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Pneumonia Flashcards

1
Q

What is pneumonia?

A

Inflammation of the substance of the lungs - an acute lower respiratory tract infection

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2
Q

What is pneumonia usually caused by?

A

Bacteria but can also be viruses and fungi

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3
Q

How is pneumonia usually categorised?

A

Community acquired and hospital acquired

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4
Q

What are the two most common causes of community acquired pneumonia?

A
  • Streptococcus pneumonia (gram positive cocci)

- Haemophilus influenza (gram negative coccobacilli)

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5
Q

What is the treatment for a community acquired pneumonia caused by streptococcus pneumonia?

A

Β-lactam e.g Amoxicillin OR cefuroxime OR cefotaxime

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6
Q

What is the treatment for a community acquired pneumonia caused by haemophilia influenzae?

A

B-lactam - amoxicillin AND co-amoxiclav’
OR Doxycycline
But NOT Macrolides

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7
Q

What are the atypical causes of community acquired pneumoniae?

A
  • Chlamydia pneumonia
  • Mycoplasma pneumoniae
  • Legionella species
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8
Q

What treatment do you use for atypical pneumonia causes?

A

Macrolides OR Fluoroquinolones OR Tetracyclines

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9
Q

How would you test for S. Pneumoniae?

A
  • Alpha haemolytic and optochin sensitive
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10
Q

What is different about an aytipical pathogen?

A
  • Difficult to grow so you need serology to test them

- Also need special antibiotics to treat them as they’re not susceptible to B-Lactams

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11
Q

What can legionella spp. be caught from?

A

Warm water, showers and air conditioning as its a free living amoeba

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12
Q

What is hospital acquired pneumonia?

A

It is defined as a new onset cough with purulent sputum along with a compatible x-ray demonstrating consolidation - 48h since admission or in healthcare within 3 months

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13
Q

What aerobic gram negative bacilli are most commonly involved with HAP?

A
  • Pseudomonas aeruginosa
  • E. coli
  • Klebsiella pneumoniae
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14
Q

What is the risk to immunocompromised patients?

A

The risk is extended, not just from the usual organisms but also opportunistic pathogens that would not be expected to cause disease

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15
Q

Give an example of an opportunistic pathogen?

A

Pneumocystis jiroveci

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16
Q

What is aspiration pneumonia?

A
  • Acute aspiration of gastric contents into the lungs can produce and extremely severe and sometimes fatal illness owing to the intense destructiveness of gastric acid.
17
Q

How is pneumonia spread?

A

By respiratory droplets

18
Q

How does pneumonia occur?

A

When the host defence is overwhelmed the alveolar macrophages change roles and instruct th17 to stimulate neutrophils and fill the alveolar space.

Cells and pus in the alveoli reduce the lungs ability to exchange gas

19
Q

What are the risk factors for pneumonia?

A
  • Under 16/over 65
  • Nursing home resident
  • Comorbidities
  • Immunosuppression
20
Q

What are the signs of pneumonia?

A
  • Raised RR - dyspnoea and breathlessness (as alveoli become filled with pus and debris limiting gas exchange
  • Coarse crackles are often heard on auscultation - due to consolidation
  • Dull to percussion
  • Bronchial breath sounds
  • Dry or productive cough (cough isn’t productive in atypical causes)
21
Q

What are the symptoms of pneumonia?

A
  • Fever
  • (night) sweats
  • Rigors
  • Cough
  • SOB
  • Malaise
  • Anorexia
22
Q

What would you see on the CXR in pneumonia?

A
  • Look for ‘air bronchogram’ in consolidated area - black branch
  • Multi-lobar is suggestive of S.pneumoniae, S.aureus and legionella spp.
  • Multiple abscesses is suggestive of s.aureus
  • Upper lobe cavity is then klebsiella pneumoniae but MUST EXCLUDE TB FIRST
23
Q

What would you see on the blood tests for pneumonia?

A
  • ESR and CRP significantly elevated
24
Q

What is the CURB-65 score?

A

It is used to assess severity of CAP

25
Q

What do you get points for in the CURB-65 score

A
  • Confusion
  • Urea >7mmol/L
  • RR >30/min
  • BP - less than 90mmHg systolic and/or 60mmHg diastolic
  • Age greater than 65
26
Q

What complication is common in pneumonia?

A

Paraneumonic effusions

27
Q

What is an empyema?

A

Where the fluid is infected, meaning there is pus/purulent fluid in the pleural space

28
Q

What are the indication for a empyema?

A
  • Ongoing fever
  • Failure of fever to settle with antibiotics
  • Pain on deep inspiration
  • Signs of pleural collection
29
Q

What is thoracocentesis?

A

Removing fluid from pleural space - should be performed to make a diagnosis of empyema?

30
Q

What would you see on a thoracocentesis in empyema?

A

Fluid should be yellow and turbid

31
Q

What test would you use to diagnose a pleural effusion?

A

CXR

32
Q

What is the treatment for pneumonia?

A
  • Maintain O2 sats
  • 1st dose Abx given within 4 hours of presentation
  • Analgesia (pleuritic pain)
  • Narrow spectrum antimicrobials - amoxicillin
  • IV antibiotics if severe - co-amoxiclav

Resp (8 decks)

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