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Stage 2: Supporting Life > Pneumonia - Features + Treatment > Flashcards

Pneumonia - Features + Treatment Flashcards

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1
Q

Who does pneumonia primarily affect?

A

Young children, elderly and immunocompromised

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2
Q

What is the most common (bacterial cause) of pneumonia?

A

Streptococcus pneumoniae (30%)

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3
Q

What are the leading respiratory virus causes of pneumonia?

A

RSV, rhinovirus, influenza (30%)

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4
Q

What are 4 other bacterial causes of pneumonia?

A
  • Haemophilius influenzae
  • Staphylococcus aureus
  • Klebsiella pneumoniae
  • Pneumocystis jirovecii
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5
Q

Describe the aetiology (spread) of pneumonia?

A
  • Nasopharyngeal aspiration → normal ecological niche = nasopharynx
  • Droplet spread
  • Inhalation of airborne microorganisms → spore format e.g. aspergillus
  • Haematogenous spread
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6
Q

Describe the action of cells in the respiratory immune system

A

1) Mucociliary clearance → entrapment in mucus, ciliary escalator
2) Alveolar macrophages → phagocytosis, inflammation
3) Neutrophils → phagocytosis (but can reach phagocytosis capacity)
4) Complement and antibodies → opsonisation, agglutination
5) Lymphocytes → inflammation, activation of other immune cells

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7
Q

What is the pathophysiology of pneumonia?

A

1) Alveoli fill with pus (can see on x ray or CT)
2) Impaired gas exchange → by pathogen and infiltrates from blood
3) SIRS → systemic inflammatory response, sepsis
4) Bacteraemia

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8
Q

What causes congestion?

A

Vascular engorgement, intra-alveolar fluid

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9
Q

What is red hepatisation?

A

When there is exudation of red cells, neutrophils and fibrin in the alveoli (precedes grey hepatisation)

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10
Q

What is grey hepatisation?

A

Disintegration of RBCs, persisting inflammatory cells leaving a fibrinosuppurative exudate in the alveoli

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11
Q

Do lungs normally scar due to pneumonia?

A

No

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12
Q

What are the (non-specific) symptoms of the infection?

A
  • Dyspnoea
  • Cough
  • Sputum ± purulence (inflammatory infiltrate)
  • Fever (cytokines)
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13
Q

Why is there not much pain in pneumonia?

A

Bc there is not much nerve supply to the lung itself

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14
Q

What are the signs of infection?

A
  • Tachypnoea
  • Tachycardia
  • Hypotension
  • Pyrexia (fever)
  • Crackles
  • Whispering pectoriloquy
  • Increased tactile fremitus
  • Increased vocal resonance
  • Central cyanosis
  • Altered mental status
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15
Q

What investigations would you do to determine pneumonia?

A
  • ABG (if hypoxic bc checking for type 2 respiratory failure)
  • CXR
  • FBC
  • U&E, CRP, LFT
  • Blood and sputum cultures
  • Viral PCR
  • Atypical serology
  • Urine Ag for legionella and S. Pneumoniae (useful if positive)
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16
Q

What is whispering pectoriloquy?

A

When as the consolidated lung has better sound transfer, what sounds like upper respiratory sounds might be at the bottom

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17
Q

What is atypical serology useful for?

A

Tells us what has caused the pneumonia (more useful for epidemiology than acutely)

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18
Q

What are the urine Ag for legionella and S. Pneumoniae useful for?

A

To find out the bacteria to be able to narrow down the spectrum of antibody (initially given broad spectrum)

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19
Q

What does consolidation of the (right) middle lobe normally obscure?

A

The heart

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20
Q

What does consolidation of the (right) lower lobe usually obscure?

A

The diaphragm

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21
Q

Where is right upper lobe consolidation located?

A

Above the horizontal fissure

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22
Q

What does left lingula consolidation obscure?

A

The left heart border

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23
Q

Which consolidation can be difficult to see with a CXR and why? (But can see with CT)

Study These Flashcards
A

(Left) lower lobe as it is behind the diaphragm

24
Q

Why might you want to follow up after consolidation CXR?

Study These Flashcards
A

To check it’s not lung cancer

25
What is patchy consolidation called?
Diffuse bronchocentric consolidation
26
What is the scoring system used for CAP?
CURB65
27
What does CURB65 tell us?
It predicts mortality and tells us which patients need to be in hospital/ICU/GP/home
28
What are the 5 parts of the CURB65 score?
1) Confusion → AMTS ≤ 8 2) Serum urea > 7mmol/L 3) RR ≥ 30 4) Systolic BP < 90 or diastolic BP ≤ 60mmHg (evidence of sepsis?) 5) Age ≥ 65
29
How does the CURB65 scoring system work?
1 point for each feature
30
What would you do with a CURB65 score of 0?
Oral antibiotics at home → however, if patient has hypoxia and low sats, don't send home (just a guideline)
31
What would you do with a CURB65 score of 1?
Consider hospital admission
32
What would you do with a CURB65 score of 2?
Consider IV antibiotics
33
What would you do with a CURB65 score of 3?
Consider ICU admission
34
How do you manage pneumonia (ABCDE)?
A - ensure patent airway B - oxygen to maintain desired saturation (94-98%) or mechanical ventilation (in patient with COPD or other factors) C - IV fluids if required → inotropes, haemofiltration (kidney support - ICU) D - GCS (confusion) E - analgesia, antipyretics ANTIBIOTICS
35
Describe antibiotic treatment in pneumonia
- Within 4 hours - Empirical (and broad spectrum in pt unwell) at initiation, then narrow if specific organism cultured - OP → penicillin derivative bc cover strep pneumo and others - IP moderate severity → penicillin derivative + macrolide (some are resistant) - IP severe → IV beta-lactamase resistant antibiotics (co-amoxiclav or cephalosporin) + macrolide
36
How would you diagnose viral pneumonia?
- Cytology → intranuclear or cytoplasmic inclusion bodies - Viral cultures - PCR → for nasopharyngeal aspirates - Rapid Ag detection - Serology
37
How do you management viral pneumonia?
Largely supportive, not v much evidence for anti-virals but give them for some viruses
38
What medications are used to treat viral pneumonia linked to influenza?
- Amantadine → slightly reduces URT symptoms and myalgia - Oseltamivir → to prevent spread of flu rather than to treat patient - Zanamivir
39
What medications are used to treat viral pneumonia linked to RSV?
Ribavarin
40
What medications are used to treat viral pneumonia linked to HSV or VSV?
Aciclovir (v effective)
41
What are 5 examples of immunosuppressed patients?
1) Malignancy 2) Steroids 3) Asplenia 4) Diabetes 5) CKD
42
What are 4 differential diagnoses for pneumonia?
1) Malignancy 2) Vasculitides 3) Infarcted lung, PE 4) Pulmonary oedema
43
What are the complications of pneumonia (can appear even if treat if treatment is late) and describe them/their treatment?
1) Septic shock → hypotension, fever 2) Adult respiratory distress syndrome → supportive care, low pressure ventilation, ECMO 3) Parapneumonic effusion and empyema → pus or fluid pH < 7.2, intercostal drain, VATS 4) Cavitation and abscess → prolonged antibiotics (4-6 weeks response), resection 5) MI → double the rate of MI after pneumonia
44
What is adult respiratory distress syndrome?
Lung inflammation syndrome after systemic infection, most common = pneumonia
45
When should you drain fluid?
If lots of fluid, pus or acidic
46
What does ARDS look like on CXR?
Large white space covering almost all of one lung
47
What does empyema look like on a CXR?
Loculated abscess → white blob
48
How do you treat an abscess?
Co-amoxiclav
49
Describe the follow-up after pneumonia
1) Clinical review at 6 weeks (might still feel tired) → mainly want to check that CXR is better (not cancer) 2) CXR if smoker, <50, still symptomatic
50
How do you prevent pneumonia?
1) Vaccination | 2) Prophylactic antibiotics
51
Describe vaccination to prevent pneumonia
1) Pneumovax → against strep pneumo, >65s are vaccinated 2) Prevenar → has an adjuvant. esp. for children <2, responsible for reduction in pneumococcal states and probably general reduction 3) Influenza vaccine
52
When are prophylactic antibiotics given and which ones?
1) Splenectomy → should be on penicillin life-long | 2) After transplant → septrin, aciclovir and penicillin
53
When would you not want to identify the species causing the pneumonia?
If patient has CURB65 score of 0 → no benefit if patient will get better on their own anyway
54
Which antibiotic is usually used for gram negative bacteria?
Gentamicin
55
Which antibiotic gives a risk of C.difficile?
Ciprofloxacin
56
What is prodrome?
Early symptoms indicating the onset of a disease or illness
57
What does a prodrome in pneumonia indicate?
More likely to be flu and strep pneumo

Stage 2: Supporting Life (30 decks)

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