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Respiratory (LECTURE NOTES) > Pneumonia > Flashcards

Flashcards in Pneumonia Deck (67):
1

What part of the respiratory tract is usually sterile

The lower respiratory tract (below the larynx)

2

How can infections reach the lungs

Inhalation, aspiration, direct inoculations and blood borne

3

Define pneumonia

A general term denoting inflammation of the gas exchange region of the lung. Usually it implies parenchymal lung inflammation caused by infection

4

Who can get pneumonia

All age groups

5

What do the circumstances of the illness include

Site of infection in the respiratroy tract
Age of the patient
community or hospital acquired
Concurrent disease
environemental and geographical factors
severity of the illness
microbiology of the pneumonia

6

What is the most common cause of primary pneumonia

Streptococcus pneumoniae

7

What is the most common cause of pneumonia in children under 2

Viruses (RSV)

8

What is the causative organism for the majority of cases in community acquired pneumonia

Streptococcus pneumonia

9

Define hospital acquired pneumonia

Pneumonia that develops 2 or more days after admission to hospital for some other reason

10

Are gram negative or gram positive organisms usually the causative organisms in hospital acquired pneumonia

Gram negative

11

Are gram negative or gram positive organisms usually the causative organisms in hospital acquired pneumonia

Gram negative

12

What 4 things can predispose to pneumonia and are associated with a greatly increased mortality

Alcohol misuse
Malnutrition
Diabetes
Underlying cardiorespiratory disease

13

Who is likely to develop aspiration pneumonia

Those with impaired swallowing or in patients with impaired consciousness

14

What organism is found in birds

Chlamydophila psittaci

15

What organism is found in farm animals

Coxiella burnetti

16

What organism is found in farm animals

Coxiella burnetti

17

What organism is found in contaminated water sources

Legionella pneumophila

18

What occurs in outbreaks every 4 years

Mycoplasma pneumoniae

19

How do we assess the severity of pneumonia

CURB 65
Confusion - new onset
Urea >7
Respiratory Rate >30
BP systolic

20

What are the typical clinical features of pneumonia

Cough
Purulent sputum
Fever
Pleuritic pain
SOB

21

What are the typical clinical features of pneumonia

Cough
Purulent sputum
Fever
Pleuritic pain
SOB

22

What is often auscultated in the chest?

Crackles
Dullness
Bronchial breathing

23

If the CURB65 score is 2 where should the patient be treated

Hospital ward

24

When should the patient be treated in ITU

When the CURB 65 score is 3 or more

25

What should be tested in a patient with suspected pneumonia

Sputum cultures
serology samples

26

What are the general investigations performed for suspected pneumonia

CXR - confirms diagnosis form consolidation
Haematology and biochemistry - helpful in assessing the severity of the disease
Oxygenation - pulse oximetry. Those lower than 94% should have ABGs done

27

What PO2 is aimed for

>8kPa

28

Who is chest physiotherapy useful for

Those with COPD with copious secretions

29

What is the treatment for community acquired pneumonia

500mg tds amoxicillin orally

30

What is the alternative for those allergic to penicillin

Doxycycline or clarithromycin

31

For severe pneumonia, what is the initial antibiotic treatment

IV Coamoxiclav 1.2g tds and clarithromycin 500mg bd

32

What is an appropriate alternative to co-amoxiclav

Cefuroxime

33

What is the appropriate treatment for hospital acquired pneumonia

combination of aminoglycoside (tobramycin) and a third generation cephalosporin (ceftazidime)

34

When should patient be switched from IV to oral antibiotics

When they are improving

35

When should patient be switched from IV to oral antibiotics

When they are improving

36

What are asplenic patients usually given

Pneumococcal vaccination and long term prophylactic phenoxymethylpenicillin

37

Who are advised to get the pneumococcal vaccination

Those 65 and above
chronic lung disease
diabetics
renal and cardiac disease
immunodeficient

38

What causes bronchopneumonia

Spread of infection into the lung parenchyma

39

What type of organism often occurs as a sequel to influenza

Staph aureus

40

Who is affected by Klesbiella pneumonia

Those who have imparied resistance to infection (alcohol misuse, malnutrition, diabetes) or underlying lung disease

41

What does Klesbiella pneumonia often show on an Xray

Lung tissue
Cavitation and abscess formation

42

Where does pseudomonas aeruginosa pneumonia come from

Endotracheal ventilation in ITU

43

How is the diagnosis made for organisms which are difficult to culture in the laboratory

Through rising antibody titre on serological tests

44

What is the treatment for organisms which are not sensitive to penicillins

Tetracycline or macrolide (clarithromycin)

45

How is mycoplasm pneumoniae spread

Infection through person to person by infected respiratory droplets

46

What are the 3 chlamydial species that cause respiratory disease

Chlamydophila psittaci
Chlamydophila pneumoniae
Chlamydia trachomatis

47

What are other symptoms of legionella pneymophila

Prostration
confusion
diarrhoea
abdominal pain
respiratory failure

48

How can we diagnose legionella

Antigen in urine

49

How do we treat legionella pneumonia

Combination of clarithromycin or a fluoroquinolone and rifampicin

50

How did the SARS coronavirus spread so quickly

Through airplane travel

51

Who should be offered HIV testing

Patients with a wide range of conditions, pneumonia, bronchiectasis, TB

52

What fungus can cause disease in immunocompromised individuals

Pneumocystis jirovecci

53

How does PCP typically present

As a subacute illness over a few weeks with cough, dyspnoea, fever, hypoxaemia, bilateral perihilar interstitial infiltrates on CXR

54

How is penumocystis pneumonia usually diagnosed

Confirmed by detecting Pneumocysstis jirovecii using a monoclonal antibody immynofluorescent technique on specimens obtained by sputum induction or by bronchoscopy and bronchoalveolar lavage

55

What is the treatment of PCP

High dose IV co-trimoxazole for 3 weeks

56

What do patients with moderate or severe PCP benefit from

THe addition of corticosteroids to reduce the pulmonary inflammation response

57

What are patients with HIV infection and impaired CD4 lymphocyte function highly susceptible to?

Developing reactivation of previously axquired latent TB and to contracting the disease from an exogenous source with rapid progression to active disease

58

Who does mycobacterium avium-intracellulare complex usually infect

Patients with advanced AIDS

59

What viruses might cause pneumonia in AIDS patients

Epstein-Barr, adenovirus , influenzae and herpes simplex

60

What is the commonest malignancy in HIV infected patients

Kaposi's sarcoma

61

What is Pulmonary Kaposi's sarcoma nearly always accompanised by

lesions in the skin or buccal mucosa

62

What do Kaposi's sarcoma apeear as at bronchoscopy

Red or purple lesions

63

What is the treatment of Kaposi's sarcoma

ANti-retroviral therapy (HAART) but also anti-neoplastic chemotherapy is needed

64

What presents as episodes of dyspnoea with pulmonary infiltrates, reduced gas diffusion and hypoxaemia

Interstitial pneumonitis

65

Who is lymphoid interstitial pneumonitis most commonly seen in

Children with HIV infection

66

How should patients be reviewed with pneumonia

Arrange a clinical review and chest X rays 6 weeks after discharge from hospital

67

Opportunistic infections develop when the CD4 count falls below what?

200/mm3