Microbiology Flashcards

Question

What is the CURB 65 severity score for community acquired pneumonia

Answer 1

``` C = new onset of confusion U = Urea >7 R = Respiratory rate >30/min B = Blood pressure systolic <90 or diastolic <61 65 = Aged 65 years or older Score 1 point for each above ```

Answer 2

Temp <35 or >40 Cyanosis PaO2 <8 kPa WBC <4 or >30 Multi-lobar involvement

Answer 3

``` Antibiotics - amoxicillin or doxycycline Oxygen - maintain SaO2 94-98% or 88-92% Fluids Bed rest No smoking ```

Answer 4

Hospital acquired - need extended gram negative cover Aspiration pneumomnia - anaerboic cover Legionella - chest symptoms minimal, GI disturbance common, confusion common

Answer 5

They can compensate well for being unwell - the CURB can be fine but they are septic C: Good cerebral vasculature - all the brain works U: Good kidneys R: Can increase Vt - increase tidal volume rather than resp rate B: Inotropic, chronotropic, vascular responses - BP won't fall They will decompansate VERY quickly

Answer 6

They could be at a CURB1 before they start: C: Poor cerebral perfusion U: Poor renal pefusion R: Rely on resp rate rather than increasing tidal volume B: Poor inotropic, chronotropic and vascular responses

Answer 7

When the oral route is not available - NPO Sensitivities - drug resistant organisms Deep seated infections - abscesses, bone, endocarditis, meningitis First dose - rapid increase in plasma conc

Answer 8

``` HIV PWID (people who inject drugs) - staph aureus Alcohol/homelessness - TB, klebsiella Frequently hospitalised - pseudomonas Returning traveller - leginoells, TB Indian sub-continent - TB Easten europre- MDR TB, XDRTB ```

Answer 9

Respiratory failure Pleural effusion Empyema Death

Answer 10

Influenza and penumococcal vacines in people: Over 65, with chronic chest or cardiac disease, diabetes, immunocompromised - splenectomy Infleunza virus - health care workers

Answer 11

The collection of pus in a cavity in the body, especially in the pleural cavity

Answer 12

Nasopharynx: nasal hairs, ciliated epithelia, IgA Oropharynx: Saliva, Sloughing, Cough

Answer 13

Alpha-haemolytic streptococci - strep pneumoniae Beta-haemolytic streptococci - strep pyogenes Staphylococcus aureus

Answer 14

Haemophilus influenzae | Moraxela cararrhalis

Answer 15

``` Mucociliary escalator Cough AMP's Cellular and humoral immunity Infections occur when there are changes: Trauma/intubation of airway Abnormalities of defence - ciliary escalator and others as occurs in CPD and CF Virulent pathogen/large inocolum ```

Answer 16

``` Infection and inflammation of the bronchi Productive cough +/- wheeze +/- fever Normal chest examination and CXR ```

Answer 17

90% viral Preceded by URT infection Normal chest examination and CXR Antibiotics not usually indicated

Answer 18

``` Adults Productive cough or acute chest illness Breathlessness Wheezing Increased sputum purulence Often follow viral infection or fall in temp and increase in humidity ```

Answer 19

``` 30% viral alone 50% bacterial Haemophilus influenzae Moraxella catarrhalis Streptococcus pneumoniae Gram-negative ```

Answer 20

Acute trachea bronchitis Cold like symptoms for 2 weeks Repeated violent exhalations with severe inspiratory whoop, vomiting common Residual cough for a month or more

Answer 21

Bordetella pertussis Gram negative coccobacillus Exculsively human pathogen Vaccine preventable

Answer 22

Bacterial culture Pernasal swab (<21 days) Serology Clinical signs and symptoms (low numbers of organisms by onset of paroxysmal cough) Treatment with antibiotics <21 days cough

Answer 23

Contact (touch) Airbourne Droplet

Answer 24

Small particles that are less than 5 microns in size Airbourne Limited indications - multi-drug resistant TB, some viruses, TRI undergoing aeresol Require standard infection control precautions and a filtering face piece 3 (FFP3)

Answer 25

Larger particles, more than 5 microns in size and fall to the floor within 2m Spread via direct contact of droplets with the mucous membranes Droplet, then surface, then contact spread Ideally in a single room, not in a ward

Answer 26

It is an inherited disease that leads to abdonrmally viscous mucus, blocking many tubular structures including conducting airways and lungs

Answer 27

Repeated chest infections and chronic colonisation

Answer 28

Inefficient clearance and build-up of mucus | Staph aureus, haemophilus influenzae, strep pneumoniae, pseudomonas aeruginosa, burkholderia cepacia and many others

Answer 29

Normally sterile No ciliary escalator, alveolar lining fluid which contains surfactant, Ig, complement, FFA, AMP Alveolar macrophages and neutrophils Phagocytosis leads to an inflammatory response

Answer 30

``` Cough Increased sputum Chest pain Dyspnoea Fever CXR with infiltrates Acquired in the community ```

Answer 31

Organism reaches the lungs leads to immune activation and infiltration (systemic response) leads to fluid and cellular build up in alveoli which leads to impaired gas exchange

Answer 32

``` Causative organisms: Streptococcus penumoniae 70% Atypicals/viruses 20% Hemophilus influenzae 5% Staphylococcus aureus 4% Other bacteria 1% ```

Answer 33

Increasing age Immunocompromised Smoking

Answer 34

Sputum culture - purulence | Viral PCR

Answer 35

Amoxicillin, doxycycline and co-trimoxazole

Answer 36

Streptocococcus pneumoniae

Answer 37

Mycoplasm pneumoniae, legionella pneumonia, chlamydophila pneumonia

Answer 38

Typical vs atypical (community acquired) Hospital associated pneumonia Aspiration pneumonia Pneumonia in the immunosupressed (Pneumocystis, TB)

Answer 39

``` Urinary antigen - pos Legioniella PCR - pos Culture - pos Routine culture - neg Viral PCR - neg ```

Answer 40

Legionalle urinary antigen Detects serogroup 1 only Culture is slow on selective media Paired serology rises in titres

Answer 41

Clarythromycin, erythromycin, quinolones (levofloxacin)

Answer 42

Flu like illness which may progress to a severe pneumonia, with mental confusion, acute renal failure and GI symptoms

Answer 43

No person-to -person spread Transmitted by inhalation of contaminated water droplets Exposure to contaminated aerosolised water and impaired immunity put you at risk for catching legionela pneumonia

Answer 44

``` Post infleunza (strep pneumo still more common that staph post influenza Haematogenous spread of staphylococcus aureus (CV infections) ```