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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
Causes of bronchiectasis
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
26
What causes TB, where does it affect and what type of reaction?
Mycobacterial infection multi-organ Type IV Hypersensitivity (granulomas with caseous necrosis) M. Tuberculosis, M.Bovis
27
Cell involved in fighting tuberculosis and why it is so difficult to fight
T cell response (enhances macrophages ability to kill mycobacterium) Mycobacteria can avoid phagocytosis- no cell wall (waxy fatty coat)
28
Primary TB vs. Secondary TB | and their location
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
29
Sign of primary TB
Gohn focus in periphery of mid zone of lung and large hilar lymph nodes
30
Sign of secondary TB
Fibrosing and cavitating apical lesions
31
Investigation of TB
``` CXR Biopsy, Bronchoalveolar lavage PCR Ziehl Neelson test-Acid fast Bacilli Liquid culture ```
32
Why may TB reactivate
Increasing age, HIV, Immunocompromised, Chemotherapy, Corticosteroids, Greater dose of infection
33
Why may TB reactivate
Increasing age, HIV, Immunocompromised, Chemotherapy, Corticosteroids, Cancer (all reduced T cell function) Greater dose of infection or more virulent organism
34
Organisms which cause lung abscess
Anaerobes | Mycobacterium tuberculosis
35
what virus causes bronchiolitis in children
RSV-
36
What causes coryza in winter and February
Winter- influenza A | Influenza B- February
37
Signs of Strep sore throat and its treatment
Exudate, pus Sore throat Dysphagia, Dysphonia Usually don't give antibiotics unless really bad
38
Sign of Tonsilitis
``` Swollen tonsils Erythematous Sore throat Dysphagia, Dysphonia Recurrent ``` Tonsilectomy
39
How to identify patients with strep sore throat who are more likely to benefit from antibiotics
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)
40
What is Quinsy and its treatment
Quinsy is a complication of tonsillitis - peritonsillar abscess-deviated uvula Drained in theatre, beware of ICA
41
what is epiglottitis what prevents epiglottitis Treatment of epiglottitis Signs
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
42
Causes of coryza
Adenovirus, Rhinovirus, Coronavirus, RSV
43
5 signs of Viral Sinusitis
Frontal headache, retro-orbital pain, Maxillary sinus pain, toothache, discharge
44
Fungal sinusitis
forms ball, erodes posteriorly to brain via ethmoid bone only happens to immunosupressed
45
Bacterial Sinusitis
Cavernous sinus thrombosis
46
When does acute sinusitis usually occur and its treatment
usually occur following viral infection usually self-limiting, some need antibiotics Nasal decongestants (oxymetazoline), nasal steroids, pseudo-ephedrine
47
Diphtheria
Pseudo-membrane | life-threatening due to toxin production, now vaccinated against
48
what does pertussis cause
whooping cough
49
When does acute bronchitis occur and its S+S | signs on CXR and examination
After common cold Productive cough, Fever, wheeze, mucus hypersecretion, pain breathlessness Normal CXR and chest examination
50
How to differentiate between pneumonia and acute bronchitis
Pneumonia has new infiltrate on CXR | Acute bronchitis CXR is normal
51
Treatment of acute bronchitis
Usually self-limiting | Antibiotics only indicate if they have secondary lung disease
52
Official definition of Pneumonia
Signs of symptoms of LRTI with new infiltrate on CXR
53
what is found in alveoli with pneumonia
Neutrophils and macrophages
54
Best indicator for if someone has an acute bacterial infection in pneumonia
Sputum colour
55
Pink frothy sputum
Pulmonary Oedema
56
Why is CURB65 subjective?
over-predicted in old people | under-predicted in young (rapidly deteriorated)
57
Other severity markers in pneumonia
Temperature < 35 or > 40​ Cyanosis PaO2 < 8 kPa​ WBC < 4 or > 30​ Multi-lobar involvement
58
Treatment of Community acquired pneumonia
``` Amoxicillin/Doxycycline O2 Fluids Bed rest Smoking cessation ```
59
Predicting organism in HOA and extra cover
Needs extra G- cover, amoxicillin and gentamicin
60
Predicting organism in Aspiration pneumonia and extra cover
anaerobes, amoxicillin and metronidazole
61
Legionella pneumonia - extra cover and symptoms
Levofloxin (resistant to penecillin) | more GI symptoms, confusion, minimal chest symptoms
62
When to use IV antibiotics
Oral route not available (NPO, Vomit) Deep routed infection (bone, abscess, endocarditis, myocarditis) Drug resistance 1st dose
63
When does sputum become important
high risk patient Resistance suspected TB/NTM suspected initial treatment not working
64
Likely organism in pneumonia with low CD4 count
Pneumocystis
65
Likely organism in pneumonia with alcoholics and homeless
TB, Klebsiella
66
Likely organism in pneumonia with IV drug misuse
Staph Aureus
67
Likely organism in pneumonia with frequently hospitalised
Pseudomonas
68
Likely organism in pneumonia with returning traveller
Legionella, TB
69
Likely organism in pneumonia with Indian - sub continental
TB
70
Likely organism in pneumonia with Eastern Europe
TB
71
Likely organism in pneumonia with immunosuppressed
Anything
72
Treatment of bronchiectasis
long-term management-treat infections as they occur, and treat underlying disease more than 4 exacerbations per year- long term antibiotics no cure
73
Signs of bronchiectasis
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
What is traction bronchiectasis
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
Differential diagnosis of bronchiectasis
Bronchiectasis secondary to CF | traction bronchiectasis secondary to Pulmonary fibrosis
76
Chronic bronchiole sepsis- presentation and who it happens to
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
Investigations of bronchiectasis
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
Treatment of bronchiectasis
Smoking cessation Flu and pseudomonas vaccine Reactive antibiotics for 14 days (send sputum sample, give antibiotics most appropriate to most recent positive sample)
79
Antibiotic therapy for bronchiectasis
Macrolides Nebulised gentamicin or colomycin (usually colomycin) Pulsed IV antibiotics Alternating between antibiotics (poor prognostic sign)
80
Anti-inflammatory treatment for bronchiectasis
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
Treating acute exacerbations of Bronchiectasis
Antibiotics Send sputum samples every day, alter antibiotics as required Aggressively eradicate Pseudomonas Aeruginosa
82
result of IgA deficiency
increased acute infections
83
Hypogammaglobulinemia
increased acute and chronic infections
84
result of CVID
recurrent infections
85
result of specific polysaccharide antibody deficiency
streptococcal infections
86
what organ is responsible for making antibodies against polysaccharides
Spleen
87
Immune paresis
the antibodies are abnormal, but normal numbers
88
Myeloma
single clone of antibody (non-functioning) due to abnormal plasma cell- typically igG is over 30 (normal is 16)
89
Lymphoma and metastatic malignancy
- antibodies dont work properly
90
if otherwise normal and has pneumonia
check for HIV
91
Chronic pulmonary infections
Empyema, abscess, chronic bronchiole sepsis, bronchiectasis, CF
92
Presentation of pulmonary abscess
``` 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
Pattern of getting an abscess after a flu
Flu> staph pneumonia> cavitating pneumonia> pulmonary abscess
94
Causes of aspiration pneumonia
Vomiting, lowered conscious level | Pharyngeal pouch
95
Bacteria that cause pulmonary abscess
Streptococcus, Staphylococcus, E coli, G- most abscess will become co-colonised with anaerobes
96
Fungi that cause pulmonary abscess and what does this suggest
Aspergillus, poor immune system
97
Cause of Septic emboli and its consequences
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
Criteria of simple effusion
Clear fluid pH >7.2 LDH<1000 Glucose >2.2 Simple doesnt need drained unless huge and causing respiratory distress
99
Criteria for Complicated effusion
pH<7.2 LDH>1000 Glucose <2.2 Requires Chest drain
100
Criteria for empyema
Frank pus | No need for further tests- requires chest drain
101
Bacteriology of empyema
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
Diagnosis of empyema- when should you suspect it and investigations
'slow to resolve pneumonia' 'persisting effusion with loculations' Preferred investigation= Ultrasound do lateral CXR
103
How to differentiate between abscess and empyema
CT scan
104
2 Treatment of septations in empyema
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
Firs line investigation for Empyema
Ultrasound
106
Antibiotic treatment of empyema
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
3 mycobacteria of mycobacterium species
mycobacterium tuberculosis, mycobacterium leprae, non-tuberculosis mycobacterium
108
initial intracellular primary niche of MTB and its effect
macrophage | phagocytosis causes granulomas, mainly in lower parts of lungs
109
Microbiology of TB
oligate aerobe, intracellular pathogen | G+ acid-fast Bacilli
110
why is TB 'acid fast'
after stain decolourise easily due to wax

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