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Flashcards in Pneumonia Deck (16)
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1

What is the definition of pneumonia?

Common lower respiratory tract infection causing inflammation of lung tissue
- associated with fever, chest signs and symptoms and chest X-Ray abnormalities

2

What are the most common organisms causing community acquired pneumonia?

Step pneumoniae
H.Influenzae
Moraxella cattarrhalis
Atypicals - legionella, S.aureus and M.pneumoniae

3

What are the most common organisms causing hospital acquired pneumonia?

Enterobacteria (gram negative)
S.aureus
Less common - pseudomonas, klebsiella and clostridia

4

What is hospital acquired pneumonia defined as?

Pneumonia diagnosed greater than 48 hours after hospital admission

5

What are the most common precipitating causes of pneumonia?

Aspiration - stroke, myaesthenia gravis, bulbar palsies and decreased consciousnesses
Immunocompromised patients - S.pneumoniae, H.influenza, S.aureus and M.pnuemoniae
S.pneumoniae often follows a viral infection
Cigarettes/alcohol
Bronchiectasis

6

What are the clinical features of pneumonia?

Fever, pyrexia
Rigors
Confusion
Tachypnoea
Malaise
Anorexia
Cyanosis
Dyspnoea
Tachycardia
Cough (purulent)
Hypotension
Haemoptysis
Pleuritic pain
Vomiting
Headache
Pleural rub
Signs of consolidation
- dull percussion, decreased expansion, increased fremitis and vocal resonance
- bronchial breathing

7

What investigations would you perform for pneumonia?

Oxygen sats
- ABG if <92% of very severe
Blood pressure
Blood tests
- FBC (WCCs, ESR, anaemia suggests an abscess)
- U&Es, LFTs and CRP
Chest X-Ray
- consilidation with air bronchograms
Cultures
- sputum, urine (legionella) and blood if septic/HAI
CURB65

8

What are the points on the CURB65 score?

Confusion
Urea >7mmol/l
Respiratory rate >30
Blood pressure <90 systolic and/or <60 diastolic
65 - age over 65 years

9

Describe the management of pneumonia?

Oxygen
IV fluids - to prevent dehydration and shock
Analgesia
VTE prophylaxis
Antibiotics (depending on CURB65 score)
Pneumococcal vaccine

10

What antibiotics are given for pneumonia?

CURB 0-1
- S.pneumoniae or H.influenza
- oral amoxicillin 500mg or clarithromycin 500mg
- doxycycline 200mg - 100mg if penicillin allergy
CURB 2
- M.pnuemoniae, S.pnuemoniae or H.influenza
- oral amoxicillin 500mg or clarithromycin 500mg (doxycycline 200mg - 100mg)
- use amoxicillin or clarithromycin if IV required
CURB 3+
- M.pnuemoniae, S.pnuemoniae or H.influenza
- IV co-amoxiclav 1.2g (cephalosporin IV) and IV clarithromycin 500mg
- add flucloxacillin if staph suspected and vancomycin if MRSA suspected

11

What antibiotics are given for atypical causes of pneumonia?

Legionella - fluroquinolone
Clamydophilia - tetracycline
Pneumocystis jiroveci - co-trimoxazole

12

What are some of the common complications of pneumonia?

Respiratory failure - type 1 common
Hypotension - due to dehydration and sepsis causing vasodilation
Atrial fibrillation - resolves with the pneumonia
Pleural effusion
Empyema
Septicaemia
Peri/myocarditis
Jaundice
Lung abscess

13

What are some causes of a lung abscess?

Pneumonia
Aspiration
Bronchial obstruction
Pulmonary infarction
Septic emboli
Suphrenic/hepatic abscess

14

What are the clinical features of a lung abscess?

Swinging fever
Cough (purulent)
Foul smelling sputum
Pleuritic chest pain
Heamoptysis
Malaise
Weight loss
Finger clubbing
Anaemia
Crepitations

15

What investigation should be done for a lung abscess?

Blood tests
- FBC, ESR and CRP
Blood and sputum culture
Chest X-Ray - shows a walled cavity

16

What is the treatment for a lung abscess?

Antibiotics until healed (4-6 weeks)
Drainage and surgical excision may be required