T4 - Clinical consequence of respiratory infection Flashcards
what are the three main anatomical classifications of pneumonia?
Lobar, broncho and diffuse
what are the three main classifications of pneumonia by setting?
CAP, HAP and ventilator related
what are the 5 main signs of pneumonia? (enough for a diagnosis in GP setting)
- reduced air entry
- dull percussion
- bronchial breathing
- increased vocal resonance
- crackles
what is used to define the severity of pneumonia?
CURB 65 (or CRB65 in GP setting)
what does the CURB 65 score assess?
C - confusion U - raised blood urea (>7mmol/L) R - increased respiratory rate (>30/min) B - low blood press (below 95/60) 65 - aged over 65 years
what is the significance of a CURB 65 score of
i) 0-1
ii) >1
0-1 - low chance of mortality, no need to admit
>1 - significant chance of mortality - admit to hospital
what are the main diagnostic tests used in pneumonia?
- FBC (especially CRP and WBCs)
- renal function
- liver function
- blood cultures
- HIV test
- Sputum
- viral throat swab for mycoplasma
- urine test for legionelle
- ABGs
- CXR
what may be seen on a CXR for a patient with pneumonia?
- lobar changes
- hazy
- opacity (infection)
- consolidation
what type of pneumonia may be seen in frail patients with significant co-morbidities?
broncho pneumonia
what does opacity on a CXR indicate?
infection
what should be done for a patient with pneumonia with a CURB score of 0 that has shown no improvement in 48hrs?
refer for admission
at how many weeks should a CXR be done to see if pneumonia has cleared?
6 weeks
what the predominate bacterial cause of pneumonia?
Strep pneumoniae
name four bacterial causes of pneumonia apart from strep pneumoniae?
- chalmidya pneumoniae
- mycoplasma pneumoniae
- haemophilus influenzae
- staph aureus
how is HAP managed?
- oxygen if required
- fluid replacement if metabolic need is high or there is acute kidney injury
- antibiotics
- critical care management if needed
what does the type of antibiotic prescribed for pneumonia depend on?
setting, co-morbidities, local infection trends (epidemiology) and allergies
what are the main class of antibiotics given for CAP?
beta lactase (amoxicillin, doxycycline, clarithromycin)
what are the main antibiotics prescribed for
i) non severe HAP
ii) severe HAP
non severe HAP - amoxicillin (if a strep) or doxycyclin (myocplas or legionella)
severe HAP - amoxicillin and doxycycline or ceftriaxone or levofloxacin (if IgE mediated)
what are the general complications of pneumonia?
respiratory failure and sepsis
what are the CV system associated complications of pneumonia?
CV failure due to low blood pressure and kidney failure
what are the local complications associated with pneumonia?
pleural effusion, empyema and lung abceses
name five possible reasons why a patient with pneumonia may not respond to treatment?
1) pleural parapneumonic effusion
2) differential diagnosis of TB
3) empyema
4) lung abscess
5) underlying bronchial obstruction
what is the main bacteria that causes a pleural parapneumonic effusion?
pneumococcus
what are the three types of parapneumonic effusions?
1) simple
2) complicated
3) empyema
