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CP1 - Respiratory > Pneumonia > Flashcards

Flashcards in Pneumonia Deck (15):

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

(symptoms and signs)


  • 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


  • 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


How is the severity of pneumonia assessed?


  • 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


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


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


List the common pathogens causing hospital acquired pneumonia

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


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.


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'


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


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


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


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.


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


What complications of pneumonia can occur?

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


Elicit the classical features of consolidation

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


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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