Pneumonia, TB, COPD

Question 1

what are the symptoms of pneumonia?

Answer 1

typical: pleuritic chest pain, SOB, fever, cough (productive, likely rusty/green sputum)
atypical (headache, myalgia, arthralgia)

Question 2

what are the signs of pneumonia?

Answer 2

fever, consolidation, pleural effusion (dullness to percussion)

Question 3

if pneumonia is suspected what tests should be done?

Answer 3

Chest X-ray, FBC, pulse oximetry (to see o2 sats)

+ microbiology investigations: i.e: sputum, blood culture, serology

Question 4

What is the most common pathogen to cause pneumonia and describe it?

Answer 4

streptococcus pneumoniae

alpha (greening) hemolytic strep, that is optochin sensitive

Question 5

apart from strep pneumoniae, what organisms can also cause pneumonia?

Answer 5

Heamophilus influenzae 
Influenza A (virus) 
mycoplasma pneumonia 
legionella pneumophilia
chlamydia pneumonia

Question 6

what are the atypical pneumonia pathogens and why can they be difficult to identify?

Answer 6

chlamydia pneumonia
mycoplasma pneumonia
legionella pneumophilia
coxiella

difficult as cannot be grown on cultures, relies on serology and antigen tests

Question 7

describe how you might identify legionella infection?

Answer 7

during the first 2 weeks of the resp infection, legionella antigen is detectable in the urine- can do ELISA test (antigen stick to antibody)
but after two weeks antigen will be too weak in the urine.

Question 8

what is it in TB which gives it its waxy cell wall and what is the benefit of this?

Answer 8

mycolic acid

significant virulence factor: resists complement deposition, phagocytosis, lysozyme, and oxygen radicals

Question 9

TB is what kind of bacteria and therefore to be identified needs what?

Answer 9

alochol and acid-fast (AAFB)
won’t stain with gram stain
therefore needs
zeihl nelson stain (ZN)
+ AP stain - auramine phenol: flurescence microscope (faster + sensitive)
+ LJ slope - lowestein jensen slope: special multure medium, speeds up growth of TB

OR MGIT- mycobacterium growth indicator tube
OR PCR- Xpert

Question 10

apart from sputum, blood cultures or urine, what else might you take to identify a respiratory infection?

Answer 10

BAL- bronchoalveolar lavage

Question 11

What organism causes pulmonary tuberculosis?

Answer 11

mycobacterium tuberculosis or mycobacterium bovis

Question 12

Describe what happens in TB infection?

Answer 12

TB gets into lungs
forms local granuloma
Most TB is killed, few survive and evade host defence (due to waxy layer can live in macrophage)
px is normally asympomatic/mild symptoms
(or can get disease in immunocomp)
TB lies dormant until reactivated when the host immune system wanes.
causes caseation, cavitation and fibrosis

Question 13

Investigations for suspected TB

Answer 13

CXR
Sputum/BAL for culture
Tissue Biopsy - histology
bloods (FBC, ESR etc)

Question 14

Known COPD patient gets increased sputum, cough and SOB. What do you think it is/next steps?

Answer 14

exacerbation caused by infection - likely by organism which has already colonised them
either viral: rhino, corona viruses, para/influenza
or bacterial: strep. pneumo, hemophilus influenza
take sputum + culture
treat with relevant abx, based on predominant organism grown

Question 15

what is bronchiecstasis? and what can cause it?

Answer 15

irreversible, abnormal dilatation of the bronchi, which chronic inflammatory and fibrotic changes and excess mucus secretions
severe bacterial infection: whooping cough/TB

Question 16

What are the symptoms of bronchiecstatis?

Answer 16

chronic cough, lots of sputum production, haemoptyesis, generally ill

Question 17

known bronchiescstatis px has exacerbation- what do you do/what do you think it is?

Answer 17

infection - caused by already colonising organisms
likely strep pneumo, h. influenza
take sputum culture and treat based on predominant organism grown

Question 18

what is cystic fibrosis? & what is the consequence?

Answer 18

autosomal recessive disease, abnormality of CFTR gene, means cl- transporter doesn’t work, therefore, secretions are much thicker and can plug off lumens.
effects many organs, i.e. exocrine, but also lungs.
Viscous secretions plug the airways and causes bronchiecstasis and increased likelihood of resp infection

Question 19

what organisms likely cause resp infection in those with CF? what do you do to test?

Answer 19

changes with age!
infants- staph aur.
children- hemophilus influenza
adults- pseudomonas

sputum culture

Question 20

first line antibiotic treatment for a pneumonia caused by strep pneumonia infection?

Answer 20

amoxicillin

Question 21

if the pneumonia is caused by one of the aypical pathogens (chlamydia, legionella, coxiella, mycoplasma) what antibiotics would you used instead?

Answer 21

reistant to amoxicillin therefore
any of:
macrolides (clarithryomycin!, erythromycin)
fluroquinolones (ciprofloxacin, levofloxacin)
tetracyclines (doxycycline)

Question 22

someone with TB has a lymph nodes biopsy- what might be seen?

Answer 22

caseating granuloma

Question 23

HIV positive has a non-productive cough and breathlessness on exertion- what organism might be causing this?

Answer 23

pneumocystis jiroveci

Question 24

If the px have a non productive cough but you want to culture a sample, what would you do?

Answer 24

induced sputum: hypertonic saline to increase secretions- will make them caught sputum
or BAL- bronchoalveolar lavage

Question 25

CD4 count in HIV will be?

Answer 25

low!

Question 26

How does TB present?

Answer 26

present with:

fatigue, weight loss, anorexia, night sweats, fever, cough, haemopytysis, chest pain, SOB

Question 27

what lung disease do people with CF get?

Answer 27

bronchiecstasis!