CT chest

A

d.critical care

19
Q

patient with pneumonia and improving what should be done for follow up

a.cxr
b.ct

A

DO NOT REPEAT CXR IF THINK IMPROVING

only repeat cxr if decrease or no improvement

19
Q

when should a 6XR be repeated post admisission

a.4 weeks
b.5 weeks
c.6 weeks
d.7 weeks

A

c.6 weeks

esp if persisting , higher risk of cancer (>50s/smokers)

to exclude any underlying condition

if unresolved do a CT

20
Q

what should be done if pneumonia unresolved after 6 week follow up x ray

a. ct chest
b. x ray chest
c. contrast ct

A

a. ct chest

21
Q
A
21
Q
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