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Unit 13 Week 2 (Sam) > Community acquired pneumonia > Flashcards

Community acquired pneumonia Flashcards

1
Q

Pathological definitino of pneumonia

A

inflammation of the lung parenchyma leading to consolidation

doesnt have to be infectious (e.g., cryptogenic causing inflammation) or bacterial (can be viruses or fungi) however usually is.

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2
Q

Consolidation

A

when areas of the lung that are normally filled with air is replaced with something else

Appears as white on X-ray

The liquid can be pulmonary edema, inflammatory exudate, pus, inhaled water, or blood (from bronchial tree or hemorrhage from a pulmonary artery).

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3
Q
A
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4
Q

Pneumonia has symptoms of a LRTi. They are:

A

pleuritic pain, cough, sputum, breathlessness

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5
Q

What changes would you see on CXR compared to healthy lung

A

shows consolidation, areas of incresaed density so whiter

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6
Q

What localised breathing sounds would you look out for?

A

respiratory crackles- reduced air entry into one section of the lung

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7
Q

definition of community acquired pneumonia

A

acquired outside the hospital or healthcare facility (didnt acquire it within 48 hours of being discharged and it wasnt incubating)

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8
Q

Hospital acquired pneumonia

A

Acquired <48 hrs into hospital admission that wasn’t incubating on admission.

Recently hospitalised patients can be treated as CAP unless additional risk factors for MDR’s/ HAP e.g. recent Ab (antibiotic) abuse

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9
Q

Disproportionately affects which 2 groups of people?

A

old and socioeconomically less well off

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10
Q

Typical bacterial pathogens that cause pneumonia

A

streptococcus pneumoniae

haemophilus influenza

staphylococcus aureus

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11
Q

Symptoms of typical bacterial infection causing pneumonia

A

Sudden onset

malaise

fever

producrtive cough

on auscultation- crackles and bronchial breath soudns are audible

Opacity related to one lobe

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12
Q

Bacterial pathogens associated with pneumonia

A

Atypical- DON’T RESPOND TO B-LACTAMS

Mycoplasma pneumonia

Chlamydia pneumoniae

Legionella pneumoniae

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13
Q

Symptoms of atypical bacterial pneumonia infection

A

Gradual onset

Unproductive cough

Dyspnoea

Auscultation is unremarkable

X-ray shows diffuse opacity- almost subtle infiltrates

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14
Q

Other bacteria that can cause pneumonia

A

Pseudomonas aeruginosa

Enterobacteriaceae

Group A steptococcus

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15
Q

Viral pathogens that can cause pneumonia

A

Influenza A and B

Rhinoinfluenza

Corona virus–> COVID-19 and SARS

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16
Q

Entry

A

Inhaled

Aspiration from oropharynx

Direst spread

Haematogenous spread

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17
Q

Protective factors

A

Lung mucosal microbiome

Immunity (innate and adaptive)

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18
Q

Risk factors for pneumonia

A
  • Age >65 years
  • Residence in a healthcare setting
  • COPD
  • HIX infection
  • Cigarette smoke exposure
  • Alcohol abuse
  • Pharmaceuticals- PPI, inhaled corticosteroids, antidiabetic drugs
19
Q

Differential diagnosis

A

Left ventricular failure

Pulmonary embolus

Infective exacerbation COPD

Acute asthma

TB

Emphysema

Lung neoplasm

20
Q

When to consider atypical pathogens

A

Foreign travel

Prior antibiotics, hyponatraemia (mycoplasma)

Air conditioning exposure

Abnormal LFTs

Neurological exposure

Subacute presentation

21
Q

Clinical signs to look for on examination

A

Fever

cyanosis, tachypnoea, dyspnoea

Tachhycardia, hypotension (think sepsis)

localising signs- dullness to percussion, bronchial breathing, crackles

AVPU- rapidly grade a patient’s level of consciousness (Alert, Verbally responsive, pianfully responsive, Unresponsive)

22
Q

What measure would you use to assess the severity of pneumonia?

A

CURB-65

Confusion (AMTS < 8/10 Abbreviated mental test score

Urea (>7mmol/L)

Respiratory rate >/= 30 breaths/min

Blood pressure (SBP < 90mmHg), DBP =60)

Age> 65 years

a score of 0-1 is low severity 3-5 is high severity

23
Q

What is the pneumonia severity index

A

Index to assess the severity of pneumonia. Higher the score higher the MR.

The more factors you have, the higher your suspected mortality rate is. Helps determine whether a patient can be treat as an outpatient or needs to be in.

Split into 4 main categories:

Demographics: age, nursing home residency

Co-morbidities: neoplasia, liver disease, CHF, renal disease, cerebrovascular disease

Physical exam/ vital signs: mental confusion, repiratory rate, tachycardia

Laboratroy imaging: Arterial pH, sodium, glucose, haematocrit, pleural effusion, oxygenation

24
Q

Once your patient has been diagnosed whaty other investigations will you need?

A

Routine bloods: FBC, U and E, LFTs, CRP procalcitonin

ABG

Blood culture testing for Ab sensitivity

Sputum culture and screen

Pneumococcal/ legionella urinary antigen screening

Paired serology if they’re not responding to treatment

25
Q

Where would you treat someone with a low severity pneumonia?

A

At home

26
Q
A
26
Q

Conraindication to outpatient therapy

A

Inability to maintain oral intake

History of substance abuse

Severe comorbid ilnesses

Cognitive impairment

Impaired functional status

Availability of support at home

27
Q

Imaging options for pnuemonia

A

Lung ultrasound

Chest CT

28
Q

Lung ultrasound for pneumonia

A

Quick

Simple

Cheap

Reliable

Assess plueral effusions

Can miss diagnosis of diffuse diseas or interstitial pneumonias

29
Q

Chest CT

A

Provides the most information

poor access and ionizing radiation

30
Q

Supportive treatment for all patients

A

Oxygen to keep SpO2 (oxygen sat) 94-> 98% or 88->92% if T2RF

Fluids if hypotensive

VTE (venous thromboembolism) prophylaxis

Nutritional support if prolonged illness

Sitting up for at least 20 mins a day

Chest physio review to remove sputum

31
Q

British Thoracic Society (BTS) Community Acquired Pneumonia Care Bundle

A
  1. Perform CXR within 4 hours of admission
  2. Assess oxygen saturation and prescribe oxygen according to appropriate target range
  3. Calculate CURB-65 in all patients where CXR demonstrates pneumonia
  4. Administer antibiotics within 4 hours of diagnosis appropriate to CURB 65 score
32
Q
A
33
Q

What is the first line antibiotic used in suspected mild pneumonia?

A

Amoxicillin

Alternatives: clarithromycin or doxycycline

34
Q

Amoxicillin

A

CLASS: semisynthetic penicillin derivative antibacterial

CHEMSITRY:

PHARMACOLOGY: Action: bacteriocydal. attaches to cell wall of susceptible bacteria and kills by inhibiting the cross-linkage of peptidoglycan polymer chains that make up the major component of the bacterial cell wall

penicillin allergy beware

Amoxicillin rash may also be an indicator of infectious mononucleosis in patients with EBV infection

35
Q

Doxycycline

A

Broad spectrum antibiotic

Tetracycline

Bacteriostatic- inhibits bacterial protein synthesis- binds the 30S ribosomal subunit, prevents the binding of transfer RNA to messenger RNA at the ribosomal subunit

Amino acids therefore cant be added to polypeptide chains meaning that no new proteins can be made

36
Q

What medication should be given to severe pneumonia

A

co-amoxiclav (consider adding clarithromycin)

37
Q

If atypical pneumonia suspected add…?

A

clarithromycin

38
Q

If aspiration pneumonia treatment

A

Antibiotics not needed unless concerned about secondary infection (co-amoxiclav)

39
Q

Discahrge and follow up

A

Discharge when established on oral Ab’s and the ‘abnormal’ vitals are normal

Patient should have CXR 6 weeks after discharge

Explain to patients/ carers that they should see the GP is symptoms do not begin to improve within 3/7 weeks of starting Ab’s and return to ED if they worsen

Pneumnonia patient information leaflet

40
Q

What to do if the patient isnt getting better

A

Consider differential diagnosis- empyema, lung abscess, lung cancer

Differnt organism? reculture

Bronchoscopy with lavage– TB?

41
Q

Empyema

A

aka pyothorax

Condition in which pus gathers in the pleural space

42
Q

Lung abscess

A

Death of lung tissue

Collection within it is either air or fluid

check for spiking temperature despite antibiotics

43
Q

How long does it take to feel better after pneumonia?

A

can take a few months to feel better

rest and build up your strangth again

Unit 13 Week 2 (Sam) (3 decks)

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