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401 - Content > Pneumonia > Flashcards

Pneumonia Flashcards

(60 cards)

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1
Q

What makes up the lower respiratory tract

A

• larynx
• bronchi
• bronchioles
• alveoli

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2
Q

What are the characteristics of pneumonia?

A

• consolidation of lung tissue
• filling of alveoli, with fluid, inflam cells and fibrin

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3
Q

< that occurs due to

A

• bacteria or virus
• damage to the chest wall
• inhalation of chemicals

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4
Q

Which part of the lungs is inflamed in CAP and HAP

A

Lung parenchyma

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5
Q

Facts

A

• most symptomatic human disease in children and adults
• more common in children

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6
Q

Which virus causes viral pneumonia

A

• COVID
• influenza
• parainfluenza
• swine flu
• SARS
• herpes

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7
Q

Symptoms

A

• gradual flu like
• fever
• chills
• muscle pain
• upper respiratory symptoms (runny nose)

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8
Q

Treatment

A

• oxygen
• antipyretics
• analgesics
• nutrition
• vaccine
• antivirals

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9
Q

Which organisms cause CAP

A

• h. Influenza
• s.pneumonia (streptococcus) (mst cmmn)
• myocoplasama
• chalmydophila

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10
Q

Which bacteria cause HAP

A

• staphylococcus aureus - MRSA
• pseudomonas aeruginosa
• klebisella
• E.coli

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11
Q

How do the bacteria enter the lower respiratory tract?

A

3 ways:

• inhalation of infected aerosol particles
• entry to lungs via blood stream from infected location outside the lungs
• aspiration of oropharyngeal contents (can occur during sleep)

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12
Q

What 2 models are used for risk stratification, used before treatment to determine level of care? (For CAP only)

A

CURB-65 & PSI

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13
Q

CURB-65?

A

Determines site of care
One point is given to each factor:

• confusion
• respiratory rate - 30 and above
• Uremia
• hypotension
• 65>

Score
• 0-1 = outpatient treatment
• 2 = admit to medical ward
• 3+ = ICU

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14
Q

PSI

A

Assess risk of mortality

Uses:
• age
• gender
• co morbidities
• physical exam
• lab findings

Scores
• 1-2 = outpatient
• 3 = short hospital stay
• 4+ = impatient

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15
Q

What is considered CAP

A

• it is developed in the community
• <48 hrs in hospital

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16
Q

Risk of CAP

A

• old age
• respiratory conditions
• contact with influenza
• contact with infected birds
• farm environment
• immune compromised
• smoking
• alcoholism

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17
Q

Symptoms of CAP

A

• cough with rusted colours sputum
• headache
• confusion
• loss of appetite
• pleuritic chest pain
• fever
• dysponea
• hypoxemia, tachycardia, hypotension, tachypnoea
• decreased breathing sounds

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18
Q

Tests and investigations for CAP

A

• x-ray (to confirm consolidation in lungs
• sputum
• RBC
• ABG
• C-reactive protein

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19
Q

When should oxygen be give

A

• hypoxemia
• high levels of CO2 in blood

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20
Q

What are the options for empirical treatment for outpatients

A

One of the following:
• macrolides (mycins)
• doxycycline
• fluoroquinolone (levofloxacin)

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21
Q

What are the options for empirical treatment for inpatients (not ICU)

A

• extended spectrum cephalosporin (ceftaraxone) + macrolide

OR
• b-lactam inhibitor + macrolide or fluoroquinolone

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22
Q

What are the options for empirical treatment for ICU patients

A

ESC or b-lactamse inhibitor + macrolide or fluoroquinolone

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23
Q

How long after cap diagnosis should abx treatment begin?

A

<4

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24
Q

Treatment is based on what score?

A

CURB-65

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25
Treatment for CURB-65 score of 0-1/low severity
• amoxicillin 500mg, TDS - 5 days Alternatives: • doxycycline, 200mg on first day, next four days 100mg OD • clarithromycin 500mg BD - 5 days • erythromycin (pregnancy) 500mg QDS - 5 days (All doses repeated are the same)
26
Treatment for moderate severity CURB - 2
Amoxicillin + clarythromycin or Erythromycin (if typical pathogen is suspected) - 5 days Alternative: • doxycycline - 5 days • erythromycin (pregnancy) - 5 days
27
Treatment for severe?
Co-amoxiclav 500/125mg TDS (or IV 1.2g) + clarythromycin or erythromycin (if atypical bacteria is suspected) Alternative • levofloxacin 500mg TDS or IV 500mg
28
HAP is considered when?
Occurring in hospital >48 hours of admission
29
Is the common causative organism gram negative or positive
Negative e
30
What are the risk factors of HAP
• in hospital >5 days • on ventilator • in ICU • have an immunosuppressive conditions • chronic respiratory condition • HIV/AIDS • high frequency on abx resistance in the hospital or community
31
Which investigation or labs would you do
• Clincal symptoms • sputum culture • WBC • FBC • ABG • C-reactive protein • urjnary antigen test • chest x ray (cloudy spaces in the lungs) • chest CT scan
32
What is the treatment for non severe or not a risk of abx resistance
• co-amoxiclav Alternative • doxycycline • co-trimoxazole (960mg BD)
33
Treatment of HAP with severe symptoms (sepsis) or high risk of resistance
• piperacillin + tazobactam 4.5mg TDS Alternative • ceftriaxone 2mg OD
34
What is the add on IV therapy if MRSA is suspected/confirmed
Vancomycin 15-20mg/kg TDS or linezolid 600mg BD (5 days for all treatment)
35
For oral Abx when should treatment be reviewed
5 days
36
Or IV abx when should treatment be reviewed
After 48 hours, then consider switching to oral
37
What is aspiration pneumonia
Occurs when aspiration of oropharyngeal contents
38
Who is at risk of this?
• unconscious patients • swallowing difficulties • weak immune system • GI conditions
39
Test/investgations
Similar to CAP/HAP + broncoscopy
40
Treatment?
• piperacillin + tazobactam
41
What are the end complications of pneumonia
• respiratory failure • death • bronchitis • emphysema • destruction of lung paranchyme • ventilations dependency
42
Drug related questions
43
What other drug is in co-trimoxazole
Sulfamethoxazole (used together for their synergic activity and prevents drug resistance)
44
Is co-trimoxazole licenced in HAP
No
45
Common ADR of co-trimoxazole
• diarrhoea • fungal overgrowth • electrolyte imbalance
46
Monitoring for co-trimoxazole
Serium K and Na
47
Amoxicillin ADR
• GI disturbances • thrombocytopenia • hypersensitivity (rash or anaphylactic)
48
How many lobes does the right vs left lung have
Right - 3 Left -2
49
What is the main symptoms difference in CAP and HAP
Onset • quicker in cap Sputum • cap - yellow green • hap - foul smelling (common in anaerobic organisms) Pleuritic chest pain • more common in cap Cynosis • common in hap
50
What is the normal oxygen saturation
95-100%
51
What are the body’s natural defence mechanisms against infections
• mucus • coughing reflex • muco illary movement • T lymohocytes • iGA • sneezing
52
Lobularpnumonia Beonchopnumonia Atypical
53
Which has no sputum
Atypical
54
Which has rusted sputum
Lobular
55
Which has homogeneous consolidation in one or more lobe
Lobular penumonia
56
Which has yellow sputum
Broncopnumonia
57
Which has patchy consolidation in bases of both lungs
Bronchopnumonia
58
Which as pleuritic chest pain
Lobular pnumonia
59
Which has wide spread patchy consolidation
Atypical
60
Which is also know as walking pneumonia
Atypical

401 - Content (18 decks)

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