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Flashcards in PNEUMONIA Deck (33)
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1
Q

Define pneumonia

A

Infection of the lung parenchyma

2
Q

Define a Community Acquired Pneumonia (CAP).

A

Either presenting with pneumonia or developing pneumonia within 48 hours of attending hospital.

3
Q

What is the most common bacterial cause of pneumonia and where is bacteria likely to have come from to cause the lower respiratory tract infection?

A

Streptococcus pneumoniae is a commensal bacteria found in the upper respiratory tract.

4
Q

Apart from S. Pneumoniae, what other bacteria commonly cause typical CAP? (Name 3)

A

Moraxella catarrhalis Staphylococcus aureus Haemophillus influenzae

5
Q

What are the most common bacteria that cause atypical CAP? (Name 4) Which is the most common?

A

Mycoplasma pneumoniae (Most common)

Legionella pneumophilia

Multiple species of Chlamydia

Coxiella burnetti

6
Q

Name 4 symptoms of typical CAP.

A

Fever

Rigors

Malaise

Cough

Purulent sputum

Haemoptysis

Pleuritic chest pain

Dyspnoea

7
Q

What is pleuritic chest pain?

A

Pain caused by inflammation of the pleura. It is reported as a sharp stabbing pain and is worse upon inspiration and coughing.

8
Q

Name 4 signs of typical CAP.

A

Pyrexia

Tachypnea

Tachycardia

Hypotension

Reduced chest movements

Dullness to percussion (often in a single lobe)

Increased vocal fremitus

Bronchial breathing

Coarse crepitations

9
Q

What might be seen on a chest x-ray with someone who has typical CAP?

A

Consolidation (most often in a single lobe)

Pleural effusion

10
Q

What does this chest x-ray show?

A

Right upper lobe consolidation

11
Q

Name 4 symptoms of atypical CAP.

A

Fever

Confusion

Myalgia (pain in groups of muscles)

Non-productive cough

Headache

As well as any of the typical symptoms

12
Q

What does this chest x-ray show and what might organism might lead to this?

A

Right hemithorax shadowing, not restricted to a single lobe.

Atypical pneumonia caused by Legionella pneumophila.

13
Q

What is the CURB 65 score used for?

A
14
Q

What is assessed when working out the CURB 65 score? What are the criteria for each part?

A

C - confusion

U - urea less than 7 mmol/L

R - resp rate of more than 30 breaths per minutes

B - systolic blood pressure of less than 90 mmHg and diastolic blood pressure of less than 60 mmHg

65 - age over 65

15
Q

What blood tests would be ordered when trying to diagnose a patient with suspected pneumonia?

A

Full Blood Count

Urea and Electrolytes

C-reactive protein

16
Q

What would you use to treat someone with CAP of unknown cause who has a CURB 65 score of 2? Can you give the doses of each drug and the route of administration?

A

Amoxicillin 500mg-1g/8h PO

AND

Clarithromycin 500mg/12h PO OR Doxycycline 200mg loading then 100mg/12h PO

17
Q

What would you use to treat someone with a typical CAP of unknown cause with a CURB 65 score of 3 or above? Can you give doses for each drug and the route of adminstration?

A

Co-amoxiclav 1.2g/8h IV

OR Cephalosporin eg Cefuroxime 1.5g/8h IV

AND

Clarythromycin 500 mg/12h IV

18
Q

What would you use to treat a severe typical pneumonia caused by Legionella?

A

Clarithromycin plus Rifampicin

19
Q

What would you use to treat someone with a pneumonia you suspect is caused by Staph aureus with a CURB 65 score of 3 or above? (Name 4)

A

Co-amoxiclav

Clarithromycin

Flucloxallin

+/- Rifampicin

20
Q

What would you use to treat someone with a pneumonia you suspected is caused by MRSA with a CURB 65 score of 3 or above? (Name 4)

A

Co-amoxiclav

Vancomycin

Flucloxallin

Rifampicin

21
Q

Apart from antibiotics what other management options are there for someone with severe pneumonia?

A

Oxygen - want to keep their sats above 94%

IV fluids especially in cases of anorexia and dehydration

Analgesia if pleurisy eg Paracetamol 1g/6h

22
Q

If a patient came in with pneumonia having recently suffered flu, what bacteria would you suspect might be causing the pneumonia? What antibiotic would you start them on in this case?

A

Staph aureus, possible community acquired MRSA

Co-amoxiclav

Vancomycin

Flucloxallin

Rifampicin

23
Q

A patient is admitted in July with pneumonia having recently returned from holiday in Portugal. The x-ray shows bi-basal consolidation. What is the most likely bacterial cause?

A

Legionella pneumophila

24
Q

A 48 year old farmer is admitted with a fever, headache, myalgia and a non-productive cough. His X-ray is shown below. What is the likely organism responsible for his admission?

A

Coxiella burnetii causes Q-fever which can progress to an atypical pneumonia.

It is often found in cattle, sheep, goats and other animals.

25
Q

What antibiotic would be recommended for someone diagnosed with atypical pneumonia which is shown to be caused by Coxiella burnetii?

A

Clarithromycin 500 mg BD

Doxycycline 200 mg loading, followed by 100 mg OD

26
Q

A 24 year old patient presents with a 1 week history of dry cough, headaches and myalgia. He has recently developped a rash. He is not displaying signs of confusion, but he is breathing at a rate of 35 breaths per minute and has sats of 92%. The medical team suspect pneumonia. What is the organism most likely to be responsible for this pneumonia and what should the patient be treated with?

A

This is not a typical pneumonia presentation and therefore the most likely organim is Mycoplasma pneumoniae. Infections as a result of M. pneumoniae usually occur in younger age groups and may be associated with neurological and systemic symptoms such as rashes.

Treatment: Clarithromycin IV at 500 mg/12hr

OR Doxycycline IV 200 mg loading followed by 100 mg OD

OR a fluroquinolone (eg Ciprofloxacin)

Oxygen as required

27
Q

A 42 year old poultry farmer is brought in with a fever of 38.2, headache, cough and myalgia. He also has blood on his face from an earlier nose bleed. He is breathing at a rate of 32 breaths per minute and his sats are 85%. His X-ray is shown below. What is a possible diagnosis based on his profession and severe symptoms? How should this patient be managed?

A

This patient may have Avian influenza. The signs that may lead to this diagnosis are the very high fever and the nose bleeds which can be an early feature of “bird flu” but the fact that he deals with birds on a daily basis would be what would make you suspect this in the first place. This patient will need ventilatory support and oxygen in isolation. Antivirals such as Oseltamivir have been shown to reduce mortality.

28
Q

When is a pneumonia classified as a Healthcare Acquired Pneumonia (HAP)?

A

An acute pneumonia commencing 48 hours or more after admission to hospital or other healthcare facility.

29
Q

What is the most common bacteria to cause a hospital acquired pneumonia?

A

Staph aureus, beware of MRSA

30
Q

What other organisms (apart from Staph aureus) are responsible for HAP?

A

Pseudomonas aeruginosa

Acinetobacter spp

Escherichia coli

Other coliforms

Respiratory viruses especially in the immunocompromised

31
Q

What is a VAP?

A

Ventilator Associated Pneumonia

32
Q

What are the risk factors associated with a healthcare acquired pneumonia? (Name at least 5)

A

Extremes of age

Chronic pulmonary disease

Severity of underlying disease

Length of time of ventilator

Oropharyngeal aspiration eg NG tube

Elevated gastric pH

Tracheostomy

33
Q

What are the groups of antibiotics used in the treatment of HAP? Name an example of a drug from each group. (There are 4)

A

The specific antibiotics used would be dictated by culture results. The groups of antibiotics that might be used are:

Broad spectrum beta-lactams eg Piperacillin-tazobactam

Aminoglycosides eg Gentamicin

Glycopeptides eg Vancomycin

Quinolone eg Ciprofloxacin