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pulmonary infection Flashcards

1
Q

D sign on CXR

A

empyema (pus in pleural space)

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2
Q

‘swinging fever’

A

lung abscess

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3
Q

what is pneumonia

A

infection and inflammation of the alveoli (distal airspaces)

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4
Q

most common cause of pneumonia

A 
bacteria
Streptococcus pneumonia (80%)
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5
Q

pneumocystis jjroveci and what does it present with

A

fungus which causes pneumonia, HIV patients, presents with dry cough

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6
Q

which organism is most likely to causes pneumonia in a patient with COPD

A

Haemophilus influenza

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7
Q

what symptoms is particularly associated with streptococcus pneumoniae

A

High fever, rapid onset and herpes labialis

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8
Q

Pneumonia straight after influenza

A

Staph Aureus

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9
Q

Pneumonia with a dry protracted paroxysmal cough and atypical chest signs/x-ray findings

A

Mycoplasma pneumonia

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10
Q

Pneumonia with Hyponatraemia and lymphopenia, infected air conditioning units

A

Legionella pneumoniae

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11
Q

Pneumonia in an alcoholic

A

Klebsiella pneumoniae

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12
Q

Signs and symptoms of pneumonia

A

Cough, sputum, dyspnoea, chest pain: may be pleuritic, fever

signs of systemic inflammatory response: fever, tachycardia
reduced oxygen saturation, reduced breath sounds, bronchial breathing
Dull on percussion

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13
Q

Investigations of pneumonia

A

CXR

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14
Q

Signs and symptoms of pneumonia

A

Preceding URTI
Cough- sputum, Haemoptysis
dyspnoea,
Pleuritic pain, abdominal pain, myalgia, athralgia
fever, tachycardia, malaise, anorexia, sweats, rigors
reduced SO2

reduced breath sounds, bronchial breathing
Dull on percussion, crackles, rub

Headache​+Confusion​

Diarrhoea

Herpes labialis​

Tachypnoea​

Cyanosis​

Hypotension

older people- unusual presentation
younger people- more classical presentation

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15
Q

Investigations of pneumonia and its findings

A

CXR- CONSOLIDATION

FBC (neutrophilia in bacterial infections)
blood cultures
U+E: check for dehydration
CRP: raised in response to infection
Arterial blood gases: if SaO2 low or the patient has pre-existing respiratory disease, eg COPD

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16
Q

Management of COPD

A

Antibiotics

Supportive care:
O2 therapy if the patients is hypoxaemic
IV fluids if hypotensive or dehydrated

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17
Q

How to decide how to manage patients with COA

A

CURB-65.

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18
Q

How to decide how to manage patients with COA

A

CURB-65.

Confusion
Urea (>7 mmol/L)
Respiratory rate >30
BP (systolic <90, diastolic <60)
65+

0 - managed in the community.

1 : Sa02assessed-should be >92% for community and a CXR performed. If the CXR shows bilateral/multilobar shadowing hospital admission is advised.

2 +: Hospital

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19
Q

What organisms usually cause Lobar pneumonia, is it more likely to be hospital or community acquired and who is more likely to get it?

A

Caused by pneumococcus, legionella and klebsiella.

Usually community acquired and occurs in otherwise healthy young adults

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20
Q

Is pneumonia due to transudate or exudate

A

Exudate (fibrin rich fluid)

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21
Q

Complications that can arise from pneumonia

A

Organisation (fibrous scarring)
Bronchiectasis
Abscess, Empyema

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22
Q

Who gets Bronchopneumonia?

Associated organisms

A

Associated with pre-existing disease, like COPD, Cardiac failure, complication of viral infection or aspiration of gastric contents

Begins in airways then spreads towards alveolar lung

Organisms are more varied- Strep pneumoniae, Haemophilus Influenza
In aspiration- anaerobes, coliforms, Staphs

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23
Q

What is a Lung abscess
S+S
Common cause
Treatment

A

Localised collection of pus inside the lung
Causes malaise and swinging fever
Often acquired by aspiration

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24
Q

Bronchiectasis

A

Abnormal fixed bronchiole dilation with purulent secretions

Airway which is thick walled and larger in diameter than its accompanying pulmonary artery

If bronchus goes more than 2 /3rds of the way out towards chest wall, bronchiectasis

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25
Q

Causes of bronchiectasis

A

Fibrous scarring post-infection (pneumonia, TB, CF)

chronic obstruction (tumour)

upper lobe bronchiectasis in patient <40 -test for CF

Rheumatoid arthritis (connection unknown)

Youngs syndrome and kartanagers syndrome(dextrocardia) = primary cillial dysfunction (don’t waft properly or low numbers)

Allergic bronchopulmonary aspergillosis - IgE antibodies against aspergillus, creates allergic inflammatory response TH2 response-mucus plugs, proximal bronchiectasis

Traction bronchiectasis associated with pulmonary fibrosis

Anyone with bronchiectasis should have immunodefiency ruled out

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26
Q

What causes TB, where does it affect and what type of reaction?

A

Mycobacterial infection
multi-organ
Type IV Hypersensitivity (granulomas with caseous necrosis)

M. Tuberculosis, M.Bovis

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27
Q

Cell involved in fighting tuberculosis and why it is so difficult to fight

A

T cell response (enhances macrophages ability to kill mycobacterium)

Mycobacteria can avoid phagocytosis- no cell wall (waxy fatty coat)

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28
Q

Primary TB vs. Secondary TB

and their location

A

Primary-1st exposure + up to 5 years after - carried to hilar lymph nodes, granulomatous response in nodes

Secondary-reactivated or reinfected TB (some immunity) - initially in lung apices

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29
Q

Sign of primary TB

A

Gohn focus in periphery of mid zone of lung and large hilar lymph nodes

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30
Q

Sign of secondary TB

A

Fibrosing and cavitating apical lesions

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31
Q

Investigation of TB

A 
CXR
Biopsy, Bronchoalveolar lavage
PCR
Ziehl Neelson test-Acid fast Bacilli
Liquid culture
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32
Q

Why may TB reactivate

A

Increasing age, HIV, Immunocompromised, Chemotherapy, Corticosteroids, Greater dose of infection

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33
Q

Why may TB reactivate

A

Increasing age, HIV, Immunocompromised, Chemotherapy, Corticosteroids, Cancer (all reduced T cell function)

Greater dose of infection or more virulent organism

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34
Q

Organisms which cause lung abscess

A

Anaerobes

Mycobacterium tuberculosis

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35
Q

what virus causes bronchiolitis in children

A

RSV-

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36
Q

What causes coryza in winter and February

A

Winter- influenza A

Influenza B- February

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37
Q

Signs of Strep sore throat and its treatment

A

Exudate, pus
Sore throat
Dysphagia, Dysphonia

Usually don’t give antibiotics unless really bad

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38
Q

Sign of Tonsilitis

A 
Swollen tonsils
Erythematous
Sore throat
Dysphagia, Dysphonia
Recurrent

Tonsilectomy

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39
Q

How to identify patients with strep sore throat who are more likely to benefit from antibiotics

A

FEVERPAIN

Fever during previous 24 hours
Purulence on tonsils 
Attended rapidly (3 days of symptom onset)
Inflamed tonsils
No cough or coryza

(higher score, greater likelihood of isolating streptococcus)

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40
Q

What is Quinsy and its treatment

A

Quinsy is a complication of tonsillitis - peritonsillar abscess-deviated uvula

Drained in theatre, beware of ICA

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41
Q

what is epiglottitis
what prevents epiglottitis
Treatment of epiglottitis
Signs

A

Bacterial infection of the epiglottis- inflammation and swelling of epiglottis

HIP vaccine prevents this
Golden rule- 1st thing you do is get an ET tube in

One shot at intubating someone with epiglottitis (will swell up if you hit it) then have to do a tracheostomy

Causes drooling as salvia cant go down and sore throat

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42
Q

Causes of coryza

A

Adenovirus, Rhinovirus, Coronavirus, RSV

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43
Q

5 signs of Viral Sinusitis

A

Frontal headache, retro-orbital pain, Maxillary sinus pain, toothache, discharge

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44
Q

Fungal sinusitis

A

forms ball, erodes posteriorly to brain via ethmoid bone

only happens to immunosupressed

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45
Q

Bacterial Sinusitis

A

Cavernous sinus thrombosis

46
Q

When does acute sinusitis usually occur and its treatment

A

usually occur following viral infection

usually self-limiting, some need antibiotics

Nasal decongestants (oxymetazoline), nasal steroids, pseudo-ephedrine

47
Q

Diphtheria

A

Pseudo-membrane

life-threatening due to toxin production, now vaccinated against

48
Q

what does pertussis cause

A

whooping cough

49
Q

When does acute bronchitis occur and its S+S

signs on CXR and examination

A

After common cold

Productive cough, Fever, wheeze, mucus hypersecretion, pain breathlessness

Normal CXR and chest examination

50
Q

How to differentiate between pneumonia and acute bronchitis

A

Pneumonia has new infiltrate on CXR

Acute bronchitis CXR is normal

51
Q

Treatment of acute bronchitis

A

Usually self-limiting

Antibiotics only indicate if they have secondary lung disease

52
Q

Official definition of Pneumonia

A

Signs of symptoms of LRTI with new infiltrate on CXR

53
Q

what is found in alveoli with pneumonia

A

Neutrophils and macrophages

54
Q

Best indicator for if someone has an acute bacterial infection in pneumonia

A

Sputum colour

55
Q

Pink frothy sputum

A

Pulmonary Oedema

56
Q

Why is CURB65 subjective?

A

over-predicted in old people

under-predicted in young (rapidly deteriorated)

57
Q

Other severity markers in pneumonia

A

Temperature < 35 or > 40​

Cyanosis PaO2 < 8 kPa​

WBC < 4 or > 30​

Multi-lobar involvement

58
Q

Treatment of Community acquired pneumonia

A 
Amoxicillin/Doxycycline 
O2
Fluids
Bed rest
Smoking cessation
59
Q

Predicting organism in HOA and extra cover

A

Needs extra G- cover, amoxicillin and gentamicin

60
Q

Predicting organism in Aspiration pneumonia and extra cover

A

anaerobes, amoxicillin and metronidazole

61
Q

Legionella pneumonia - extra cover and symptoms

A

Levofloxin (resistant to penecillin)

more GI symptoms, confusion, minimal chest symptoms

62
Q

When to use IV antibiotics

A

Oral route not available (NPO, Vomit)
Deep routed infection (bone, abscess, endocarditis, myocarditis)
Drug resistance
1st dose

63
Q

When does sputum become important

A

high risk patient
Resistance suspected
TB/NTM suspected
initial treatment not working

64
Q

Likely organism in pneumonia with low CD4 count

A

Pneumocystis

65
Q

Likely organism in pneumonia with alcoholics and homeless

A

TB, Klebsiella

66
Q

Likely organism in pneumonia with IV drug misuse

A

Staph Aureus

67
Q

Likely organism in pneumonia with frequently hospitalised

A

Pseudomonas

68
Q

Likely organism in pneumonia with returning traveller

A

Legionella, TB

69
Q

Likely organism in pneumonia with Indian - sub continental

A

TB

70
Q

Likely organism in pneumonia with Eastern Europe

A

TB

71
Q

Likely organism in pneumonia with immunosuppressed

A

Anything

72
Q

Treatment of bronchiectasis

A

long-term management-treat infections as they occur, and treat underlying disease
more than 4 exacerbations per year- long term antibiotics

no cure

73
Q

Signs of bronchiectasis

A

Irreversible dilated inflamed airways which are easily collapsible

Airway obstruction

Abnormal cilia and mucosa therefore impaired mucous clearance

Yellow/green sputum production

Recurrent ‘chest infections’ short lived response to antibiotics

74
Q

What is traction bronchiectasis

A

Pulmonary fibrosis - as lung fibroses it pulls together then contracts, pulling airways apart- this is Traction bronchiectasis (completely different to bronchiectasis)- doesnt lead to recurrent infection, not caused by the same things

75
Q

Differential diagnosis of bronchiectasis

A

Bronchiectasis secondary to CF

traction bronchiectasis secondary to Pulmonary fibrosis

76
Q

Chronic bronchiole sepsis- presentation and who it happens to

A

Hallmarks of bronchiectasis but normal on CT scan, positive sputum results
young, mainly women involved in childcare
Probably picking up haemophilus infections from toddlers
also older with COPD
remember to check sinuses-reservoir for infection

77
Q

Investigations of bronchiectasis

A

HRCT of chest
Full blood count, urea & electrolytes, liver function test
Ig A/G/M
Functional antibodies
Aspergillus IgG and IgE/ total IgE
Standard and mycobacterial cultures
Consider vasculitis screen/ and connective tissue diseases screen

78
Q

Treatment of bronchiectasis

A

Smoking cessation
Flu and pseudomonas vaccine
Reactive antibiotics for 14 days (send sputum sample, give antibiotics most appropriate to most recent positive sample)

79
Q

Antibiotic therapy for bronchiectasis

A

Macrolides
Nebulised gentamicin or colomycin (usually colomycin)
Pulsed IV antibiotics
Alternating between antibiotics (poor prognostic sign)

80
Q

Anti-inflammatory treatment for bronchiectasis

A

Anti-inflammatory treatment for bronchiectasis
Clarithromycin, 250mg, once per day or
Azithromycin, 250mg, three times per week
Both work equally well, but don’t work in current smokers

81
Q

Treating acute exacerbations of Bronchiectasis

A

Antibiotics
Send sputum samples every day, alter antibiotics as required
Aggressively eradicate Pseudomonas Aeruginosa

82
Q

result of IgA deficiency

A

increased acute infections

83
Q

Hypogammaglobulinemia

A

increased acute and chronic infections

84
Q

result of CVID

A

recurrent infections

85
Q

result of specific polysaccharide antibody deficiency

A

streptococcal infections

86
Q

what organ is responsible for making antibodies against polysaccharides

A

Spleen

87
Q

Immune paresis

A

the antibodies are abnormal, but normal numbers

88
Q

Myeloma

A

single clone of antibody (non-functioning) due to abnormal plasma cell- typically igG is over 30 (normal is 16)

89
Q

Lymphoma and metastatic malignancy

A
  • antibodies dont work properly
90
Q

if otherwise normal and has pneumonia

A

check for HIV

91
Q

Chronic pulmonary infections

A

Empyema, abscess, chronic bronchiole sepsis, bronchiectasis, CF

92
Q

Presentation of pulmonary abscess

A 
Slow, indolent presentation
Weight loss (lose appetite) 
Lethargy, tired, weak
Cough, possibly sputum (pneumonia) abscess itself is enclosed 
Antibiotics usually take weeks to work
93
Q

Pattern of getting an abscess after a flu

A

Flu> staph pneumonia> cavitating pneumonia> pulmonary abscess

94
Q

Causes of aspiration pneumonia

A

Vomiting, lowered conscious level

Pharyngeal pouch

95
Q

Bacteria that cause pulmonary abscess

A

Streptococcus, Staphylococcus, E coli, G-

most abscess will become co-colonised with anaerobes

96
Q

Fungi that cause pulmonary abscess and what does this suggest

A

Aspergillus, poor immune system

97
Q

Cause of Septic emboli and its consequences

A

Septic embolic: IV drug user

Injection into groin> sinus (difficult to clean)> staphylococci get into sinus>constantly injecting so get a clot> clot gets infected, breaks off and moves to lungs> Infarct, PE, Abscess

Causes right sided endocarditis (infection causes vegetation on tricuspid or pulmonary valve, breaks off and goes to lung- rare unless IV drug user)

infected DVT

Septicaemia (bacteria enter blood stream>blood poisoning>sepsis )

98
Q

Criteria of simple effusion

A

Clear fluid
pH >7.2
LDH<1000
Glucose >2.2

Simple doesnt need drained unless huge and causing respiratory distress

99
Q

Criteria for Complicated effusion

A

pH<7.2
LDH>1000
Glucose <2.2
Requires Chest drain

100
Q

Criteria for empyema

A

Frank pus

No need for further tests- requires chest drain

101
Q

Bacteriology of empyema

A

Mostly aerobes, only anaerobes 13% of the time (severe pneumonia, poor dental hygiene)

G+: Strep milleri, Staph Aureus (usually post-operative or nosocromial, immunocompromised)

G-:E. Coli, pseudomonas, haemophilus influenza, Klebsiella

102
Q

Diagnosis of empyema- when should you suspect it and investigations

A

‘slow to resolve pneumonia’
‘persisting effusion with loculations’

Preferred investigation= Ultrasound
do lateral CXR

103
Q

How to differentiate between abscess and empyema

A

CT scan

104
Q

2 Treatment of septations in empyema

A

Fibrin creates web- drain required to break down septations- dnase and altaplase (breaks down clots)

Allows better drainage of empyema. If this doesnt work, needs surgery (VATS), or antibiotics

105
Q

Firs line investigation for Empyema

A

Ultrasound

106
Q

Antibiotic treatment of empyema

A

IV antibiotics
Broad spectrum- Amoxicillin and metronidazole initially

Oral antibiotics - directed towards the cultured bacteria
Usually co-amoxiclav for 5 weeks

(High mortality and mixed bacteriology so broad spectrum is used initially, then culture fluid)
With g- give gentamicin
Co-amoxiclav- good spectrum of coverage

107
Q

3 mycobacteria of mycobacterium species

A

mycobacterium tuberculosis, mycobacterium leprae, non-tuberculosis mycobacterium

108
Q

initial intracellular primary niche of MTB and its effect

A

macrophage

phagocytosis causes granulomas, mainly in lower parts of lungs

109
Q

Microbiology of TB

A

oligate aerobe, intracellular pathogen

G+ acid-fast Bacilli

110
Q

why is TB ‘acid fast’

A

after stain decolourise easily due to wax

Respiration (6 decks)

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