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Pneumonia + Lower Respiratory Tract Infections Flashcards

(54 cards)

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1
Q

What is pneumonia?

A

Inflammation of the alveoli in which they fill up in fibrin rich fluid e.g. mucous + pus

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2
Q

Signs + symptoms of pneumonia

A
  • cough: dry > mucous
  • dyspnoea
  • pleuritic chest pain
  • pleurisy fever + chills
  • tachycardia
  • organ dysfunction e.g.mental dysfunction
  • crackles
  • bronchial breathing
  • confusion
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3
Q

Clinical findings of pneumonia

A
  • dull to percussion
  • fine crackles
  • decreased breath sounds
  • bronchial breathing
  • increased vocal resonance
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4
Q

Investigations of pneumonia

A
  • chest X ray
  • sputum sample
  • blood culture
  • nose + throat swab (for viruses)
  • urine (legionella + strep pneumococcus)
  • ABG
  • C reactive protein
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5
Q

What four tests should you always do in a patient with suspected pneumonia?

A

Sputum
Blood culture
Nasal and throat swab
Urine antigens

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6
Q

Complications of pneumonia

A

Emphysema
Lung abscess
Bacteraemia

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7
Q

What is empyema?

A

Collection of pus in pleural cavity

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8
Q

What is bacteraemia?

A

Presence of bacteria in the blood

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9
Q

What are the types of pneumonia?

A
  • community acquired pneumonia
  • healthcare acquired pneumonia : > 48 hours post admission
  • ventilated acquired pneumonia: > 48 hours post intubation
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10
Q

What is the gold standard for diagnosing pneumonia?

A
  • presence of infiltrate + consolidations on imaging
  • alongside symptoms + other findings
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11
Q

How does ventilator associated pneumonia occur?

A
  • develops when a person is connected to a ventilator
  • biofilm can cover the endotracheal tube + infect the lung
  • person can’t cough + already ill so infection builds up > pneumonia
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12
Q

Common microbiota of the respiratory tract

A

Viridans streptococci
Neisseria
Anaerobes
Candida
Strep pneumoniae + pyogenes
Haemophilia influenzae

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13
Q

List lower respiratory infections

A

Acute bronchitits
Empyema
Lung abscess
Pneumonia
Bronchiectasis

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14
Q

What is acute bronchitits?

A

Inflammation of medium sized airways of the lungs (bronchi)
Normal chest X ray

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15
Q

What is bronchiolitits?

A

Viral infection of the bronchioles
Most commonly in children <12 months

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16
Q

What causes bronchiolitis?

A

Respiratory syncytial virus

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17
Q

What is a lung abscess?

A
  • Localised collection of pus within the lung
  • Leads to cavity formation with a thick wall
  • due to microbial infection causing necrosis of lung parenchyma
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18
Q

What is seen on imaging of a patient with a lung abscess?

A

Presence air-fluid levels in cavity

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19
Q

What is an air fluid level?

A

Occurs when air rises above a fluid in a contained space (lungs) + there is a flat surface at the air fluid interface

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20
Q

Defences of the respiratory tract

A
  • mucociliary clearance: nasal hairs + ciliated columnar epithelium of respiratory tract
  • coughing + sneezing
  • alveolar microbiota
  • respiratory mucosal immune system: tonsils, alveolar macrophages, secretary IgA + IgG
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21
Q

Describe the responses to an infection in the lungs

A
  • alveolar macrophages fails to stop the pathogen
  • cytokines recruit more macrophages
  • inflammation > increased permeability
  • more WBCs to aid the macrophages
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22
Q

Describe the responses to a infection outside the lungs

Study These Flashcards
A
  • inflammatory mediators enter systemic circulation
  • activates bone marrow,increases cardiac output + increases body temp
  • dysregulation causes damage to surrounding tissues
23
Q

What demographic are more at risk of lower respiratory tract infections?

Study These Flashcards
A
  • > 65 years old
  • smoking (abnormal ciliary function)
  • alcohol/drugs
  • chronic lung diseases
  • dysphagia
  • immunocompromised
  • malnutrition
  • co-infection with viruses (abnormal ciliary function)
24
Q

What are upper respiratory tract infections most commonly caused by?

Study These Flashcards
A

Viruses
e.g. rhinovirus, coronavirus, influenza, RSV

25
Symptoms of community acquired pneumonia
- cough - dyspnoea - pleuritic chest pain - mucopurulent sputum - myalgia - fever
26
What are 3 common causative organism of community acquire pneumonia?
- Streptococcus pneumoniae (most common) - haemophilius influenzae - moraxella catarrhalis
27
Treatment of community acquired pneumonia
_Mild-moderate_: - *Amoxicillin* 5 days - Or *doxycycline* or *clarithromycin* _Moderate-severe_: - hospital admission - *co-amoxiclav* AND *doxycycline/clarithromycin* (to cover atypical organisms) 7-10 days
28
What is acute bronchitis most commonly caused by?
Viruses
29
Treatment of acute bronchitits
Bronchodilation Physiotherapy (Antibiotics if bacterial)
30
What atypical organisms may cause community acquired pneumonia?
- **Mycoplasma pneumoniae** (commonest): lacks peptidoglycan bacterial cell wall - **Chlamydia pneumoniae** - **Legionella pneumophila** (at contamined water sources) - **Chlamydophila psittaci** (exposure to birds)
31
History suggestive of atypical cause of pneumonia
- **contaminated water sources** (travel) - **farm animals** (>hepatitis) - **exposure birds** (>rash, splenomegaly, haemolytic anaemia)
32
What is the significance of the lack of a peptidoglycan cell wall in the management of mycoplasma pneumoniae?
- **Penicillins kill bacterial by inhibiting the synthesis of peptidoglycan cell wall** - no cell wall = no bacterial death - penicillins are ineffective to mycoplasma pneumoniae - macrolides are used instead *e.g. erthyromycin, clarithromycin*
33
How does atypical pneumonia present on a CXR?
Concentrated in perihilar region
34
What is hospital acquired pneumonia?
Infection of the lower respiratory tract in hospitalised patients > 48 hours after admission
35
What organisms cause hospital acquire pneumonia?
- staph aureus + MRSA - E. coli - pseudomonas aeruginosa - Candida
36
First line treatment of hospital acquired pneumonia
*Co-amoxiclav*
37
Second line treatment of hospital acquired pneumonia
*piperacilin with taxobactam*
38
What do you use to score the severity of pneumonia?
CURB-65
39
Outline CURB-65 score
One point for each: - **Confusion** - **Urea**: >7mmol/l - **Respiratory rate**: >30 - **Blood pressure**: <90 systolic <60 diastolic - **>65 years old** Score 2 = mild, admit or mange Score 2-5 = severe
40
What is the use of CURB-65?
- used to guide management + risk stratify - ITU if CURB-65 score is high
41
Prevention of pneumonia
- Flu vaccine - Pneumococcal vaccine - covid 19 vaccine - Chemoprophylaxis (oral penicillin/erythromycin) - Smoking advice
42
Demographic of patients affected with aspiration pneumonia
- neurological dysphagia (stroke) - epilepsy - alcoholics - drowning
43
Treatment of aspiration pneumonia
*co-amoxiclav*
44
Causes on non resolving pneumonia
**CHAOS** - **C**omplication: emypema, lung absess - **H**ost: immunocompromsied - **A**ntibiotic: inadequate dose, poor oral absorption - **O**rganism: resistant or unexpected organism non covered by antibiotics given - **S**econdary diagnosis: PE, cancer
45
Pneumonia follow up
- repeat imaging - follow up appointment in 6 weeks in clinic - HIV test - immunoglobulins
46
Risk factors of aspiration pneumonia
- poor dental hygiene - swallowing difficulties - prolonged hospitalisation or surgical procedures *e.g intubation* - impaired consciousness - impaired mucocillary clearance
47
Most common sites on lung affected by aspiration pneumonia
Right middle + lower lobe
48
What microorganism typically causes pneumonia in alcoholics?
Klebisella pneumoniae
49
What microorganism most commonly causes aspiration pneumonia
Klebsiella pneumoniae
50
Features of klebsiella pnuemonia
- more common in alcoholics + diabetes - can occur after aspiration - red current jelly sputum - upper lobes
51
Treatment of severe pneumonia
Co-amoxiclav AND Clarithromycin
52
Presentation of acute bronchitis
Cough Sore throat Rhinorrhoea Wheeze
53
Management of acute bronchitis
- analgesia - good fluid intake - consider abx if: systemically very unwell, pre-existing co-morbidities, CRP >100 - doxycycline first line - amoxicillin if child or pregnant woman
54
Pneumonia follow up
Repeat chest X-ray at 6 weeks after clinical resolution

Respiratory System (25 decks)

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