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Yr 5 Respiratory > Infection > Flashcards

Infection Flashcards

(46 cards)

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1
Q

How is HAP defined?

A

> 48hours since admission

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2
Q

What are the bacterial causes of pneumonia?

A 
Streptococcal- COMMONEST
Moraxella
HiB
Mycoplasma
Legionella
Klebsiella
Chlamydia pneumonia/psittaci
TB
Pneumocystis jiroveci (HIV)
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3
Q

What viruses can cause pneumonia?

A

Influenza
Measles
VZV

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4
Q

What fungi can cause pneumonia?

A

Aspergillus

Candida

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5
Q

What are the commonest causes of HAP?

A

Staph Aureus

Gram -ve

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6
Q

What are the typical features of pneumonia?

A 
Pleuritic chest pain
Productive cough
Dyspnoea
Fever + rigors
I/L Dull percussion
Bronchial breathing
Coarse crepitations
↑Tactile fremitus I/L
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7
Q

How is pneumonia investigated?

A 
Bloods: FBC, Blood cultures, U&E, CRP
ABG if sats <92%
Sputum MC&amp;S
CXR: Consolidation 
Serology/PCR: Mycoplasma + Chlamydia
Urine Ag: Legionella
CURB65
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8
Q

What does CURB65 stand for? What do the scores correlate to?

A 
Assesses severity &amp; determines management:
C: Confusion- AMTS <8/10
U: Urea- <7
R: RR >20
B: sBP <90
65: >65yo

0-1 = Mild (manage at home)
2 = Moderate (admit)
>3 = Severe (ITUw/ IV Abx)
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9
Q

In pneumonia what does the colour of the sputum correlate to?

A

Rusty colour = Strep
Green/yellow
Black = Pneumoconiosis

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10
Q

How is pneumonia caused by Aspergillus treated?

A

Aflatoxin

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11
Q

How is a mild pneumonia treated?

A

Amoxicillin 500mg TDS for 5 days

Pen allergic: Clarithro/Doxy

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12
Q

How is a moderate or severe pneumonia treated?

A

Amoxicillin 500mg TDS + Clarithromycin (Macrolide) for 7-10days
CURB >3 = Co-Amoxiclav

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13
Q

How would an atypical pneumonia be treated? Why?

A

Macrolide OR Fluoroquinolones- Both act intracellularly:
<5d since admission: Co-Amox/ Cefuroxime
>5d since admission: Tazocin/ Cefuroxime

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14
Q

When in pneumonia would you consider a change in antibiotic?

A

Failure of ↓CRP in 72hours = Treatment Failure

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15
Q

What are the indications to not discharge a patient following pneumonia?

A

In PAST 24hrs pt has 2 of:

  • Temp >37.5
  • RR >24
  • HR >100
  • sBP <90
  • O2 sats <90% ORA
  • Inability to eat/drink without assistance
  • Abnormal mental status
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16
Q

Is any follow-up required in pneumonia?

A

CXR at 6w

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17
Q

Which groups are at high risk of pneumonia caused by Klebsiella?

A

Alcoholics

Diabetics

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18
Q

Which groups are at high risk of pneumonia caused by pseudomonas?

A

Bronchiectasis
HAP (ITU post-surgery)
CF

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19
Q

What are the signs of pneumonia caused by Legionella?

Study These Flashcards
A 
Flu-like dry cough
SOB
HIGH fever
HAEMATURIA
Diarrhoea &amp; vomiting
Hepatitis
Renal failure
Confusion
Coma
20
Q

What are the complications of pneumonia?

Study These Flashcards
A 
T1RF
Pleural Effusion
Lung abscess
Sepsis/Septicaemia
Empyema
AF
HypoT
21
Q

What is a pleural effusion?

Study These Flashcards
A

Accumulation of fluid in pleural cavity

22
Q

What is an empyema?

Study These Flashcards
A

Pus (pH <7.2) in the pleural cavity

23
Q

What are the 2 types of pleural effusion?

Study These Flashcards
A

Transudative: <25g/L Protein
Exudative: >35g/L Protein

24
Q

What are the causes of a transudative effusion?

Study These Flashcards
A 
↑hydrostatic (force of blood on vessel wall) 
↓Oncotic pressure (↑solute in pleural space) 
HF/CCF
Fluid overload
Constrictive pericarditis
PE
Nephrotic syndrome
Cirrhosis
Malabsorption
25
What are the causes of a exudative effusion?
↑permeability of pleural surface +/- capillaries due to inflammation: Infection – pneumonia, TB Infarction – PE Inflammation – SLE, RA, pancreatitis Malignancy– Lymphoma, mesothelioma, bronchial SCC, Mets – lung & breast
26
If someone had a chylothorax what differentials would you be worried about?
Lymphoma Sarcoidosis Amyloidosis Cirrhosis
27
How is a pleural effusion investigated?
``` CXR Bloods: FBC, LDH & total protein USS guided aspiration LIGHT'S CRITERIA Percutaneous pleural biopsy Bronchoscopy ```
28
What should be commented on/tested when assessing a pleural aspirate?
Appearance: Clear/turbid/purulent/haemorrhagic Odour Protein: >35 = E, <25 = T, 25-35 = Light's criteria Cytology: Neut/Lymph/Mesothelial cells, giant multinucleated cells Glucose: <3.3 = TB, RA, SLE, Malignancy, empyema pH: <7.2 = CHEST DRAIN LDH: Light's criteria Amylase: Raised Immunology: RF, ANA, Complement
29
What is Light's criteria?
Distinguish between transudative & exudative effusion EXUDATIVE if one of: - Pleuritic fluid protein/serum protein = >0.5 -Pleural LDH/Serum LDH = >0.6 -Pleural LDH >2/3rd upper limit of normal of serum LDH
30
How is a pleural effusion managed?
1) Chest drain NEVER drain >1.5L = Pulm Oedema 2) Pleurodesis w/Tetracycline or talc if recurrent effusions
31
What condition needs to be considered in a female w/ a R pleural effusion?
Meig's Syndrome: - Ovarian fibroma - Hypothyroid - Ascites - R pleural effusion
32
How does TB cause a systemic infection?
1o/LATENT: Macrophages in alveoli engulf bacteria + transport to Hilar LN to control spread Some bacteria disseminates via lymphatics/blood to distant sites + small granulomas form around bacterium in body (lungs, kidney, spine, adrenals) 80% cases spont heal or encapsulate (fibrosis + calcification) and lie dormant (ghon focus) 2o/ACTIVE: When malnourished/ immunoS/elderly, Ghon focus reactivates Spreads to lung apex (high O2 area) Memory T-cells release +++ cytokines Caseous necrosis & cavitation TB disseminates via pulmonary venous system = systemic Miliary TB
33
How does primary TB present?
Asymptomatic Fever/pyrexia of unknown origin ↓Weight/anorexia/FTT Malaise/fatigue
34
How does secondary TB present?
``` 60% Pulmonary: Chronic productive cough Purulent/blood-stained sputum Dyspnoea Palpable LN Night sweats + rigors ``` ``` GU- commonest site outside of lungs: Sterile pyuria/haematuria Dysuria Loin pain Infertility (F) Swollen epididymis (M) ```
35
How is primary TB investigated?
1) Mantoux test: Tuberculin skin injection <6mm = -ve 6-15mm = +ve (may be due to past infection) >15mm = +ve (Highly suggestive of TB infection) 2) Interferon-gamma test 3) PCR
36
How is secondary pulmonary TB investigated?
PULMONARY: 1) CXR 2) Sputum sample x3: For MC&S, Ziel-Neelson stain 3) Bronchial lavage sample via bronchoscopy: if no sputum
37
What is seen on a CXR of someone with TB? What do each of these signs tell you?
I/L Hilar lymphadenopathy (Ghon focus) = 1o Apical consolidation = 2o Cavitating lesion = 2o Reticular pattern/milliary lesions = 2o Fibre-Calcification → Tracheal shift toward Miliary lesion
38
How is secondary GU TB investigated?
1) Urine MC&S 2) Early morning urine sample x3 3) Renal USS
39
How does secondary MSK present & how is it investigated?
``` Pain/Arthritis Osteomyelitis Abscess formation: Loin/psoas/spinal Nerve root compression Post disease (Infection of lumbar spine) ``` Ix: MRI/CT spine
40
How does secondary CNS present & how is it investigated?
``` TB meningitis Fever Headache Vomiting Abdo pain Drowsy/delirius Cranial nerve palsy/tremor ``` Ix: LP = Fibrin web, mononuclear cells, ↓G, ↑P CT/MRI head = Signs of ↑ICP
41
How does secondary Skin present?
Erythema Nodosum | Lupus Vulgaris: Face/neck
42
How does secondary Cardiac present & how is it investigated?
Pericardial effusion Constrictive Pericarditis Ix: ECHO
43
How is latent TB managed?
Rifampicin + Isoniazid = 3m OR Isoniazid = 6m
44
How is active TB managed?
``` RIPE Abx for 2m: R: Rifampicin 3/w I: Isoniazid 3/w P: Pyrazinamide 3/w E: Ethambutol 3/w CONTINUATION PHASE: Abx x2 for 4m: Rifampicin + Isoniazid ```
45
What is given in addition to Abx in TB meningitis treated?
Dexamethasone | CONTINUATION PHASE = 1yr
46
What TB prophylaxis can be given?
BCG vaccine: <35yo + at risk | Abx to close contacts: Rifampicin/Isoniazid for 6m or both for 3m

Yr 5 Respiratory (6 decks)

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