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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
How long should antibiotic treatment for severe aspiration pneumonia be continued for?
7 days
26
What is the first line empirical antibiotic regimen for patients with severe aspiration pneumonia?
IV amoxicillin, metronidazole and gentamicin
27
If the treatment for severe aspiration pneumonia cannot be tolerated because of a penicillin allergy, which other antibiotics can be used instead of amoxicillin?
IV clarithromycin or PO doxycycline
28
In which URTI is a toxin responsible for forming a pharyngeal pseudo-membrane?
Diphtheria
29
How does acute bronchitis present? The presence of what feature would suggest bacterial infection?
A cough, often preceded by coryzal symptoms; the presence of purulent sputum production
30
How long does the cough associated with pertussis usually last for?
12 weeks
31
Which antibiotic is required to treat acute epiglottitis?
IV ceftriaxone
32
Which antibiotic is used to treat pertussis if the cough has lasted < 21 days?
Clarithromycin
33
What are some potential complications of pharyngitis caused by group A strep?
Rheumatic fever and glomerulonephritis
34
The risk of developing CAP is highest in which two population groups?
Children aged < 5 and those aged 65+
35
Name some risk factors for the development of CAP?
Smoking, alcohol abuse, medical co-morbidities and immunosuppression
36
What are the complications of CAP that can arise when bacteria spreads from the lungs to the a) blood and b) pleura?
a) sepsis b) empyema
37
What happens to the percussion note in someone with pneumonia?
Dull
38
What are some sounds which may be heard on auscultation of someone with pneumonia?
Coarse crepitations, bronchial breathing, pleural rub
39
Urine antigen testing can be used for the rapid identification of which potentially causative organisms of CAP?
Strep pneumoniae and Legionella pneumophila
40
Patients with pneumonia and features suggestive of a pleural effusion should undergo which further investigation?
Pleural US + aspirate
41
CXR changes of consolidation may be obscured in those with chronic lung disease. When should you suspect pneumonia?
New fever, raised inflammatory markers, unexplained drop in O2 saturations
42
Name the four main treatment aspects for CAP?
Antibiotics, oxygen, IV fluids and pain relief
43
Empirical antibiotic treatment for CAP is based on what?
CURB-65 score
44
Describe what is meant by hospital acquired pneumonia?
Pneumonia which is acquired in hospital or within one week of discharge
45
What are the predominant causative organisms of HAP and VAP?
Staph aureus and gram negative pathogens
46
What are some non-specific ways in which VAP might present?
New pyrexia and/or increasing oxygen requirement
47
What is the first line antibiotic treatment for non-severe HAP?
Amoxicillin PO
48
What is the second line antibiotic treatment for non-severe HAP?
Doxycycline PO
49
How long should antibiotic treatment for non-severe HAP be continued for?
5 days
50
What is the first line antibiotic treatment for severe HAP?
Amoxicillin and gentamicin IV
51
What is the second line antibiotic treatment for severe HAP?
Co-trimoxazole and gentamicin IV
52
How long should antibiotic treatment for severe HAP be continued for?
7 days
53
What is the stepdown empirical antibiotic treatment for severe HAP?
Co-trimoxazole PO
54
What is the treatment for pneumocystis pneumonia?
Co-trimoxazole
55
What are some infective complications of HIV in those with a CD4 count of a) > 200/ml and b) < 200/ml?
a) TB and CAP (usual organisms) b) CAP (caused by organisms only seen in the immunosuppressed)
56
Describe what is meant by a subacute lung infection?
A pneumonia with a longer history (weeks-months) and more focal CXR changes
57
What is the most common cause of a subacute lung infection?
TB
58
Lung abscesses are associated with the production of large quantities of what?
Foul smelling, purulent sputum
59
CXR/CT of a lung abscess will show what?
Cavitation and an air-fluid level
60
Describe the management of subacute lung infections and abscesses?
Prolonged antibiotic therapy for 3-6 weeks +/- drainage for an abscess
61
What investigation is used to confirm the diagnosis of pneumonia? What may it show?
CXR- consolidation +/- pleural effusion
62
Which blood test is most useful for monitoring response to treatment of CAP?
CRP
63
Which microbiological investigations are most useful in patients with suspected CAP?
Sputum and blood cultures
64
What investigation is most useful for identifying viral causes of CAP?
Nasopharyngeal aspirate
65
Which investigation should be done to assess O2 requirements in those with suspected CAP?
ABG
66
If the patient agrees, those with suspected CAP should be tested for which disease?
HIV
67
Which organism causing CAP may also cause lymphopenia, deranged LFTs and haematuria?
Legionella pneumophila
68
Most cases of CAP present as what broad type of pneumonia?
Lobar
69
Bronchopneumonia causes widespread, small patches of consolidation in both lungs- which organism is most likely to cause this?
Staph aureus
70
Interstitial pneumonia causes subtle bilateral interstitial infiltrates on CXR- what organism usually causes this?
Mycoplasma/chlamydophila pneumoniae
71
Aspiration pneumonia typically occurs when? What organism usually causes this?
When a patient's conscious level is reduced- a mix of organisms, including anaerobes
72
If a patient with bronchitis requires antibiotic treatment, what is the first and second line option? How long should they be treated for?
First line is amoxicillin PO and second line is doxycycline PO, both are given for 5 days
73
Which cause of CAP is associated with fever, pleurisy and herpes labialis, and CXR shows lobar consolidation?
Strep pneumoniae
74
Which cause of CAP typically causes a bilateral cavitating bronchopneumonia?
Staph aureus
75
Which organism that can cause CAP is a common pathogen in bronchiectasis and CF?
Pseudomonas aeruginosa
76
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?
Mycoplasma pneumoniae
77
Most URTIs and bronchitis are self-limiting within how long?
10 days
78
Which organism is most commonly responsible for causing bronchiolitis in childhood?
RSV
79
Aside from respiratory viruses, which organisms may cause bronchiolitis in adults?
Mycoplasma/chlamydophila pneumoniae
80
Describe the treatment of bronchiolitis?
Supportive treatment only
81
RSV infection in infancy predisposes children to the development of what condition later in life?
Asthma
82
Describe the 5 areas of the CURB65 scoring system?
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
What are the first and second line antibiotic options for the treatment of mild-moderate CAP? How long should treatment be continued for?
First line is PO/IV amoxicillin, second line is doxycycline PO- treatment should be continued for 5 days
84
Most patients with CAP improve within how long of being on antibiotic therapy?
72 hours
85
What is the first line antibiotic therapy for severe CAP (CURB64 3-5), providing the patient is not penicillin allergic?
Co-amoxiclav IV and doxycycline PO
86
How long should antibiotic therapy for severe CAP be continued for?
7 days
87
Which organism that causes pneumonia in the immunosuppressed is most likely to cause bilateral hilar interstitial shadowing on a CXR?
Pneumocystis jirovecii
88
Name two fungal organisms that are known for causing pneumonia in the immunosuppressed?
Pneumocystis jirovecii and Aspergillus
89
Describe the typical presentation of pneumocystis pneumonia?
Dry cough, progressive dyspnoea and desaturation on exercise
90
Other than the typical respiratory viruses, what is another virus which is known for causing pneumonia in the immunosuppressed?
CMV

Med Spec (Infectious Diseases) (4 decks)

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