Aani Micro: Resp/TB Flashcards by S Chakka

Which is a common Co-pathology if you have TB?

HIV

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What gram stain is TB?

Gram Positive Rods

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What should you do if you find someone with TB?

Notify
Negative Pressure isolation
BCG (live attenuated M.Bovis)

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What are the 3 main strains of TB Mycobacterium?

BAT
Bovis
Africanum
Tuberculosis

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How long does fever last in TB?

approx 3 months

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Which strain of MTB is resistant to Pyrazinamide?

M. Bovis

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What are the drugs used to treat TB?

RIPE
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

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Side Effects of:

Ethambutol?

Optic neuritis + Visual disturbances (do ishihara test)

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Side Effects of:

Rifampicin?

Orange secretions
Cytochrome P450 inducer
Hepatotoxicity

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Side Effects of:

Isoniazid

Hepatotoxicity

Peripheral Neuropathy - give B6/Pyridoxine

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Side Effects of:

Pyrazinamide

Gout

Hepatotoxicity

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What is the classical pulmonary lesion in TB?

Caseating granulomas

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Are the atypical mycobacteria strands fast or slow growing?

Slow growing (and not spread person to person)

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What is a Ghon Focus?

A primary lesion usually subpleural caused by Mycobacterium bacilli (tuberculosis) developed in the lung of a nonimmune host (usually a child).

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What is the RIPE treatment regime for TB?

RIPE for 2 months then I+R for 4 months

RI - 6mth
PE - 2 mth

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What is the RIPE treatment regime for TB meningitis?

RIPE for 2 months then R+I for 8 months

10 months RI
2 month PE

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How to treat latent TB?

Isoniazid 6 months

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What is the second line treatment for TB?

Injectables: fluroquinolines

other injectables:
(capreomycin, kanamycin, amikacin), Quinolones (moxifloxacin), Cycloserine, Ethionamide/Protionamide, PAS, Linelozid, Clofazamine Resistances)

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What is the name of the pleural surface lesion caused by TB?

Ghon Focus

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Which TB is resistant to just 1 drug?

Mono

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Resistant to R+ I

MDRTB

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Resistant to R + I and injectables?

XMDRTB

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Prophylaxis against TB ?

isoniazid alone

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Where is the cavitation on the lung?

Upper lobe

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What can you give to induce sputum for sputum sampling?

Hypertonic Saline

What are the Atypical Mycobacteria?

UMA - M. Ulcerans - M. Marinarum - M. Avium Intracellular Complex (MAC)

What vaccine is given for TB?

BCG: Bacille Calmette Guerin M.bovis attenuated strain

Which stains are used for TB sputum microscopy?

- Ziehl Neelson and Auramine | - Will show Alcohol Acid Fast Bacilli

Is MTB slow or fast growing?

Slow

How do you diagnose TB meningitis?

CT | Lumbar Puncture

How do you treat TB meningitis?

Anti-Tb meds plus Steroids

Which types of TB is the BCG vaccine good/bad for?

Bad: Pulmonary TB Good: TB meningitis, disseminated TB, TB leprosy

Which gene gives Rifampicin resistance?

RPO gene

If you immune system is really weak, what is the worst presentation of TB you can get?

Milliary (widespread)

What is it called when you have TB in the cervical lymph nodes?

Scrofula (glandular swelling)

What is leprosy called?

hansen's disease

What causes leprosy?

Mycobacterium Leprae or Mycobacterium Lepromatosis

What parts of the body does leprosy affect?

Skin Nerves Limbs Eyes

Management of leprosy?

Rifampicine Dapsone Clofazimine remember wild west scene with rifle, deputy badge and cloth

How does your risk of getting active TB from latent change if you have HIV?

No HIV? Latent will turn to active 5-10% in lifetime | HIV + Latent will turn to active 5-10% in year

How is M.Marinarum spread?

Fish tanks/swimming pools

How is M.Ulcerans spread?

Insects/tropics

How does MAC present in kids?

Pharyngitis/cervical adenitis

How does M.Marinarum present?

Clusters of papules/plaques

How does M.Ulcerans present?

painless nodules that slowly become ulcerations and hideous deformities

Describe some extrapulmonary manifestations of TB?

Pott's disease- TB of bones and joints e.g. spine/hand | Milliary TB- Lots of dots on CT & they're more likely to have TB meningitis

What are the clinical investigation findings of pulmonary TB?

Sputum tests + AAFB on ZH and Auramine Upper lobe changes Mediastinal lymph nodes Caseating granulomas

What are the features of the CURB 65 penumonia screen?

``` Confusion Urea >7mmol/ Resp rate > 30 BP <90 <60 65 (more than 65 years old) ```

How do you interpret the results of a CURB 65 screen?

1 point for each of the 5 areas. 2 points- admit 3+ point - severe

CXR findings of bronchitis?

Normal

Which organisms cause Bronchitis?

H.Influenza Strep. Pneumoniae M.Cataeehalis

Describe how this organism would look under the microscope: MTB

Gram + Rods

Describe how this organism would look under the microscope: Strep Pneumonia

Gram + Diplococci

Describe how this organism would look under the microscope: Staph Aureus

Gram + cocci (grape bunch clusters)

Describe how this organism would look under the microscope: H.Influenza

Gram - Cocco-baccili remember candy shop with the coccobacillus candy machine

Describe how this organism would look under the microscope: M. Catarrhalis

Gram - | Coccus

Describe how this organism would look under the microscope: Klebsiella Pneumonia

Gram - Rods

Which organism gives rusty coloured sputum?

Strep Pneumoniae

Which organism is associated with Post-Influenza infection + cavitation on CXR?

Staph Aureus

Which people groups are at risk of getting Kelbsiella Pneumoniae?

Alcoholics | Elderly

Which organism is associated with Birds?

Chlamydia Psittaci

Which organism causes whooping cough?

Bordatella Pertussis

Which groups are at risk of getting Legionella Pnemuophillia?

Smokers Hotel Pond Water jobs

What is the biochem of someone with Legionella?

Low Sodium

What can you develop if you get infected with legionela?

Hepatitis | Legionairre's disease --> organ failure

If you have Batwing on CXR what organism could be be?

PCP Pneumocistic Jiroveci Penumonia

If you have HIV which Resp tract infections are you most at risk of?

PCP TB Cryptococcus Neoformans

If you have neutropaenia which RTI are you most at risk of?

Fungi (aspergillus spp.)

If you have CF which RTI are you most at risk of?

Pseudomonas Auerginosa | Burkholderia Cepacia

If you have BMT which RTI are you most at risk of?

Aspergilus

If you have Splenectomy which RTI are you most at risk of?

H. Influenza S. Pneumonia N. Meningitidis

If you see boat-shapes on silver stain, which organism is it likely to be?

Pneumocystis Pneumonia

How to treat mild/mod CAP?

Amoxicillin or Macrolide if atypical

How to treat severe CAP?

Co-amoxiclav + Clarithromycin | Cefuroxime if allergic to Pen

Which atypical CAPs do you get?

Chlamydia | Mycloplasma

How to treat atypical CAPs?

Macrolide or Tetracyclin

How to treat MRSA?

Vancomycin

What do cold agglutinins usually suggest?

Mycoplasma

5 causes of typical Pneumonia?

``` Meeran Says Sole Helps Kids M.Catarrhalis Staph Aureus Strep Pneum H Influenza Klebsiella Pneumonia ```

4 causes of Atypical Pneumonia?

My Lungs Can't Cope Chlamydia Pneumoniae Chlamydia Psittaci Legionella Pneumophilia Mycoplasma Pneumonia