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CP1 - Respiratory > Pneumonia > Flashcards

Flashcards in Pneumonia Deck (15):
1

Describe the typical presentation of a patient with a community aquired pneumonia (CAP)

(symptoms and signs)

Symptoms:

  • Acute systemic illness
    • Fever
    • Rigors
    • Vomiting
  • Cough
    • Initally short, dry and painful progressing to a productive with mucopurulent sputum
  • Dyspnoea
  • Pleuritic chest pain - may be referred to shoulder or anterior abdominal wall

Signs:

  • Tachypnoea
  • Decreased chest expansion on the affected side
  • Dullness to percussion over the affected area
  • Coarse crackles and a pleural rub over the affected area, with bronchial breathing
  • Increased vocal resonance
    • 'Blue balloons' can be heard better: seen in consolidation, can't hear as well in effusions, pneumothorax or collapse
  • Upper abdominal tenderness: in lower lobe pneumonia

2

How is the severity of pneumonia assessed?

CURB-65

  • Confusion: mini mental test score <8
  • Urea >7mmol/l
  • Respiratory rate >30 per minute
  • Blood pressure: hypotensive <90/60
  • 65 years or older

One point for each finding

0/1 = non-severe CAP

2 = moderately severe CAP
>2 = severe CAP

3

How is hospital acquired pneumonia defined?

  • Pneumonia that develops at least 48 hours after admission to hospital, with no signs of incubation on adission or develops in somebody in hospital in the past 10 days

4

List the common pathogens causing community acquired pneumonia

  • Conventional bacteria (60-80%)
    • Streptococcus pneunomia (most common)
    • Haemophilus influenzae
  • Atypical bacteria (10-20%)
    • mycoplasma pneumonia
    • Chylamdia pneumonia
    • Legionella pneumonia
  • Viruses (10-20%)
    • Influenza/parainfluenza

5

List the common pathogens causing hospital acquired pneumonia

  • Gram –ve bacteria (E Coli, Pseudomonas, Klebsiella)
  • Staph Aureus

6

Who is more suspectable to pneumonia?

Patients at most risk are those following viral infection, hospitalized and ill, smokers, alcoholics, bronchiectasis, bronchial obstruction, immunosuppressed, IVDU, GORD.

7

How can pneumonia be classified with regard to the main site of the inflammatory response?

  • Pneumonia can be classified into lobar pneumonia or bronchopneumonia based on the main site of inflammatory response within lung parenchyma (s the portion of the lung involved in gas transfer - the alveoli, alveolar ducts and respiratory bronchioles)
  • Inflammatory exudate within the alveolar air spaces is what renders the infected areas of the lung macroscopically solid in 'consolidation'

8

Describe the pathology of bronchopneumonia

Who is it most common in? Why?

Where is the lobe does it mot commonly affect?

  • Primary infection centres around the bronchi, spreading to involve adjacent alveoli which become consolidated
  • The initial consolidation is patchy (involves lobules), but if untreated can become confluent (involves whole lobes)
  • Most common in infancy and old age due to immobility and retention of secretions thus bronchopneumonia moster most commonly affects lower lobes due to effect of gravity

9

Describe the pathology of lobar pneumonia

  • Organims gain entry to distal air spaces rather than colonising bronchi, thus there is rapid spread of infection through alveolar air spaces
  • Macroscopically, the whole of the lobe becomes consolidated and airless
  • These patients are normally adults, and become severely ill with associated bacteraemia

10

What investigations would you do for a patient presenting with community-acquired pneumonia

  • Observations & oxygenation assessment
  • Bloods: FBC, CRP, U&Es, LFTs
  • Blood cultures
  • CXR
  • Sputum sample for culture
    • Plus mycoplasma PCR if suspected
  • Urine for legionella/pneumococcal antigen if moderate/severe (empiral treatment wont cover legionella)
  • Serum mycoplasma IgM if suspected
  • Throat swab in viral transport medium if sever pneumonia or suspected viral pneumonia

11

What antibiotic treatment woud you give for a patient with community acquired pneumonia?

  • CURB 65 0/1: Non-severe CAP
    • Oral amoxicillin
    • Managed as outpatietn
  • CURB 65 2: moderately severe CAP
    • Oral amoxicillin and clarithromycin
    • Usually admitting patient
  • CURB 65 >2: severe CAO
    • IV clarithromycin plus co-amoxiclav
    • Admit to high-dependency unit

Antibiotic treatment should be guided to sputum sensitivity results, microbiology advice, trust guidelines and patient’s allergy status.

12

Other than antibiotic how else should a patient with CAP be treated?

  • Patients should stop smoking
  • have physiotherapy to clear mucous and ensure no decline with regards to ADL once infection is resolved
  • should be kept well oxygenated
  • should have fluid balance maintained
  • should be kept out of pain with pharmacological consideration of co-morbidities

13

What complications of pneumonia can occur?

  • Parapneumonic effusion/Empyema (presence of pus in the pleural cavity)
  • Post-infective bronchiectasis
  • Lung abscess: clubbing
  • Sepsis

14

Elicit the classical features of consolidation

Dullness, increased vocal fremitus and bronchial breathing are all a result of consolidation.

15

Recognise the radiological features of consolidation on CXR

Greyness - patchy in broncho, homogenous in lobar.

Middle lobe = heart border obscured

Lower lobe = diaphragm obscured

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