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Respiratory System > Pneumonia + Lower Respiratory Tract Infections > Flashcards

Pneumonia + Lower Respiratory Tract Infections Flashcards

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

What are the most common organisms causing pneumonia?

A
  • streptococcus pneumoniae (commonest)
  • Haemophillus influenzae
  • moraxella catarrhalis
  • staph aureus + methicillin resistant S aureus (MRSA)
  • group A streptococcus pyogenes
  • anaerobes
  • viruses: influenzae, covid19, rhinovirus, RSV
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3
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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4
Q

Describe pleuritic chest pain

A

Chest pain made worse when taking a deep breath, coughing or sneezing

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5
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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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

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
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
22
Q

Describe the responses to a infection outside the lungs

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?

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 is rhinitis?

A

Common cold

25
Q

What are upper respiratory tract infections most commonly caused by?

A

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

26
Q

Symptoms of community acquired pneumonia

A
  • cough
  • dyspnoea
  • pleuritic chest pain
  • mucopurulent sputum
  • myalgia
  • fever
27
Q

What are 3 common causative organism of community acquire pneumonia?

A
  • Streptococcus pneumoniae (most common)
  • haemophilius influenzae
  • moraxella catarrhalis
28
Q

What is acute bronchitis most commonly caused by?

A

Viruses

29
Q

Treatment of acute bronchitits

A

Bronchodilation
Physiotherapy
(Antibiotics if bacterial)

30
Q

What atypical organisms may cause community acquired pneumonia?

A
  • Mycoplasma pneumoniae (commonest): lacks peptidoglycan bacterial cell wall
  • Chlamydia pneumoniae
  • Legionella pneumophila (at contamined water sources)
  • Chlamydophila psittaci (exposure to birds)
31
Q

What is hospital acquired pneumonia?

A

Infection of the lower respiratory tract in hospitalised patients > 48 hours after admission

32
Q

What organisms cause hospital acquire pneumonia?

A
  • staph aureus + MRSA
  • E. coli
  • pseudomonas aeruginosa
  • Candida
33
Q

Treatment of community acquired pneumonia

A

Mild-moderate:
- Amoxicillin
- Or doxycycline or clarithromycin

Moderate-severe:
- hospital admission
- co-amoxiclav AND doxycycline/clarithromycin (to cover atypical organisms)

34
Q

First line treatment of hospital acquired pneumonia

A

Co-amoxiclav

35
Q

Second line treatment of hospital acquired pneumonia

A

piperacilin/taxobactam or meropenem

36
Q

What do you use to score the severity of pneumonia?

A

CURB-65

37
Q

Outline CURB-65 score

A

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

38
Q

Prevention of pneumonia

A
  • Flu vaccine
  • Pneumococcal vaccine
  • covid 19 vaccine
  • Chemoprophylaxis (oral penicillin/erythromycin)
  • Smoking advice
39
Q

History suggestive of atypical cause of pneumonia

A
  • contaminated water sources (travel)
  • farm animals (>hepatitis)
  • exposure birds (>rash, splenomegaly, haemolytic anaemia)
40
Q

What is the significance of the lack of a peptidoglycan cell wall in the management of mycoplasma pneumoniae?

A
  • 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
41
Q

How does aspiration pneumonia occur?

A

Aspiration of exogenous material or endogenous secretions into respiratory tract

42
Q

Demographic of patients affected with aspiration pneumonia

A
  • neurological dysphagia (stroke)
  • epilepsy
  • alcoholics
  • drowning
43
Q

Treatment of aspiration pneumonia

A

co-amoxiclav

44
Q

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

A

Sputum
Blood culture
Nasal and throat swab
Urine antigens

45
Q

How does atypical pneumonia present on a CXR?

A

Concentrated in perihilar region

46
Q

How does pneumonia present in percussion

A

Dull
(Lung consolidation)

Respiratory System (20 decks)

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