Respiratory medicine notes detailing lung and airwaypathologies and conditions for medical school examinations. Notes made from multiple resources such as oxford handbook, question banks, university lectures and UK guidelines.
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Pneumonia in General
Presentation Investigations
- General: Dyspnoea; Cough; Pleuritic chest pain - CXR: Consolidation; Cavitation; Effusion
- Infection: Purulent sputum ± haemoptysis - ABG: Perform if SpO2 <92 %
- Observations: ↑To; ↑ HR; ↑ RR; ↓ BP; ↓ SpO2 - Bloods: FBC; U+E; CRP; LFTs
- Exam: ↓ Percussion; ↑ Fremitus; ↓ Expansion - Culture: Blood; Sputum
- Auscultation: Pleural rub; Bronchial breathing - Urine: Legionella/Pneumococcal antigens
Causes - Pleural fluid: MC&S + Microscopy
- Infectious (common) - BAL: Consider if immunocompromised / ITU
o NB: See lung infection notes - CURB-65: See below
- Non-infectious (uncommon) Management
o Common: Lung cancer; ARDS - Antibiotics: See lung infection notes
o Uncommon: Eosinophilic pneumonia; Sarcoidosis - Supportive: Fluids; O2 therapy
o Rare: Cryptogenic organising pneumonia - VTE Prophylaxis: LMWH
o AID: Vasculitis; RA - CXR: Repeat for progression + follow up at 6 wks
o Iatrogenic: amiodarone; Radiation pneumonitis
Aspiration Pneumonia
Description Causes
- Path: Oral or gastric contents get into lung lobes - Risks: Poor dental hygiene; Dysphagia; ↓ GCS
- NB: Acidic aspirates lead to chemical pneumonitis - G+Ve: S. pneumoniae; S. aureus
- Location: Right middle-lower lobes usually affected - G-Ve: H. influenzae; P. aeruginosa
Severity Assessment
CURB-65 Interpretation
- Confusion (abbreviated mental test ≤8) - 0-1: Home prescription is possible
- Urea >7 mmol/L - 2: Hospital admission + therapy
- Respiratory rate ≥30 breaths/min - ≥3: Severe pneumonia + consider ITU
- BP <90 mmHg systolic or <60 mmHg diastolic Prognosis
- Age ≥65 YO - Px: Score of 4 carriers 30 % mortality at 30 days
Pneumonia Complications
Respiratory Failure Empyema
- T1RF: Common complication - Features: Pneumonia; Recurrent fever
- Mx: High flow 60 % O2 - Ix: pH <7.2; ↓ Glucose; ↑ LDH
- Ix: ↓ O2; ↑ CO2 - Mx: Guided chest drain
- NB: Monitor ABG for CO2 retention Atrial Fibrillation (AF)
Pleural Effusion - Paroxysmal: Usually resolves with pneumonia mx
- Exudate Effusion: Protein >25 g/L; ↑ LDH - Mx: Short-term β-blockers or digoxin
- Transudate Effusion: Protein <25 g/L; ↓ LDH - NB: More common in elderly patients
- Pleurocentesis: If large or symptomatic drain effusion Septicaemia
- Mx: Guided aspiration (1-1.5 L max) - Spread: Pneumonia source may metastasise
- Cc: Re-expansion oedema; ↓ BP; Shock - NB: IE; Meningitis; Hepatitis; Pericarditis
Description
The lungs are one of the most exposed internal organ within the body to the outside environment and so are one of
the most common entry points and sites of infection. One of the most common lung infections in pneumonia which is
most commonly caused by contagious bacteria. Factors that increase the risk of lung infections include comorbidities
such as asthma, COPD and CF, immunocompromised and old age.
Infectious Pneumonia
Causes
- Community-Acquired Pneumonia (CAP) - Aspiration Pneumonia
o Common: S. pneumoniae o G+Ve: S. pneumoniae; S. aureus
o Mild: S. pneumoniae; H. influenzae o G-Ve: H. influenzae; P. aeruginosa
o Mod: S. pneumoniae; H. influenzae; M. pneumoniae - Neutropenic Pneumonia
o Severe: Panton-Valentine Leucocidin S. aureus o G+Ve: G+Ve cocci (e.g. Staphylococcus)
o Atypical: Legionella pneumophilia; PJP o G-Ve: G-Ve bacilli (e.g. Pseudomonas)
- Hospital-Acquired Pneumonia (HAP) o Fungi: Aspergillus; Candida; PJP
o Timing: Occurs ≥48 hrs post-admission - Viral pneumonia
o G-Ve: Usually G-Ve anaerobic Bacilli o Virus: Influenza; RSV; Parainfluenza; Rhinovirus
o Common: Pseudomonas aeruginosa o Cc: Increases chance of 2o bacterial infx
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