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Pneumonia Flashcards

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1
Q

What are the two main classifications of pneumonia?

A

Community-acquired pneumonia and hospital-acquired pneumonia

Pneumonia can also occur in immunocompromised hosts.

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2
Q

What is lobar pneumonia?

A

A radiological and pathological term referring to homogeneous consolidation of one or more lung lobes, often with associated pleural inflammation.

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3
Q

What does bronchopneumonia refer to?

A

More patchy alveolar consolidation associated with bronchial and bronchiolar inflammation, often affecting both lower lobes.

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4
Q

What percentage of adults in the UK are estimated to suffer from community-acquired pneumonia (CAP) each year?

A

5-11 per 1000 adults, accounting for around 5%-12% of all lower respiratory tract infections.

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5
Q

What is the most common infecting agent in community-acquired pneumonia?

A

Streptococcus pneumoniae.

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6
Q

What are some factors that may impair local defenses and predispose individuals to community-acquired pneumonia?

A
  • Cigarette smoking
  • Upper respiratory tract infections
  • Alcohol
  • Glucocorticoid therapy
  • Old age
  • Recent influenza infection
  • Pre-existing lung disease
  • HIV
  • Indoor air pollution.
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7
Q

What are the typical systemic features of pneumonia?

A
  • Fever
  • Rigors
  • Shivering
  • Malaise
  • Delirium may be present.
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8
Q

What pulmonary symptoms are commonly associated with pneumonia?

A
  • Cough (initially short, painful, and dry)
  • Expectoration of mucopurulent sputum
  • Rust-colored sputum in Streptococcus pneumoniae infection
  • Pleuritic chest pain.
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9
Q

Which organism is more common in young people with pneumonia?

A

Mycoplasma pneumoniae.

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10
Q

What is the CURB-65 score used for?

A

To assess the severity of pneumonia based on examination and investigation findings.

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11
Q

What are the most important aspects of managing pneumonia?

A
  • Oxygenation
  • Fluid balance
  • Antibiotic therapy
  • Nutritional support may be required in severe cases.
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12
Q

What are some common causative organisms of community-acquired pneumonia?

A
  • Streptococcus pneumoniae
  • Mycoplasma pneumoniae
  • Legionella pneumophila
  • Chlamydia pneumoniae
  • Haemophilus influenzae
  • Influenza
  • Parainfluenza.
  • Viruses like adenovirus and coronaviruses.
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13
Q

What is the differential diagnosis of pneumonia?

A
  • Pulmonary infarction
  • Pulmonary/pleural tuberculosis
  • Pulmonary edema
  • Pulmonary eosinophilia
  • Malignancy (bronchoalveolar cell carcinoma)
  • Cryptogenic organizing pneumonia.
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14
Q

Fill in the blank: The presence of herpes labialis may point to _______ infection.

A

streptococcal.

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15
Q

True or False: Legionella pneumophila occurs in local outbreaks centered on contaminated cooling towers.

A

True.

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16
Q

What can a chest examination reveal in a patient with pneumonia?

A
  • Dullness to percussion
  • Bronchial breathing
  • Whispering pectoriloquy
  • Crackles heard throughout.
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17
Q
A
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18
Q

What does CURB-65 score assess?

A

Severity of pneumonia

CURB-65 score includes: Confusion, Urea > 7 mmol/L, Respiratory rate > 30/min, Blood pressure (systolic < 90 mmHg or diastolic < 60 mmHg), Age > 65 years.

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19
Q

What are the indications for referral to an intensive care unit?

A

Score of 4 or 5 on CURB-65

Indicates severe pneumonia requiring higher-level care.

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20
Q

What should be administered to all patients with tachypnoea or hypoxemia?

A

Oxygen therapy

Target oxygen saturations must be maintained.

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21
Q

What is the role of CPAP in pneumonia management?

A

Consider in hypoxic patients despite high-concentration oxygen therapy

Requires management in a high-dependency or intensive care environment.

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22
Q

When should intravenous fluids be considered?

A

In severe illness, older patients, or those with vomiting

Adequate oral fluid intake should be encouraged otherwise.

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23
Q

What is the typical duration of antibiotic treatment for uncomplicated pneumonia?

A

5 days

Longer treatment may be needed for pneumonia due to specific pathogens.

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24
Q

What is the definition of hospital-acquired pneumonia (HAP)?

A

Pneumonia presenting at least 48 hours after hospital admission

Not incubating at the time of admission.

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25
What is the leading cause of healthcare-associated infection (HAI)-associated death?
Hospital-acquired pneumonia (HAP) ## Footnote It is the second most common HAI after surgical-site infections.
26
What are common features indicating pneumonia in hospitalized patients?
Purulent sputum, new radiological infiltrates, unexplained increase in oxygen requirement, core temperature >38.3°C, leucocytosis or leucopenia ## Footnote These features warrant consideration of pneumonia diagnosis.
27
What should be done for patients with pleural pain?
Relieve pain for normal breathing and efficient coughing ## Footnote Simple analgesia is usually sufficient.
28
What is the mortality rate of adults with non-severe pneumonia?
<1% ## Footnote Hospital death rates for severe illness can be between 5% and 10%, and may reach 50%.
29
What should be arranged for patients upon discharge after pneumonia treatment?
Clinical review in 6 weeks ## Footnote A chest X-ray should be obtained if there are persistent symptoms.
30
Fill in the blank: The initial choice of antibiotic is guided by clinical context, ______, local knowledge of antibiotic resistance patterns, and antibiotic guidelines.
Severity assessment
31
True or False: Physiotherapy is usually indicated in patients with community-acquired pneumonia (CAP).
False ## Footnote It may assist in expectoration for patients who suppress cough due to pleural pain.
32
What vaccination should be offered to patients at highest risk of pneumonia?
Influenza and pneumococcal vaccination ## Footnote Particularly for those over 65 or with chronic health conditions.
33
What is the recommended approach for managing patients with shock?
Vasopressor support may be required ## Footnote Especially in cases of severe illness.
34
What is the common outcome of antibiotic therapy in pneumonia patients?
Most patients respond promptly ## Footnote Fever may persist for several days, and chest X-ray resolution can take weeks or months.
35
36
What is a very high white cell count indicative of?
Marker of severity ## Footnote Very high (>20 x 10^9) or low (<4 x 10^9) white cell count can indicate severity of conditions.
37
What does neutrophil leucocytosis > 15 x 10^9 suggest?
Bacterial aetiology ## Footnote Neutrophil leucocytosis is often used to indicate a bacterial infection.
38
What urea level is considered a marker of severity?
Urea >7 mmol/L (-20 mg/dL) ## Footnote High urea levels can indicate more severe cases.
39
What is hyponatraemia a marker of?
Marker of severity ## Footnote Low sodium levels can indicate more severe conditions.
40
What indicates abnormal liver function tests in pneumonia?
Basal pneumonia inflames liver ## Footnote Liver function may be affected during pneumonia.
41
What does hypoalbuminaemia indicate?
Marker of severity ## Footnote Low albumin levels can suggest more severe illness.
42
What does a high procalcitonin level suggest?
Bacterial rather than viral infection ## Footnote Procalcitonin is a biomarker that helps differentiate between types of infections.
43
What do C-reactive protein and erythrocyte sedimentation rate indicate?
Non-specifically elevated ## Footnote These markers can indicate inflammation but are not specific.
44
What is the purpose of blood culture in pneumonia investigations?
To identify bacteraemia ## Footnote Blood cultures can reveal the presence of bacteria in the bloodstream.
45
What should sputum samples be measured for?
Ventilatory failure or acidosis ## Footnote Sputum samples are assessed when SpO2 <93% or with severe clinical features.
46
What does a Gram stain of sputum help identify?
Presence of bacteria ## Footnote Gram staining is used to categorize bacteria based on their cell wall properties.
47
What is NAAT used to detect?
Respiratory viruses and bacteria ## Footnote NAAT stands for nucleic acid amplification test.
48
What does chest X-ray show in lobar pneumonia?
Patchy opacification evolving into homogeneous consolidation ## Footnote Air bronchograms may also be present in lobar pneumonia.
49
What does bronchopneumonia typically show on a chest X-ray?
Patchy and segmental shadowing ## Footnote This pattern is characteristic of bronchopneumonia.
50
What complications can arise from pneumonia?
Para-pneumonic effusion, intrapulmonary abscess, empyema ## Footnote These are potential complications associated with pneumonia.
51
What suggests Staphylococcus aureus infection in pneumonia?
Multilobar shadowing, cavitation, pneumatoceles, abscesses ## Footnote These findings can indicate a Staphylococcus aureus infection.
52
When should pleural fluid be aspirated and cultured?
When present in more than trivial amounts ## Footnote Ultrasound guidance is preferred for aspiration.
53
What is the CURB score used for?
Indications for referral to intensive care ## Footnote A CURB score of 4-5 indicates severe illness requiring intensive care.
54
What are indications for intensive care referral?
* CURB score of 4-5 * Failing to respond rapidly to initial management * Progressive hypercapnia * Severe acidosis * Persisting hypoxia (PaO2 < 8 kPa) * Circulatory shock * Reduced conscious level ## Footnote These criteria help assess severity and need for intensive care.
55
What is a key principle of pneumonia management?
Adequate oxygenation, appropriate fluid balance, antibiotics ## Footnote Management principles focus on stabilizing the patient.
56
What is the challenge in choosing empirical antibiotic therapy for pneumonia?
Diversity of pathogens and potential drug resistance ## Footnote Local patterns of microbiology and resistance should guide therapy.
57
What is the initial choice of antibiotic agents guided by?
Knowledge of local patterns of microbiology and antibiotic resistance ## Footnote Understanding local infections helps tailor treatment.
58
What is the importance of physiotherapy in pneumonia management?
Aids expectoration in less mobile patients ## Footnote Physiotherapy helps clear secretions from the lungs.
59
What is the most appropriate duration of antibiotic therapy based on?
Clinical judgement ## Footnote There is no established standard for duration.
60
What is the antibiotic treatment for low severity community-acquired pneumonia (CAP) with a CURB-65 score of 0-1?
Amoxicillin 500 mg 3 times daily orally (or IV if necessary) ## Footnote If allergic to penicillin: Doxycycline 200 mg loading dose then 100 mg/day orally or clarithromycin 500 mg twice daily orally.
61
What is the antibiotic treatment for moderate severity community-acquired pneumonia (CAP) with a CURB-65 score of 2?
Amoxicillin 500 mg-1g 3 times daily orally (or IV if oral medication not possible) or benzylpenicillin 1.2g 4 times daily IV plus clarithromycin 500 mg twice daily orally/IV ## Footnote If allergic to penicillin: Doxycycline 200 mg loading dose then 100 mg/day orally or levofloxacin 500 mg/day orally.
62
What is the antibiotic treatment for severe community-acquired pneumonia (CAP) with a CURB-65 score of 3-5?
Co-amoxiclav 1.2g 3 times daily IV or cefuroxime 1.5g 3 times daily IV or ceftriaxone 1-2g daily IV plus clarithromycin 500 mg twice daily IV ## Footnote If Legionella is suspected, consider adding levofloxacin 500 mg twice daily IV.
63
What factors should be considered when using antibiotics in individual patients?
Local guidance and antibiotic sensitivity patterns ## Footnote Reasons include impaired consciousness, impaired swallowing reflex, and functional or anatomical reasons for malabsorption.
64
What is the approximate mortality rate from hospital-acquired pneumonia (HAP)?
Approximately 30% ## Footnote Thus, prevention is crucial.
65
What are key prevention strategies for hospital-acquired pneumonia?
* Good hygiene, particularly hand-washing * Minimising chances of aspiration * Limiting use of stress ulcer prophylaxis with proton pump inhibitors * Oral antiseptic (chlorhexidine 2%) for upper airway decontamination * Selective decontamination of the digestive tract in intensive care units
66
How is suppurative pneumonia characterized?
Destruction of lung parenchyma by the inflammatory process ## Footnote Micro-abscess formation is a characteristic histological feature.
67
What are the common infectious agents in suppurative pneumonia and pulmonary abscess?
* Staph. aureus * K. pneumoniae * Actinomyces spp. * Prevotella melaninogenica * Fusobacterium necrophorum * Bacteroides fragilis
68
What are the complications of pneumonia?
* Para-pneumonic effusion * Empyema * Retention of sputum causing lobar collapse * Deep vein thrombosis and pulmonary embolism * Pneumothorax * ARDS, renal failure, multi-organ failure
69
What factors predispose individuals to hospital-acquired pneumonia?
* Reduced cough reflex * Reduced immune defences * Disordered mucociliary clearance * Aspiration of nasopharyngeal or gastric secretions * Bacteria introduced into the lower respiratory tract
70
What is a common cause of pulmonary abscesses associated with Lemièrre syndrome?
Fusobacterium necrophorum ## Footnote Illness typically starts with a sore throat and progresses to severe symptoms.
71
What is exogenous lipid pneumonia?
A non-infective form of aspiration pneumonia due to aspiration of animal, vegetable, or mineral oils.
72
What are the radiological features of suppurative pneumonia?
Homogeneous lobar or segmental opacity consistent with consolidation or collapse, cavitation, and fluid levels in abscesses.
73

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