Infections of the Respiratory System Flashcards

1
Q

What is the definition of community acquired pneumonia?

A

Lung infection with inflammation and associated consolidation or infiltrates acquired in the community or within 48 hours of hospital admissions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the most common causative organisms of community acquired pneumonia?

A

Streptococcus Pneumoniae
Haemophilus influenzae,
Staph aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the most common cause of community acquired pneumonia and what are the classical symptoms you would associate with it?

A

S. Pneumoniae

Rust coloured sputum, acute onset, high temperature and classical lobular pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What IS Hx associated with Haemophilus influenzae?

A

Hx of COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the typical presentation and Hx with Legionella infections?

A

Hx of recent travel
Hyponatraemia and deranged LFTS
Neurological symptoms
Younger patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the typical presentation and Hx associated with Mycoplasma infection?

A

Extrapulmonary features - Haemoloysis, Skin and joint involvement, erythema multiforme
Younger patient
Dry cough - often referred to as the walking pneumonia
Patchy or diffuse X ray NOT LOBAR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is unique about blood results in a mycoplasma infection?

A

No raise in Neutrophils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What causative organism is associated with pneumonia in immunocomprimised patients?

A

pneumocystis jiroveci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which causative organism is associated with pneumonia in patients who have a hx of bird contact and what are typical features of presentation?

A

Chlamydophila psittaci

Photophobia, long duration, headache and cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are risk factors for the development of community acquired pneumonia?

A

SMOKING
Immunocomprimise
Aspiration
Alcoholism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which causative organism is associated with patients with a Hx of alcoholism and diabetes - what is typical sign?

A

Klebsiella

Red current sputum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the scoring system used for pneumonia, what are the figures and how is it interpreted?

A

CURB 65
Confusion, Urea >7, RR >30, BP <90/60 and age >65
Score >1 consider referral
Score of 3 or more associated with high mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are investigations carried out and when are they indicated?

A

Bloods indicated in hospital only
Blood cultures all patients with moderate to severe CAP
Sputum - if producing high volumes of purulent sputum
CXR - all patients admitted to hospital
U&E and LFTs (atypical pneumonia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When would you consider urine test for community acquired pneumonia and what are you looking for?

A

All patients with severe and moderate CAP

Streptococcal urine antigen and legionella antigen (severe only)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is empirical antibiotic for non severe community acquired pneumonia?

A

Oral Amoxicillin for 7 days

+ Doxy for atypical cover

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is empirical antibiotic for severe community acquired pneumonia?

A

Pipilleracilin + Tazobactam = Tazocin IV

WITH c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the Abx of choice for a confirmed S pneumoniae infection?

18
Q

What is the Abx of choice for a confirmed Staph aureus (methicillin sensitive) infection?

A

IV fluclox

19
Q

What is the Abx of choice for a confirmed legionella infection?

A

Clarithromycin + Rifampicin

20
Q

What is the Abx of choice for a confirmed PCP infection?

A

Co- Trimoxazole IV

21
Q

What are the most common causative organisms for HAP?

A

Staph aureus
Pseudomonas
E coli

22
Q

What is the management of non-severe community acquired pneumonia?

A

Amox + doxy

23
Q

What is the management of non-severe aspiration pneumonia?

A

Amoxicillin + metronidazole

24
Q

What is the management of severe HAP or Aspiration pneumonia?

A

IV tazocin with

+ clarithromycin if legionella suspected

25
What are risk factors for the development of a lung abscess?
DM CF Chronic alcoholism COPD
26
What is the presentation of a lung abscess?
``` Insidious onset Swinging fevers Productive purulent cough +/- haemoptysis Night sweat SOB ```
27
What are Ix of choice for lung abscess?
Blood and sputum cultures | CXR and CT if needed
28
What is the management of lung abscess?
Antibiotics - long course 2 weeks IV and 2-6 weeks oral Co-amox or clindamycin + metronidazole
29
What is the definition of TB?
Granulomatous disease caused by M. turberculosis
30
What is the pathophysiology of TB?
Respiratory droplet transmission Myobacteria engulfed and replicate within the alveolar macrophage . Released Mycolic acid prevents degradation of the resulting in granuloma formation to prevent further spread
31
What is the presentation of pulmonary TB?
Productive cough +/- haemoptysis Fever Malaise Weight loss
32
What are extra-pulmonary presentations of TB?
``` Clubbing Erythema nodosum Meningitis Arthritis Potts Spine ```
33
What are the imaging techniques that should be used to identify TB?
CXR - effecting apical and upper lobes predominantly
34
What samples are collected and what is done with them in the diagnosis of TB?
At least 3 sputum samples with one being an early morning Ziehl-Neelson stain to identify acid fast baccili Cultures are done but take 4-8 weeks to grow
35
What blood tests should be done in TB and why?
FBC | LFT and U&E lots of the anti-TB drugs are hepato and nephro toxic
36
What test would be done if a patient presented with no active TB?
Mantoux test to identify latent TB
37
What is the management on TB?
1st Rifampicin. Isoniazid, Pyrazinamide and ethambutanol for 2 months FURTHER 4 months of Rifampicin and isoniazid
38
What are the side effects of Rifampicin?
Red- orange secretions | Heptatitis
39
What are the side effects of Ethambutanol?
Optic neuritis | Renal impairment
40
What are the side effects of Isonized?
Peripheral neuropathy Hepatitis Agranulocytosis
41
What are the side effects of pyrazinamide?
High uric acid leading to gout Myalgia Hepatitis
42
What is the antibiotic class of choice for patients with
Carbapenems