Medical Microbiology & Clinical Pneumonia Flashcards
55 year old woman with breathlessness
PMH: known diabetes
SH: smoker 30 per day
What are differentials
left ventricular failure
pullmuanry oedema
pleural effusion
pneumonia
55 year old woman with breathlessness
PMH: known diabetes
SH: smoker 30 per day
On examination:
- Expansion : reduced on right
- Tactile vocal fremitus: reduced on R
- Percussion: stony dull at right base
- Auscultation: reduced breath sounds on right
What is this?
Pleural effusion
55 year old woman with breathlessness
PMH: known diabetes
SH: smoker 30 per day
On examination:
- Expansion : reduced on right
- Tactile vocal fremitus: reduced on R
- Percussion: stony dull at right base
- Auscultation: reduced breath sounds on right
What investigation would you like to do ?
- A) Sputum for culture
- B) Arterial blood gas
- C) Chest X-ray
- D) Pneumococcal and Legionella urinary antigen
Chest X-ray
What does this CXR show
massive pleural effusion
meniscus at the top
trachea is deviated (there could be an endobronchial lesion below)
you see someone with a pleural effusion?
what investigation woudl you like to do
pleural tap
What are causes of unilateral pleural effusion?
infection
malignancy
Someone has a pleural effusion
you want to do a pleural tap
What lab do you send it to
A) Clinical Chemistry
B) Microbiology
C) Cytology
D) All of the above
D) All of the above
If you measure the amount of protein within the pleural tap?
What are the 2 different categories and what are their normal values?
transudate: low protein less than 30mg
exudate: high protein more than 30mg
What causes a transudate?
low protein
Heart failure
liver failure
Kidney failure
What causes an exudate
maligancy
infection
What does the microbiology look at in a pleural tap
Why would you need that?
-
stain for neutrophils or mononucluar cell
- not really detailled for mononuclear)
- send to cytology if you really want to know
- do a gram stain and can tell you whether it is gram postitive or negative
- culture- sensitivity, what it is
What are the likely oraganisms that cause pnuemonia
strep pneumonia
haemophilus influenza
describe how strep pneumonia look under the microscope
gram positive dipplococci
describe how haemophilus influenza look under the microscope
gram negative rod
What are the differences between gram postitive adn gram negative bacteria?
positive have a thick peptidoglycan cell wall
negative have a thin peptidoglycan cell wall with LPS (don’t stain stay pink)
What is this?
strep pneumonia
What is this?
someone has pneumonia
haemophilus influenza
