Pneumonia Flashcards Preview

child health diploma > Pneumonia > Flashcards

Flashcards in Pneumonia Deck (33)
Loading flashcards...
1
Q

How many children does Pneumonia kill worldwide per year

How many kids get Pneumonia

A

1 million kid die
156 million get pneumonia per year
Biggest killer of kids <5yrs in the world ( after the neonatal period)
In Australia 2nd leading cause of death <5y age grp after the neonatal period. ( leading cause is injury0

2
Q

<5year old worldwide pneumonia acconts for what proportion of death

A

1 : 6. Childhood deaths from pneumonia

3
Q

Prevention of pneumonia

A
Vaccination 
Breast feeding
Reducing smoking exposure
Avoid environmental toxins
Good hygiene 
HIV prevention and treatment
4
Q

Which vaccination prevent pneumonia (4)

A

HIB. Pneumvax measles pertussis

5
Q

ATSI children are more prone to pneumococcal Pneumonia

A

True 3x increased risk
So they have a different vaccination schedule
3x Prevanar13 and then 4th at 12 months and then PPV23 15years

6
Q

Pneumonia often starts with an URTI. T/F

A

TRUE

7
Q

SIGNS OF PNEUMONIA 2 KEY ONES

A

FEVER >38 C
TACHYPONEA at rest

Cough may be absent later sign

8
Q

Where do you listen for the lingue or right ML in the lung

A

Axial last

9
Q

Features suggestive of mycoplasma pneumonia

A

More common in school age children
Assoc symptoms. Headache /rash
Mycoplasma m/o has no cell wall

Wheeze /creptitations bilaterally
CXR bilateral worse than clinical presentation diffuse changes Bronchopneumonia
Diagnosis serology /cultures
Treatment Roxithromycin/azithromycin/ EES. Macrolide antibiotics

10
Q

What things should you consider in TB with ? Pneumonia

A

Visiting an endemic region
Close Relative with active TB
Travel

11
Q

With a history of travel what chest infections should you consider

A

Measles TB fungi

12
Q

Risk factors for pneumonia

A
Premature infant
Smoke exposure
Low SES
Chronic lung disease 
Chronic heart disease
CF, Cilary dysfunction, 
Immunological def congenital or acquired
Abnormal swallow or cough reflex. ( neuromuscular)
13
Q

Pneumonia severity assessment

A
Mild 
oxygen sat normal (>92%)
Normal color 
Temp <38.5
No or mild resp distress 
Normal heart rate 
Normal capillary refill
Severe Pneumonia 
Hypoxia ( O2 <92%)
Cyanosis
Mod-severe resp distress
Difficulty breathing
Temp>38.5
Altered mental status
Or they have pneumonia with sepsis ( raised HR/LOW BP/cap refill slow)OR pneumonia with eye a
14
Q

Pneumonia is a clinical diagnosis don’t need tests but which ones would you consider

A
MICRO 
Sputum c/s
Viral NPA culture nad Pcr
PNA pertussis
Blood cultures?sepsis
Mycoplasma/chlamydia
CXR not necessary in mild P
CRP not necessary does not dd viral/bacterial
FBC may aid dd viral/bacterial
TB 
Histoplasmosis birds/bats
15
Q

Who do you admit with Pneumonia

A

Severe pneumonia
People not getting better with mild
Children <12/12 of age

16
Q

What are the DD of pneumonia (6)

A
Heart failure
Bronchiolitis
Sepsis
Inhaled FB
Metabolic acidosis
Asthma exacerbation with viral induced illness
17
Q

CXR in pneumonia when

A

Severe pneumonia
?CCF
Complications eg pl effusion

18
Q

Management of mild pneumonia

A

Oxygen if necessary
Oral antibiotics amoxicillin 25-30mg /kg tds
IV benzepenicillin 60mg/kg QID
Mycoplasma macrolides roxithromycin 4mg /kg bd

19
Q

Severe pneumonia treatment

A

Oxygen
Antibiotics
Fluids ( watch avoid SIADH)
Antibiotics 3rd generation cephalosporin 50mg/kg
Add in clindomycin 10mg/kg iv tds toxin clover staph strep
Add Azithromycin atypical
Add Vancomycin MRSA

20
Q

A positive NPA viral rules out bacterial cause for pneumonia T/F

A

False 50% can have an associated bacterial infection

21
Q

Bacterial pneumonia

A
Usually a lobar Pneumonia 
Pneumococcus/ S. Aurueus/ H Influenza common m/o
Treat with an antibiotics for 7-10 days
Complications pl effusion 
Emphysema
Necrotising P
Abscess 
Should respond to antibiotics in 48hours if does not consider addition of 3rd generation cephalosporin  ( cephtriaxone 50mg /kg)if not responding to the antibiotics
22
Q

Pneumococcus Pneumonia features

A
Normally use amoxicillin/ penicillin 
Vaccination reduces the incidence 
Normal kids prevenar13 x3
At risk eg ATSI 4th prevenar 13 at 12/12
And PPV23 at 15years
23
Q

Staph aureus Pneumonia

A

If SEVERE Pneumonia always cover add in clindomycin good for toxins and if ?MRSA vancomycin

24
Q

Viral pneumonia

A

Common viruses are RSV paraInfluenza Influenza A/B
Adenovirus. Usually from URT
Symptoms coryza, fever, coug
Signs are bilateral wheezing cracked recession reduced Oxygen stat
APONEA in infants
CXR hyperinflation diffuse patchy
NPA
Treatment is conservative management
But 50% have co infection so watch for need for antibiotics
Rare complication Bronchiolitis obliterans adenovirus
Or Bronchiectasis

25
Q

Pneumonia in infants/neonates

A

Group B strep
Seen in prolonged rom, chorioamniocentesis prem labor
Associated with rapid deterioration in neonates
CXR shows diffuse / focal
Treatment iv ampicillin and gentamicin

Chlamydia
Pneumonia first 3months of life 
50% conjunctivitis 
Pneumonia 10-20%
Dx conjunctival inclusion body /NPA culture /serology
Treatment erythromycin 14/7
Chlamydia
26
Q

Complications of pneumonia (8)

A
SIADH
Pl effusion 
Empyma
Necrotising P
Lung abscess
Resp failure ARDS
Sepsis
Bronchiectasis
27
Q

Pleural effusion

A
Common complication of pneumonia
Assoc with chest pain / dysponea
Dull to percussion 
Decreased breath sounds 
Ix CXR/USS ( volume estimate type watery or thick/fibrous)
Treatment 
Small conservative watch and antibiotics 
Large /resp distress. Drain
28
Q

SIADH

A

Can be a complication of pneumonia
HypoNa+ and fluid retention
Treatment is fluid restrict 2/3 and very carefully replace Na+

29
Q

Empyma

A

Extension of a pl effusion
Pus in the intrapl space
Consider this if fever >48hours despite proper antibiotics
Diagnosis CXR /USS fibrous strands thick
Treatment is antibiotics
Chest drain ( if very thick ?use urokinase to thin it down)
Aspiration ( likely to reaccumulate)
VATS surgical drainage
Monitor inflammatory markers

30
Q

If pleural fluid is drained send for micro and cytology

A

Micro bacterial C/S
STAIN AFB
Step pneumonia Ag test
16SPCR

Cytology
Raised lymphocytes?malignacy /TB

31
Q

Necrotising pneumonia

A

Rare/sever/sepsis
Often have a pl effusion
Abscess +/- broncholpleural fistula
Good prognosis if managed correctly
S. Aureus/ S pneumonia/ mycoplasma
Diagnosis CXR /CTscan ( esp if surgery being considered )
Treatment is prolonged antibiotics IV / +/- chest tube/ +/- surgery

32
Q

Lung abscess

A

Can be part of necrotising pneumonia
Cavitation inflmatatory lesion
Can be caused by inadequate treatment of a lobar pneumonia
Can be assoc with an aspiration ( FB/Vomit)
CXR thick walled lesion with an air filled level

33
Q

Pneumatocoele

A

Air filled /thin walled sac
Associated with Staph Aureus
Risk of broncholpleual fistula / pneumothorax
Associated with empyma