Respiratory Flashcards
1
Q
What are the causes of cludding?
A
- Resp:
- Bronchial carcinoma
- lung fibrosis
- bronchiectasis (suppurative lung disease as in cystic fibrosis)
- mesothelioma
- TB
- lung abscess
- Cardio:
- Atrial myoma
- infective endocarditis
- cyanotic heart disease
- GI:
- Cirrhosis
- inflammatory bowel disease
2
Q
Define pneumonia.
A
Infection of the lung parenchyma
3
Q
What is the aetiology and risk factors for pneumonia?
A
- impaired lung defenses
- poor cough/gag reflex (e.g. illness, drug-induced)
- impaired mucociliary transport (e.g. smoking, cystic fibrosis)
- immunosuppression (e.g. steroids, chemotherapy, AIDS/HIV, DM, transplant, cancer)
- increased risk of aspiration
- impaired swallowing mechanism (e.g. impaired consciousness, neurologic illness causing dysphagia, mechanical obstruction)
- no organism identified in 75% of hospitalized cases, and >90% of ambulatory cases
4
Q
What are the common organisms that cause community acquired pneumonia?
A
- Typical Bacteria
- Streptococcus pneumoniae
- Moraxella catarrhalis
- Haemophilus influenzae
- Staphylococcus aureus
- GAS
- Atypical Bacteria
- Mycoplasma pneumoniae
- Chlamydophila pneumoniae
- Legionella pneumophila
- Viral
- Influenza virus
- Adenovirus
5
Q
What are the common organisms that cause nosocomial pneumonia?
A
- Enteric GNB (E. coli)
- Pseudomonas aeruginosa
- S. aureus (including MRSA)
6
Q
What are the common organisms that cause aspiration pneumonia?
A
- Oral anerobes (Bacteroides)
- Enteric GNB (E. coli)
- S. aureus
- Gastic contents (chemical pneumonitis)
7
Q
What are the common organisms that cause HIV associated pneumonia?
A
- Pneumocystis jiroveci
- Fungi (Cryptococcus)
- Nocardia
- CMV
- HSV
- TB
8
Q
What are the common organisms that cause alcoholic pneumonia?
A
- Klebsiella
- Enteric
- GNB
- S. aureus
- Oral anaerobes (aspiration)
- TB
9
Q
What are the clinical features of pneumonia?
A
- cough (± sputum), fever, pleuritic chest pain, dyspnea, tachypnea, tachycardia
- elderly often present atypically; altered LOC is sometimes the only sign
- evidence of consolidation (dullness to percussion, bronchial breath sounds, crackles)
- features of parapneumonic effusion (decreased air entry, dullness to percussion)
- complications: ARDS, lung abscess, parapneumonic effusion/empyema, pleuritis ± hemorrhage
10
Q
What Ix should be done on a pt with pneumonia?
A
- pulse oximetry to assess severity of respiratory distress
- FBC and differential, electrolytes, urea, Cr, ABG (if respiratory distress), troponin/CK, LFTs, urinalysis
- sputum Gram stain/C&S, blood C&S, ± serology/viral detection, ± pleural fluid C&S (if effusion >5 cm or respiratory distress)
- CXR±CT chest shows distribution (lobar consolidation or interstitial pattern), extent of infiltrate ± cavitation
- bronchoscopy ± washings for:
- (1) severely ill patients refractory to treatment or
- (2) immunocompromised patients
11
Q
What is the Rx for CAP and HAP?
A
- Supportive:
- ABCs, O2, IV fluids, consider salbutamol
- Determine prognosis and need for hospitalisation and Abx
- ABx
- CAP need to assess severity: CURB65 or SMARTCOP
- Mild amoxycillin or doxycycline
- Moderate: benzylpenicillin IV PLUS doxycycline oral
- Severe : ceftriaxone IV PLUS azithromycin IV
- Hospital-acquired pneumonia:
- Mild: amoxycillin + clavulanate PO
- Moderate: ceftriaxone IV
- Severe: ceftriaxone
- High risk of MDR all severities: piperacillin + tazobactam IV
- CAP need to assess severity: CURB65 or SMARTCOP
12
Q
What is CURB65
A
- Used as a diagnostic tool for the severity of pneumonia
- CURB 65: 0-1 outpatient, 2-3 hospitalise, 4-5 ICU admit
- Confusion: Altered mental status = 1
- Urea/BUN: Urea>7mmol or BUN>20mg/ml = 1
- Respiratory rate: >30 = 1
- Blood pressure: Systolic <90 or diastolic <60 = 1
- Age: 65 or lder = 1
13
Q
What is SMARTCOP
A
15
Q
What are the pathological stages of pneumonia?
A
- Congestion in the first 24 hours: characterized histologically by vascular engorgement, intra-alveolar fluid, small numbers of neutrophils, often numerous bacteria. Grossly, the lung is heavy and hyperemic.
- Red hepatization or consolidation: Vascular congestion persists, with extravasation of red cells into alveolar spaces, along with increased numbers of neutrophils and fibrin.
- Grey hepatization: Red cells disintegrate, with persistence of the neutrophils and fibrin. The alveoli still appear consolidated, but grossly the color is paler and the cut surface is drier.
- Resolution (complete recovery): The exudate is digested by enzymatic activity, and cleared by macrophages or by cough mechanism.
16
Q
What are the complications of pneumonia?
A
- Healing by fibrosis
- PLeuritits
- empyema
- abscess formation
- haematogenous seeding - bacteraemia
- Pleural effusion
- ARDS
- death
