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Med Spec (Infectious Diseases) > Lung Infections > Flashcards

Lung Infections Flashcards

1
Q

Which organism is responsible for annal winter epidemics of flu?

A

Influenza A

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2
Q

Which organism is the predominant bacterial cause of CAP?

A

Strep pneumoniae

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3
Q

Which organism can rarely cause a life-threatening acute epiglottitis?

A

Haemophilus influenzae type B

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4
Q

Which organism causes a rare type of CAP, caught from birds?

A

Chlamydia psittaci

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5
Q

Which organism is an uncommon cause of upper lobe CAP, especially in patients with a history of alcohol abuse?

A

Klebsiella pneumoniae

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6
Q

What are the three most predominant respiratory pathogens, casing the vast majority of deaths from respiratory infection worldwide?

A

Influenza A, strep pneumoniae and mycoplasma tuberculosis

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7
Q

Which two organisms are the major causes of acute or chronic bronchial infection in patients with COPD or bronchiectasis?

A

Haemophilus influenzae and moraxella catarrhalis

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8
Q

What organism is the most common cause of hospital acquired respiratory infections?

A

Staph aureus

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9
Q

Which respiratory pathogen is commonly found in sources of water such as air conditioning units?

A

Legionella pneumophila

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10
Q

Which type of organisms are associated with the production of a foul-smelling pus?

A

Anaerobic bacteria

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11
Q

Which type of bacteria are Legionella, Klebsiella and Pseudomonas?

A

Gram negative bacilli

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12
Q

Which organism is responsible for causes PCP, a pneumonia seen in immunocompromised individuals? Which broad category of organisms does this belong to?

A

Pneumocystis jirovecii- a fungus

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13
Q

What are some indications for treating acute COPD exacerbations with antibiotics?

A

New changes on CXR, increased purulence of sputum, suspicion of pneumonia

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14
Q

What are the two types of URTI which can cause life-threatening upper airway obstruction?

A

Diphtheria and epiglottitis

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15
Q

Which organism causes diphtheria?

A

Corynebacterium diphtheriae

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16
Q

Which organism causes whooping cough?

A

Bordetella pertussis

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17
Q

What is the empirical antibiotic therapy for a patient with severe CAP who is penicillin allergic?

A

Levofloxacin IV

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18
Q

What is the stepdown antibiotic therapy for all patients with severe CAP?

A

Doxycycline PO

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19
Q

If a patient with severe CAP is NBM, the doxycycline in the standard empirical antibiotic regime gets changed to what?

A

Clarithromycin IV

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20
Q

If you give clarithromycin as a treatment for CAP, you must remember to stop which other drugs?

A

Statins and any other drugs which prolong the QT interval

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21
Q

If consolidation hasn’t resolved after 6 weeks, patients should undergo which investigation to exclude what?

A

Bronchoscopy to exclude bronchial obstruction caused by lung cancer

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22
Q

What is the first line empirical antibiotic regimen for non-severe aspiration pneumonia?

A

Amoxicillin and metronidazole PO

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23
Q

What is the second line empirical antibiotic regimen for non-severe aspiration pneumonia?

A

Doxycycline and metronidazole PO

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24
Q

How long should antibiotics be given for for non-severe aspiration pneumonia?

A

5 days

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25
Q

How long should antibiotic treatment for severe aspiration pneumonia be continued for?

A

7 days

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26
Q

What is the first line empirical antibiotic regimen for patients with severe aspiration pneumonia?

A

IV amoxicillin, metronidazole and gentamicin

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27
Q

If the treatment for severe aspiration pneumonia cannot be tolerated because of a penicillin allergy, which other antibiotics can be used instead of amoxicillin?

A

IV clarithromycin or PO doxycycline

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28
Q

In which URTI is a toxin responsible for forming a pharyngeal pseudo-membrane?

A

Diphtheria

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29
Q

How does acute bronchitis present? The presence of what feature would suggest bacterial infection?

A

A cough, often preceded by coryzal symptoms; the presence of purulent sputum production

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30
Q

How long does the cough associated with pertussis usually last for?

A

12 weeks

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31
Q

Which antibiotic is required to treat acute epiglottitis?

A

IV ceftriaxone

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32
Q

Which antibiotic is used to treat pertussis if the cough has lasted < 21 days?

A

Clarithromycin

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33
Q

What are some potential complications of pharyngitis caused by group A strep?

A

Rheumatic fever and glomerulonephritis

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34
Q

The risk of developing CAP is highest in which two population groups?

A

Children aged < 5 and those aged 65+

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35
Q

Name some risk factors for the development of CAP?

A

Smoking, alcohol abuse, medical co-morbidities and immunosuppression

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36
Q

What are the complications of CAP that can arise when bacteria spreads from the lungs to the a) blood and b) pleura?

A

a) sepsis b) empyema

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37
Q

What happens to the percussion note in someone with pneumonia?

A

Dull

38
Q

What are some sounds which may be heard on auscultation of someone with pneumonia?

A

Coarse crepitations, bronchial breathing, pleural rub

39
Q

Urine antigen testing can be used for the rapid identification of which potentially causative organisms of CAP?

A

Strep pneumoniae and Legionella pneumophila

40
Q

Patients with pneumonia and features suggestive of a pleural effusion should undergo which further investigation?

A

Pleural US + aspirate

41
Q

CXR changes of consolidation may be obscured in those with chronic lung disease. When should you suspect pneumonia?

A

New fever, raised inflammatory markers, unexplained drop in O2 saturations

42
Q

Name the four main treatment aspects for CAP?

A

Antibiotics, oxygen, IV fluids and pain relief

43
Q

Empirical antibiotic treatment for CAP is based on what?

A

CURB-65 score

44
Q

Describe what is meant by hospital acquired pneumonia?

A

Pneumonia which is acquired in hospital or within one week of discharge

45
Q

What are the predominant causative organisms of HAP and VAP?

A

Staph aureus and gram negative pathogens

46
Q

What are some non-specific ways in which VAP might present?

A

New pyrexia and/or increasing oxygen requirement

47
Q

What is the first line antibiotic treatment for non-severe HAP?

A

Amoxicillin PO

48
Q

What is the second line antibiotic treatment for non-severe HAP?

A

Doxycycline PO

49
Q

How long should antibiotic treatment for non-severe HAP be continued for?

A

5 days

50
Q

What is the first line antibiotic treatment for severe HAP?

A

Amoxicillin and gentamicin IV

51
Q

What is the second line antibiotic treatment for severe HAP?

A

Co-trimoxazole and gentamicin IV

52
Q

How long should antibiotic treatment for severe HAP be continued for?

A

7 days

53
Q

What is the stepdown empirical antibiotic treatment for severe HAP?

A

Co-trimoxazole PO

54
Q

What is the treatment for pneumocystis pneumonia?

A

Co-trimoxazole

55
Q

What are some infective complications of HIV in those with a CD4 count of a) > 200/ml and b) < 200/ml?

A

a) TB and CAP (usual organisms) b) CAP (caused by organisms only seen in the immunosuppressed)

56
Q

Describe what is meant by a subacute lung infection?

A

A pneumonia with a longer history (weeks-months) and more focal CXR changes

57
Q

What is the most common cause of a subacute lung infection?

A

TB

58
Q

Lung abscesses are associated with the production of large quantities of what?

A

Foul smelling, purulent sputum

59
Q

CXR/CT of a lung abscess will show what?

A

Cavitation and an air-fluid level

60
Q

Describe the management of subacute lung infections and abscesses?

A

Prolonged antibiotic therapy for 3-6 weeks +/- drainage for an abscess

61
Q

What investigation is used to confirm the diagnosis of pneumonia? What may it show?

A

CXR- consolidation +/- pleural effusion

62
Q

Which blood test is most useful for monitoring response to treatment of CAP?

A

CRP

63
Q

Which microbiological investigations are most useful in patients with suspected CAP?

A

Sputum and blood cultures

64
Q

What investigation is most useful for identifying viral causes of CAP?

A

Nasopharyngeal aspirate

65
Q

Which investigation should be done to assess O2 requirements in those with suspected CAP?

A

ABG

66
Q

If the patient agrees, those with suspected CAP should be tested for which disease?

A

HIV

67
Q

Which organism causing CAP may also cause lymphopenia, deranged LFTs and haematuria?

A

Legionella pneumophila

68
Q

Most cases of CAP present as what broad type of pneumonia?

A

Lobar

69
Q

Bronchopneumonia causes widespread, small patches of consolidation in both lungs- which organism is most likely to cause this?

A

Staph aureus

70
Q

Interstitial pneumonia causes subtle bilateral interstitial infiltrates on CXR- what organism usually causes this?

A

Mycoplasma/chlamydophila pneumoniae

71
Q

Aspiration pneumonia typically occurs when? What organism usually causes this?

A

When a patient’s conscious level is reduced- a mix of organisms, including anaerobes

72
Q

If a patient with bronchitis requires antibiotic treatment, what is the first and second line option? How long should they be treated for?

A

First line is amoxicillin PO and second line is doxycycline PO, both are given for 5 days

73
Q

Which cause of CAP is associated with fever, pleurisy and herpes labialis, and CXR shows lobar consolidation?

A

Strep pneumoniae

74
Q

Which cause of CAP typically causes a bilateral cavitating bronchopneumonia?

A

Staph aureus

75
Q

Which organism that can cause CAP is a common pathogen in bronchiectasis and CF?

A

Pseudomonas aeruginosa

76
Q

Which organism that is a cause of CAP occurs in epidemics every 4 years, and presents insidiously with flu-like symptoms followed by a dry cough?

A

Mycoplasma pneumoniae

77
Q

Most URTIs and bronchitis are self-limiting within how long?

A

10 days

78
Q

Which organism is most commonly responsible for causing bronchiolitis in childhood?

A

RSV

79
Q

Aside from respiratory viruses, which organisms may cause bronchiolitis in adults?

A

Mycoplasma/chlamydophila pneumoniae

80
Q

Describe the treatment of bronchiolitis?

A

Supportive treatment only

81
Q

RSV infection in infancy predisposes children to the development of what condition later in life?

A

Asthma

82
Q

Describe the 5 areas of the CURB65 scoring system?

A

Confusion (abbreviated mental test score 8/10 or less), urea > 7mmol/L, respiratory rate > 30, BP < 90 systolic and/or < 60 diastolic, aged 65+

83
Q

What are the first and second line antibiotic options for the treatment of mild-moderate CAP? How long should treatment be continued for?

A

First line is PO/IV amoxicillin, second line is doxycycline PO- treatment should be continued for 5 days

84
Q

Most patients with CAP improve within how long of being on antibiotic therapy?

A

72 hours

85
Q

What is the first line antibiotic therapy for severe CAP (CURB64 3-5), providing the patient is not penicillin allergic?

A

Co-amoxiclav IV and doxycycline PO

86
Q

How long should antibiotic therapy for severe CAP be continued for?

A

7 days

87
Q

Which organism that causes pneumonia in the immunosuppressed is most likely to cause bilateral hilar interstitial shadowing on a CXR?

A

Pneumocystis jirovecii

88
Q

Name two fungal organisms that are known for causing pneumonia in the immunosuppressed?

A

Pneumocystis jirovecii and Aspergillus

89
Q

Describe the typical presentation of pneumocystis pneumonia?

A

Dry cough, progressive dyspnoea and desaturation on exercise

90
Q

Other than the typical respiratory viruses, what is another virus which is known for causing pneumonia in the immunosuppressed?

A

CMV

Med Spec (Infectious Diseases) (4 decks)

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