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Yr 5 Respiratory > Infection > Flashcards

Infection Flashcards

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?

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?

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

What is a pleural effusion?

A

Accumulation of fluid in pleural cavity

22
Q

What is an empyema?

A

Pus (pH <7.2) in the pleural cavity

23
Q

What are the 2 types of pleural effusion?

A

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

24
Q

What are the causes of a transudative effusion?

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
Q

What are the causes of a exudative effusion?

A

↑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
Q

If someone had a chylothorax what differentials would you be worried about?

A

Lymphoma
Sarcoidosis
Amyloidosis
Cirrhosis

27
Q

How is a pleural effusion investigated?

A 
CXR
Bloods: FBC, LDH &amp; total protein
USS guided aspiration
LIGHT'S CRITERIA
Percutaneous pleural biopsy
Bronchoscopy
28
Q

What should be commented on/tested when assessing a pleural aspirate?

A

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
Q

What is Light’s criteria?

A

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
Q

How is a pleural effusion managed?

A

1) Chest drain
NEVER drain >1.5L = Pulm Oedema
2) Pleurodesis w/Tetracycline or talc if recurrent effusions

31
Q

What condition needs to be considered in a female w/ a R pleural effusion?

A

Meig’s Syndrome:

  • Ovarian fibroma
  • Hypothyroid
  • Ascites
  • R pleural effusion
32
Q

How does TB cause a systemic infection?

A

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
Q

How does primary TB present?

A

Asymptomatic
Fever/pyrexia of unknown origin
↓Weight/anorexia/FTT
Malaise/fatigue

34
Q

How does secondary TB present?

A 
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
Q

How is primary TB investigated?

A

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
Q

How is secondary pulmonary TB investigated?

A

PULMONARY:

1) CXR
2) Sputum sample x3: For MC&S, Ziel-Neelson stain
3) Bronchial lavage sample via bronchoscopy: if no sputum

37
Q

What is seen on a CXR of someone with TB? What do each of these signs tell you?

A

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
Q

How is secondary GU TB investigated?

A

1) Urine MC&S
2) Early morning urine sample x3
3) Renal USS

39
Q

How does secondary MSK present & how is it investigated?

A 
Pain/Arthritis
Osteomyelitis
Abscess formation: Loin/psoas/spinal
Nerve root compression
Post disease (Infection of lumbar spine)

Ix: MRI/CT spine

40
Q

How does secondary CNS present & how is it investigated?

A 
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
Q

How does secondary Skin present?

A

Erythema Nodosum

Lupus Vulgaris: Face/neck

42
Q

How does secondary Cardiac present & how is it investigated?

A

Pericardial effusion
Constrictive Pericarditis
Ix: ECHO

43
Q

How is latent TB managed?

A

Rifampicin + Isoniazid = 3m
OR
Isoniazid = 6m

44
Q

How is active TB managed?

A 
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
Q

What is given in addition to Abx in TB meningitis treated?

A

Dexamethasone

CONTINUATION PHASE = 1yr

46
Q

What TB prophylaxis can be given?

A

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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