Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

103 Theme 4 - Lungs > Clinical consequences of respiratory infections > Flashcards

Clinical consequences of respiratory infections Flashcards

1
Q

What are the 4 respiratory infections?

A
  • URTI
  • Acute Bronchitis
  • Exacerbation of chronic airway disease
  • COPD
  • Bronchiectasis

•Pneumonia (CXR diagnosis in hospital, clinical in community setting)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the different classifications of pneumonia?

A

Anatomical

  • lobar
  • broncho-pneumonia
  • diffuse

Setting

  • community acquired
  • hospital acquired
  • ventilator related
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What ages are patients more likely to get pneumonia?

A

More common in very young and very old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How many people per million die of pneumonia?

What percentage of people with pneumonia need hospital admission?

A

214 for every million dies of pneumonia

About 25% require hospital admission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the clinical signs of pneumonia?

A
  • Reduced Air Entry /PN
  • Bronchial Breathing
  • Increased Vocal resonance
  • Crackles

Are they confused?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which diagnostics are used for pneumonia?

A

•Bloods tests

  • Assess for evidence of infection/Inflammation
  • Assess renal function
  • Assess liver function
  • Blood cultures
  • HIV test
  • Sputum
  • Viral throat swab/ Mycoplasma
  • Urine –legionella Ag
  • Arterial blood gas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does this show?

A

Lobar Pneumonia - CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does this show?

A

Broncho-pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is pneumonia severity tested?

A

The CURB 65 score

  • Confusion
  • raised blood Urea (>7 mmol/L)
  • raised Respiratory rate (>30/min)
  • low Blood pressure (S<95; D≤60)
  • age > 65 years

If no Urea – CRB-65 score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What would be appropriate action for different CURB-65 scores?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is pneumonia managed in the community with no risk factors?

A
  • Rest
  • Push fluids
  • Analgesics
  • Antibiotic

Safety net

Refer if no improvement in 48 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is pneumonia managed in the hospital?

A
  • Oxygen if required
  • Fluid replacement if required
  • Antibiotics
  • Critical care management
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which pathogens are responsible for community acquired pneumonia?

A

Streptococcus pneumoniae 39%

Chlamydia pneumoniae 13%

Mycoplasma pneumoniae 11%

Haemophilus influenzae 5%

Staphylococcus aureus 2%

Viruses 12%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does antibiotic choice depend on?

A

– Setting

– Severity

– Co-morbidities (esp resp disease)

– Epidemiology

– Patient allergies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which antibiotics will be used to treat pneumonia in -

Community

Hospital - not severe

Hospital - severe

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the clearence rates for community acqured pneumonia (CAP)?

A
  • In adults aged 18-60, 95% of CAP will clear within 6 weeks (hence CXR at 6/52)
  • In older people clearance is slower

–35.1% within 3 weeks

–60.2% within 6 weeks

–84.2% within 12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which factors make community acquired pneumonia clearence slower?

A

Clearance is slower with ­comorbidity, bacteremia, multilobar involvement, or enteric gram-negative bacilli pneumonia

18
Q

What does this chest x-ray show?

A

Consolidation obscuring L heart border (i.e. in lingula) with air bronchograms

19
Q

What do these ABG results show?

A

•Type 1 respiratory failure

Metabolic acidosis

20
Q

Which patients can you kill with oxygen?

A

worsening Type 2 Respiratory failure patients

21
Q

What are the different patient interfaces for oxygen?

A
  • Nasal cannulae
  • Controlled (fixed percentage - venturi) masks
  • Uncontrolled masks
  • Hudson
  • Reservoir mask
22
Q

What units does oxygen reach the patient as?

A

•Oxygen reaches the patient either as

litres per minute

percentage inspired oxygen

23
Q

What can you only give to patients in critical care?

A

Can give higher oxygen concentration, positive pressure and reduce work of breathing

–Nasal HiFlow

–CPAP (continuous positive airway pressure)

–NIV (Non-invasive ventilation)

–Intubation and invasive Ventilation

–If everything fails consider ECMO (Extracorporeal membrane oxygenation)

24
Q

What are the general complications of pneumonia?

A

General –

  • respiratory failure
  • sepsis – multi-system failure
25
Q

What are the local complications of pneumonia?

A

Local –

  • pleural effusion
  • empyema
  • lung abscess
  • “organising pneumonia”
26
Q

What are the possible reasons for pneumonia failing to respond?

A
  • Wrong or incomplete diagnosis
  • Antibiotic problem
  • Complication developing
  • Underlying bronchial obstruction
  • Approach: Re review
27
Q

Patient has pneumonia which is failing to respond.

On examination -

  • Left side reduced expansion
  • Left sided Reduced AE
  • Stony dull percussion note

Whats the diagnosis?

A

Pleural parapneumonic Effusion

28
Q

Whats the diagnosis?

A

Pleural parapneumonic Effusion

29
Q

When should a Pleural parapneumonic Effusion be considered?

A

To be considered when the patient is not responding to treatment for pneumonia

30
Q

What are the 3 types of Pleural parapneumonic Effusion?

A

–Simple parapneumonic

–Complicated parapneumonic

–empyema

31
Q

What are the dominant pathogens which cause Pleural parapneumonic Effusion?

A

Dominant microbiology is Pneumococcus, but also Staph. aureus and Strep. milleri

32
Q

Which differential diagnosis should be considered with
Pleural parapneumonic Effusion?

A

•Consider differential diagnosis of pleural tuberculosis

33
Q

What are the indications for drainage of empyema?

A
  • visibly purulent effusion
  • radiologically loculated effusions
  • positive microbial culture from effusion
  • pleural pH less than 7.2
34
Q

What does this chest x-ray show?

A

Lung absesses

Circular with straight line through it.

35
Q

Why do lung absesses form?

A
  • Formation of abscess can be another cause of failure to respond
  • Need to think of cause
  • Consider endocarditis
36
Q

How are lung absesses treated?

A
  • Need lavage
  • Prolonged antibiotic course
37
Q

What does this show?

A

Lung
Abscess

38
Q

What are the common differential diagnoses of pneumonia?

A

CAP and lung cancer

CAP and heart failure

pulmonary emboli / infarction

39
Q

What are the unusal and rare differential diagnoses of pneumonia?

A

Unusual

  • specific infections, eg Tuberculosis
  • complicating chronic bronchial suppuration,

eg bronchiectasis, Cystic Fibrosis

Rare

  • vasculitis
  • pulmonary eosinophilia

Crytogenic organising pneumonia

40
Q
  • Treated for bilateral CAP
  • Failure to improve

What does this imply?

A

‘Atypical pneumonia’

–Antibiotics ineffective

41
Q
  • Treated for bilateral CAP
  • Failure to improve

What are the alternate diagnoses for this patient?

A

–Hypersensitivity pneumonitis

–COP

–Heart faluire

–Vasculitis

42
Q

This is an atypical pneumonia which didn’t respond to antibiotics.

Patient is HIV positive.

What is the diagnosis?

A

Pneumocystis jiroveci (PJP)

103 Theme 4 - Lungs (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions