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Respiratory medicine > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

Pneumonia :Strep Pneumonia - definition

A
  1. Pneumococcus
  2. Accounts for 80% of cases of pneumonia
  3. Gram + Bacteria
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2
Q

Pneumonia :Strep Pneumonia - Clinical features

A
  1. Acute onset of fever
  2. Productive cough with purulent sputum
  3. Pleuritic chest pain
  4. Shortness of breath
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3
Q

Pneumonia :Strep Pneumonia - Investigations

A

CXR : Lobar consolidation
Blood cultures : to r/o baactaraemia
Sputum sample + culture

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4
Q

Pneumonia :Strep Pneumonia - Complications

A
  • Herpes Labialis - cold sore/blisters
  • Pleural effusions
  • Pleural abscess formation
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5
Q

Hamophilius influenza : Definition

A
  • Gram - bacteria
  • Most common in patients with COPD
  • Influenza vaccine can be given annually
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6
Q

Staphylococcus aureus : Definition

A

Gram + bacteria
Usually occurs in patients post influenza

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7
Q

Staphylococcus aureus : Risk factors

A
  • Age > 65
  • COPD
  • Smoking
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8
Q

CAP : Mx

A
  1. Confusion
  2. Urea > 7
  3. Respiration rate >30
  4. BP < 90 / < 60
  5. > 65
    * Curb 0-1 : Amoxicillin +/- Clarithromycin for 5 days
    * Curb 1-2 : Consider Hospital referral
    * Curb >3 : Hospital admission
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9
Q

Atypical pneumonia : Mycoplasma Pneumonia - Pathophysiology

A
  • Small bacterial which lacks a cell wall and unable to produce toxins
  • No cell wall means it is able to attach and invade host cells more easily
  • Target a range of tissues, including skin, joints and GI tract
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10
Q

Atypical pneumonia : Mycoplasma Pneumonia - Incidence

A

Normally affects children and young adults

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11
Q

Atypical pneumonia : Mycoplasma Pneumonia - Clinical features

A

Gradual onset of symptoms over a period of several days
* Dry cough with minimal sputum production
* Mild - moderate fever
* Sore throat, head ache, fatigue

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12
Q

Atypical pneumonia : Mycoplasma Pneumonia - Extrapulomary manifestation

A
  • Autoimmune haemolytic anaemia -
    immune system mistakenly targets and destroys RBCs, due to immune dysregulation and bacterium sharing structural similarities with host antigens RBCs,
  • Erythema multiform
    skin lesions, target bulls eye rash
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13
Q

Atypical pneumonia : Mycoplasma Pneumonia -* CXR*

A

CXR : Normal or show interstitial infiltrates

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14
Q

Atypical pneumonia : Legionella pneumophilia - Definition

A

Gram - aerobic bacteria responsible for causing legionnaire’s disease

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15
Q

Atypical pneumonia : Legionella pneumophilia -Risk factors

A

Risk factors } within 2 weeks of exposure
* Infected air conditioning units
* Contaminated drinking water
* Recent water exposure - got tub, spa or plumbing work

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16
Q

Atypical pneumonia : Legionella pneumophilia -Clinical features

A
  1. Dry cough / SOB / Chest pain / Fever } typical signs of pneumonia
    Systemic sx :
  2. Headache - may be prominent symptoms
  3. Confusion_ -
  4. GI sx : nausea, vomiting, diarrhoea
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17
Q

Atypical pneumonia : Legionella pneumophilia -Investigation

A
  1. Sputum Gram stain and culture
  2. Urine antigen test
  3. Throat swab PCR if urine is negative due to higher sensitivity
  4. Bloods: normal or may show;
    * Hyponatremia : Triggers SIADH due to inflammatory process - excess ADH cause kidneys to retain water and results in dilution hyponatremia
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18
Q

Atypical pneumonia : Klebsiella pnemoniae - Definition

A

Gram - organisms

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19
Q

Atypical pneumonia : Klebsiella pnemoniae -Clinical features

A
  • High fever and chills
  • Pleuritic chest pain and SOB
  • Cough - productive and blood stained
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20
Q

Atypical pneumonia : Klebsiella pnemoniae - CXR

A

CXR : dense caviatry lesions and consolidation in the lungs

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21
Q

Atypical pneumonia : Klebsiella pnemoniae -Risk factors

A

Alcoholism - higher risk of aspiration of stomach contents due to intoxications

Diabetics

22
Q

Atypical pneumonia :Pneumocytis jiroveci- Definition

A

Fungal organism

23
Q

Atypical pneumonia :Pneumocytis jiroveci- Risk factors

A

Severe immunocompromised patients : especially HIV +, or chronic immunosuppressant therapy

24
Q

Atypical pneumonia :Pneumocytis jiroveci- Clinical features

A

; - /Develops over several weeks/
* Fatigues, fever chills
* Night sweats
* Non productive cough - dry cough
* Oral candidiasis

25
Q

Atypical pneumonia :Pneumocytis jiroveci-Investigations

A

CXR : Pulmonary reticular infiltrates
* ABG - shows reduced O2
* Serum LDH : elevated in 90% of patients and decline with treatment
* Induced sputum - for sample and culture

26
Q

Atypical pneumonia :Pneumocytis jiroveci-Management

A
  1. Trimethoprim/Sulfamethoxazole
  2. Pt with low CD4 count can be prescribed prophylactic co-trimoxazole.
27
Q

Atypical pneumonia :Mycoplasma pneumonia - Clinical features

A

presents with a ‘target lesion’ like rash called erythema multiform and can cause neurological symptoms in younger patients

28
Q

Atypical pneumonia :Chlamydia psittaci

A
  • Contracted from contact with infected birds
29
Q

Hospital acquired pneumonia : < 5 days

A
  1. Acute lower respiratory tract infection that is acquired at least after 48 hours of admission to hospital
  2. < 5 days into admission - Early onset HAP
    * Often caused by Streptococcus pneumonia
30
Q

Hospital acquired pneumonia : > 5 days poast admission

A

Late onset > 5 days post admission
* Due to micro organisms found in the hospital
1. Most commonly : Gram - bacteria
* MRSA
* Pseudomonas aureginosa : HAP, ventilator acquired pneumonia

31
Q

Hospital acquired pneumonia : Risk factors

A

Sx starting more than > 5 days after hospital admission
* Cormorbidities such as severe lung disease or immunosuppression
* Recent use of broad spectrum antibiotics
* Aspiration risk : in frail or neurological disorders

32
Q

Hospital acquired pneumonia : Clinical features

A
  • Cough with increased sputum : thick yellow or green
  • Dyspnea
  • Fever
33
Q

Hospital acquired pneumonia : Investigations

A
  • O2 sats : decreased
  • Bloods : leukocytosis or leukopenia (high or low wbc)
  • CXR : New consolidation
  • ABG (Before O2) : Hypoxia, raised lactate, respiratory alkalosis (increased respiratory rate)
  • Sputum samples for culture : before antibiotics started
  • Nasopharyngeal swab : if unable to produce sputum
34
Q

Hospital acquired pneumonia : Management

A
  1. Severe symptoms or high risk of resistance
    * IV Broad spectrum antibiotics : IV Pip-Taz
  2. Moderate symptoms
    * PO Co-amoxiclax
  3. If MRSA risk
    * Add IV Vancomycin or IV Teicoplanin
35
Q

Aspiration pneumonia : Pathophysiology

A
  1. Inhalation of oropharyngeal contents into the lower airways
  2. Bacterial enter the lung via the aspiration of colonised secretion from the oropharynx
  3. This causes inflammation and lung injury resulting in distruption of the sterile environment
  4. Thus - results in secondary bacterial infection - known as ‘Aspiration Pneumonia’
36
Q

Aspiration pneumonia : Risk factors

A
  1. Swallowing dysfunctions secondary to neurological pathology
    * e.g.; stroke, dementia, epilepsy, Parkinsons
    Impaired consciousness }
  2. General anaesthetic / Opioid OD/ Alcohol intoxication
    * High risk of regurgitation
    * Impaired GI emptying : haitus hernia, obesity, GORD, upper GI surgery
  3. Vomitting
  4. Difficulty of clearance
    Poor cough : due to vocal chord palsy or neuromuscular disease
37
Q

Aspiration pneumonia : Clinical features

A
  1. Breathlessness / Fever / cough } pneumonia symptoms
  2. Cough;
  3. Frothy or purulent sputum : raises suspicion for aspiration pneumonia
    * Foul smelling sputum } associated with presence of anaerobic bacteria
    * Hx of vomitting } witnessed aspiration
38
Q

Aspiration pneumonia : Diagnosis

A

Clinical signs of pneumonia and a risk factors for aspiration } diagnosis of aspiration pneumonia

39
Q

Aspiration pneumonia : Antibiotic management

A

Empirical antibiotics - recommended coverage of both anaerobic and aerobic organisms can be given but is not needed.

  1. Co amoxiclav / amoxicillin } same as for HAP/CAP

Consider;

  1. Ceftraixone and metronidazole : provides aerobic and anaerobic micro-organism cover
40
Q

Aspiration pneumonia : General management

A
  1. Controlled O2 therapy
    * Aim for 96% sats only - >96% associated with higher level of mortality
    * 88-92% if hypercapnic
  2. Thromboprophylaxis - higher risk of VTE
  3. Assess swallow function and manage dysphagia via SALT team
    * If unknown cause of dyspgaia - needs OGD
    * Refer to oral/dental hygienist if 2nd to poor oral hygiene
41
Q

Acute brochitis : Definition

A

Mainly viral
inflammation of the trachea and major bronchi

Associated with oedematous large airways and the production of sputum.

The disease course usually resolves before 3 weeks,

is accepted that viral infection is the leading cause. Around 80% of episodes occur in autumn or winter.

42
Q

Acute brochitis : Clinical features

A

Patients typically present with an acute onset of:
* cough: may or may not be productive
* sore throat
* rhinorrhoea
* wheeze

No focal chest signs on examination - less sputum/wheezining/breathlessness than in pneumonia

43
Q

Acute Bronchitis : Investigations

A
  • acute bronchitis is typically a clinical diagnosis
  • however, if CRP testing is available this may be used to guide whether antibiotic therapy is indicated
44
Q

Acute Bronchitis : Management

A
  • analgesia
  • good fluid intake
  • consider antibiotic therapy if patients:
    • are systemically very unwell
    • have pre-existingco-morbidities
    • have aCRPof 20-100mg/L (offer delayed prescription) or a CRP >100mg/L (offer antibiotics immediately
  • NICE Clinical Knowledge Summaries/BNF currently recommenddoxycyclinefirst-line
    • doxycycline cannot be used in children or pregnant women
    • alternatives include amoxicillin
45
Q

Lung Abscess : Definition

A

Bacterial infection of the lungs causing a localised collection of pus within the lung tissue.

46
Q

Lung Abscess : Causes

A
  1. Aspiration pneumonia - poor dental hygiene, swallowing issues due to neurological impairment
  2. Haematogenous spread - infective endocarditis
  3. Bronchial obstruction - Lung tumore
  4. Extension of existing infection - Pneumonia
47
Q

Lung Abscess : Causative organisms

A
  • Staphylococcus aureus Klebsiella pneumonia
    Pseudomonas aeruginosa
48
Q

Lung Abscess : Clinical features

A

Subacute onset - over weeks
1. Swinging fever
2. Night sweats, weight loss
3. Productive cough - foul smelling sputum, +/- haemoptysis
4. Clubbing

49
Q

Lung Abscess : Investigation

A
  • chest x-ray
    • fluid-filled space within an area of consolidation
    • an air-fluid level is typically seen
  • sputum and blood cultures should be obtained
50
Q

Lung Abscess : Management

A
  • intravenous antibiotics
  • if not resolvingpercutaneous drainagemay be required and in very rare cases surgical resection

Respiratory medicine (18 decks)

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