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Revision Cards > Weel 120 - Bronchial sepsis > Flashcards

Weel 120 - Bronchial sepsis Flashcards

1
Q

What is palmar erythema?

A

Red palms.

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2
Q

What further tests would you perform for a diagnosis of severe community acquired pneumonia with sepsis?

A
  • Sputum culture.
  • Blood culture x 2.
  • Legionella antigen (urine)
  • Atypical serology.
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3
Q

A lady with severe pneumonia and sepsis is in the hospital, she has a BP of 75/48, what is your intitial plan of action?

A
  • ‘Agressive’ IV fluids to maintain systolic BP of >100.
  • Analgesics.
  • 60% FiO2
  • IV benzylpenicillin
  • IV clairthromycin
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4
Q

What two IV antibiotics would you give as part of the initial treatment plan of pneumonia with sepsis?

A
  • IV benzylpenicillin

* IV clarithromycin

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5
Q

What is the incidence of community acquired pneumonia?

A

4-10 in 1000

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6
Q

What is the incidence of hospital acquired pneumonia amongst the hospital population?

A

1 in 100

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7
Q

What is the historical way of classifying pneumonias?

A

Atypicial and typical.

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8
Q

What is ‘Atypical’ Pneumonia?

A
  • Gradual onset
  • Dry cough
  • Myalgias
  • Headache
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9
Q

What is ‘typical pneumonia’?

A
  • Sudden onset
  • Purulent sputum
  • High fever
  • Focal consolidation
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10
Q

What is ‘focal consolidation’?

A

The replacement of gas in the lungs with fluid, protein, cells in a single spot in the lungs.

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11
Q

What are the four microbiology classifications on pneumonia?

A
  • Bacteria
  • Virus
  • Fungal
  • Helminths/protozoa (rare)
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12
Q

Describe steptococcus pneumoniae.

A
  • Gram +ve
  • Lives in respiratory tract
  • Rapid multiplication
  • Abrupt onset
  • Very ill
  • MEDICAL EMERGENCY!
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13
Q 
Which strain of bacteria is this describing?
• Gram +ve
• Lives normally in respiratory tract
• Abrupt multiplication
• Causes host to be very ill
• Is a medical emergency?
A

Streptococcus pneumoniae

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14
Q

Which form of pneumonia occupies one lobe and what are the three pathogens that most frequently cause it?

A

Lobar pneumonia
• Streptococcus pneumoniae
• Haemophilus influenza
• Morexxa Catarrhalis

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15
Q

Describe haemophilus influenza.

A
  • Gram -ve
  • Usually encapsulated
  • Small pleural effusions can occur.
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16
Q

Which bacteria can cause lobar pneumonia, is usually encapsulated and can cause small pleural effusions?

A

Haemophilus influenza.

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17
Q

Which anatomical description of pneumonia has been most linked to hospital acquired pneumonia?

A

Bronchopneumonia

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18
Q

What is bronchopneumonia and what are the four most likely organisms to cause it?

A 
It is pneumonia that is the acute inflammation of the walls lining the bronchioles, it is characterised by multiple loci.
• Staphylococcus aureus
• Klebsiella
• E. Coli
• Pseudomonnas
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19
Q

Describe Staphylococcus aureus.

A
  • Gram +ve
  • Spread via airway or bacteraemia
  • Lung tissue lysis can lead to cavitation.
  • Septicaemia, abscesses and empyema are common.
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20
Q

Which gram +ve bacteria that causes the majority of hospital acquired pneumonia, is spread via the airway and can cause cavitation, septicaemia, abscesses and empyema?

A

Staphylococcus aureus.

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21
Q

Describe klebsiella.

A
  • Gram -ve
  • Colonise the oropharynx
  • Nosocomial
  • Comorbity is common
  • Very ill
  • Haemoptosis
  • Poor prognosis.
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22
Q

Which gram-ve bacteria (that causes pneumonia) colonises the oropharynx, is nosocomial causes people to be very ill, have haemoptosis and has a poor prognosis?

A

Klebsiella

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23
Q

What does nosocomial mean?

A

Hospital acquired infection.

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24
Q

Describe Escherichia coli.

A
  • Gram -ve
  • Often occurs in patients with comorbities who are chronically ill.
  • Occurs from aspiration.
  • Often affects the lower lobe.
  • Poor prognosis.
25
Q

Which gram -ve bacteria which often infects those with comorbidites who are chronically ill, usually via aspiration, affecting the lower lobe with a poor prognosis?

A

Escherichia coli

26
Q

Describe Pseudomonas aeriginosa.

A
  • Gram -ve
  • Chronically ill patients often with structural lung disease.
  • Produces copious amounts of very green sputum.
  • Gradual onset.
27
Q

Which gram -ve bacteria causes pneumonia in chronically ill patients, often with structural lung disease, produces copious amounts of very green sputum and has a gradual onset?

A

Pseudomonas aeriginosa.

28
Q

Describe Legionella pneumophilia.

A
  • gram -ve intracellular bacteria.
  • Often from water or air conditioning.
  • Affects people who are immunosupressed.
  • Causes; dry cough, myalgia, acute renal failure, hepatoslenomegaly, diarrhoea, oliguria, rash, rhabdomyolysis.
29
Q

What are the 8 symptoms of Legionella pneumophilia?

A

1) Rash
2) Oliguria
3) Diarrhoea
4) Acute renal failure
5) Hepatosplenomegaly
6) rhabdomyolysis
7) Dry cough
8) Myalgia

30
Q

What is oliguria?

A

Oliguria is poor urine output.

31
Q

What is rhabdomyolysis?

A

Breakdown of skeletal muscle.

32
Q

What is mycoplasma pneumoniae?

A 
Occurs in closed populations.
Causes the following symptoms;
• Arthralgias
• Myalgias
• Diarrhoea
• Endocarditis
• Meningitis
• Hepatitis
• Vomitting
• Skin eruptions
33
Q

Which bacteria that causes pneumonia causes the following symptoms; Arthralgias, myalgias, diarrhoea, vomitting, skin eruptions, myocarditis, meningitis, hepatits?

A

Mycoplasma pneumoniae.

34
Q

Which pneumonia causing bacteria can you be infected by birds?

A

Chlamydia psttacci.

35
Q

What are the symptoms of infection caused by Chlamydia psttacci and what can you catch it from?

A

Birds.

Fever, myalgia, macular rash, splenomegaly, severe cough, depression, dyspnoea.

36
Q

Describe pneumocystis jirovecii.

A
  • Fungus
  • Immunocompromised individuals
  • Gradual onset SOB
  • Dry cough
  • Fever
  • Weight loss
  • Often minimal signs.
37
Q

What is the most common pathogen that causes pneumonia?

A

Stretococcus pneumoniae (Pneumococcus)

38
Q

Which pathogen normally causes epiglottitis?

A

Haemophilus influenza b

39
Q

What are the four D’s of epiglottitis?

A

Drawn, Dysphagia, Dysphonia, Drooling

40
Q

What is the management of epiglottitis?

A

It is a medical emergency, secure the airway and give IV cefuroxime.

41
Q

What is the clinical definition of pneumonia?

A

Acute LRTI, usually associated with fever, symptoms and signs in the chest with an abnormal x-ray.

42
Q

Which drugs are risk factors for pneumonia?

A
  • Sedatives - Reduce cough and epiglotic function.
  • MST and atropine - Reduces mucociliary movement.
  • Steroids and salicylates - Reduces phagocytosis.
43
Q

What are the generic symptoms of pneumonia?

A
  • Fever (Chills)
  • Cough
  • Pain
  • Dyspnoea
  • Myalgias
  • General malaise
  • Headache
  • Vomitting
44
Q

What are the initial investigations for pneumonia and what is the acronym to remember them?

A 
SUBEC
• Sputum - Acid Fast Bascili, General Culture, Gram Stain.
• Urine - Legionella antigen, output.
• Blood - WBC, Urea, serology, cultures
• E - ECG
• C - Chest X-ray
45
Q

What does SUBEC stand for, when talking about pneumonia?

A 
Initial investigations;
• S - sputum
• U - Urine
• B - Blood
• E - ECG
• C - Chest X-ray
46
Q

What is the antibiotic treatment for uncomplicated pneumonia?

A

• p.o. amoxycillin and p.o. clarithromycin
Or,
• p.o. Cephalosporin

47
Q

What is the antibiotic treatment for complicated pneumonia?

A

• IV Cefuroxime and p.o clarithromycin
Or,
• I.V. Augmentin and p.o. clarithromycin

48
Q

What is CURB 65?

A 
Assessment system for pneumonia;
C - Confusion
U - Urea over >7mmol/L
R - Respiratory rate greater than 30/min
B - Blood pressure < 60 diastolic
65 - Over 65
49
Q

What concentration of urea scores a point on CURB 65?

A

> 7mmol/L

50
Q

What respiratory rate scores a point on CURB 65?

A

> 30bpm

51
Q

What blood pressure scores a point on CURB 65?

A

<60 Diastolic

52
Q

In community acquired pneumonia what would be the management plan for a CURB 65 score of 0-1?

A

In community, Amoxycillin (clarithromycin if allergic to penicillin).

53
Q

In community acquired pneumonia what would be the management plan for a curb score of 2?

A

Consider in-patient or supervised out patient, Amoxycillin PLUS clarithromycin.

54
Q

In community acquired pneumonia what would be the management plan for a curb score of 3+?

A
  • Severe Pneumonia!
  • Consider HDU
  • IV augmentin and p.o. clarithromycin.
55
Q

What would the management of ‘atypical’ pneumonia be?

A
  • I.V. Clarithromycin

* I.V. Rifampicin

56
Q

If cavitation occurred with pneumonia what would the management plan be?

A
  • I.V. cefuroxime
  • I.V. Metronidazole
  • I.V. Flucloxacillin
57
Q

What would the management be for aspiration pneumonia?

A
  • I.V. Cefuroxime

* I.V. Metronidazole

58
Q

What are the five main complications of pneumonia?

A

1) Abscesses
2) Bronchiectasis
3) Empyema
4) ARDS
5) Pulmonary emboli

59
Q

What is ARDS?

A

Acute Respiratory Distress Syndrome
• PaO2/FiO2 <200mmHg
• Bilateral infiltrates

Revision Cards (61 decks)

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