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Year 3: Respiratory > Respiratory: Pneumonia II > Flashcards

Respiratory: Pneumonia II Flashcards

1
Q

Describe the criteriaNICE recommends that patients should initially be assessed in primary care using [4]

A
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2
Q

Based of CRB65 scores, how do you determine where care occurs? [2]

NB CRB65 is primary care

A

Home-based care for patients with a CRB65 score of 0 (or 1)

Hospital assessment for all other patients, particularly those with a CRB65 score of 2 or more.

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3
Q

Alongside CURB65, describe which test is sometimes used to determine Abx therapy in the primary care setting [3]

A

NICE also mention point-of-care CRP test. This is currently not widely available but they make the following recommendation with reference to the use of antibiotic therapy:

CRP < 20 mg/L - do NOT routinely offer antibiotic therapy

CRP 20 - 100 mg/L - consider a DELAYED antibiotic prescription

CRP > 100 mg/L - OFFER antibiotic therapy

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4
Q

What CURB65 scores determine the level of care patients recieve? [3]

A

Home care: 0-1

Hospital care: 2+

Intensive care: 3+

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5
Q

Which investigations would you conduct for HAP? [5]

A

Chest x-ray
Hypoxia
Full blood count: Elevated WCC
Renal profile: urea level for the CURB-65 score and acute kidney injury
CRP
Culture of sputum

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6
Q

Describe the treatment algorithm for mild / low severity CAP? [2]

A

First line: 5 day course
- Amoxicillin
- If if penicillin allergic: clarithromycin (macrolide) OR doxycycline (tetracycline)

Second line:
- No respond to amoxicillin monotherapy, consider adding, or switching to, a macrolide (e.g., clarithromycin).

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7
Q

How quickly should you try and prescribe treatment for moderate severity pneumonia after hospital admission? [1]

A

This should be within 4 hours of presentation to hospital

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8
Q

Describe the treatment algorithm for confirmed CAP on chest x-ray: presenting in hospital | moderate-severity (CURB-65 = 2)?

A

7-10 day course is recommended

1st line:
- ORAL amoxicillin plus a macrolide: clarithomycin
- For patients who are allergic to penicillin in whom oral antibiotics are contraindicated: second-generation cephalosporin (e.g., cefuroxime) or a third-generation cephalosporin (e.g., cefotaxime or ceftriaxone)

PLUS
clarithromycin, or intravenous levofloxacin monotherapy

2nd line:
- Change to doxycycline or a fluoroquinolone: ciprofloxacin AND pneumococcal cover: levofloxacin or moxifloxacin

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9
Q

d

What are NICE guidelines about route of administration about Abx? [1]

A

NICE guidelines on antimicrobial prescribing in adults recommend reviewing intravenous antibiotics by 48 hours, and considering switching to oral treatment if possible

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10
Q

Describe the treatment algorithm for confirmed CAP on chest x-ray: presenting in hospital | high-severity (CURB-65 = 3-5)?

DOUBLE CHECK

A

1st line:
- A broad-spectrum beta-lactamase-resistant penicillin: amoxicillin/clavulanate plus a macrolide: clarithromycin
- If allergic to penicillin: second-generation cephalosporin (e.g., cefuroxime) or a third-generation cephalosporin (e.g., cefotaxime or ceftriaxone) PLUS a macrolide (e.g., clarithromycin)

2nd line:
- Doxycycline OR
- Cefalexin OR
- Trimethoprim

3rd Line:
- levofloxacin

BMJ BP

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11
Q

In patients with suspected or confirmed Staphylococcus aureus MRSA infection, what are the two treatments? [2]

A

IV Vancomycin
OR
IV teicoplanin

with or without

Rifampicin (orally or intravenously)

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12
Q

In patients with suspected or confirmed Staphylococcus aureus non-MRSA infection, what are the two treatments? [2]

A

Flucloxacillin (intravenously)

with or without

Rifampicin (orally or intravenously)

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13
Q

State the treatments for these atypical pneumonias [5]

A

A: Clarithromycin (orally or intravenously)

B: Fluoroquinolone (ciprofloxacin) (orally or intravenously)

C: Amoxicillin (orally) or
D: benzylpenicillin
(intravenously)

E: Doxycycline (orally)

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14
Q

What is the treatment algorithm for mild to moderate symptoms/signs and not at higher risk of resistance for HAP? [2]

How long for? [1]

A

5 day prescription

ORAL:
- amoxicillin/clavulanate (aka Co-amoxiclax)
- If allergic: Doxycycline
Cefalexin (use caution in penicillin allergy)
Trimethoprim/sulfamethoxazole

NICE

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15
Q

What is the treatment algorithm for severe symptoms/signs and not at higher risk of resistance for HAP? [2]

How long for? [1]

A

1st line:
- piperacillin/tazobactam OR
- ceftazidime OR
- cefuroxime OR
- meropenem

2nd line:
- levofloxacin

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16
Q

In severe pneumonia, strong suspicion of what needs to be suspected? [1]

How do you manage this? [1]

A

Pneumonia is one of the main sources of sepsis

17
Q

State 5 potential pulmonary complications of pneumonia [5]

A
  • Pleural effusion
  • Empyema
  • Acute respiratory distress syndrome (ARDS)
  • Lung abscess
  • Pneumothorax
18
Q

State 4 potential extra -pulmonary complications of pneumonia [5]

A

Bacteremia and sepsis
Acute kidney injury (AKI): esult from sepsis, hypovolemia, or drug-induced nephrotoxicity
Pericarditis: direct extension of pneumonia or hematogenous spread

19
Q

NICE recommend that patients are not routinely discharged if in the past 24 hours they have had 2 or more of the following findings? [6]

A
  • temperature higher than 37.5°C
  • RR 24 breaths per minute or more
  • HR over 100 beats per minute
  • SBP 90 mmHg or less
  • oxygen saturation under 90% on room air
  • abnormal mental status
  • inability to eat without assistance.
20
Q

Label the progress expected post-pneumonia from 1 week - 6 months

A

1 week:
- Fever should have resolved

4 weeks:
- Chest pain and sputum production should have substantially reduced

6 weeks:
- Cough and breathlessness should have substantially reduced

3 months
- Most symptoms should have resolved but fatigue may still be present

6 months:
- Most people will feel back to normal.

21
Q

What immunological cause makes alcoholics more likely to suffer from pneumonia? [1]

A

Alveolar macrophages are less effective in alcoholics

22
Q

All patients admitted to hospital with pneumonia should have what investigations? [5]

(NICE & BTS)

A

CXR
FBC (WCC raised; CRP raised)
U&E
LFTS
Oxygen sats

23
Q

All patients with moderate-severe pneumonia should have what investigations? [3]

(NICE & BTS)

A

All in patients:
- CXR
- FBC (WCC raised; CRP raised)
- U&E
- LFTS
- Oxygen sats

Moderate-Severe:
- Blood and sputum culture
- Pneumococcal urinary antigen
- Legionella urinary antigen + sputum

24
Q

All patients with severe + outbreaks of pneumonia should have what investigations? [3]

(NICE & BTS)

A

All in patients:
- CXR
- FBC (WCC raised; CRP raised)
- U&E
- LFTS
- Oxygen sats

Moderate-Severe:
- Blood and sputum culture
- Pneumococcal urinary antigen
- Legionella urinary antigen + sputum

Severe+:
- Mycoplasma PCR
- Chlamydophilia PCR
- Viral PCR

25
Q

Urine dipstick tests are only currently available for which two pathogens? [2]

A

Pneumococcal
Legionella

BUT - don’t give data on sensitivity

26
Q

Despite the fact there are no pathognomonic radiographic changes for pneumonia, what changes are highly suggestive that have pneumonia

A

Air bronchograms:* dark lines going through white area of lung.

Caused by aerated bronchi surrounded by pus filled alveoli

((Basically consolidation)

27
Q

Describe which CURB65 scores require admission / can be treated at home [4]

A

0-1: at home
2: short admission
3+: admit + urgent senior review
4-5: admit + ITU / HDU

28
Q

BTS Guidelines:

Gram negative enteric bacilli are rec. to be treated with which drugs? [3]

A

Cefuorxime 1.5g TDS
Cefotaxime 1-2g TDS
Ceftriaxone 1-2g BD IV

29
Q

BTS guidelines:

What are the treatments for

S. aureus non-MRSA? [1]
S. aureus MRSA? [2]

A

S. aureus non-MRSA: flucloxacillin

S. aureus MRSA: vancomycin OR linezolid OR teicoplanin +/- rifampicin

30
Q

How long after the pneumonia do you check up on patients? [1]

A

6 weeks

31
Q

Which groups are given a seasonal influenza vaccine? [5]

A
  • All 65+ & 2-4
  • Healthcare workers

> 6months in the following groups:
- Asthma
- COPD
- Chronic resp, heart, kidney, liver or neurological disease
- Diabetes
- IS
- Pregnant women

32
Q

Which groups are given a seasonal pneumococcal vaccine? [5]

A
  • All 65 yr olds
    > 2 in at risk groups:
  • Asthma
  • COPD
  • Chronic resp, heart, kidney, liver or neurological disease
  • Diabetes
  • IS
  • Pregnant women
  • Asplenia / splenic dysfunction
  • Cochlea implants
  • CSF leaks
33
Q

Which patient groups do you revaccinate pneumococcal in? [2]

How often? [1]

A

Asplenia / splenic problems & CKD every 5 years

Other at risk patients: yearly

34
Q

A 69-year-old male is investigated by the respiratory team for worsening shortness of breath and cough over the past nine months. He has never smoked and is usually fit and well. The only significant history of note is that he has taken up pigeon racing since retiring. Following investigation, the patient is diagnosed with interstitial pneumonia.

Which of the following organisms is most commonly associated with interstitial pneumonia?

Haemophilus

Klebsiella

Streptococcus

Staphylococcus

Mycoplasma

A

Mycoplasma

Year 3: Respiratory (42 decks)

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