Condition- pneumonia Flashcards
(29 cards)
What is Pneumonia?
An acute Lower Respiratory Tract Infection
What are the different categories to classify pneumonia aetiologically?
- Community acquired
- Hospital acquired (developed >48hrs after admission)
- Aspiration Pneumonia
- Immunocompromised
List the three main causative agents of Community acquired Pneumonia
- Streptococcus Pneumoniae
- Haemophilius Influenza
- Moraxella Catarrhalis
List the three main causative agents if Hospital- acquired pneumonia…
- Gram -ve enterobacter:
- Klebsiella
- Pseudomonas aeroginosa
- Staphylococcus Areus
List the main causative agent of aspiration pneumonia
Streptococcus Pneumoniae
List the 3 (+2) main causative agents of immunocompromised pneumonia…
- Streptococcus pneumoniae
- Haemophilius Influenza
- Staphylococcus Aureus
- Moraxxella catarrhalis (COPD)
- Mycoplasma pneumoniae
List some of the presenting symptoms of pneumonia…
- Fever
- SOB
- Cough- green sputum
- Pleuritic Chest pain
- Malaise
- Weight loss
- Sweats
- Rigors
- haemoptysis
- Confusion
List some of the signs of pneumonia on physical examination…
- Low oxygen saturation, pyrexia, tachycardia, tachyopnoea, hyoptension
- Confusion (AMT), hypothermia
- Percuss: dullness
- Palpate: reduced expansion
- Auscultate:
- Increased tactile fremitus/ vocal resonance
- Bronchial breathing
- Coarse crackles
What are the different types of pneumonia you can see on an x-ray?
- Bronchopneumonia: Patchy shadowing
- Lobar/ multilobar
- Consolidation: Pleural effusion/ cavitation
List the different investigations you would perform on someone with suspected Pneumonia
- Bedside: pulse ox, BP, sputum sample, urine dip
- Bloods: FBC (elevated WCC), LFTs (in case its HPS), U+Es (urea), CRP, ABG (to check for resp failure)
- Imaging: CXR, bronchoscopy
- Special: Bronchoalveolar lavage, sputum and pleural fluid (MC+S)
Which scoring system can be used to assess the severity of pneumonia? What are the criteria?
CURB-65
- Confusion (AMTS<8)
- Urea >7mmol/L
- Resp rate >30
- BP <90 SBP or 60 DBP
- >65yrs
What do you interpret the CURB-65 score?
- 0-1: can treat at home
- 2: Short hospital admission reqiured
- 3: Severe, ITU may be required
What are the steps to be taken in the management of pneumonia?
- CURB-65
- ABC:
- Supplemental Oxygen
- Treat hypotension/ shock: IV fluids
- Analgesia if pleurisy
- CPAP if necessary
- Surgical drainiage (if abscess/ empyema)
- Antibiotics
- Vaccination
Which antibiotics are given to a patient with community acquired pneumonia with a CURB-65 score of:
- 0-1
- 2
- >3
- 0-1: oral amoxicillin or clarithromycin
- 2: oral amoxicillin AND clarithromycin
- >3: IV co-amoxiclav/ cephalosporin AND IV clarithromycin
Which antibiotics are given to a patient with hospital acquired pneumonia?
- IV aminoglycoside
- AND IV pseudomonal penicillin/cephalosporin
Which antibiotics are given to patient with aspiration pneumonia?
- IV cephalosporin + IV metronidazole
Which antibiotics are given to patients with pneumonia caused by atypical bacteria?
- Clarithromycin
Which antibiotic is given to patients pneumonia caused by Staph A (2)
- If staph: Flucloxacillin + gentamycin
- If MRSA: Vancomycin
Which pathogen often causes pneumonia in alcoholics?
Klebsiella
Which pathogen commonly causes pneumonia in COPD patients?
Haemophilus Influenza B
List some potential complications of Pneumonia…
- Spread of infection:
- Sepsis
- Lung abscess
- Empyema
- Pleural effusion
- myopericarditis
- Damage to structure:
- ARDS
- Bronchiectasis
- Pneumothorax
Which vaccinations protect against strains of pneumonia causing agents and which subset of the population are allowed the vaccines?
- HIB and pneumococcus vaccine
- GROUPS:
- >65
- Chronic heart, liver or renal disease
- Immunocompromised
- DM
Which pathogen is likely to infect a pt who has recently had a new AC fit in? and describe its presentation
Legionella (hypoNa + lymphopenia)
Which pathogen is likely to infect a pt with pneumonia who has dogs and cats?
Chlamydia psittaci
