LRTI 2

Question 1

healthcare associated pneumonia

Answer 1

caused by infectious agents not present or incubating at the time of admission
multi drug resistant

Question 2

examples of healthcare associated pneumonia

Answer 2

ESBLs
acinetobacter
pseudomonas aeruginosa
MRSA

Question 3

ESBL

Answer 3

extended spectrum beta lactamases

destroy beta lactatese antibiotics

Question 4

HCAP symptoms

Answer 4

as per CAP
patient may be unconscious or unable to describe symptoms
new onset fevers and chest x ray infiltrates
may be aspiration pneumonia
particularly affects upper lobes

Question 5

VAP

Answer 5

ventilation associated pneumonia
common complication of mechanical ventilation
10% of patients on ICU
most risk during first 5 days

Question 6

3 main factors of VAP

Answer 6

oropharynx colonisation - replaced by pathogens
aspiration - endotracheal tube bypasses mechanisms preventing aspiration
compromised defences - trauma

Question 7

HAP/VAP diagnosis

Answer 7

sputum collection is difficult
must avoid contamination
via endotracheal tube - use quantitative culture
- in special circumstances use invasive techniques - BAL, open lung biopsy

Question 8

HAP/VAP treatment

Answer 8

antibiotic selection pressure lease to MDR bacteria as a cause for HCAP
high risk - IV pipericillin - Tazocin

Question 9

chronic pneumonia caused by

Answer 9

caused by mycobacterium tuberculosis 
nocardia species 
fungi 
- pneumocystis jiroveci 
crytococcus neoformans 
aspergillus

Question 10

TB

Answer 10

1 in 3 infected world wide

Question 11

MAC pneumonia

Answer 11

mycobacterium avian and M intracellular complex
environmental, soil and water
chronic pneumonia in patients with pre existing lung disease
also elderly women with no previous lung disease

Question 12

pleurisy and empyema

Answer 12

pleural cavity 
a relative vacuum in the space 
keeps the visceral and parietal pleura in close proximity 
surface tension helps expansion 
small volume of pleural fluid 
a lubricant to facilitate movement

Question 13

pleurisy

Answer 13

inflammation of the pleura
cause fever and pleuritic chest pain
may be bacterial or viral or TB

Question 14

pleural effusion

Answer 14

abnormal collection of fluid in the pleural space
excess fluid production of decreased absorption or both
common manifestation of pleural disease

Question 15

transudates

Answer 15

result from an imbalance in oncocitic and hydrostatic pressures - cardiac failure, cirrhosis, hypoalbuminaemia

Question 16

exudates

Answer 16

the result of inflammation of the pleura and/or decreased lymphatic drainage - infection, cancer, inflammatory, PE

Question 17

parapneumonic pleural effusions - uncomplicated

Answer 17

exudative, neutrophilic
no organisms
increasing passage of interstitial fluid as a result of inflammation associated with pneumonia

Question 18

parapneumonic pleural effusions - complicated

Answer 18

bacterial invasion into pleural space
increased number of neutrophils, decreased glucose levels, pleural fluid. acidosis, and an elevated lactic dehydrogenase concentration
bacteria may be seen and cultured

Question 19

empyema

Answer 19

frank pus in the pleural space 
preexisting pleural fluid is required for the development 
bacterial invasion 
thick, vicious and opaque 
need draining using. a chest tube

Question 20

bronchiectasis

Answer 20

abnormal and permanent dilatation of the bronchi
can be localised of diffuse
inability to clear secretions
a consequence of inflammation dn destruction of the bronchial architecture

Question 21

causes of bronchiectasis

Answer 21

infection, autoimmune disease, cystic fibrosis

Question 22

bronchiectasis sequelae

Answer 22

colonised with pseudomonas and heamophilus influenzas 
release protease and toxins 
host immune response triggered 
further damage, mucus plugging 
chronic cough, haemoptysis 
acute exacerbations

Question 23

lung abscesses

Answer 23

most often follows aspiration
also complication of pneumonia or blood stream infection
particularly nectrotising infection
pus filled cavities
high bacterial burden, inadequate clearance, anaerobes most common, gram negatives

Question 24

tropical pneumonia

Answer 24

burkhoderia pseudomallei 
acute septicaemia and pneumonia 
associated with wet season 
predisposed hosts - diabetes, alcoholism 
endemic in NT, northern Queensland

Question 25

melioidosis

Answer 25

contact with soil and water
percutaneous inoculation, ingestion or inhalation
incubation period is 9 days

Question 26

melioidosis diagnosis

Answer 26

culture of clinical sample
PCR
serology

Question 27

treatment of melioidosis

Answer 27

meropenam

3-6 months of oral cotrimoxazole

Question 28

HIV

Answer 28

when CD4< 200 see opportunistic infections
commonest is pneumocystis pneumonia
- pneumocystis jivovecii
fungus
prevented using praphylactic antibtiotics

Question 29

cancer and transplant patients

Answer 29

immunocompromisedd and immunosuppressed

more at risk of infections

Question 30

aspergillus

Answer 30

ubiquitous spore forming moulds
main human pathogen is aspergillum fumigatus
asexual reproduction occurs via the production of conidia

Question 31

aspergillus causes

Answer 31

allergic bronchopulmonary aspergillosis - an allergic or hypersensitivity response to aspergillosis spores
aspergilloma - a fungal ball which grows inside a pre existing lung cavity
invasive aspergillosis - fatal without treatment, spreads via invasion of blood vessels and spread to other organs e.g. brain, liver, spleen

Question 32

cystic fibrosis

Answer 32

autosomal recessive genetic disorder - abnormal transport of chloride and sodium cross epithelium
lungs, pancreas, liver, intestine
thick viscous secretions
inflammation and bacterial infections destroy lung architecture