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infection > 5 Infection of resp systems PNEUMONIA > Flashcards

5 Infection of resp systems PNEUMONIA Flashcards

LRT infection ! (44 cards)

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1
Q

Examples of different pathogens that cause pneumonia ?

A
  • viruses
  • bacteria
  • fungi (pneumocystis jirovecii)
  • parasites
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2
Q

Pneumonia classified depending on source of infection how ?

A
  • community-acquired pneumonia (CAP)
  • hospital-acquired pneumonia (HAP)
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3
Q

Pneumonia diagnosis ? list 3 ways:
1. symptoms and signs of …
2. diagnosis confirmed by ….. which shows …..that’s not due to any other cause
3. different …. strategies for CAP and HAP

A

1.LRT infection
2. chest X ray showing new shadowing, not due to any other cause
3.management

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4
Q

Pneumonia risk factors that aren’t age, lifestyle, underlying medical conditions & exposure to contaminated resp therpay equipment , water sources or exposure to healthcare setting ?

A
  • impaired cough reflex
  • aspiration of naso- or oropharyngeal secretions
  • antibiotic therapy
  • surgery of head, neck, thorax, or upper abdomen
  • intubation / mechanical ventilation
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5
Q

Pneumonia risk factors that are from exposure of ….?

A
  • contaminated respiratory therapy equiment
  • contaminated water sources
  • healthcare setting
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6
Q

Pneumonia classified by sites how ?

A
  • loba - entire lobe (streptococcus pneumoniae)
  • bronchopneumonia - (Descending infection around bronchi and bronchioles, lower lobes )
  • interstitial
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7
Q

4 stages of lobar pneumonia ? and the durations of each stage

A
  1. congestion (24 - 48 hr)
  2. red hepatisation (2 - 3 days)
  3. grey hepatisation (4 - 8 days)
  4. resolution (day 8 - 4 weeks)
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8
Q

macroscopic features of congestion stage

A
  • partial consolidation of the parenchyma
  • red - purple
  • lungs are heavy , boggy
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9
Q

microscopic characteristics of congestion stage

A
  • vascular engorgement
  • intra-alveolar oedema
  • many bacteria / few neutrophils
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10
Q

macropscopic features of red hepatisation

A
  • red-pink, dry, granular, airless
  • parenchymal consolidation
  • reversible
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11
Q

microscopic characteristics of red hepatisation ?

A
  • fibrin strands replace oedema fluid
  • cellular exudate of neutrophils
  • extravasation of erthrocytes
  • desquamated epithelial cells
  • alveolar septa become less prominent
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12
Q

macroscopic features of grey hepatisation

A
  • lung appears grey
  • liver-like consistency
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13
Q

microscopic characteristics of grey hepatisation

A
  • lung appears grey
  • liver-like consistency (due to fibrin deposition)
  • red cell lysis / disintegration / clearance
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14
Q

macroscopic features of resolution

A

gradual restoration of aeration

part of body e.g. lung / portion lung tissue gradually regains its ability to take in air

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15
Q

microscopic characteristics of resolution stage of lobar pneumonia

A
  • resolution and restoration of pulmonary architecture
  • enzymatic fibrinolysis
  • macrophages remove neutrophils and debris
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16
Q

community - acquired pneumonia infection acquired where ?

A

outside of hospitals

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17
Q

In CAP mortality and morbidity increase if patients are ….

A

transferred to intensive care within 24 - 48hr admission

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18
Q

Why will ~ 10% of patients admitted with CAP will need intensive care admission ?

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A
  • severe respiratory failure
  • septic shock
  • sepsis
19
Q

symptoms of CAP ? that typically present with signs / symptoms of which tract ?

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A

lower respiratory tract infection
* cough
* dyspnoea (SOB)
* pleuritic chest pain
* mucopurulent sputum
* myalgia (muscle aches and pains)
* fever

onset over hours to days

20
Q

Management (assessment) of CAP and HAP that are similar ?

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A

Chest x-ray
Full blood count
Oxygen saturations
Blood gas
Urine antigen testing

21
Q

management (assessment) specific to CAP ?

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A

Sputum gram stain
Sputum culture
Blood culture
Test for influenza

CURB-65
Pneumonia severity index

22
Q

management (assessment) specific to HAP ?

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A
  • CT scan chest
  • Chest ultrasound
  • Thoracocentesis and pleural fluid culture
23
Q

Prevention of CAP ?

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A
  • Vaccination
  • Lifestyle changes
  • Good respiratory hygiene
24
Q

Treatment of CAP ?

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A
  • Administration of antibiotics
  • Initiate antibiotic treatment within 4 hours of presentation
  • Supplement oxygen for patients with oxygen saturation < 94% or 88% for those at risk of CO2 retention
  • Consider risk of sepsis
25
What is CAP mortality risk assessment ?
CURB-65 Confusion Urea Respiratory rate Blood pressure Age >= 65
26
How is CURB65 scored ?
1 point for the presence of each crieterion (confusion, urea, respiratory rate, blood pressure, age)
27
CURB65 cirterion presence for confusion ?
abbreviated mental test score 8 or less , or new disorientation in person , place or time
28
CURB65 cirterion presence for urea ?
> 7 mmol
29
CURB65 cirterion presence for respiratory rate ?
> = 30 breaths per minute
30
CURB65 cirterion presence for blood pressure?
diastolic 60 mmHg or less systolic less than 90 mmHg
31
Using the CURB65 score how are patients stratified for risk of death ?
* 0 = low risk , 1% mortality risk * 1 / 2 = intermediate risk , 1-10% mortality risk * 3 / 4 = high risk , > 10% mortality risk
32
How is nosocomial pneumonia defined ? acquired when ?
Hospital-acquired pneumonia * acute lower respiratory tract infection acquired at least 48 hours of admission * not present/ incubating on admission
33
risk factors of nosocomial pneumonia - HAP ?
* endotracheal intubation * mechanical ventilation (ventilator-associated pneumonia) * aspiration
34
symptoms / signs of HAP ?
* Cough with increasing sputum production * Dyspnoea * Dever (core temperature > 38.5 ) * Chest pain * Asymmetrical expansion of the chest * Diminished resonance * Raised or lower WBC counts * Worsening gaseous exchange and increase in O2 requirements
35
Treatment of HAP ?
Antibiotics
36
Treatment of HAP , antibiotics include what ?
* Clinical judgement * number of days hospitalisation * Severity * Risk of complications * Microbiological results * Risk of adverse events from broad-spectrum antibiotics (e.g. clostridium difficile)
37
Commonly observed pathogens of CAP and HAP ? (6)
* Streptococcus pneumonia * Staphylococcus aureus (including MRSA) * Haemophilius influenzae * Moraxella catarrhalis * Klebsiella pneumoniae * Escherichia coli
38
how do typical pneumonia and atypical pneumonia differ ?
in terms of causative agents, clinical presentation, severity of symptoms, and radiographic findings
39
typical pneumonia of CAP ?
* streptococcus pneumoniae * staphylococcus aureus * group A streptococcus * klebsiella pneumoniae * haemophilus influenzae * moraxella catarrhalis * MRSA * Escherichia coli * other enterobacteriaceae
40
atypical pneumonia of CAP ?
* mycoplasma pneumoniae * chlamydophila pneumoniae * legionella pneumophilia * influenza pneumophila * chlamydophila psittaci
41
Aetiology of CAP that are common secondary bacterial infections with influenza ?
* streptococcus pneumoniae * staphylococcus aureus
42
Name 9 viruses that are involved in aetiology of CAP
* influenza A and B viruses * SARS-CoV-2 * other coronoviruses * rhinoviruses * parainfluenza viruses * adenoviruses * respiratory syncytial virus * human metapneumovirus * human bocaviruses
43
Pathogens causing HAP that doesn't cause CAP ?
Pseudomonas aeruginosa Acinetobacter species Serratia species Candida species legionella aspergillus fumigateurs
44
complications of pneumonia
* acute respiratory distress syndrome (ARDS) * pleural effusions (swelling of / fluid filling the pleura) * empyema (infection of fluid filling the pleura) * pleurisy (inflammation and swelling of pleura) * lung abscesses * respiratory failure * septic shock * sepsis * bacteremia

infection (33 decks)

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