Respiratory: Pneumonia I Flashcards
What are the localised symptoms of pneumonia? [5]
What are the systemic symptoms of pneumonia? [3]
To be diagnosed with pneumonia, patients need to be suffering from:
Localised:
- Cough: productive or non-productive
- Dysopnoea
- Tachyopneoa
- Pleuritic chest pain
- Haemoptysis
Systemic:
- Sweating / Fever
- Weight loss: decreased appetite
- Confusion
- Fever > 38
What are the signs of pneumonia from examination? [3]
Bronchial breath sounds (harsh inspiratory and expiratory breath sounds) due to consolidation around the airways
Focal coarse cracklescaused by air passing through sputum in the airways
Dullness to percussion due to lung tissue filled with sputum or collapsed
What are the non-examination signs of pneumonia? [3]
- Tachypnoea, Tachycardia
- Hypoxia
D
Describe how you assess the severity of pneumonia [5]
Within hospital:
C – Confusion (new disorientation in person, place or time)
U – Urea > 7 mmol/L
R – Respiratory rate ≥ 30
B – Blood pressure < 90 systolic or ≤ 60 diastolic.]
65 – Age ≥ 65
NB Community: CRB-65
What CURB-65 scores would indicate:
Treatment at home [1]
Admission [1]
Intensive care [1]
Score 0/1: Consider treatment at home
Score ≥ 2: Consider hospital admission
Score ≥ 3: Consider intensive care
Which infective organisms are most likely to cause CAP? [3]
Streptococcus pneumonia; - 1st
Haemophilus influenzae; Staphylococcus aureus;
Which type of organisms are most likely to cause HAP? [1]
Which infective organisms are most likely to cause HAP? [4]
Gram negative organisms:
PEKA:
Pseudomonas aeruginosa,
Escherichia coli
Klebsiella pneumoniae
Acinetobacter species.
What are the features that would make pneumonia atypical? [4]
- symptoms may be subacute or less severe hence the term ‘walking pneumonia’
- absence of lobar consolidation on chest x-ray
- not detectable on Gram stain
- lack of response to penicillin antibiotics
Which organisms are most likely to cause atypical pneumonias?
TOM TIP: You can remember the 5 causes of atypical pneumonia with the mnemonic: “Legions of psittaci MCQs”:
Legions: Legionella pneumophila
Psittaci: Chlamydia psittaci
M – Mycoplasma pneumoniae
C – Chlamydophila pneumoniae
Qs – Q fever (coxiella burnetii)
Atypical pneumonias:
Which type of pneumonia occurs from inhaling infected water from infected water systems, such as air conditioning units? [1]
Legionella pneumophila (Legionnaires’ disease)
The typical exam patient has recently had a cheap hotel holiday and presents with pneumonia symptoms and hyponatraemia
Describe the pathological consequences of Legionella pneumophila [2]
Causes SIADH: results in hyponatraemia
Describe the clinical presentation of Legionella pneumonia [5]
- high fever
- chills
- malaise
- non-productive cough
- dyspnea
- pleuritic chest pain.
How do you detect Legionella infection? [1]
Legionella urinary antigen
Comparison of Legionella and Mycoplasma pneumonia
Name three distinguishing features of Leginella pneumonia that would differentiate from Mycoplasma pneumonia
Hyponatramia (from SIADH)
Lymphopenia
Diagnosis via urinary antigen
Which drug do you use to tx Legionellas? [1]
With erythromycin/clarithromycin
Describe the clinical features of Mycoplasma pneumonia [3]
- prolonged and gradual onset
- Erythema multiforme RASH: effects 1/3rd of patients on trunks and limbs
- flu-like symptoms ( classically PRECEED a dry, persistent cough
- bilateral consolidation on x-ray
Name and describe the rash exhibited by Mycoplasma pneumoniae [2]
erythema multiforme:
- Target lesions: pink rings and pale centres
Describe ascultation findings of Mycoplasma pneumonia [1]
Coarse crackles will CHANGE to fine crackles at a late phase (3-5 days after initial onset).
If an atypical pathogen such as Mycoplasma pneumoniae is suspected, it is best to confirm the diagnosis using a [] ?
If an atypical pathogen such as Mycoplasma pneumoniae is suspected, it is best to confirm the diagnosis using a NAAT: e.g., polymerase chain reaction [PCR] on nose and throat swabs
State 4 clinical consequences of untreated Mycoplasma pneumonia [4]
Haemolytic anaemia
Erythema multiforme
Encephalitis
Peri / myocarditis
How do you treat Mycoplasma pneumonia? [2]
1st line:Erythromycin OR Clarithromycin
2nd line: Doxycycline or a macrolide (e.g. )
Because generally there is no diagnosis of the pathogen at the time of treatment, initiation of the treatment is usually empirical
BMJ BP
Mycoplasma pneumonia may cause what haematological consequence? [1]
haemolytic anaemia
State and describe this complication of Mycoplasma pneuomia [2]
bullous myringitis: painful vesicles on the tympanic membrane
Which infective organsim causing atypical pneumonia is linked to exposure by bodily fluids of animals? [1]
Coxiella burnetii, or Q fever, is linked to exposure to the bodily fluids of animals. The typical exam patient is a farmer with a flu-like illness.
Atypical pneuomonia
[] is typically contracted from contact with infected birds. The typical exam patient is a parrot owner.
Chlamydia psittaci is typically contracted from contact with infected birds. The typical exam patient is a parrot owner.
Which infective organism causes pneumonias in immunocompromised patients? [1]
Pneumocystis jirovecii
Patients with poorly controlled HIV and a low CD4 count are particularly at risk
Pneumocystis jirovecii pneumonia (PCP)
How does PCP usually present? [5]
Pneumocystis jirovecii pneumonia (PCP)
dyspnoea
night sweats
dry cough
fever
very few chest signs
Pneumothorax is a common complication of PCP.
What drug is used as prophylaxis [1] and to treat [1] PCP?
Treatment:
- Co-trimoxazole
Prophylaxis:
- co-trimoxazole
What clinical presentation may indicate COVID caused pneuomonia? [1]
Silent hypoxia: Patients may not feel particularly short of breath despite having low oxygen saturations
What is important to know about the most common cause of pneumonia? [1]
Most common KNOWN cause is Strep. pneumonie;
But in a greater number of cases there is no pathogen identified
what is HAP definition with regards to timings? [2]
HAP = Inpatient > 48hrs or less than ten days post discharge
Elderly patients are less likely to suffer pneumonia from which two pathogens? [2]
Mycoplasma pneumoniae
Legionella
Describe which type of bacteria alcoholics are most likely to get pneumonia from [1]
Risk of aspiration pneumonia; anaerobic pathogens have increased chance
HIV / AIDs patients are more likely to suffer from which infective organisms that cause pneumonia? [2]
TB
PCP
Chemotherapy patients are more likely to suffer pneumonia from what group of infective agents? [1]
Fungal
