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PATHOLOGY > lung pathology > Flashcards

lung pathology Flashcards

1
Q

what anatomy does URTI effect

A

sinus
tonsills

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2
Q

what is included in LRTI

A

bronchitis
pneumonia
empyema
bronchiectasis
lung abscess

ie when infection seeds way into the lungs

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3
Q

why do we get resp infections

A

compromise to resp defences:
* poor swallow - CVA, muscle weakness, alcohol
* abnormal ciliary function - smoking, viral infection, Kartagener’s
* abnormal mucus
* dilated airways - bronchiectasis
* defect in host immunity - HIV, immunosuppression

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4
Q

gram stain of streptococci

A

gram +ve diplococci
on blood culture plates - gren tinge, alpha haemolysis

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5
Q

summarise strep pneumoniae

A

gram +ve strep
30-50% CAP
acute onset
severe pneumonia, fever, rigors, lobar consolidation
penicillin sensitive

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6
Q

what is pneumonia

A

inflammation of the lung alveoli

patients are sick - high mortality and admission
sx
* fever
* cough
* pleuritic chest pain
* shortness of breath

localising signs
abnormal CXR

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7
Q

classification of pneumonia

A

community acquired
hospital-acquired/nosocomial - ventilator associated

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8
Q

underlying factors that contribute to pneumonia

A

pre-existing lung disease
immuno-compromise
geography, seasons, epidemics
travel, exposure to animals

HAP - people that have been in hospital for a while and cant clear lungs

not unusual to get staph aureus post-flu - flu seeds the way for the bacteria

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9
Q

organisms in CAP

A

strep pneumoniae
haemophilus influenzae
morazella catarrhalis
staphylococcus areus
klebsiella pneumonia

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10
Q

why arent the microbes in CAP identified most of the time

A

we’re bad at sending sputum
also need to send urine for legionella and strep pneumoniae

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11
Q

how does age alter the pathogen for CAP

A
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12
Q

what are the typical and atypical microbes for CAP

A

typical:
* S pneumoniae
* Haemophilus influenzae

atypical
* legionella - from fountains and AC in summer
* mycoplasma (epidemics 4-6yrs)
* coxiella burnetii (Q fever) - worldwide, farm animals, hepatitis
* chlamydia psittaci (psittacosis) - exposure to birds, splenomegaly, rash, haemolytic anaemia

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13
Q

sx of CAP

A

SOB
cough +- sputum
fever
rigors
pleuritic chest pain
malaise nausea and vomiting

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14
Q

signs of CAP o/e

A

pyrexia
tachycardia
tahypnoea
cyanosis
dullness to percussion, tactile vocal fremitus
bronchial breathing
crackles

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15
Q

ix for CAP

A

FBC
UE (deranged - think legionella)
CRP
BCs, sputum MC&S
ABGs
CXR
urine antigen - fro strep pneumoniae and legionella

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15
Q

CURB-65 score

A

confusion
urea >7
RR >30
BP <90 <60
>65yrs

score = 2 - admit
score = 2-5 - manage as severe

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16
Q

what is bronchitis

A

inflammation of medium sized airways
smopking
cough, fever, increased sputum, increased SOB

normal CXR

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17
Q

organisms on bronchitis

A

mainly viruses eg RSV in children, flu, covid
S pneumoniae
H influenzae
M catarrhalis

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18
Q

mx of bronchitis

A

bronchodilation
physio

dont need Abx unless also got pneumonia

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19
Q

what is the most likely pathogen?

56yo m
flu like illness
cough
fever
bood stained sputum
pyrexial
not severely unwell

A

Haemophilis influenzae

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20
Q

summarise haemophilus influenze

A

gram -ve coccobacilli
Looks like snot on an agar plate
Blood that has been haemolysed - better surface for them to grow on

more common with pre-existing lung disease
may produce B lactamnase

21
Q

what is the most likely organism?

62yo m
SOB
recent confusion n
]smoker
sats 91%
exam normal
Na 124

A

legionella pneumophilia

22
Q

summarise legionella pneumophilia

A

from inhalation of infected water droplets - aerosol spread
env outbreaks
confusion, abdo pain,. diarrhoea
lymphopenia
hypoNa
can cause multi-organ failure - lung and liver - need ITU
needs special culture = buffered charcoal yeast extract

23
Q

summarise atypical pneumonia

A

organisms:
* mycoplasma
* legionella
* chlamydia
* coxiella

Abx that work on cell wall eg penicillins dont work

need abx that work on protein synth - macrolides (clarithomycin/erythgromycin), tetracyclines (doxycycline)

extrapul features - hepatitis, low Na

20% of CAP

flu like prodrome before fever and pneumonia - legionella can give pontiac fever

24
how is legionella diagnosed
antigen in serum or urine *ask lab which serotypes that detect - because some serotypes more common in other countries and might not be detected*
25
mx of legionella
macrolides
26
summarise coxiella burnetii
common in domestic or farm animals transmission - aerosol or milk dx - serology mx - macrolides
27
summarise chlamydia psittaci
transmission - from birds by inhalation dx - serology mx - macrolides
28
started on abx - didnt work ?likely dx?
empyema
29
differentials to think of when pneumonia is not improving with abx
empyema/abscess prox obstruction eg tumour resistant org inc TB not recieving/absorpbng abx immunosuppression other dx - cancer, cryptogenic organising pneumonia
30
CXR for covid
Patchy consolidation Speckled infiltration Ground glass
31
CT for covid
now have antivirals - wont see this bad
32
what is teh organism
TB
33
summarise TB
clues: ethnicity, prolongedprodrome, fever, wht loss, haemoptysis, night sweats can have - discitis, osteomyelitis, diarrhoea CXR - upper lobe (but can vary)
34
ix for TB
35
what is HAP
after >48hrs in hospital often prev abx use +- ventilator ?have abnormal CXR/lung functon bronchial lavage desirable to differentiate upper from lower resp flora
36
microbes that cause HAP
37
likely organism
pneumocystis jirovecii
38
summarise pneumocystis jirovecii
protazoan ubiquitous in environment insidious onset dry cough sob wht loss malaise CXR - bat's wing, Bilateral infiltrative change dx - immunoflurescence on BAL, or PCR Rx - septrin (co-trimoxazole) prophylaxis - septrin Can see in many patients, not just HIV, because we give lots of people immunosuppression Walk test: Get them to stand up - do sats When walk to next room - they desaturate
39
what is the likely organism
aspergillus fumigatus
40
summarise aspergillus fumigatus
allergic bronchopulmonary aspergillosis * chronic wheeze * eosinophilia * bronchiectasis aspergilloma * fungal ball - often in pre-existing cavity * maybe haemoptysis invasive aspergillosis * immunocomp * Rx - amphotericin B
41
summarise immunosuppression and LRTI
42
ix for LRTI
sputum and blood cultures before abx BAL pleural fluid ag tests ab tests immunoflurescence PCR
43
what microbes do you do antigen tests foir
s pneumoniae legoionella pneumophilia ie send in severe CAP *Be cautious of what negative means - especially if been abroad because lab just might not test for it*
44
Ab test for LRTI
oinly useful if send paired sample - on presentation at 10-14days after look for rise in ab titre useful for organisms that are difficult to titre - chlamydia, legionella
45
immunoflurescence to dx resp infection
ab labelled wqith flurescent dye used in virology PCP immunology is the only flurescence donw in labs may also be detected by silver stain in cytology labs moved over to PCR now
46
abx choice for resp infections
depends on whether: * HAP or CAP * severity of illness * host riks factors * ventilator associated
47
abx for CAP
mild to mod - amox or erythromycin/clarithromycin mod-severe - needing hospital admission: augmentin (co-amox) and clarithromycin. if allergic - cefuroxime and clarithromycin
48
abx for HAP
49
abx for HAP
50
what abx would you give
cefuroxime nd clarithromycin *fluid resus oxygen enior support*
51
prevention of pneumonia
smoking advice vaccination - childhood immunisation schedule, adults - influenza, pneumococcal

PATHOLOGY (94 decks)

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