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FRCR 2A (Crack The FRCR 2A) > 1. Chest p47-55 (Infection) > Flashcards

1. Chest p47-55 (Infection) Flashcards

1
Q

Strep. Pneumoniae (imaging)

A

Lobar consolidation

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2
Q

Strep. Pneumoniae (trivia) (3)

A

Favours lower lobe.
Severe in sickle cell pts post splenectomy.
Commonest pneumonia in AIDS pts.

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3
Q

Staph aureus pneumonia (imaging)

A

Bronchopneumonia - patchy opacities

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4
Q

Staph Aureus pneumonia (trivia) (3)

A

Often bilateral,
Can make abscesses,
Can spread via blood in endocarditis

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5
Q

Anthrax pneumonia - imaging (3)

A

Haemorrhagic lymphadenitis,
Mediastinitis,
Haemothorax

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6
Q

Anthrax pneumonia - classic look (2)

A

Mediastinal widening with pleural effusion,
Setting of bio-terrorism

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7
Q

Klebsiella pneumonia - imaging (2)

A

“Bulging fissure” from inflammation.
More likely to have pleural effusions, empyema and cavity than conventional pneumonia

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8
Q

Klebsiella - Trivia (2)

A

Alcoholics and nursing home pts.
Current jelly sputum

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9
Q

Haemophilus - imaging (2)

A

Usually bronchitis.
Can get bilateral lower lobe bronchopneumonia

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10
Q

Haemophilus - trivia (2)

A

Seen in COPD and people without spleen

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11
Q

Pseudomonas - imaging (2)

A

Patchy opacities with abscess formation.
Pleural effusions are common but usually small

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12
Q

Pseudomonas - trivia (2)

A

ICU pts (or CF/primary cilliary dyskinesia)

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13
Q

Legionella - imaging (3)

A

Peripheral and sublobar airspace opacity.
Imaging lags behind resolution of symptoms.
Cavitates only if immunosuppressed.

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14
Q

Legionella - trivia (2)

A

COPD pts.
Seen around bad air conditioners.

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15
Q

Aspiration - imaging (2)

A

Anaerobes with airspace opacity.
Can cavitate and form abscess.

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16
Q

Aspiration - trivia (4)

A

Posterior lobes if supine while swallowing.
Basal lower lobes if upright.
May favour right side, like ET tube.
Commonest complication is empyema, which may lead to bronchopulmonary fistula.

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17
Q

Actinomycosis - imaging (2)

A

Airspace opacity in peripheral lobes.
Can be aggressive and cause rib osteomyelitis or invade chest wall

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18
Q

Actinomycosis - trivia

A

Commonly dental procedure gone wrong, leading to mandible osteomyelitis and aspiration.

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19
Q

Mycoplasma - imaging (2)

A

Fine, reticular pattern on CXR.
Patchy airspace opacity with tree-in-bud

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20
Q

Commonest cause of death post bone marrow transplant

A

Pneumonia, occurs in almost 50% of people after BMT

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21
Q

Graft vs Host disease post BMT (types) (4)

A

Acute:
- 20-100 days
- Favours extrapulmonary systems (Liver, skin, GI)
Chronic:
- >100 days
- Lymphocytic infiltration of airways and obliterative bronchiolitis.

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22
Q

Post BMT Pulmonary findings (types) (3)

A

Early neutropenic (0-30 days),
Early (30-90 days),
Late (>90 days)

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23
Q

Early neutropenic post BMT findings (lung) (4)

A

Pulmonary oedema,
Haemorrhage,
Drug induced lung injury,
Fungal pneumonia (invasive aspergillosis)

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24
Q

Early post BMT findings (lung) (2)

A

PCP, CMV

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25
Q

Late post BMT findings (lung) (2)

A

Bronchiolitis obliterans,
Cryptogenic organising Pneumonia

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26
Q

AIDS infections - CD4 >200 (2)

A

Bacterial infections,
TB

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27
Q

AIDS infections - CD4 <200 (2)

A

PCP,
Atypical mycobacterial

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28
Q

AIDS infections - CD4 <100 (3)

A

CMV,
Disseminated fungal,
Mycobacterial

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29
Q

AIDS - focal airspace opacity - DDx (3)

A

Bacterial infection (strep most common),
Consider TB if low CD4,
Consider lymphoma or kaposi sarcoma if chronic

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30
Q

AIDS - multi-focal airspace opacity - DDx (2)

A

Bacterial or TB

31
Q

AIDS - ground glass - DDx (2)

A

PCP.
Consider CMV if CD4<100

32
Q

PCP - trivia

A

Most classic AIDS infection

33
Q

PCP - imaging (2)

A

Perihilar ground glass, sparing periphery.
Can have thin walled cysts within the ground glass opacities (30%)

34
Q

AIDS - flame shaped perihilar opacity (Dx)

A

Kaposi sarcoma

35
Q

AIDS - persistent opacities (Dx)

A

Lymphoma

36
Q

AIDS - Lung cysts

A

LIP

37
Q

AIDS - Lung cysts & ground glass & pneumothorax

A

PCP

38
Q

AIDS - hypervascular lymph nodes (2)

A

Castlemans or Kaposi

39
Q

TB - types (4)

A

Primary,
Primary progressive,
Latent,
Post primary (reactivation)

40
Q

Primary progressive TB - definition (2)

A

Local progression of parenchymal disease with development of cavitation (at initial site or site of haematogenous spread).
Similar in course to post-primary disease

41
Q

Primary TB - Progression (7)

A
  • Inhaled bug leads to necrosis.
  • Body attacks it, forms granuloma (Ghon focus).
  • Nodal expansion (bulky in kids, less common in adults), can calcify (Ranke complex).
  • Bulky nodes can cause compression, leading to atelectasis.
  • Node may rupture into a bronchus (causing endobronchial spread) or vessel (haematogenous spread –> milliary TB).
  • Cavitation is NOT common in primary TB.
  • Effusions can be seen, more common in adults.
42
Q

Primary progressive TB - associations (6)

A

Uncommon, associated with HIV or immunocompromise:
- transplant,
- steroids,
- jejuno-ileal bypass,
- subtotal gastrectomy,
- silicosis

43
Q

Latent TB - definition

A

Positive skin test, negative CXR and no symptoms

44
Q

Post primary (reactivation) TB - definition (2)

A

Endogenous reactivation of latent infection.
Happens in 5% of cases.

45
Q

Post primary (reactivation) TB - anatomy (4)

A

Classically apical and posterior upper lobe, and superior lower lobe (more oxygen, less lymphatics).
Primary infection tends to show healing, post primary tends to show progression.
Cavity development is key feature of post-primary.
Arteries near the cavity can form aneurysms (Rasmussen aneurysm)

46
Q

Immune Reconstitution Inflammatory Syndrome (clinical & Rx) (2)

A

Pt with TB & AIDS doing worse clinically after starting HAART.
Rx = steroids

47
Q

Pleural involvement with TB (3)

A

Primary TB - pleural effusion can occur any time, usually 3-6 months, as a hypersensitivity response.
Pleural fluid is culture negative (60%), pleural biopsy then needed for diagnosis.
Post-primary: Pleural effusions are rarer but more often culture positive.

48
Q

Ghon lesion (2)

A

Calcified TB granuloma.
sequela of primary TB

49
Q

Ranke complex (2)

A

Calcified TB granuloma & calcified hilar node.
healed primary TB

50
Q

Bulky hilar and paratracheal adenopathy

A

Kids

51
Q

TB patterns in HIV (3)

A

Reactive pattern (cavitations) seen when CD4 >200.
Primary progressive pattern (adenopathy, consolidation, milliary spread) seen when CD4 <200.
TB does NOT usually form lobar pattern in HIV.

52
Q

Non-tuberculous mycobacterium - types (4)

A

Cavitary (“classic”),
Bronchiectatic (“non-classic”, “Lady Windermere”),
HIV,
Hypersensitivity pneumonitis (“Hot tub lung”)

53
Q

Cavitary mycobacterium (3)

A

Usually caused by MAC (Mycobacterium Avium-intracellulare Complex).
Commonly old, white, male with COPD or chronic lung disease.
Looks like reactivation TB (upper lobe cavitating lesion w/adjacent nodules).

54
Q

Bronchiectatic mycobacterium (4)

A

a.k.a. Non-classic or Lady Windermere.
Caused by not coughing.
Favours old, white lady.
Tree-in-bud and cylindric bronchiectasis in the right middle lobe and lingula.

55
Q

HIV mycobacterium (4)

A

Seen with CD4 <100
GI infection disseminated in blood. Hepatosplenomegaly.
Mediastinal lymphadenopathy is commonest manifestation.
Frequently mixed with other chest infections, lungs can look like anything.

56
Q

Hypersensitivity pneumonitis (3)

A

Hot tub lung.
Aerosolised bugs.
Ill defined, ground glass, centrilobular nodules.

57
Q

Aspergillus infections - types (3)

A

Normal immune system.
Immunocompromised.
Hyper-immune.

58
Q

Aspergillus - normal immune system (2)

A

Aspergilloma (fungus ball) formed within an existing cavity.
Cavity can be from trauma, prior infection, etc.

59
Q

Aspergillus - Immune compromised (5)

A

AIDS or transplant patient.
Invasive aspergillosis.
2 appearances:
1) Halo sign - solid nodule/mass surrounded by ground glass (gg is actually the invasive component)
2) Air crescent sign - thin crescent of air within solid mass, which represents healing as the necrotic lung separates from parenchyma. 2-3 weeks after healing.
May also see peripheral, wedge shaped infarcts in setting of some halo signs

60
Q

Aspergillus - hyper immune (3)

A

Asthmatic (long standing) or CF.
ABPA - Allergic Broncho-Pulmonary Aspergillosis.
Upper lobe central saccular bronchiectasis with mucoid impaction (finger in glove)

61
Q

Mucormycosis (2)

A

Seen in immune compromised (AIDS, steroids, bad diabetes).
Invasion of mediastinum, pleura and chest wall.

62
Q

CMV - causes (2)

A

Reactivation of latent virus after prolonged immunosuppression (e.g. 30-90 days post BMT).
Infusion of CMV positive bone marrow or other blood products.

63
Q

CMV - imaging

A

Multiple ground glass or solid nodules.

64
Q

Measles - imaging

A

Multifocal ground glass opacities with small nodular opacities.

65
Q

Measles - trivia

A

Pneumonia can be before or after skin lesions.
Complications higher in pregnant or immunocompromised

65
Q

Influenza - Imaging (2)

A

Coalescent lower lobe opacity.
Pleural effusion is rare.

66
Q

SARS - imaging

A

Ground glass opacities, predominantly lower lobe

67
Q

Varicella - imaging (2)

A

Multiple peripheral nodular opacities.
Forms small round calcific nodules in healed version.

68
Q

Varicella - trivia (2)

A

1 in 6 with skin findings get pneumonia.
Usually kids. Usually immunocompromised (AIDS, lymphoma)

69
Q

Ebstein Barr - imaging (2)

A

Rarely affects lung. Can cause lymph node enlargement.
Most common radiographic abnormality is splenomegaly.

70
Q

Septic emboli (lung) - trivia (5)

A

Lower lobe predominant (more blood flow).
Can infarct - peripheral nodular densities with wedge shaped infarcts.
Can cavitate.
Feeding vessel sign - nodule with big vessel going towards it (also seen with haematogenous mets).
Empyema and pneumothorax are known complications.

71
Q

Causes for lung cavities (6)

A

CAVITY:
Cancer (usually squamous cell)
Autoimmune (Wegeners, Rheumatoid/Caplan syndrome)
Vascular (septic emboli, other emboli)
Infection (TB)
Trauma (Pneumatoceles)
Young (Congenital - CCAMs, Sequestrations)

72
Q

Lemierre Syndome - definition

A

Jugular vein thrombosis with septic emboli.

73
Q

Lemierre syndrome - cause (2)

A

Seen after oropharyngeal infection or recent ENT surgery.
Causative organism is commonly Fusobacterium Necrophorum.

FRCR 2A (Crack The FRCR 2A) (56 decks)

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