Pneumonia Flashcards
(21 cards)
1
Q
Pneumonia definition
A
- inflammation of lung parenchyma
- bacterial/viral
2
Q
Pneumonia investigations
A
- observations
- bloods - FBC, U&Es, CRP, LFTs
- ABG
- chest X-ray
- consider blood or sputum culture
3
Q
Pneumonia signs and symptoms
A
- cough with sputum
- shortness of breath
- pleuritic chest pain
- fever, rigors
- confusion
- night sweats
- CURB65 - confusion, urea > 7, RR 30+, SPB < 90 or DBP < 60, 65+ years old
4
Q
Community acquired pneumonia definition
A
pneumonia acquired outside a hospital or healthcare facilities
5
Q
Community acquired pneumonia aetiology
A
- Strep pneumoniae is most common (around 50%) followed by Haem influenzae (around 20%)
- M. Catarrhalis in immunocompromise or chronic lung disease
- Ps. Aeruginosa in cystic fibrosis, bronchiectasis
- Staph Aureus in cystic fibrosis
6
Q
Community acquired pneumonia pathophysiology
A
- pathogen reaches lower respiratory tract via inhalation, aspiration, haematogenous spread, extension
- invasion and overgrowth of pathogen in lung parenchyma
- host defences overwhelmed, exudate production
7
Q
Community acquired pneumonia management
A
- CURB65 0-1 - PO amoxicillin for 5 days or clarithromycin/doxycycline if allergic
- CURB65 2-3 - admit, PO amoxicillin + clarithromycin for 5 days (or doxy)
- CURB65 4+ - admit, consider ITU, IV co-amoxiclav + clarithromycin for 5 days (or levofloxacin)
8
Q
Hospital acquired pneumonia definition
A
- acute lower respiratory tract infection acquired after 48h+ in hospital
- not incubating on admission
9
Q
Hospital acquired pneumonia aetiology
A
- early onset (under 5 days) - Strep pneumoniae
- late onset (over 5 days) - MRSA, Pseudomonas, E. Coli, Klebsiella
10
Q
Hospital acquired pneumonia management
A
- non-severe symptoms - oral antibiotics, e.g. amoxicillin/ clavulanate
- other abx - doxycycline, cephalexin, co-trimoxazole, trimethoprim
- oxygen, IV fluids, vasopressors, VTE prophylaxis as needed
- severe symptoms - IV antibiotics such as pip-taz or meropenem
- MRSA - vancomycin, teicoplanin
- consider ITU
11
Q
Legionella
A
- infected water supplies
- air conditioning, e.g. hotels (holidays)
- hyponatremia
12
Q
Chlamydia psittachi
A
- infected birds
- parrot owners etc
13
Q
Mycoplasma pneumoniae
A
- causes erythema multiforme (target lesions)
- neurological symptoms
- cold agglutinin disease
14
Q
Q fever/Coxiella burnetti
A
- exposure to animals’ bodily fluids
- farmers with flu-like symptoms
15
Q
Atypical pneumonia management
A
- macrolides (azithromycin, clarithromycin, erythromycin)
- fluoroquinolones (levofloxacin, ciprofloxacin)
- tetracyclines (doxycycline)
16
Q
Pneumocystis jirovecii pneumonia presentation
A
- fungal lung infection affecting patients with CD4 less than 200
- fever, dry cough, dyspnoea
- hepatosplenomegaly, lymphadenopathy, choroid lesions
- CXR - bilateral interstitial infiltrates
- exercise-induced desaturation
- silver stain on bronchoalveolar lavage shows cysts
17
Q
Pneumocystis jirovecii pneumonia management
A
- co-trimoxazole IV or PO for 21 days
- if severe add pentamidine and consider ITU admission
- if hypoxic add steroids as reduces risk of respiratory failure and death
- give prophylactic co-trimoxazole if CD4 count known to be under 200
18
Q
Aspergillosis
A
- fungal lung infection affecting immunocompromised patients
- allogenic stem cell transplants
- haematological malignancy
- solid organ transplants
- AIDS
19
Q
Aspergillosis pathophysiology
A
- inhalation of spores
- neutropenia
- decreased CD4 count (under 100) or decreased macrophages
- dissemination may be haematogenous or via parasinus cavity
20
Q
Aspergillosis signs and symptoms
A
- non-productive cough
- pleuritic chest pain
- haemoptysis
- dyspnoea
- sinus headache, congestion
- skin - ecthyma gangrenosum
21
Q
Aspergillosis management
A
- investigate with CXR, high resolution CT and consider bronchoalveolar lavage
- manage with antifungals - amphotericin B, voriconazole etc
- reverse immunosuppression
