[pneumonia] Flashcards by Johannes Staufenberg

Strep. Pneumoniae
Haemophilus Influenzae
Mycoplasma pneumoniae

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strep pneumoniae
haemophilus influenzae
mycoplasma pneumoniae

staphylococcus aureus
legionella pneumophilia
moraxella catarrhalis
chlamydia

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Strep. Pneumoniae
Haemophilus Influenzae
Mycoplasma pneumoniae

+
other

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strep pneumoniae
haemophilus influenzae
mycoplasma pneumoniae

staph aureus
legionella
moraxella catarrhalis
chlamydia

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Staph aureus
klebsiella
shigella
salmonella
yersinia pestis
e coli

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Staph Aureus

gram negative enterobacteria

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Salmonella
klebsiella 
Shigella
E coli
Yersina pestis

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Staph aureus
klebsiella
shigella
salmonella
yersinia pestis
e coli

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Staph Aureus
gram negative enterobacteria
Pseudomonas

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Staph aureus
klebsiella
shigella
salmonella
yersinia pestis
e coli
pseudomonas

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aspiration oropharyngeal anaerobes

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Pneumocystis jiroveci

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tachypnoea
consolidation
pleural rub
cyanosis

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dyspnoea
pleuritic pain
purulent sputum 
haemoptysis
cough

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anorexia
fevers
rigors
malaise

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confusion

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tachypnoea
consolidation
pleural rub
cyanosis

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increased tactile vocal fremitus/resonance
reduced expansion
dull percussion note
bronchial breathing

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sputum

pleural fluid

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pyrexia
confusion
tachycardia
hypotension

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normal lung architecture replaced by cavity

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cavitation
unilobar/multilobar
pleural effusion

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sputum

pleural fluid

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Strep pneumoniae

Legionella

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[pneumonia]: when would BAL be considered for serology

immunocompromised patients

[pneumonia]: how is severity measured in pneumonia

CURB-65 score

[pneumonia]: CURB-65: define BP +ve

less than 90 systolic | less than 60 diastolic

[pneumonia]: what does CURB-65 stand for

``` confusion urea Respiratory rate BP >=65yrs ```

[pneumonia]: CURB-65: define confusion +ve

abbreviated mental test score

[pneumonia]: CURB-65: define urea +ve

>7mmol/L

[pneumonia]: CURB-65: what does a score of >=3 mean

severe - ICU transfer

[pneumonia]: CURB-65: define respiratory rate +ve

>= 30

[pneumonia]: CURB-65: define BP +ve

less than 90

[pneumonia]: CURB-65: define '65' +ve

>= age 65

[pneumonia]: CURB-65: what does a score of 1 mean

Tx at home

[pneumonia]: CURB-65: what does a score of 2 mean

Tx in hospital

[pneumonia]: CURB-65: what does a score of >=3 mean

severe - ICU

[pneumonia]: what CXR finding is an independent risk factor for a worsened prognosis (2)

multilobular involvement | bilateral involvement

[pneumonia]: above what % and kPa should O2 be kept

94% | 8 kPa

[pneumonia]: what 4 pulmonary complications can results from pneumonia

Respiratory failure pleural effusion empyema abscess

[pneumonia]: what 5 cardiovascular related complications of pneumonia can present

``` myocarditis pericarditis hypotension septicaemia Atrial fibrillation ```

[pneumonia]: what hepatobilliary complication may occur

jaundice

[pneumonia]: what type of respiratory failure do you get in pneumonia

type 1

[pneumonia]: give the 2 possible pathophysiological happenings which give rise to type 1 respiratory failure

venous blood bypasses ventilated alveoli (e.g. right to left cardiac shunt) under-ventilated alveoli

[pneumonia]: what is Tx for type 1 respiratory failure

60% high-flow oxygen

[pneumonia]: what must you carefully monitor during O2 therapy

PaCO2 levels

[pneumonia]: what is suspected in a patient who develops a recurring fever despite a resolving pneumonia

empyema

[pneumonia]: in what patients may a rising PaCO2 occur during high flow O2 therapy

COPD

[pneumonia]: outline why O2 therapy a worry in COPD

normally PaCO2 is major driving force behind respiratory drive COPD hypoxia is a major drive for rr and pulmonary venous constriction o2 therapy reduces hypoxia therefore reduced respiratory drive REDUCED HYPOXIC CONTROLLED VASOCONSTRICTION VQ mismatch as increased blood flow to poorly ventilated areas therefore increase in CO2

[pneumonia]: Tx: what is the 1st step taken in hypotension

fluid challenge

[pneumonia]: Tx: what volume of fluid is delivered over what time

250mL colloid over 15 mins

[pneumonia]: Tx: what is a +ve fluid challenge

increase in cardiac output of 10-15%

[pneumonia]: what is the pathophysiology behind pleural effusion in pneumonia

pleural inflammation fluid exudation accumulates faster than reabsorbed

[pneumonia]: Tx: what is the Tx for pleural effusion

drainage

[pneumonia]: what is suspected in a patient who develops a resolving pneumonia with a recurring fever

empyema

[pneumonia]: give 5 characteristic of aspirated pleural fluid in a patient with an empyema (5)

``` turbid yellow low glucose high LDH low pH ```

[pneumonia]: Tx: what is 1st line Tx of an empyema

chest drain

[pneumonia]: define a pulmonary abscess

localised suppurative infection

[pneumonia]: give 6 causes of an abscess

``` aspirational embolic (IE) bronchial obstruction pulmonary infarction subphrenic/hepatic abscess partially treated pneumonia ```

[pneumonia]: give 5 clinical signs of an abscess

``` foul smelling sputum swinging fever haemoptysis cough pleuritic chest pain ```

[pneumonia]: what is the appearance of an abscess on CXR

``` walled cavity fluid level (often) ```

[pneumonia]: Tx: what are the Txs of an abscess (2)

Abx - to sensitivity | surgical excision if failure above

[pneumonia]: what type of jaundice can complicate pneumonia

cholestatic

[pneumonia]: what are the 2 causes of jaundice in pneumonia

sepsis | 2ry to drugs

[pneumonia]: what 2 drugs are implicated in pneumonia associated jaundice

flucloxacillin | co-amoxiclav

[pneumonia]: what heart rate irregularity may be present

[pneumonia]: how is AF treated (2)

usually resolves with pneumonia Tx | B-blockers

[pneumonia]: vaccine: who would you preferentially vaccinate

at risk groups

[pneumonia]: vaccine: what are CIs to vaccination (3)

pregnancy lactation increased temperature

[pneumonia]: vaccine: what vaccine is used?

Pneumovax 2 0.5mL SC

[pneumonia]: vaccine: what are the 4 broad st risk groups

immunosupressed chronic organ failure diabetes mellitus >65 age

[pneumonia]: vaccine: who would you preferentially vaccinate

at risk groups

[pneumonia]: vaccine: what are the 4 broad st risk groups

immunosupressed chronic organ failure diabetes mellitus >65

[pneumonia]: vaccine:

[pneumonia]: Mx: CAP: what are the 3 drug options for mild to moderate CAP

Amoxicillin 500mg/8hrs Clarithromycin 500mg/12hrs Doxycycline 200mg load - 100mg dose

[pneumonia]: Mx: CAP: what are the 3 drug options for mild to moderate CAP

Amoxicillin 500mg/8hrs Clarithromycin 500mg/12hrs Doxycycline 200mg load - 100mg dose

[pneumonia]: Mx: CAP: what category of drug is clarithromycin

Macrolide

[pneumonia]: Mx: CAP: what category of drug is doxycycline

tetracycline

[pneumonia]: Mx: CAP: what are the 3 atypical organisms which cause CAP

Legionella Chlamydia Pneumocystis jiroveci

[pneumonia]: what would indicate urinary antigen testing

mod/severe pneumonia with legionella/pneumococcal species suspected

[pneumonia]: what organism may complicate influenza by causing pneumonia

staphylococcus aureus

[pneumonia]: what organism causes bilateral cavitating bronchopneumonia

staphylococcus aureus

[pneumonia]: pneumonia associated with CF or bronchiectasis or HAP post surgery is often caused by what organism

pseudomonas

[pneumonia]: what organism causes pneumonia outbreaks every 4 years or so

mycoplasma pneumoniae

[pneumonia]: what pneumonia often presents with patchy consolidation of 1 lower lobe

pseudomonas pneumoniae

[pneumonia]: what organism causing pneumonia is often found in cold water tanks (

legionella pneumophilia

[pneumonia]: what organism may cause pneumonia from spreading through parrots

Chlamydiophilia ptsittaci

[pneumonia]: what organism may cause pneumonia in the immunosuppressed

Pneumocystis jiroveci

[pneumonia]: what organism may cause pneumonia in the immunosuppressed

Pneumocystis jiroveci

[pneumonia]: in what organism can a CXR be normal

pneumocystis jiroveci

[pneumonia]: in what organism can a CXR be normal

pneumocystis jiroveci

[pneumonia]: what strain of influenza can cause death via avian-human transmission

H5N1 (influenza strain--> death from pneumonia)

[pneumonia]: when would you suspect H5N1 influenza strain causing pneumonia

contact with poultry

[pneumonia]: when would you suspect H5N1 influenza strain causing pneumonia

contact with poultry

[pneumonia]: what organism would you suspect if the patient presented with herpes labialis as well

cold sores

[pneumonia]: what organism would you suspect if the patient presented with herpes labialis as well

cold sores

[pneumonia]: Mx: what indicates that you should start O2 at 24-28%

history of COPD | history of hypercapnia

[pneumonia]: Mx: how many steps are there in Mx of pneumonia

[pneumonia]: Mx: what is the 1st step in Mx

ABC assessment

[pneumonia]: Mx: what sat % constitutes hypoxia

less than 88%

[pneumonia]: Mx: what 2 assessments must you include in 'C' assessment

hypotension/shock (from infection) | Dehydration (IV support)

[pneumonia]: Mx: what is the 2nd stage Mx

Send off investigations

[pneumonia]: Mx: when would you send of for blood cultures

if pyrexial

[pneumonia]: Mx: what is the 4th step in Mx

analgesia (pleuritic chest pain)

[pneumonia]: Mx: what is the 5th step in Mx (i.e. still hypoxic)

consider CPAP

[pneumonia]: Mx: what is the 5th step in Mx (i.e. still hypoxic)

consider CPAP

[pneumonia]: Mx: what is empirical treatment of severe normal organism pneumonia

Co-amoxiclav 1.2g/8h IV + Clarithromycin 500mg/12hrs IVI or Ciprofloxacin

[pneumonia]: Mx: what is empirical treatment of severe normal organism pneumonia in a penicillin allergic patient

Cefuroxime 1.5g/8hr IV + Clarithromycin 500mg/12hrs or Ciprofloxacin

[pneumonia]: Mx: what is empirical treatment of severe normal organism pneumonia

Co-amoxiclav 1.2g/8h IV + Clarithromycin 500mg/12hrs IVI or Ciprofloxacin

[pneumonia]: Mx: what is empirical treatment of severe normal organism pneumonia in a penicillin allergic patient

Cefuroxime 1.5g/8hr IV + Clarithromycin 500mg/12hrs or Ciprofloxacin

[pneumonia]: Mx: what is empirical treatment of severe pneumonia with Staphylococcus aureus (MSSA) suspected

``` Co-amoxiclav 1.2g/8h IV + Clarithromycin 500mg/12hrs IVI or Ciprofloxacin + Flucloxacillin + Rifampicin ```

[pneumonia]: Mx: what is empirical treatment of severe pneumonia with Staphylococcus aureus (MRSA) suspected

``` Co-amoxiclav 1.2g/8h IV + Clarithromycin 500mg/12hrs IVI or Ciprofloxacin + Vancomycin or Teicoplanin ```

[pneumonia]: Mx: what is empirical treatment of severe normal organism pneumonia

Co-amoxiclav 1.2g/8h IV + Clarithromycin 500mg/12hrs IVI or Ciprofloxacin

[pneumonia]: Mx: what is empirical treatment of severe pneumonia with Staphylococcus aureus (MRSA) suspected

``` Co-amoxiclav 1.2g/8h IV + Clarithromycin 500mg/12hrs IVI or Ciprofloxacin + Vancomycin or Teicoplanin ```

[pneumonia]: Mx: what is empirical treatment of mild normal organism pneumonia

``` Amoxicillin 500mg/8hrs or Clarithromycin 500mg/12hrs or Doxycycline 200mg load 100mg dose ```

[pneumonia]: Mx: what is empirical treatment of moderate normal organism pneumonia

``` Amoxicillin 500mg/8hrs + Clarithromycin 500mg/12hrs or Doxycycline 200mg load 100mg dose ```

[pneumonia]: Mx: what is empirical treatment of pneumocystis jirovecii organism pneumonia

``` Co-amoxiclav 1.2g/8h IV + Clarithromycin 500mg/12hrs IVI or Ciprofloxacin + Co-trimoxazole 120mg/kg/d ```

[pneumonia]: Mx: what is empirical treatment of legionella pneumonia

``` Co-amoxiclav 1.2g/8h IV + Clarithromycin 500mg/12hrs IVI or Ciprofloxacin + levofloxacin + rifampicin ```

[pneumonia]: Mx: what is empirical treatment of chlamydiophila (parrot) pneumonia

``` Co-amoxiclav 1.2g/8h IV + Clarithromycin 500mg/12hrs IVI or Ciprofloxacin + Doxycycline ```

[pneumonia]: Mx: what is empirical treatment of chlamydiophila (parrot) pneumonia

``` Co-amoxiclav 1.2g/8h IV + Clarithromycin 500mg/12hrs IVI or Ciprofloxacin + Doxycycline ```

[pneumonia]: Mx: what is empirical treatment of HAP

``` gentamicin + Ticarcillin (anti-pseudomonal) or cephotaxime ```

[pneumonia]: Mx: what is the 4th step in Mx

Paracetamol 1g/6hrs | analgesia: pleuritic chest pain

[pneumonia]: Mx: what is empirical treatment of HAP

``` gentamicin + Ticarcillin (anti-pseudomonal) or cephotaxime ```

[pneumonia]: a 'rusty' sputum is classically seen with wha t organism

pneumococcus

[pneumonia]: when will you perform an ABG

if O2 sats are less than 92% | Severe pneumonia

[pneumonia]: after Tx when should you order a repeat check up CXR

after 6 weeks

[pneumonia]: after Tx when should you order a check up

after 6 weeks

[pneumonia]: which patient would require a revaccination after 6 years due to increased risk of fatal pneumococcal infection

asplenic patients

[pneumonia]: which patient would require a revaccination after 6 years due to increased risk of fatal pneumococcal infection

asplenic patients

[pneumonia]: if pneumonia is caused due to aspiration what is the Tx?

Cephalosporin + Metronidazole

[pneumonia]: septicaemia due to pneumonia can cause metastatic disease e.g.

infective endocarditis

[pneumonia]: Mx: what is empirical treatment of chlamydiophila pneumoniae/psittaci pneumonia

``` Co-amoxiclav 1.2g/8h IV + Clarithromycin 500mg/12hrs IVI or Ciprofloxacin + Doxycycline ```

[pneumonia]: septicaemia due to pneumonia can cause metastatic disease e.g.

infective endocarditis

[pneumonia]: what drug is used for exposure prophylaxis in H5N1

Oseltamivir

[pneumonia] Flashcards

(134 cards)