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Medicine, Year 3, Cardiovascular and Respiratory Medicine > Pneumonia and Tuberculosis > Flashcards

Pneumonia and Tuberculosis Flashcards

1
Q

How does a Ghon Complex form from a Ghon Focus?

A

Following invasion of nearby lymph nodes

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2
Q

How does a Ranke complex form from a Ghon Complex?

A

Via fibrosis and calcification

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3
Q

What type of Hypersensitivity Reaction is associated with the Inflammatory changes in Tuberculosis?

A

Type 4 Hypersensitivity

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4
Q

Discuss the microbiology of Tuberculosis

A

Rod shaped, aerobic bacilli with a mycolic acid cell wall. Acid fast, thus stains red on a Ziehl Neelson stain

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5
Q

Why does TB commonly affect the upper lobes of the lung?

A

More aerobic conditions in upper lobes

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6
Q

How can Miliary TB affect the brain, kidneys, liver, lymph nodes, adrenal glands and lumbar vertebrae?

A 
Brain - Meningitis
Kidneys - Sterile pyuria
Liver - Hepatitis
Lymph Nodes - Cervical Lymphadenopathy (Scrofula)
Adrenal Glands - Addison's Disease
Lumbar Vertebrae - Pott's Disease
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7
Q

Why might the Interferen Gamma release assay be preferred over the Mantoux test?

A

Is more specific to TB, and is unlikely to be positive from BCG vaccine

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8
Q

What are some symptoms of TB?

A

Coughing >3 weeks, Haemoptysis, Chest pain, Unintentional weight loss, Fatigue, Fever, Night sweats, Chills

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9
Q

What are some reasons for false negatives on the Mantoux Test?

A

Miliary TB, Sarcoidosis, HIV, Lymphoma

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10
Q

What is the treatment for Active Tuberculosis?

A

RIPE (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol) for 2 months, followed by RI for 4 months

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11
Q

What is the treatment for Latent Tuberculosis?

A

3 months of RIP (Rifampicin, Isoniazid, Pyrazinamide) or 6 months of IP

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12
Q

Give examples of sets of patients who may be indicated for Directly Observed Treatment (DOT)?

A
  • Homeless people with TB
  • All prisoners with TB
  • TB Patients with poor compliance
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13
Q

What is the main X-Ray finding in patients with Pneumonia?

A

Lung consolidation (lungs filled with liquid > air)

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14
Q

Discuss the elements of the CURB-65 screening tool for Pneumonia in community

A

C: Confusion (< 8/10 on Mental Test Score)
R: Respiratory Rate (>30/min)
B: Blood Pressure (<90/60 mmHg)
65: Age (>65)

If 0 -> Manage in Community
If 1 -> Assess O2 sats and perform CXR. O2 should be >92% and CXR should be normal. If abnormal -> hospital
If 2 -> Hospital

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15
Q

What addition is added to CRB65 in assessing patients for Pneumonia when they are in hospital?

A

CURB65

U: Urea (>7mmol/L)

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16
Q

What is the most common cause of Community Acquired Pneumonia? What type of pneumonia picture does it cause?

A 
Streptococcus Pneumoniae (80% of cases)
Lobar pneumonia
17
Q

Which bacteria causing pneumonia is associated with COPD patients?

A

Haemophilus Influenzae

18
Q

State three causes of Atypical Pneumonia? What makes these bacteria atypical?

A

Mycoplasmia pneumonae
Chlamydophila pneumoniae
Legionella pneumoniae

Atypical because they do not have a cell wall

19
Q

Which bacteria causing pneumonia is associated with alcoholics and diabetics? What is the characteristic finding on CXR? What is the characteristic sputum description

A

Klebsiella pneumoniae
On CXR: Cavitation of Upper Lobes
Red currant jelly sputum

20
Q

Which fungi causing pneumonia is associated with immuno-compromised patients?

A

Pneumocystis jiroveci

21
Q

Outline the Point-of-care CRP test used for patients with pneumonia

A

If CRP <20 = do not give ABX
If CRP 20-100 = consider delayed ABX
If CRP >100 = give ABX

22
Q

What is the treatment for community acquired pneumonia with a CURB65 score < 1?

A

5 days of Amoxicillin or Macrolide ABX

23
Q

What is the treatment for community acquired pneumonia with a CURB65 score < 3?

A

7-10 days of Amoxicillin + Macrolide ABX

24
Q

State the four stages of Pneumonia

A
  1. Congestion
  2. Red Hepatisation
  3. Grey Hepatisation
  4. Resolution
25
Q

What is the risk of mortality in pneumonia patients with CRB-65 scores of 0, 1 - 2 and 3 - 4?

A

0: low risk (less than 1% mortality risk)
1 or 2: intermediate risk (1‑10% mortality risk)
3 or 4: high risk (more than 10% mortality risk)

26
Q

What skin lesions are commonly associated with Community Acquired Pneumonia?

A

Herpes Labialis

27
Q

What is the treatment for community acquired pneumonia with a CURB65 score > 3?

A

7-10 days of Coamoxiclav or

7-10 days of Macrolide and Cefuroxime

28
Q

Most Non-tuberculous Mycobacteria (NTM) which are bacteria that can’t cause TB but can cause respiratory disease is due to what?

A

Myocobacterium avium

29
Q

PNEUMONIA

  1. Which is the most common cause?
  2. Which one is associated with COPD?
  3. Which one is associated with HIV?
  4. Which one is associated with children?
  5. Which one is associated with parrots?
  6. Which one is associated with animals?
  7. Which one is associated with influenza?
  8. Which one is associated with hyponatremia?
  9. Which one is associated with cold sores?
  10. Which one is associated with Erythema Multiforme?
  11. Which one is associated with alcoholics and diabetics?
  12. Which one is associated with cystic fibrosis?
  13. Haemophilus influenza is associated with?
  14. Staph aureus is associated with?
  15. Strep pneumonia is associated with?
  16. Pneumocystis jiroveci is associated with?
  17. Klebsiella is associated with?
  18. Legionella is associated with?
  19. Mycoplasma is associated with?
  20. Chlamydia is associated with?
  21. Coxiella burnetii is associated with?
  22. Chlamydia psittaci is associated with?
  23. What are the atypical causes of pneumonia? Why are they atypical?
  24. Discuss the CURB-65 assessment
  25. Discuss what the actions are for the scores
  26. Discuss the CRP point of care test and score
  27. What are some investigations for patients with suspected pneumonia?
  28. What is the treatment for mild CAP?
  29. What is the treatment for mod / severe CAP?
  30. What is the treatment for pneumocystis jiroveci?
  31. What are treatment options for atypical pneumonias?
A
  1. Strep pneumoniae
  2. Haemophilus influenzae
  3. Pneumocystis jiroveci
  4. Chlamydophila pneumonia
  5. Chlamydia psittaci
  6. Coxiella burnetti
  7. Staph aureus
  8. Legionella pneumoniae
  9. Strep pneumoniae
  10. Mycoplasma pneumoniae
  11. Klebsiella pneumoniae
  12. Staph aureus, pseudomonas aueriginosa
  13. COPD
  14. Influenzae
  15. Cold sores
  16. HIV, CD4 < 200
  17. Alcoholics, diabetics
  18. Hyponatraemia, deranged LFTs, air conditioning
  19. Erythema multiforme
  20. Children
  21. Q fever, infected animals
  22. Parrots
  23. Legions of ptsitacci MCQs (Legionella, Psitacci, Mycoplasma, Chlamydia, Q fever / Coxiella)
  24. Confusion (8/10), Urea >7, RR >30, BP <90/60
  25. 0 = consider home treatment, 1-2 = hospital admission, 3 = ICU assessment
  26. If <20 = no ABX, 20-100 = delayed prescription, >100 = immediate ABX
  27. Basic Obs, resp exam, COVID-19 test, FBC (neutrophillia), U&Es (hyponatraemia), CRP, ABG (type 1 rep failure), Sputum culture, CXR
  28. 5 day course Amoxicillin
  29. 7-10 day course Amoxicillin + Macrolide
  30. co-tramoxazole
  31. macrolides, fluoroquinones, tetracyclines
30
Q

TUBERCULOSIS

  1. What is the main investigation to SCREEN for latent TB?
  2. What investigations can diagnose ACTIVE TB? What would you find?
  3. Outline how the Mantoux test is performed
  4. Side-effect of Rifampicin?
  5. Side-effect of Isoniazid?
  6. Side-effect of Pyrazinamide?
  7. Side-effect of Ethambutol?
  8. Which test is very important before beginning TB therapy?
  9. What is the management for Active TB?
  10. What is the management for Latent TB?
  11. What should be co-prescribed with Isoniazid, why?
  12. What are the features of TB?
A
  1. Mantoux test
  2. CXR: Upper lobe cavitation, bilateral hilar lymphadenopathy. Sputum smear, red for Ziehl-Neelsen Stain, Sputum culture for drug sensitivities, NAAT
  3. 0.1ml of 1/1000 PPD (Purified Protein Derivative) is injected intradermally. The size of induration is then measured 2-3 days later. < 6 mm = Negative. 6 - 15 mm = Positive. > 15 mm = Strongly Positive
  4. Hepatitis, orange secretions, liver enzyme inducer
  5. Hepatitis, Peripheral neuropathy, liver enzyme inhibitor
  6. Hepatitis, GOUT
  7. Optic neuritis
  8. LFTs, visual acuity
  9. 2 months of RIPE, followed by 4 months of RI
  10. 3 months of RI, or 6 months of I
  11. Pyridoxine, to reduce likelihood of peripheral neuropathy
  12. Cough +/- haemoptysis, night sweats, lymphadenopathy, weight loss

Medicine, Year 3, Cardiovascular and Respiratory Medicine (19 decks)

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