Resp infections- TB, pneumonia... Flashcards by Sandy 27

what type of TB might present as a calcifed nodule

what test can you do for it

Latent TB

test -> interferon gamma assay

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previously had TB

Hemoptysis

‘circular area of colnsolidation’ on CXR

waht is this & what causes it

Aspergilloma

aspergillus fumigatus

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Othet than TB, what else can cause bilateral hilar lymphadenoapthy

Sarcoidosis

PJP

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what causes tB

mycobacterium TB

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what are the 2 main types of TB

Primary -> inital infectoin

Secondary -> reactivation of inital infection

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what is the name of lesions that form after the inital (primary) TB infection

Ghons

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what type of TB is ‘disseminated’ that spreads to the lungs via the pulmonay venous system

Miliary TB

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How is TB actually diagnosed

CXR

3x deep throat suputum samples for micrsopy and culture

1 of the samples needs to be done in the ealry morning

AFB smearing is used for the microscopy and culture

ZN staining use d

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what is used in the micrsopsy and culture for the deep throat sputum samples

AFB smearing

LJ media

ZN stainign

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what test do you need to do prior to getting the BCG vaccine

Mantoux test

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are the mantoux and tuberculin skin test the same thing?

Yes it is

tuberculin is just the substance used in the test

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whats the most sevre complicatoin of TB that affects the CNS

TB meningitis

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what can cause a false +ve and -ve Mantoux test

False +ve

BCG vaccine

False -ve

AIDS

Sarcoidosis

Lymphoma

Steroids

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why might someone with UC get a false -ve mantoux test

cause they’re on steroids

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where does the consolidation occur in TB

upper lobe

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how would you describe the cough in TB

Productive

Sputum often clear

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what can you give to prevent isoniazid’s peripheral neuropathy

Vit. B6

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for anyone diagnsoed with TB, what else do you have to check for

HIV

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what do you need to do prior to kicking of ethambutol & why

visual acuity

Cuase it can cause optic neuropathy

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what test do you have to do prior to pretty much all TB drugs and why

LIver function tests

they’re hepatotoxic

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what does AFB stand for

acid fast bacilli

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how do you assess TB drug sensitivity

sputum culture

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how is TB treated

6 months total of drugs

Inital 2 months: all 4

Next 4 months: just rifampicin & isoniazid

All 4: rifampicin, isoniazid, ethambutol & pyrazinamide

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what are the SEs of the TB drugs

Isoniazid

Hepatitis

Peripheral neuropathy

Rifampicin

Hepatitis

Orange secretions

Ethambutol

Optic neuropathy

Pyrazinamide

Gout

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other than mycobacterium TB, what other bacteria can cause it

mycobacterium bovis get it from unpastuised milk

what is miliary TB

widespread small granulomas disemminated infection spreads via pulmonary venous system

whats the most common cause other than primary

reactivation

what are the characterisitcs of mycobacterium TB

Aerobic Slow Thick wall

what signs on the nails can occur due to TB

clubbing

what is the pathogenesis of TB

Garnulomas cause tissue damage Th cells activate macrophages Phagocytosis occurs on the bacteria Free radicals and proteases are released in the alveoli

what are signs of TB on histology

central ceaseating necrosis Langhan giant cells

what criteria is used to determine if the tonisilits is bacteria what aer the bits

**Centor criteria** No cough Fever Cervical lymphadenopathy Exudates visible

**bronchiectasis** 1. what is it 2. whats the main presenting features 3. what causes it 4. what's the best investigation 5. what is it associated with

1. permanent dilation of bronchi due to chronic infections 2. coughing lots of sputum, clubbing, xeackles 3. H. influenzae 4. CT 5. CF, TB & pertussis

in bronchiectasis, what causes the bronchi to be permanently widened

chronic infections

what bacteria causes bronchiectasis

H. influenzae

what viruses cause these... 1. common cold 2. bronchiolitis 3. croup

1. rhinovirus 2. resp syntical virus 3. parainfluenza virus

what bacteria cause this... 1. HAP in ITU pts on ventilators, common in CF, "ground glass" on CXR 2. Ertheyma migrans, headaches & joint pain 3. flu-like symptoms, GI stuff, hepatitis, from Spain 4. IVDU 5. alcohol abuse, dibaetes, "red jelly" sputum

1. pseudoomas 2. Mycoplasma 3. Legionnaires 4. staph A 5. Klebseiilla

what are the 3 ways in which pneumonia are classified

Aeitological (best) Microbiological Anatomical

what are the differnt aeitiological classes of pneumonia

CAP HAP Recurrent Aspiration Aytipical Immunocomprimised

what is the pathoophysiology of penumonia

1. infection 2. consolidation due to excess fluid 3. acute infection & inflammation 4. pus formation in alveoli 5. pus spreads to adjacent alveoli 6. pus replaces the air

what are the 3 broad types of pneumonia

Broncho Segmental Lobar

what resp infection can make you suffocate in your own blood and why

**bronchiectasis** Cause the lungs can't drain proberly which results in them being more likely to bleed so you can suffocate on your own blood

once a pneumonia pt is discharged, what must be arranged for follow-ip

CXR in 6-8 weeks

what are some general complications of pneumonia

pleural effusion sepsis empyema abscess

how is aspiratoin pneumonia treated

Amox & met

pneumonia causes 1. after having influenza 2. cold sores (?), pts on artifical ventilation 3. relative bradycardia, low Na, +ve urinary antigen 4. Myocarditis, erythema migrans, IgM & neurological symtpoms 5. rusty coloured sputum, somker, cold sores (?)

1. staph A 2. pneumococcal 3. legionella 4. mycoplasma 5. srep pneumoniae

how is legionnaires treated

clarithromycin erythromycin is preggers

what is a common cause of legionnaires disease what tests do you have to do

poor air conditioning tests: urinary antigen Bloods -\> Na (low), WCC (low)

what are the most common examination signs of pneumonia

reduced chest expantions dull percussion crackles increaed vocal fremitius

**HAP treatments** 1. whats used if \<5 days 2. whats used if \>5 days

1. co-amox 2. tazocin (bad boy)

what the main findings on a CXR for legionnaires

bilateral basal consolidation

pneumonia Painful BLUE fingers +ve cold agglution test **whats this & what causes it**

Cold-Autoimmune heamolytic anaemia **mycoppalsma**

if a pt treated for pneumonia develops 'swinging' fevers (up and down all the time), what is it & what must you check

Empyema check pH

for all types of managemnt, what do you have to work out before you decide the management

CURB-65

for any potential viral cause, what test do you do

viral PCR

what are the criteria for CURB-65

Confusion Urea \>7 RR\> 30 Bp \<90 (sy) or \<60 (di) Over 65

what BP will score you a point on CURB-65

\<90 sys or \<60 di

what do CURB-65 scores of 1, 2 and 3 mean

1= low severity, can discharge on treatment (home) 2= moderate severity, needs hospital treatment (ward) 3= severe, needs high-level treatemnt (itu) **esseneitaly where they need to be treated**

what are some causes of typical and aytpical pneumonia

**typical** Strep pneumoinia H. influenzae Staph A Moraxella **aytpical** Legionnaires Mycoplasma Chalymdia TB

how are these CAPs treated: 1. CURB 3 2. CURB \<3

1. IV co-amox + clarithromycin 2. amox (clarith if PA)

what are some risk factors for penumona

Smoking Ashtma & COPD Cancer Diabetes Immunocomprismied Low weight

if you get pneumonia whilst on a ventilator, what is the cause and how do you treat

Pseudomonas IV ciprofloxacin

if you have a high CURB-65 score, what must you consider

SEPSIS

what are some differences between typical and atypical pneumonai

**typical** Gram-stanining is useful Penicllin usually works Symptoms have sudden onset Clinical featurs are more pulmonary rather than systemic CXR finidngs are localised rather than diffuse

**what type of pneumonia is this:** gram stainign not useful (no cell wall) gradual onset systemic symtpoms diffuse CXR findigns

Aytpical

what lobe is most commonly affetcd by apsiration penumonia & why how would the CXR look

Right middle lobe Bronchus is wider and more vertical conolidaton on the right middle lobe= ALWAYS GUESS THIS

what are some risk factors for aspiration pneumonia

Stroke NGT Swallowing issues MS

has aspiratoin pnuemonia INR is going up why

on metronidazole

if someones breathing isn't all that great who has pneimona (maybe also has COPD) what do you give

Prednisalone

for Klebsiella pneumonia, what would the sputum and CXR look like

sputum -\> red current CXR -\> cavitating opacities

cold sores (herpes labilais) is associated with what type of penumoina

strep prenumnonia or pseumodomas

what is the cause of pneumonia from exoctic birds

chlamydia psittiaci

what blood test sign is a good marker that pneumonia is improving

WCC dropping