10 Lung Infection: Viral and Bacterial Pneumonias Flashcards
(34 cards)
Q: What causes pneumonia? (2) Why does it seem that one doesn’t have a cause?
A: Community acquired (CAP)-> large percentage of cases don’t have known cause- maybe not discovered the bacteria yet or we don’t have a test for it yet
Hospital infections (‘nosocomial’)
Q: What can cause community acquired pneumonia that we know about and can do something about? (5- bacteria)
A: Strep. Pneumoniae Mycoplasma pneumoniae Staph. Aureus Chlamydophila pneumoniae Haemophilus influenzae
Q: What can cause hospital acquired pneumonia? (3- bacteria)
A: Staphylococcus aureus (28%) Pseudomonas aeruginosa (21.8%) Klebsiella species (9.8%)
Q: What are atypical bacteria? (2)
A: not covered by standard penicillin antibiotics and require specific antibiotics to treat (usually macrolides- different mechanism of action to penicillins)
Q: Name 3 common ‘typical’ pathogens that cause community acquired pneumonia. 3 atypical ones? (bacteria)
A: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis
Mycoplasma pneumoniae, Chlamydophilia pneumoniae, Legionella pneumophilia
Q: What increases mortality from pneumonia?
A: higher mortality rates with age
Q: Risk factors for pneumonia. Demographic/lifestyle? (3)
A: - age (<2; >65)
- cigarette smoking
- excess alcohol consumption
Q: Risk factors for pneumonia. Social factors? (3)
A: - contact with children <15yrs
- poverty
- overcrowding
Q: Risk factors for pneumonia. Medications? (3)
A: - inhaled corticosteroids (could suppress innate antibacterial responses)
- immunosuppressants
- proton pump inhibitors
Q: Risk factors for pneumonia. Medical history? (9)
A: - COPD (chronic airway disease)
- asthma (chronic airway disease)
- heart disease
- liver disease
- diabetes mellitus
- HIV / complement/Ig deficiencies
- malignancy
- hyposplenism
- previous pneumonia
Q: Risk factors for pneumonia. Specific for certain pathogen. (3)
A: - geographical variation
- animal contact
- healthcare contact (good or bad access)
Q: What is seretide? Salbutamol?
A: steroid and bronchodilator combination
short acting bronchodilator
Q: What are normal oxygen saturation levels (on air)?
A: 94-99% (on 21% oxygen air)
Q: What is a normal respiration rate?
A: 12-20
Q: What are crepitations?
A: crackling or rattling sound
Q: What are the initial investigations performed for possible community acquires pneumonia? (10)
A: - Chest radiograph
- Blood test: Full blood count,
- Blood test: Urea
- Blood test: Electrolytes
- Blood test: Liver function
- Blood test: C reactive Protein
- Arterial Blood gases
- Microbiological investigations – sputum culture
- Microbiological investigations – blood cultures
- Microbiological investigations – urine antigen tests
Q: How does a chest X ray appear in someone with pneumonia?
A: one side/ both are more cloudy
Q: How can you tell it’s pneumonia and not bronchitis or a cold? (6)
A: - New resp. symptoms or signs
- Pleuritic chest pain
- Usually febrile- temperature
- Often hypoxic (can be confused)
- New X ray changes over time eg several days -> inflammation would shift around and progress
- Severe enough to be admitted
Q: How can you tell it’s acute bronchitis and not pneumonia or a cold? (3)
A: Cough +++
Tracheal pain, not pleuritic
No new X ray changes over time
Q: BTS guidelines for diagnosing pneumonia. (4)
A: 1. Acute lower respiratory tract symptoms
- New focal chest signs and, if in hospital, new CXR changes
- > 1 systemic feature (fever, shivers, aches and pains, temperature >38 degrees)
- No other explanation for illness
Q: When should we admit community acquired pneumonia cases to hospital? What is also taken into account?
3 categories?
A: CRB65 severity score
being over 65
0 points: can go home with antibiotics
1-2: can consider hospital
3-4: high severity and needs hospital NEEDS URGENT ANTIBIOTICS
Q: Supportive therapy for pneumonia. (4)
A: Oxygen (for hypoxia) Fluids (for dehydration) Analgesia (for pain) Nebulised saline (may help expectoration of mucous / phlegm) Chest physiotherapy
Q: What do you follow for antibiotic therapy? What’s critical? How long for?
A: local guidelines
time crucial : esp if sepsis has occured
usually for 1 week
Q: What causes community acquired pneumonia in terms of viruses? (2)
A: influenza A or B, respiratory syncytial virus
