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RM - Resp Conditions Profiles > Community Acquired Pneumonia - no specific types > Flashcards

Community Acquired Pneumonia - no specific types Flashcards

1
Q

Describe pneumonia

A

Inflammation of the lung parenchyma

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2
Q

In pneumonia, the airspaces fill with ___, leading to localised ___ and therefore ___

A

In pneumonia, the airspaces fill with EXUDATE, leading to localised OEDEMA and therefore CONSOLIDATION

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3
Q

What are the 3 ways in which pneumonia can be classified?

A

Clinical setting
Causative organism
Morphology

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4
Q

What 2 things must a patient NOT have to be diagnosed with CAP?

A

Immunosuppression or malignancy

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5
Q

What 2 ages is CAP particularly apperent in?

A

The extremes of life

<16 and >65 y/o

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6
Q

What gender are 2x more likely to get CAP?

A

Men

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7
Q

State the 5 major risk factors for CAP

A 
Age
Co-morbidities
Resp conditions
Smoking
Immunosuppression
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8
Q

What kind of comorbidities increase the risk of CAP?

A

HIV, Liver disease, diabetes, heart failure, malnutrition, low BMI

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9
Q

What are the 4 main resp conditions that can increase the risk of CAP?

A

COPD
Asthma
CF
Obstruction

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10
Q

What 3 lifestyle components increase the risk of CAP?

A

Smoking
Alcohol
IV drugs

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11
Q

What 3 medications are known to increase the risk of CAP?

A

ICS
Oral steroids
PPIs

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12
Q

What 2 things is the presentation of CAP dependant on?

A

The causative organisms

Age/health of the patient

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13
Q

Why does a patient become breathless in CAP?

A

The pus and debris impairs gas exchange

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14
Q

What are the 3 clinical examination findings in CAP that are due to consolidation?

A

Coarse crackles
Dull to percussion
Bronchial breathing

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15
Q

What does a swinging fever indicate?

A

Empyema

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16
Q

Why does pleuritic pain occur in CAP?

A

Pleural inflammation

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17
Q

What can sometimes be heard early in CAP?

A

Pleural rub

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18
Q

What population gets very generalised/non-specific symptoms in CAP?

A

Elderly

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19
Q

What is a common skin manifestation of CAP and why does it occur?

A

Herpes lablialis

Reactivation of the virus due to the altered immune system

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20
Q

What 2 conditions should always be considered when a patient has a possible pneumonia?

A

TB

Lung cancer

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21
Q

What is the severity assessment of CAP?

A

CURB 65

22
Q

What are the components of the CURB 65 score?

A 
C - new onset confusion
U - urea >7 mmol/L
R - RR >30/min
B - BP (systolic <90, diastolic <60)
65 - >65 y/o
23
Q

What are the 3 tiers of treatment based on the CURB65 score?

A

O-1 = outpatient treatment
2 - admission
3+ = ICU required

24
Q

What are the 2 antibiotics used in the treatment of mild, outpatient CAP?

A

Amoxicillin

Clarithromycin if penicillin allergic

25
Q

What should be done if a CAP outpatient patient fails to improve within 48 hrs?

A

CXR

26
Q

What should be measured in bloods taken from a CAP patient? (5)

A 
FBC
U&amp;Es
Biochemistry
Serology
LFTs
27
Q

What 2 cultures should be taken in a CAP patient?

A

Sputum

Blood

28
Q

Ideally, when should blood cultures be taken in CAP?

A

In all patients with moderate-severe, before antibiotics

treatment should not be delayed to do this

29
Q

What test should be offered to all CAP patients?

A

HIV

30
Q

What are the 6 other severity markers in CAP?

A 
Multi-lobar involvement
PaO2 <8 kPa
Low albumin <35 g/l
WCC <4 or >30
Positive blood culture
Fever <35 or >40
31
Q

What are the 3 times at which a CXR should be performed in pneumonia?

A

on admission
2-3 days post-admission
6 weeks post admission

32
Q

Why is a CXR done 6 weeks after a pneumonia?

A

To look for underlying malignancy

33
Q

What are the 5 general principles of pneumonia management?

A 
Oxygen
Fluids
Antibiotics
Thromboprophylaxis (if admitted for >12 hrs)
Analgesia
34
Q

If a patient has a CURB score of 0-2, what antibiotic treatment should they get?

A

Amoxicillin for 5 days

35
Q

If a 0-2 CURB patient is penicillin allergic, what are the 2 options for antibiotics?

A

Doxycycline or clarithromycin

36
Q

If a patient has a CURB score of 3-5, what antibiotics should they be on?

A

Co-amoxiclav IV
+
Doxycyline oral

37
Q

What should be given to pencillin allergic 3-5 CURB patients?

A

IV levofloxacin

38
Q

If a CAP patient is in ICU/HDU, what 2 antibiotics should they be on?

A

Co-amoxiclav IV
+
Clarithromycin IV

39
Q

What should all ICU/HDU patients be stepped down to? (antibiotics)

A

Doxycyline

40
Q

What are the 2 components of thromboprophylaxis?

A

Subcutaneous, low molecular weight heparin

Compression stockings

41
Q

Why should CAP patients be given analgesia?

A

For the pleuritic pain - reduces

42
Q

What are the 2 general complications of CAP?

A

Resp failure/ARDS

Sepsis - multi-organ failure

43
Q

What are the 4 resp complications of CAP?

A

Pleural effusion
Empyema
Lung abscesses
Organising pneumonia

44
Q

What kind of therapy is needed in hospital acquired pneumonia?

A

Extensive gram negative cover

45
Q

What kind of therapy is needed in aspiration pneumonia?

A

Anaerobic cover

46
Q

What 4 groups of people should be offered both the flu jab and the pneumococcal vaccination?

A

Over 65 y/o
Chronic chest/cardio conditions
Diabetes
Immunocompromised

47
Q

Define lobar pneumonia

A

Confluent consolidation involving a complete lung lobe

48
Q

What organism normally causes lobar pneumonia?

A

Strep. pneumoniae

49
Q

What are the 2 rarer organisms that can cause lobar pneumonia?

A

Legionella

Klebsiella

50
Q

In what 2 ways is a lobar pneumonia a classic picture of acute inflammation?

A

Exudation of fibrin-rich fluid

Neutrophil and macrophage inflitration

51
Q

Describe bronchopneumonia

A

Starting in the airways and spreading to the adjacent alveolar lung

52
Q

What context is bronchopneumonia normally seen in?

A

With underlying/pre-existing conditions

RM - Resp Conditions Profiles (8 decks)

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