Aani Micro: Resp/TB Flashcards
Which is a common Co-pathology if you have TB?
HIV
What gram stain is TB?
Gram Positive Rods
What should you do if you find someone with TB?
- Notify
- Negative Pressure isolation
- BCG (live attenuated M.Bovis)
What are the 3 main strains of TB Mycobacterium?
BAT
Bovis
Africanum
Tuberculosis
How long does fever last in TB?
approx 3 months
Which strain of MTB is resistant to Pyrazinamide?
M. Bovis
What are the drugs used to treat TB?
RIPE Rifampicin Isoniazid Pyrazinamide Ethambutol
Side Effects of:
Ethambutol?
Optic neuritis + Visual disturbances (do ishihara test)
Side Effects of:
Rifampicin?
Orange secretions
Cytochrome P450 inducer
Hepatotoxicity
Side Effects of:
Isoniazid
Hepatotoxicity
Peripheral Neuropathy - give B6/Pyridoxine
Side Effects of:
Pyrazinamide
Gout
Hepatotoxicity
What is the classical pulmonary lesion in TB?
Caseating granulomas
Are the atypical mycobacteria strands fast or slow growing?
Slow growing (and not spread person to person)
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).
What is the RIPE treatment regime for TB?
RIPE for 2 months then I+R for 4 months
RI - 6mth
PE - 2 mth
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
How to treat latent TB?
Isoniazid 6 months
What is the second line treatment for TB?
Injectables: fluroquinolines
other injectables:
(capreomycin, kanamycin, amikacin), Quinolones (moxifloxacin), Cycloserine, Ethionamide/Protionamide, PAS, Linelozid, Clofazamine Resistances)
What is the name of the pleural surface lesion caused by TB?
Ghon Focus
Which TB is resistant to just 1 drug?
Mono
Resistant to R+ I
MDRTB
Resistant to R + I and injectables?
XMDRTB
Prophylaxis against TB ?
isoniazid alone
Where is the cavitation on the lung?
Upper lobe
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
