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YR6: RESPIRATORY > Pneumonia > Flashcards

Pneumonia Flashcards

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
Q

What investigation allows definitive diagnosis of CAP? What does this show?

A

CXR
Consolidation

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26
Q

What pathogens can be detected with urine antigen testing? When should this be ordered?

A

Legionella + Pneumococcus
Mod-high severity CAP
Those with specific RFs

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27
Q

Describe management of low-severity CAP

A

Amoxicillin 5 days
(If pen allergic: Macrolide (Clarithromycin) or Tetracycline)

28
Q

Describe the management of moderate severity CAP

A

Amoxicillin + Clarithromycin
PO or IV

29
Q

Describe the management of high severity CAP

A

Co-amoxiclav + Clarithromycin IV
(if pen allergic: Ceftriaxone + Clarithromycin)

30
Q

A patient with CAP should not be discharged if in the past 24h they have had 2 or more of what 7 findings?

A

Temp >37.5
RR >,24
HR >100
SBP ,<90
O2 sats <90% on RA
Abnormal mental status
Inability to eat without assistance

31
Q

Describe the timeline of how symptoms should have resolved from CAP

A

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
Q

What follow up should be performed in all cases of pneumonia?

A

CXR 6w after clinical resolution to ensure consolidation has cleared + no underlying secondary abnormalities

33
Q

List 4 symptoms of atypical pneumonia

A

Headache
Flu-like Sx + low grade fever
Cough
Myalgia

34
Q

Give 5 signs of legionella pneumophila pneumonia

A

Hyponatraemia
Deranged LFTs
Lymphopenia
Relative bradycardia
Pleural effusion (30%)

35
Q

Give 3 features of mycoplasma pneumoniae

A

Prolonged + gradual onset
Flu-like Sx precede dry cough
Bilateral consolidation on CXR

36
Q

Give 2 haematological complications caused by cold agglutinins (IgM) of mycoplasma pneumoniae

A

Haemolytic anaemia
Thrombocytopenia

37
Q

Give 2 dermatological complications of mycoplasma pneumoniae

A

Erythema multiform
Erythema nodosum

38
Q

Give 2 neurological complications of mycoplasma pneumoniae

A

Meningoencephalitis
Guillain Barre Syndrome

39
Q

What is a renal complication of mycoplasma pneumoniae?

A

Acute glomerulonephritis

40
Q

What is an ENT complication of mycoplasma pneumoniae?

A

Bullous myringitis
Painful vesicles on the TM

41
Q

What are the cardiac complications of mycoplasma pneumoniae?

A

Pericarditis
Myocarditis

42
Q

What are the GI complications of mycoplasma pneumoniae?

A

Hepatitis
Pancreatitis

43
Q

What are the investigations for mycoplasma pneumoniae?

A

Mycoplasma serology
+ve cold agglutination test

44
Q

In which age group is atypical pneumonia more common?

A

<50s

45
Q

What investigations should be performed for atypical pneumonia?

A

FBC: minor raise in WCC, mycoplasma can cause anaemia
LFTs: raised (mycoplasma + legionella)
Urinary antigen test + Sputum culture (Legionella)
CXR

46
Q

Describe management of atypical pneumonia

A

Macrolide: Clarithromycin/ Erythromycin
or
Doxycycline

47
Q

What environmental condition is legionella pneumophila associated with?

A

Air conditioning units

48
Q

When in bronchoscopy performed in pneumonia cases?

A

if Pneumocystitis carinii is suspected
If Pneumonia fails to resolve

49
Q

When would you add metronidazole to the baseline antibiotics being used to treat a pneumonia?

A

Aspiration
Lung abscess
Empyema

50
Q

Describe management of severe HAP/ for patients at higher risk of resistance

A

Piperacillin/ Tazobactam IV
or Ceftriaxone IV
If MRSA suspected/ confirmed: + Vancomycin IV

51
Q

Describe management of mild-moderate HAP/ patients not at high risk of resistance

A

Co-amoxiclav PO
(if pen allergic Doxycycline)

52
Q

What supportive treatment may be necessary in treating pneumonia?

A

Oxygen
IV fluids
CPAP, BiPAP or ITU care for respiratory failure
Surgical drainage for lung abscesses + empyema

53
Q

What would you consider in a non-resolving pneumonia?

A 
Other causes:
PE
PH
RHF
Drug toxicity
Unusual pathogens
Alveolar haemorrhage
54
Q

List 2 approaches to prevention of pneumonia

A

Pneumococcal vaccine
Haemophilus influenzae type B vaccine
Only usually given to high risk groups (e.g. >65, splenectomy)

55
Q

List 5 complications of pneumonia

A 
Pleural effusion  
Empyema 
Abscess
Septic shock  
ARDS
56
Q

Give 2 characteristics of klebsiella pneumoniae

A

Gram -ve rod
Part of human gut flora

57
Q

Who does klebsiella pneumonia more commonly effect? When?

A

Alcoholics
Diabetics
May occur following aspiration

58
Q

Give 2 features of klebsiella pneumonia

A

Red-currant jelly sputum
Often affects upper lobes

59
Q

What is the prognosis of Klebsiella pneumonia?

A

Commonly causes lung abscesses + empyema
Mortality 30-50%

60
Q

How is Chlamydia psittaci transmitted?

A

Via birds/ bird secretions

61
Q

How do patients with psittacosis usually present?

A

Flu like Sx: fever, headache + myalgia
Resp Sx: dyspnoea, dry cough + chest pain

62
Q

What signs may be found in the chest in psittacosis?

A

Unilateral crepitations + vesicular breathing
Evidence of pleural effusion (uncommon)

63
Q

What 2 signs may psittacosis rarely present with in the abdomen?

A

Hepatomegaly
Splenomegaly

64
Q

List 5 risk factors for aspiration pneumonia

A

Poor dental hygiene
Swallowing difficulties
Prolonged hospitalisation/ surgical procedures
Impaired consciousness
Impaired mucociliary clearance

65
Q

Which lobes are most commonly affected by aspiration pneumonia?

A

Right middle + lower lobes
Due to larger calibre + more vertical orientation of R main bronchus

66
Q

List 5 aerobic bacteria that may cause aspiration pneumonia

A

Strep pneumoniae
Staph aureus
Haemophilus influenzae
Pseudomonas aeruginosa
Klebsiella

67
Q

List 4 anaerobic bacteria that may cause aspiration pneumonia

A

Bacteroides
Prevotella
Fusobacterium
Peptostreptococcus

YR6: RESPIRATORY (38 decks)

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