Revision Flashcards
What are the three ways pneumonia can be acquired?
CAP - community acquired pneumonia
Hospital acquired pneumonia
Aspiration
What are the symptoms of pneumonia?
SOB Chest (pleuritic) pain Cough Malaise Rusty purulent sputum Fever
What are the clinical presentations of pneumonia?
Pyrexia
Tachypnoea
Central cyanosis
inspiratory crepitations
Decreased lung expansion on the affected side
Increased vocal resonance on affected side
Increased dullness on percussion on affected side
Sounds more like bronchial sounds on auscultation
State some differential diagnoses of pneumonia
Lung cancer
Pulmonary embolism
Cardiac failure
State some complications of pneumonia
Fibrosis Empyema Pleural effusion Recurrent infections - Local bronchial obstruction (tumour) - Local pulmonary damage (bronchiectasis) - Generalised lung disease (COPD) - Non respiratory disease (HIV) Lung abscesses
Treatment for pneumonia
Rest, hydration, nutrition, oxygenation
Non severe:
oral antibiotics - amoxicillin
Severe:
IV antibiotics - coamoxicillin, clarithromycin
Empyema should be drained
State some ways that pneumonia can be prevented
Annual influenza vaccine
Cessation of smoking
Pneumococcal polysaccharide vaccine every three years
State some investigation that should be done for pneumonia?
CXR Blood tests Sputum culture Arterial blood gases HIV testing U and Rs Full blood count Urinary legionella antigen
how many people out of 1000 get pneumonia?
5-11 per 1000
what s the mortality percentage?
5.7-12%
what percentage of community acquired pneumonia needs to be hospitalised ?
30%
who are most affected by pneumonia?
over 65 year olds
immunocomprimised
COPD patients
what is the main cause of patients to acquire pneumonia from hospitals?
use of antibiotics which reduce the good bacteria in the body so opportunistic bacteria can enter the body with reduced defence mechanisms so can colonise better
what are the five main patterns of pneumonia?
bronchopneumonia lobar/ segmental hypostatic endogenous lipid pneumonia aspiration
describe the pattern of bronchopneumonia?
tends to be focal infection with bilateral basal consolidations
(patches of pus)
How does lobar pneumonia happen?
the body responses the pneumonia bacteria by over producing secretions
the secretions spread the infection all over the lobe
How does endogenous lipid pneumonia occur?
obstruction of airways which results from accumulation of lipids in the airways (cholesterol) which macrophages find difficult to digest which also accumulate in the airways.
what is the severity scoring system which is used to assess pneumonia?
CURB 65
confusion
blood urea >7
respiratory rate >30
diastolic BP 65
What is the treatment for score
0
1-2
3-5
0
- low risk
- amoxycillin or clarithromycin
1-2
- usually needs hospitalisation
- amoxycillin and clarithromycin
3-5
- high risk and usually needs ICU
- co-amoxycillin and clarithromycin
What treatment is used if the patient is allergic to penicillin ?
levofloxacin
What are the three outcomes of organisation of pneumonia?
- mass lesion
- COP (cryptogenic organising pneumonia)
- constrictive bronchiectasis
Lung abscess is a complication of pneumonia
what are the five causes of pneumonia?
- obstructed bronchi (tumour?)
- particular organism (staph. aureus, pnuemococcal, kelbsiella)
- aspiration
- necrotic lung
- Metastatic in Pyaemia
name four ways in which defence mechanisms are lowered for recurrent infections to occur? and give some examples
local bronchial obstruction
- tumour, aspiration
local pulmonary damage
- bronchiectasis
generalised lung disease
- CF, COPD
non-respiratory disease
- immunocompromised (HIV)
name some ways for aspiration pneumonia to occur?
sedation
vomiting
neuromuscular disorders
oesophageal lesion
in which lobe does aspiration pneumonia usually occur?
lower right lobe
does hypoxaemia occur in pneumonia?
yes
fluid/secretions fill the alveolar
therefore the pulmonary circulation around the affect area vasoconstrict to prevent blood from entering the area
as air cannot enter the affected areas of the lung, ventilation/perfusion mismatch occurs.
if the pneumonia is very severe then a shunt occurs as not air can enter the lung.
what is the normal volume of air breathed per minute?
4 l/min
What is the normal cardiac output per min?
5 l/min
therefore what is the normal ventilation/perfusion ratio?
0.8
what does low V/Q mismatch respond well to?
small increase in FIO2
what do shunts respond badly to ?
increase in FIO2
Why do shunts respond badly to increase in FIO2?
because the haemoglobin is already saturated
What is chronic for pulmonale?
when the left side of the heart become hypertrophic
this is due to
- pulmonary vasoconstriction
- pulmonary embolism
the heart wants to maintain the normal cardiac output so the left side of the heart pumps harder
the tunica media becomes thicker and a layer of fibrosis forms on the tunica intima
Secondary polycythaemia- more RBCs are produced so the blood becomes thicker and therefore harder to pump.
more stress on the heart
