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
