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YR6: RESPIRATORY > Pneumonia > Flashcards

Pneumonia Flashcards

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1
Q

What is Pneumonia?

A

inflammation of the lungs with consolidation or interstitial infiltrates
In the majority this is secondary to bacterial infection

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2
Q

How can pneumonia be categorised?

A

Community or hospital
Typical or atypical (Mycoplasma, Chlamydia, Legionella)
Aspiration or Immunocompromised

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3
Q

What is the most common cause of pneumonia? What is it particularly associated with?

A

Streptococcus pneumoniae
(pneumococcus)
high fever, rapid onset, herpes labialis reactivation

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4
Q

In which patients is haemophilus influenzae pneumonia common?

A

COPD

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5
Q

Which organism is a classic cause of pneumonia in alcoholics?

A

Klebsiella pneumoniae

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6
Q

In which patients is pneumocystis jiroveci pneumonia typically seen? How does this present?

A

HIV
Dry cough, exercise-induced desaturations + absence of chest signs

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7
Q

What is idiopathic interstitial pneumonia?

A

Group of non-infective causes of pneumonia e.g.
Cryptogenic organising pneumonia

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8
Q

What is hospital acquired pneumonia?

A

Pneumonia occurring >,48h after admission

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9
Q

Which infections may cause HAP?

A

Gram-negative aerobes: Pseudomonas, Klebsiella, Escherichia coli

Anaerobes (due to aspiration pneumonia)

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10
Q

What is ventilator associated pneumonia?

A

A type of HAP that develops in intubated patients on mechanical ventilation for >48h

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11
Q

What is atypical pneumonia caused by?

A

Organisms undetectable on Gram stain + can’t be cultured with standard methods

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12
Q

List 3 organisms causing atypical pneumonia

A

Mycoplasma pneumoniae
Legionella pneumophila
Chlamydia pneumoniae

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13
Q

List 6 risk factors for CAP

A

Age >,65
Residence in nursing home
Contact with children
Pre-existing lung disease (e.g. COPD)
Smoking
Alcohol

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14
Q

List 4 common symptoms of CAP

A

Cough with increasing sputum
Dyspnoea
Pleuritic chest pain
Fever/ Rigors

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15
Q

What do elderly patients with CAP often present with?

A

Confusion

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16
Q

List 4 signs of CAP

A

Signs of systemic infection: fever, tachycardia
Reduced O2 sats + tachypnoea
Auscultation: reduced breath sounds, crackles, wheeze
Dullness to percussion

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17
Q

What should be used in primary care to assess CAP?

A

CRB65 criteria
Confusion: AMTS <8
RR >30
BP: SBO <90 or DBP <60
>65y

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18
Q

What is the mortality risk based on CRB65 scores? How should this be acted upon?

A

0: low risk <1%
1-2: intermediate risk 1-10%
3-4: high risk >10%

Home based care (abx) if score 0
Hospital assessment for all others

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19
Q

If a point of care CRP test is available, how does this guide antibiotic therapy?

A

CRP <20: do not routinely offer abx
CRP 20-100: consider delayed prescription
CRP >100: offer abx

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20
Q

What criteria is used to assess patients presenting to hospital with pneumonia?

A

CURB-65
Confusion: AMTS <8
Urea >7
RR >30
BP: SBP <90 +/or DBP <60
>65

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21
Q

How do CURB65 score influence management?

A

0-1: low risk <3%. Home based care
>,2: intermediate risk 3-15%. Admit.
>,3: high risk >15%. ICU assessment

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22
Q

What bloods are performed for CAP?

A

FBC: raised WCC
U+Es: urea for CURB65
CRP: raised, used to monitor response to Tx
LFTs: for baseline

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23
Q

How does CRP change differ from that of WCC? Why is this? When may this be seen?

A

CRP can lag in decreasing in comparison to WCC
CRP is an acute phase reactant
1. At start of infection, CRP can be inappropriately low/ normal
2. When infection is resolving, CRP can be unexpectedly high given the clinical picture.

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24
Q

What additional investigations are indicated for moderate-high severity CAP?

A

Blood culture
Sputum culture
Legionella + Pneumococcal urinary antigen test
CRP monitoring for admitted

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25
What investigation allows definitive diagnosis of CAP? What does this show?
CXR Consolidation
26
What pathogens can be detected with urine antigen testing? When should this be ordered?
Legionella + Pneumococcus Mod-high severity CAP Those with specific RFs
27
Describe management of low-severity CAP
Amoxicillin 5 days (If pen allergic: Macrolide (Clarithromycin) or Tetracycline)
28
Describe the management of moderate severity CAP
Amoxicillin + Clarithromycin PO or IV
29
Describe the management of high severity CAP
Co-amoxiclav + Clarithromycin IV (if pen allergic: Ceftriaxone + Clarithromycin)
30
A patient with CAP should not be discharged if in the past 24h they have had 2 or more of what 7 findings?
Temp >37.5 RR >,24 HR >100 SBP ,<90 O2 sats <90% on RA Abnormal mental status Inability to eat without assistance
31
Describe the timeline of how symptoms should have resolved from CAP
1w: fever resolved 4w: chest pain + sputum production substantially reduced 6w: cough + breathlessness substantially reduced 3 mo: most Sx resolved, fatigue may still be present 6 mo: most feel back to normal
32
What follow up should be performed in all cases of pneumonia?
CXR 6w after clinical resolution to ensure consolidation has cleared + no underlying secondary abnormalities
33
List 4 symptoms of atypical pneumonia
Headache Flu-like Sx + low grade fever Cough Myalgia
34
Give 5 signs of legionella pneumophila pneumonia
Hyponatraemia Deranged LFTs Lymphopenia Relative bradycardia Pleural effusion (30%)
35
Give 3 features of mycoplasma pneumoniae
Prolonged + gradual onset Flu-like Sx precede dry cough Bilateral consolidation on CXR
36
Give 2 haematological complications caused by cold agglutinins (IgM) of mycoplasma pneumoniae
Haemolytic anaemia Thrombocytopenia
37
Give 2 dermatological complications of mycoplasma pneumoniae
Erythema multiform Erythema nodosum
38
Give 2 neurological complications of mycoplasma pneumoniae
Meningoencephalitis Guillain Barre Syndrome
39
What is a renal complication of mycoplasma pneumoniae?
Acute glomerulonephritis
40
What is an ENT complication of mycoplasma pneumoniae?
Bullous myringitis Painful vesicles on the TM
41
What are the cardiac complications of mycoplasma pneumoniae?
Pericarditis Myocarditis
42
What are the GI complications of mycoplasma pneumoniae?
Hepatitis Pancreatitis
43
What are the investigations for mycoplasma pneumoniae?
Mycoplasma serology +ve cold agglutination test
44
In which age group is atypical pneumonia more common?
<50s
45
What investigations should be performed for atypical pneumonia?
FBC: minor raise in WCC, mycoplasma can cause anaemia LFTs: raised (mycoplasma + legionella) Urinary antigen test + Sputum culture (Legionella) CXR
46
Describe management of atypical pneumonia
Macrolide: Clarithromycin/ Erythromycin or Doxycycline
47
What environmental condition is legionella pneumophila associated with?
Air conditioning units
48
When in bronchoscopy performed in pneumonia cases?
if Pneumocystitis carinii is suspected If Pneumonia fails to resolve
49
When would you add metronidazole to the baseline antibiotics being used to treat a pneumonia?
Aspiration Lung abscess Empyema
50
Describe management of severe HAP/ for patients at higher risk of resistance
Piperacillin/ Tazobactam IV or Ceftriaxone IV If MRSA suspected/ confirmed: + Vancomycin IV
51
Describe management of mild-moderate HAP/ patients not at high risk of resistance
Co-amoxiclav PO (if pen allergic Doxycycline)
52
What supportive treatment may be necessary in treating pneumonia?
Oxygen IV fluids CPAP, BiPAP or ITU care for respiratory failure Surgical drainage for lung abscesses + empyema
53
What would you consider in a non-resolving pneumonia?
``` Other causes: PE PH RHF Drug toxicity Unusual pathogens Alveolar haemorrhage ```
54
List 2 approaches to prevention of pneumonia
Pneumococcal vaccine Haemophilus influenzae type B vaccine Only usually given to high risk groups (e.g. >65, splenectomy)
55
List 5 complications of pneumonia
``` Pleural effusion Empyema Abscess Septic shock ARDS ```
56
Give 2 characteristics of klebsiella pneumoniae
Gram -ve rod Part of human gut flora
57
Who does klebsiella pneumonia more commonly effect? When?
Alcoholics Diabetics May occur following aspiration
58
Give 2 features of klebsiella pneumonia
Red-currant jelly sputum Often affects upper lobes
59
What is the prognosis of Klebsiella pneumonia?
Commonly causes lung abscesses + empyema Mortality 30-50%
60
How is Chlamydia psittaci transmitted?
Via birds/ bird secretions
61
How do patients with psittacosis usually present?
Flu like Sx: fever, headache + myalgia Resp Sx: dyspnoea, dry cough + chest pain
62
What signs may be found in the chest in psittacosis?
Unilateral crepitations + vesicular breathing Evidence of pleural effusion (uncommon)
63
What 2 signs may psittacosis rarely present with in the abdomen?
Hepatomegaly Splenomegaly
64
List 5 risk factors for aspiration pneumonia
Poor dental hygiene Swallowing difficulties Prolonged hospitalisation/ surgical procedures Impaired consciousness Impaired mucociliary clearance
65
Which lobes are most commonly affected by aspiration pneumonia?
Right middle + lower lobes Due to larger calibre + more vertical orientation of R main bronchus
66
List 5 aerobic bacteria that may cause aspiration pneumonia
Strep pneumoniae Staph aureus Haemophilus influenzae Pseudomonas aeruginosa Klebsiella
67
List 4 anaerobic bacteria that may cause aspiration pneumonia
Bacteroides Prevotella Fusobacterium Peptostreptococcus

YR6: RESPIRATORY (38 decks)

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