[11] Pneumonia Flashcards
(76 cards)
1
Q
What is pneumonia?
A
Pneumonia is a general term denoting inflammation of the gas-exchanging region of the lung, usually due to infection (bacterial or viral). It is therefore an infection of the lung parenchyma
2
Q
What is pneumonitis?
A
Inflammation of the lung parenchyma due to other causes, such as physical or chemical damage
3
Q
What are the different types of pneumonia?
A
- Lobar pneumonia
- Bronchopneumonia
- Aspiration pneumonia
- Interstital pneumonia
- Chronic pneumonia
4
Q
What is lobar pneumonia?
A
Pneumonia that is localised to a particular lobe of the lung
5
Q
What is lobar pneumonia most commonly due to?
A
Streptococcus pneumoniae
6
Q
What is bronchopneumonia?
A
Pneumonia that is diffuse and patchy
7
Q
How does bronchopneumonia develop?
A
It starts in the airways, and spreads to adjacent alveoli and lung tissue
8
Q
What organisms cause bronchopneumonia?
A
- Streptococcus pneumoniae
- Haemophilus influenza
- Staphylococcus aureus
- Anaerobes
- Coliforms
9
Q
What is aspiration pneumonia?
A
When aspiration of food, drink, saliva, or vomit causes pneumonia
10
Q
What organisms cause aspiration pneumonia?
A
- Oral flora
- Anaerobes
11
Q
What is interstitial pneumonia?
A
Inflammation of the intersticium of the lung
12
Q
What does the intersticium of the lung consist of?
A
- Alveolar epithelium
- Pulmonary capillary endothelium
- Basement membrane
- Perivascular and perilymphatic tissue
13
Q
What is chronic pneumonia?
A
Inflammation of the lungs that persist for an extended period of time
14
Q
What are the common bacteria causing pneumonia?
A
- Streptococcus pneumoniae
- Haemophilus influenzae
- Klebsiella pneumoniae
15
Q
What are the atypical bacteria causing pneumonia?
A
- Chlamydia pneumophilia
- Mycoplasma pneumoniae
- Legionella pneumophilia
16
Q
What hospital acquired bacteria cause pneumonia?
A
- Gram -ve enteric bacteria
- Pseudomonas
- Staphylococcus aureus/MRSA
17
Q
What features are associated with S. Pneumoniae pneumonia?
A
- Elderly
- Co-morbidities
- Acute onset
- High fever
- Pleuritic chest pain
18
Q
What features are associated with H. Influenzae pneumonia?
A
COPD
19
Q
What features are associated with legionella pneumonia?
A
- Recent travel
- Younger patient
- Smoker
- Illness
- Multi-system involvement
20
Q
What features are associated with mycoplasma pneumonia?
A
- Young
- Prior antibiotics
- Extra-pulmonary involvement, e.g. haemolysis, skin and joint problems
21
Q
What features are associated with S. Aureus pneumonia?
A
- Post-viral
- IV drug users
22
Q
What features are associated with chlamydia pneumonia?
A
Contact with birds
23
Q
What features are associated with klebsiella pneumonia?
A
- Thrombocytopenia
- Leucopenia
24
Q
What viruses can cause pneumonia?
A
- Most commonly RSV
- Influenza type A or B
25
What % of pneumonia cases are caused by viruses?
About 15%
26
What groups are at higher risk of pneumonia?
* Babies and very young children
* Elderly
* Smokers
* Co-morbidities
* Immunocompromised
27
What co-morbidities can increase the risk of pneumonia?
* Asthma
* CF
* Heart, kidney, or liver conditions
28
What can cause immunocompromisation?
* Recent illness such as flu
* Infection with HIV/AIDS
* Chemotherapy
* Anti-organ transplant rejection medication use
29
What are the risk factors for aspiration pneumonia?
* Altered level of conciousness
* Problems swallowing
30
What can cause altered level of consciousness increasing the risk of aspiration pneumonia?
* Anaesthesia
* Alcohol
* Drug abuse
31
What can cause problems swallowing increasing the risk of aspiration pneumonia?
Nerve or oesophageal damage, e.g after stroke
32
Is the presentation of pneumonia consistent?
It can be variable, however there is almost always malaise, fever, and a productive cough
33
How quickly is the onset of pneumonia?
Can be of very rapid onset, particularly if pneumococcal or staphylococcal
34
What are the symptoms of pneumonia?
* Malaise
* Fever
* Productive cough
* Dyspnoea
* Pleuritic chest pain
* Malaise
* Anorexia and vomiting
* Headache
* Myalgia
* Diarrhoea
* Sweats or chills
35
What is pleuritic chest pain?
A sharp pain when you breathe, cough, or sneeze
36
What is involved in the diagnosis of pneumonia?
* History and examination, including percussion and auscultation
* Chest x-ray
* Oxygen testing
* Microbiological testing
* Blood tests
37
What is the CURB 65 score used for?
To assess the severity of pneumonia
38
How is the CURB score interpreted?
A score of 2 or more is an indication for hospital treatment, and higher scores may require ICU treatment
39
What is C in the CURB 65 score?
New mental confusion
40
What is U in CURB 65?
Urea \>7mmol/L
41
What is R in CURB 65?
Respiratory rate \>30/min
42
What is B in CURB 65?
Blood pressure \< 90/60mmHg
43
What is 65 in CURB 65?
Over 65 years old
44
What are the chest signs of pneumonia?
* Bronchial breath sounds
* Crackles
* Wheeze
* Dullness to percussion
* Reduced vocal resonance
45
What are the CXR findings in pneumonia?
* Lobar or multilobar infiltrates
* Cavitation
* Pleural effusion
46
What samples can be collected in pneumonia?
* Sputum
* Nose and throat swabs
* Endotracheal aspirates
* Broncho-alveolar-lavage fluid (BAL)
* Open lung biopsy
* Blood culture, *preferably before antibiotics*
* Urine
* Serum
47
What is the purpose of microbiological testing in pneumonia?
* To confirm a diagnosis
* Isolate the causative organism to guide treatment
48
What microbiological testing can be done in pneumonia?
* Macroscopic examination
* Microscopy
* Culture
* PCR
* Antigen detection
* Antibody detection
49
What is done in macroscopic examination of sputum in pneumonia?
Look to see if sputum is purulent or blood stained
50
What is included in microscopy in pneumonia?
Gram staining and acid fast
51
What is the purpose of culture in pnuemonia?
To isolate bacteria and viruses
52
What is the purpose of PCR in pneumonia?
To identify respiratory viruses
53
What is the purpose of antigen detection in pneumonia?
To look for Legionella
54
What blood tests are done in pneumonia?
* FBC
* U&E
* LFT
* CRP
55
What is included in the management of pneumonia?
* Antibiotics
* Oxygen therapy
* Fluids
* Analgesia *if pleurisy*
56
When should ITU be considered in the management of pneumonia?
If shock, hypercapnia, or persistent hypoxia
57
What antibiotic regime is used in the treatment of pneumonia when the CURB score is 0-1 and the causative organism is *S. Pneumoniae* or *H. influenza*?
Oral amoxicillin, clarithromycin, or doxycycline for 5 days
58
What antibiotic regime is used in the treatment of pneumonia when the CURB score is 2 and the causative organism is *S. pneumoniae, H. influenza,* or *mycoplasma pneumoniae*?
* Oral amoxicillin and clarithromycin or doxycycline
* If IV required, amoxicillin and clarithromycin for 7 days
59
What antibiotic regime is used in the treatment of pneumonia when the CURB score is 3+ and the causative organism is *S. pneumoniae, H. influenzae,* or *mycoplasma pneumoniae*?
IV Co-amoxiclav or cephalosporin, *and*
IV clarithromycin for 7 days
60
What antibiotic regime is used in the treatment of pneumonia when the CURB score is 3+ and the causative organism is suspected to be *S. Aureus?*
* IV co-amoxiclav or cephalosporin, *and*
* IV clarithromycin for 7 days, *and*
* Flucoxacillin and/or rifampicin for 10 days
61
What antibiotic regime is used in the treatment of pneumonia when the CURB score is 3+ and the causative organism is suspected to be MRSA?
* IV Co-amoxiclav or cephalosporin for 7 days, *and*
* IV clarithromycin for 7 days, *and*
* Vancomycin for 10 days
62
What antibiotic regime is used in the treatment of pneumonia when the causative organism is legionella pneumophilia?
Fluroquinolone combined with clarithromycin, or rifampicin if severe
63
What antibiotic regime is used in the treatment of pneumonia when the causative organism is chlamydial species?
Tetracycline
64
What antibiotic regime is used in the treatment of pneumonia when the causative organism is pneumocystis jiroveci?
High dose co-trimoxazole
65
What antibiotic regime is used in the treatment of pneumonia when the causative organism is gram -ve bacilli, *Pseudomonas*, or anaerobes?
IV aminoglycosides, and antipseudomodal penicillin, or 3rd generation cephalosporin
66
What antibiotic regime is used in the treatment of pneumonia when the causative organism is *S. pneumoniae* or anaerobes?
IV cephalosporin and metronidazole
this is the last box on the table im not sure if its right cus its on the lusuma notes which are now down but if you remind me i'll look and see if i have it printed, if not just ignore this card i guess?
67
What is the aim of oxygen therapy in pneumonia?
Aim to keep PaO2 \>8.0, and/or saturations \>94%
68
What should you explain to patients recovering from community-acquired pneumonia\>
That after starting treatment, their symptoms should steadily improve
69
What should people be told to expect regarding their symptoms after 1 week of treatment?
Fever should have resolved
70
What should people be told to expect regarding their symptoms after 4 weeks?
Chest pain and sputum production should have substantially reduced
71
What should people be told to expect regarding their symptoms after 6 weeks/
Their cough and breathlessness should have substantially reduced
72
What should people be told to expect regarding their symptoms after 3 months?
Most symptoms should have resolved, but fatigue may still be present
73
What should people be told to expect regarding their symptoms after 6 months?
Most people should feel back to normal
74
What should patients be advised to do if they feel that their symptoms are deteriorating, or not improving as expected after treatment?
Consult their HCP
75
What are the potential complications of pneumonia?
* Pleural effusion
* Empyema
* Lung abscess
* Respiratory failure
* Septicaemia
* Brain abscess
* Pericarditis
* Myocarditis
* Cholestatic jaundice
76
What can cause pneumonia in immunocompromised patients?
Immunocompromised patients might have a virulent infection with a common organism, or might be infected by an opportunistic pathogen, for example;
* Cytomegalovirus
* *Mycobacterium avium intracellulare*
* *Aspergillus*
* *Candida*
* *Pneumocystis jiroveci*
* Cryptosporidia
* Toxoplasma
