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
Name and describe the rash exhibited by Mycoplasma pneumoniae [2]
erythema multiforme:
- Target lesions: pink rings and pale centres
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.
