Resp infections- TB, pneumonia... Flashcards
what type of TB might present as a calcifed nodule
what test can you do for it
Latent TB
test -> interferon gamma assay
previously had TB
Hemoptysis
‘circular area of colnsolidation’ on CXR
waht is this & what causes it
Aspergilloma
aspergillus fumigatus
Othet than TB, what else can cause bilateral hilar lymphadenoapthy
Sarcoidosis
PJP
what causes tB
mycobacterium TB
what are the 2 main types of TB
Primary -> inital infectoin
Secondary -> reactivation of inital infection
what is the name of lesions that form after the inital (primary) TB infection
Ghons
what type of TB is ‘disseminated’ that spreads to the lungs via the pulmonay venous system
Miliary TB
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
what is used in the micrsopsy and culture for the deep throat sputum samples
AFB smearing
LJ media
ZN stainign
what test do you need to do prior to getting the BCG vaccine
Mantoux test
are the mantoux and tuberculin skin test the same thing?
Yes it is
tuberculin is just the substance used in the test
whats the most sevre complicatoin of TB that affects the CNS
TB meningitis
what can cause a false +ve and -ve Mantoux test
False +ve
BCG vaccine
False -ve
AIDS
Sarcoidosis
Lymphoma
Steroids
why might someone with UC get a false -ve mantoux test
cause they’re on steroids
where does the consolidation occur in TB
upper lobe
how would you describe the cough in TB
Productive
Sputum often clear
what can you give to prevent isoniazid’s peripheral neuropathy
Vit. B6
for anyone diagnsoed with TB, what else do you have to check for
HIV
what do you need to do prior to kicking of ethambutol & why
visual acuity
Cuase it can cause optic neuropathy
what test do you have to do prior to pretty much all TB drugs and why
LIver function tests
they’re hepatotoxic
what does AFB stand for
acid fast bacilli
how do you assess TB drug sensitivity
sputum culture
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
what are the SEs of the TB drugs
Isoniazid
Hepatitis
Peripheral neuropathy
Rifampicin
Hepatitis
Orange secretions
Ethambutol
Optic neuropathy
Pyrazinamide
Gout
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
- what is it
- whats the main presenting features
- what causes it
- what’s the best investigation
- what is it associated with
- permanent dilation of bronchi due to chronic infections
- coughing lots of sputum, clubbing, xeackles
- H. influenzae
- CT
- 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…
- common cold
- bronchiolitis
- croup
- rhinovirus
- resp syntical virus
- parainfluenza virus
what bacteria cause this…
- HAP in ITU pts on ventilators, common in CF, “ground glass” on CXR
- Ertheyma migrans, headaches & joint pain
- flu-like symptoms, GI stuff, hepatitis, from Spain
- IVDU
- alcohol abuse, dibaetes, “red jelly” sputum
- pseudoomas
- Mycoplasma
- Legionnaires
- staph A
- 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
- infection
- consolidation due to excess fluid
- acute infection & inflammation
- pus formation in alveoli
- pus spreads to adjacent alveoli
- 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
- after having influenza
- cold sores (?), pts on artifical ventilation
- relative bradycardia, low Na, +ve urinary antigen
- Myocarditis, erythema migrans, IgM & neurological symtpoms
- rusty coloured sputum, somker, cold sores (?)
- staph A
- pneumococcal
- legionella
- mycoplasma
- 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
- whats used if <5 days
- whats used if >5 days
- co-amox
- 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:
- CURB 3
- CURB <3
- IV co-amox + clarithromycin
- 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
