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Pathology > Mi - LRTI > Flashcards

Mi - LRTI Flashcards

1
Q

contrast URTI and LRTI

A

URTI = sinusitis / tonsilitis
LRTI = bronchitis / pneumonia / empyema / bronchiectasis / lung abscess

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2
Q

list 5 ways the airway can be compromised

A

poor swallow
abnormal ciliary function
dilated airways
HIV
immunosuppression

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3
Q

18F PC: fever, cough, malaise
Presented at A&E with:
sats 87
temp 38
RR 24
WCC high - neuts high
CRP high
CXR shows consolidation R lower lobe
CT shows collapsed R lower lobe
Dx & most likely organism?

A

R lower lobe pneumonia
streptococcus pneumoniae

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4
Q

what does strep pneumoniae look like

A

diplococci
purple (gram stain +)

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5
Q

why can strep pneumonia look green on the agar plate

A

alpha haemolysis as its sensitive to optochin

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6
Q

what % of CAP is caused by strep pneumoniae

A

30-50%

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7
Q

what is strep pneumoniae sensitive to almost always

A

penecillin

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8
Q

what is pneumonia

A

inflammation of the lung alveoli (LRTI)

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9
Q

what is the mortality % of pneumonia

A

5-10%

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10
Q

what % of people with pneumonia are admitted

A

20-40%

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11
Q

how can you tell where in the lung the pneumonia is

A

localising Sx
abnormal CXR

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12
Q

PC of pneumonia

A

fever
pleuritic chest pain
cough
SoB
malaise
N&V

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13
Q

what is HAP associated with

A

ventilators

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14
Q

RFs for developing pneumonia

A

lung disease
immunocompromise
geography / seasonal / epidemics
travel
exposure

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15
Q

bacterial causes of CAP

A

strep pneumoniae
Hameophilus influenzae
Moraxella catarrhalis
Staph aureus
klebsiella pneumoniae

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16
Q

what 2 bugs cause the most CAP and what % of CAP do they cause

A

strep pneumoniae
haemophilus influenzae
85%

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17
Q

bacterial causes of HAP

A

legionella mycoplasma
coxiella burnetti
chlymidia psitticae

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18
Q

what is coxiella burnetti also known as

A

Q fever

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19
Q

who gets chlymidia psitticae

A

people with birds

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20
Q

what do people with chlymidia psitticae get (physical sign)

A

splenomegaly

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21
Q

what pneumonia pathogens affect neonates (0 to 1 month)

A

E coli
group B strep (GBS)
Listeria

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22
Q

what pneumonia pathogens affect 1-6 month olds

A

Chlymidia trachomatia
RSV
Staph aureus

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23
Q

what pneumonia pathogens affect 6 months - 5 year olds

A

Mycoplasma
Influenza

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24
Q

what pneumonia pathogens affect 5+ year olds

A

strep pneumoniae

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25
Q

Ix for pneumonia

A

FBC, U&Es, CRP
blood cultures
sputum MC&S
ABGs
CXR

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26
Q

why are ABGs done in pneumonia

A

detect hypoxia

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27
Q

what score is used to determine who should be admitted with pneumonia

A

CURB65

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28
Q

components & cut offs of CURB65

A

confusion
urea >7
RR >30
BP <90S or<60D
>65 years old

2+ admit
2-5 severe

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29
Q

what is bronchitis

A

inflammation of medium sized airways

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30
Q

who gets bronchitis

A

smokers
kids with RSV

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31
Q

Sx of bronchitis

A

cough
fever
increased sputum
SoB

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32
Q

what does the CXR of bronchitis show

A

nothing its normal

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33
Q

what causes bronchitis

A

viruses - RSV, COVID, influenza
CAP bacteria

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34
Q

Mx of bronchitis

A

bronchodilators
physiotherapy

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35
Q

what stain is used to detect haem influenzae

A

chocolate agar

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36
Q

what does H influenzae look like

A

coccibacilli
gram - (pink)

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37
Q

what % of CAP is caused by H influenzae

A

18-35%

38
Q

who gets H influenzae CAP

A

people with lung disease

39
Q

what caution must be taken with treating H Influenzae

A

be careful with beta lactams as it may produce beta lactamase

40
Q

62M SoB & recent confusion
smoker
Bloods: low Na
CXR: bilateral interstitial changes
Dx?

A

Legionella

41
Q

Sx of legionella

A

confusion
abdo pain
low sodium
low lymphocytes

42
Q

how do you get legionella

A

inhalation of infected water droplets
from aerosols / air con

43
Q

how do you diagnose legionella

A

Ag in urine

44
Q

what do you culture legionella on

A

buffered charcoal yeast extract

45
Q

what is legionella sensitive to

A

macrolides

46
Q

what do the atypical CAP organisms have in common

A

no cell wall

47
Q

name the CAP atypicals

A

mycoplasma
legionella
chlymidia
Coxiella

48
Q

what ABx work with atypicals

A

clari
doxycycline

49
Q

what extrapulmonary features can be present with atypicals

A

hepatitis
low Na

50
Q

what % of CAP are atypicals

A

20%

51
Q

what is clinical course of atypicals

A

flu like prodrome
fever
pneumonia

52
Q

who gets coxiella burnetti

A

people with pets / farm animals

53
Q

how is coxiella burnetti spread

A

aerosol / infected milk

54
Q

how do you diagnose coxiella burnetti

A

serology

55
Q

what is coxiella burnetti sensitive to

A

macrolides

56
Q

who gets chlymidia psittaci

A

people with birds

57
Q

how is chlymidia psittaci spread

A

inhalation of infected droplets

58
Q

how is chlymidia psittaci diagnosed

A

serology

59
Q

what is chlymidia psittaci sensitive to

A

macrolides

60
Q

74F SoB, fever, R pleuritic chest pain
O/E reduced percussion, reduced air entry at R base
CXR - consolidation R base
Admitted, given beta lactams, atypical cover but continued to spike fevers and have raised CRP
Dx?

A

Empyema with collapsed lung

61
Q

what causes are behind why resp patients fail to improve when on a Tx

A

Empyema / abscess
tumour
resistance eg TB
not absorbing the ABx
immunosuppression

62
Q

what clues in the history suggest TB

A

ethnicity
prolonged prodrome
fever
weight loss
haemoptysis

63
Q

CXR of TB

A

upper lobe cavitation but high variability

64
Q

when can HAP be diagnosed

A

> 48 hours in hospital

65
Q

who gets HAP

A

previous ABx
ventilator users

66
Q

what type of bacteria usually cause HAP

A

gram -

67
Q

bacterial causes of HAP

A

staph aureus
enterpbacteria
pseudomonas
candida

68
Q

% of HAP caused by staph aureus

A

19%

69
Q

% of HAP caused by enterobacteria

A

31%

70
Q

% of HAP caused by pseudomonas

A

17%

71
Q

% of HAP caused by candida

A

7%

72
Q

who gets candida HAP

A

immunosuppressed

73
Q

64M in hopsital for months, treated for lymph node TB, has SoB.
CXR shows bilateral patchy ground glass shadowing. Dx?

A

PCP - pneumocystis jirovecii

74
Q

what is pneumocystis jirovecii

A

protazoa
ubiquitous in environment

75
Q

Sx of pneumocystis jirovecii

A

INSIDIOUS
dry cough
weight loss
SoB
malaise

76
Q

what does the CXR of pneumocystis jirovecii show

A

bats wing sign
ground glass shadowing

77
Q

how is pneumocystis jirovecii clinically diagnosed

A

walking test - their O2 sats will drastically fall after walking

78
Q

how is pneumocystis jirovecii properly diagnosed

A

immunoflurescence on BAL or PCR

79
Q

Tx of pneumocystis jirovecii

A

septrin (co-trimoxazole)

80
Q

how can you prevent someone from getting pneumocystis jirovecii & who would you give this to

A

prophylactic septrin if immunosuppressed

81
Q

who typically gets pneumocystis jirovecii

A

HIV pts
cancer pts
immunosuppressed pts

82
Q

22M chemo for leukaemia.
Prolonged neutropenia, fevers, raised CRP despite ABx.
CT thorax: infiltration, interstitial change
Dx and pathogen?

A

Aspergillosus
aspergillus fumigatus

83
Q

what is aspergillosus

A

allergic bronchopulmonary disease due to aspergillus

84
Q

what does the agar plate look like for aspergillus

A

flowering spores of aspergillus

85
Q

what LRTI is associated with HIV

A

PCP
TB
atypical mycobacteria

86
Q

what LRTI pathogen is associated with neutropenia

A

fungi eg aspergillus

87
Q

what LRTI virus is associated with BM transplant

A

CMV

88
Q

what LRTI is associated with splenectomy

A

encapsulated bacteria eg strep pneumoniae, H.influenzae

89
Q

possible Ix for LRTI

A

sputum
blood culture
BAL / pleural fluid
Ag or AB test
immunoflurescnce
PCR

90
Q

what is BAL and when is it used

A

broncheoalveolar lavage
ITU

91
Q

which pathogens are diagnosed by Ag test

A

strep pneumoniae
legionella

92
Q

what is important to remember when taking BCs for Dx of LRTI

A

do it before ABx

Pathology (87 decks)

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