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RESP > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What is pneumonia?

A
  • Acute lower respiratory infection of the lung parenchyma
  • inflammatory consolidation from intra-alveolar exudate
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2
Q

What are the three types of pneumonia?

A
  • Community acquired
  • Hospital acquired
  • Aspiration; bowel contents are inhaled into pulmonary tracts after vomiting

Ventilator associated and atypical also

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3
Q

What are pulmonary defences?

A
  • Nasal hair
  • Microflora of RT
  • Cough
  • Mucus
  • Mucociliary escalator
  • Alveolar macrophages
  • IgA
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4
Q

What causes loss of pulmonary defences?

A
  • Loss of cough reflex; Coma
  • Injured mucociliary escalator; smoking
  • Decrease in alveolar macrophages; smoking + alcohol
  • Pulmonary congestion
  • Obstruction
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5
Q

What are risk factors for pneumonia?

A
  • > 65 years
  • Smokers
  • Malnourished
  • Immunocompromised
  • Reccurent RTI’s
  • Medications
  • Seasonal
  • Organism virulence

environmental

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6
Q

What species is most common in community acquired pneumonia?

A
  • Streptococcus pneumoniae (60%)
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7
Q

What species is most common in hospital pneumonia?

A
  • Pseudomonas Aeruginosa
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8
Q

What species is most common in aspiration pneumonia?

A
  • Gram-negative anaerobes

E.coli, Klebsiella pneumoniae, Haemophilus influenzae

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9
Q

How is pneumonia transmitted?

A
  • Droplet spread
  • water, air-conditioning, hospital ventilators
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10
Q

What happens after transmission?

of pneumonia

A
  1. Inhalation; colonises nasopharynx
  2. Infection; virulence factors cause inflammation of lung parenchyma
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11
Q

How does pathogenesis occur in the alveoli?

A
  1. Pathogen arrives in alveolar space
  2. Uncontrolled multiplication of pathogens
  3. Cytokines produced by alveolar macrophages
  4. Neutrophils recruited into alveolar space → systemic circulation
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12
Q

What are the cardinal symptoms of pneumonia?

A
  1. Cough; usually productive with purulent sputum
  2. SOB
  3. Pleuritic chest pain
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13
Q

What are some systemic symptoms of pneumonia?

A
  • Fever/Chills
  • Malaise
  • Fatigue
  • Anorexia
  • Confusion
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14
Q

What are the cardinal signs of pneumonia?

A

Vitals:
- Tachypnoea
- Hypoxia
- Tachycardia
- Fever

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15
Q

What are chest examination findings of pneumonia?

signs

A
  • Dull percussion (fluid)
  • increased tactile fremitus
  • inspiratory crackles
  • reduced air entry at site of infection
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16
Q

What is parapneumonic pleural effusion?

A
  • pleural effusion that forms adjacent to site of pneumonia
17
Q

What causes cough, phlegm, SOB, hypoxia, dull percussion in pneumonia?

A
  • accumulation of exudate in alveolar spaces
  • impairs gas exchange
18
Q

What causes systemic effects of pneumonia?

fever, chills, tachycardia

A
  • endotoxins, exotoxins
  • interleukin, TNF release
  • sepsis; RAAS + baroreceptor activation, catecholamine, NO release
19
Q

What is the anatomical classification of pneumonia?

A
  • Lobar
  • Bronchopneumonia: starts at bronchioles
20
Q

What are the stages of lobar pneumonia?

A
  1. Congestion
  2. Red Hepatization
  3. Grey Hepatization
  4. Resolution or Scarring

95% cases due to Strep. pneumoniae, M>F 3:1, neglected people, alcoholic

21
Q

What are some characteristics of bronchopneumonia?

A
  • Patchy infiltrate
  • affects old or very young
  • abscess
  • strep pneumoniae/haemophilus influenza
22
Q

What is atypical pneumonia?

A
  • Infiltrate OUTSIDE alveoli
  • no consolidation
  • milder symptoms
  • non-productive cough, rales

“walking pneumonia”

23
Q

What organisms are responsible for atypical pneumonia?

A
  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae
  • Legionella pneumoniae
  • Mycobacteria
  • Viruses
24
Q

What are some risk factors for aspiration pneumonia?

A
  • impaired cough reflex
  • pyloric stenosis
  • oesophageal obstruction
  • hiatus hernia
25
Q

Which organisms casue pneumonia in immunocompromised hosts?

A
  • Pneumocystis jiroveci
  • CMV
  • unusual mycobacteria
  • toxoplasma
26
Q

What is Friedlander’s pneumonia?

A
  • Klebsiella pneumoniae
  • hospital acquired
  • 30-50% lung cavitation (less common in E.coli, staph)
27
Q

What are the complications of pneumonia?

A
  • Emypema: collection of pus in pleural cavity
  • Abscess: necrosis + cavities
  • ARDS/ALI
  • Respiratory failure
  • Confusion
  • Septic shock
  • Infection can spread to other sites

bold are local infection complications

28
Q

What is the sepsis give 3, take 3?

A

Take:
- Blood culture
- Blood test
- Urine output

Give:
- O2
- IV fluids
- IV antimicrobials

29
Q

What is seen on a CXR for pneumonia?

A
  • Opacity
  • Consolidation
  • Infiltrates
30
Q

What is a silhouette sign?

CXR

A
  • loss of normal silhouettes; heart, borders, diaphgram due to consolidation
31
Q

What is air-bronchograms?

CXR

A
  • Due to consolidation and opacity bronnchi are seen on CXR

usually should not be seen

32
Q

When should a follow-up CXR be done?

A
  • 4-6 weeks after treatment

RESP (20 decks)

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