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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
Q

how is legionella diagnosed

A

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
Q

mx of legionella

A

macrolides

26
Q

summarise coxiella burnetii

A

common in domestic or farm animals
transmission - aerosol or milk
dx - serology
mx - macrolides

27
Q

summarise chlamydia psittaci

A

transmission - from birds by inhalation
dx - serology
mx - macrolides

28
Q

started on abx - didnt work

?likely dx?

A

empyema

29
Q

differentials to think of when pneumonia is not improving with abx

A

empyema/abscess
prox obstruction eg tumour
resistant org inc TB
not recieving/absorpbng abx
immunosuppression
other dx - cancer, cryptogenic organising pneumonia

30
Q

CXR for covid

A

Patchy consolidation
Speckled infiltration
Ground glass

31
Q

CT for covid

A

now have antivirals - wont see this bad

32
Q

what is teh organism

A

TB

33
Q

summarise TB

A

clues: ethnicity, prolongedprodrome, fever, wht loss, haemoptysis, night sweats
can have - discitis, osteomyelitis, diarrhoea
CXR - upper lobe (but can vary)

34
Q

ix for TB

A
35
Q

what is HAP

A

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
Q

microbes that cause HAP

A
37
Q

likely organism

A

pneumocystis jirovecii

38
Q

summarise pneumocystis jirovecii

A

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
Q

what is the likely organism

A

aspergillus fumigatus

40
Q

summarise aspergillus fumigatus

A

allergic bronchopulmonary aspergillosis
* chronic wheeze
* eosinophilia
* bronchiectasis

aspergilloma
* fungal ball - often in pre-existing cavity
* maybe haemoptysis

invasive aspergillosis
* immunocomp
* Rx - amphotericin B

41
Q

summarise immunosuppression and LRTI

A
42
Q

ix for LRTI

A

sputum and blood cultures before abx
BAL
pleural fluid
ag tests
ab tests
immunoflurescence
PCR

43
Q

what microbes do you do antigen tests foir

A

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
Q

Ab test for LRTI

A

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
Q

immunoflurescence to dx resp infection

A

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
Q

abx choice for resp infections

A

depends on whether:
* HAP or CAP
* severity of illness
* host riks factors
* ventilator associated

47
Q

abx for CAP

A

mild to mod - amox or erythromycin/clarithromycin

mod-severe - needing hospital admission: augmentin (co-amox) and clarithromycin. if allergic - cefuroxime and clarithromycin

48
Q

abx for HAP

A
49
Q

abx for HAP

A
50
Q

what abx would you give

A

cefuroxime nd clarithromycin

fluid resus
oxygen
enior support

51
Q

prevention of pneumonia

A

smoking advice
vaccination - childhood immunisation schedule, adults - influenza, pneumococcal

PATHOLOGY (94 decks)

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