Flashcards in Pneumonia Deck (28):
What antibiotic would you give for atypical pneumonia?
Macrolide or doxycycline
Drug induced pneumonitis?? What about pneumonia in an immunocompromised patient?
Chemotherapy toxicity reaction can cause a pneumonitis effect. Immunocompromise in chemotherapy patients is also considered like klebsiella etc
what are some 'typical' organisms that cause pneumonia?
Strep pneumoniae, haemophillus influenza, staph aureus, mycoplasma pneumoniae
What are some 'atypical' organisms that can cause pneumonia?
legionella, chlamydophillia, mycoplasma tuberculosis
What organisms usually cause hospital acquired pneumonia?
pseudomonas, klebsiella (gram negative rods), staph aureus
What is a classic bug that causes pneumonia in immunocompromised patients?
pneumocystis jiroveci = PCP
What are some fungi that can cause pneumonia?
what are some clinical symptoms of pneumonia?
fever, rigor, cough, dyspnoea, purulent sputum, anorexia, haemoptesis, pleuritic chest pain
What are some clinical SIGNs of pneumonia?
tachycardia, pyrexia, cyanosis, confusion in elderly, decreased percussion note over consolidation, pleural rub
Are breath sounds increased or decreased with consolidation?
INCREASED (bronchial breathing)
What are some tests you would do to confirm pneumonia?
Sputum culture, gram stain, transtracheal aspirate, CXR, FBE, blood cultures (performed before antibiotics)
How would we treat pneumonia?
Antibiotics depending on the organism, O2 supply if sat is low, paracetamol for pleuritic chest pain
what are some complications of pneumonia?
empyema, AF, pleural effusion, abscess, septicemia, respiratory failure
what are the 3 main categories of pneumonia
1. Community acquired; 2. hospital acquired; 3. immunocompromised patient
what other things would you want to watch out for in mycoplasma pneumonia?
pericarditis, myocarditis and skin rashes
what is a rare association with legionella pneumonia?
what is the commonest cause of CAP?
what are the standard antibiotics for CAP?
amoxicillin or clarithromycin for those with a history of penicillin allergy
how do we assess the severity of pneumonia?
CURB 65 score
C : confusion present (abbreviated mental test score 7 mmol/L
R : respiratory rate >30/min
B : systolic BP 65
Give each 1 point. If 2= admit to hospital; 4-5= ICU care
what are some investigations you'd want to do if you suspect pneumonia?
Bloods – FBC ( high WCC) / CRP( high ) / U&E / Blood culture
ABG – is the patient hypoxic
general management of pneumonia?
2. IV fluids if hypotensive
4. Physiotherapy for sputum if sputum retention
6. analgesia for pleuritic chest pain
what would we use to cover atypical organisms that cause pneumonia?
erythromycin and tetracycline bc they do not have a cell wall
what organisms would predispose a cavitating pneumonia and cause a lung abscess?
staph aureus and klebsiella
what is first line treatment for PCP
high-dose co-trimoxazole (bactrim)
what are some risk factors of legionella pneumonia?
chronic lung disease, smoking, diabetes, immunosuppression, malignancy, chronic corticosteroid use and end-stage kidney disease
what are some extra investigations you might consider in serious pneumonia?
• Urinary antigen assay for pneumoccal and legionella
• Nose and throat swabs for nucleic acid testing
• IgM serology for M. pneumoniae
• Last resort- bronchoalveolar lavage
what are some signs of a staphylococcal pneumonia?
-a short clinical course before requiring intensive care support
-early multilobar involvement on chest X-ray
-progression to pulmonary cavitation
-disseminated intravascular coagulation