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Oh no- Infections > Resp infections- TB, pneumonia... > Flashcards

Resp infections- TB, pneumonia... Flashcards

1
Q

what type of TB might present as a calcifed nodule

what test can you do for it

A

Latent TB

test -> interferon gamma assay

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2
Q

previously had TB

Hemoptysis

‘circular area of colnsolidation’ on CXR

waht is this & what causes it

A

Aspergilloma

aspergillus fumigatus

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3
Q

Othet than TB, what else can cause bilateral hilar lymphadenoapthy

A

Sarcoidosis

PJP

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4
Q

what causes tB

A

mycobacterium TB

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5
Q

what are the 2 main types of TB

A

Primary -> inital infectoin

Secondary -> reactivation of inital infection

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6
Q

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

A

Ghons

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7
Q

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

A

Miliary TB

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8
Q

How is TB actually diagnosed

A

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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9
Q

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

A

AFB smearing

LJ media

ZN stainign

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10
Q

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

A

Mantoux test

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11
Q

are the mantoux and tuberculin skin test the same thing?

A

Yes it is

tuberculin is just the substance used in the test

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12
Q

whats the most sevre complicatoin of TB that affects the CNS

A

TB meningitis

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13
Q

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

A

False +ve

BCG vaccine

False -ve

AIDS

Sarcoidosis

Lymphoma

Steroids

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14
Q

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

A

cause they’re on steroids

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15
Q

where does the consolidation occur in TB

A

upper lobe

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16
Q

how would you describe the cough in TB

A

Productive

Sputum often clear

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17
Q

what can you give to prevent isoniazid’s peripheral neuropathy

A

Vit. B6

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18
Q

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

A

HIV

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19
Q

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

A

visual acuity

Cuase it can cause optic neuropathy

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20
Q

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

A

LIver function tests

they’re hepatotoxic

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21
Q

what does AFB stand for

A

acid fast bacilli

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22
Q

how do you assess TB drug sensitivity

A

sputum culture

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23
Q

how is TB treated

A

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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24
Q

what are the SEs of the TB drugs

A

Isoniazid

Hepatitis

Peripheral neuropathy

Rifampicin

Hepatitis

Orange secretions

Ethambutol

Optic neuropathy

Pyrazinamide

Gout

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25
Q

other than mycobacterium TB, what other bacteria can cause it

A

mycobacterium bovis

get it from unpastuised milk

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26
Q

what is miliary TB

A

widespread small granulomas

disemminated infection

spreads via pulmonary venous system

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27
Q

whats the most common cause other than primary

A

reactivation

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28
Q

what are the characterisitcs of mycobacterium TB

A

Aerobic

Slow

Thick wall

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29
Q

what signs on the nails can occur due to TB

A

clubbing

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30
Q

what is the pathogenesis of TB

A

Garnulomas cause tissue damage

Th cells activate macrophages

Phagocytosis occurs on the bacteria

Free radicals and proteases are released in the alveoli

31
Q

what are signs of TB on histology

A

central ceaseating necrosis

Langhan giant cells

32
Q

what criteria is used to determine if the tonisilits is bacteria

what aer the bits

A

Centor criteria

No cough

Fever

Cervical lymphadenopathy

Exudates visible

33
Q

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
A
  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
34
Q

in bronchiectasis, what causes the bronchi to be permanently widened

A

chronic infections

35
Q

what bacteria causes bronchiectasis

A

H. influenzae

36
Q

what viruses cause these…

  1. common cold
  2. bronchiolitis
  3. croup
A
  1. rhinovirus
  2. resp syntical virus
  3. parainfluenza virus
37
Q

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
A
  1. pseudoomas
  2. Mycoplasma
  3. Legionnaires
  4. staph A
  5. Klebseiilla
38
Q

what are the 3 ways in which pneumonia are classified

A

Aeitological (best)

Microbiological

Anatomical

39
Q

what are the differnt aeitiological classes of pneumonia

A

CAP

HAP

Recurrent

Aspiration

Aytipical

Immunocomprimised

40
Q

what is the pathoophysiology of penumonia

A
  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
41
Q

what are the 3 broad types of pneumonia

A

Broncho

Segmental

Lobar

42
Q

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

A

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

43
Q

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

A

CXR in 6-8 weeks

44
Q

what are some general complications of pneumonia

A

pleural effusion

sepsis

empyema

abscess

45
Q

how is aspiratoin pneumonia treated

A

Amox & met

46
Q

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 (?)
A
  1. staph A
  2. pneumococcal
  3. legionella
  4. mycoplasma
  5. srep pneumoniae
47
Q

how is legionnaires treated

A

clarithromycin

erythromycin is preggers

48
Q

what is a common cause of legionnaires disease

what tests do you have to do

A

poor air conditioning

tests:

urinary antigen

Bloods -> Na (low), WCC (low)

49
Q

what are the most common examination signs of pneumonia

A

reduced chest expantions

dull percussion

crackles

increaed vocal fremitius

50
Q

HAP treatments

  1. whats used if <5 days
  2. whats used if >5 days
A
  1. co-amox
  2. tazocin (bad boy)
51
Q

what the main findings on a CXR for legionnaires

A

bilateral basal consolidation

52
Q

pneumonia

Painful BLUE fingers

+ve cold agglution test

whats this & what causes it

A

Cold-Autoimmune heamolytic anaemia

mycoppalsma

53
Q

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

A

Empyema

check pH

54
Q

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

A

CURB-65

55
Q

for any potential viral cause, what test do you do

A

viral PCR

56
Q

what are the criteria for CURB-65

A

Confusion

Urea >7

RR> 30

Bp <90 (sy) or <60 (di)

Over 65

57
Q

what BP will score you a point on CURB-65

A

<90 sys

or

<60 di

58
Q

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

A

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

59
Q

what are some causes of typical and aytpical pneumonia

A

typical

Strep pneumoinia

H. influenzae

Staph A

Moraxella

aytpical

Legionnaires

Mycoplasma

Chalymdia

TB

60
Q

how are these CAPs treated:

  1. CURB 3
  2. CURB <3
A
  1. IV co-amox + clarithromycin
  2. amox (clarith if PA)
61
Q

what are some risk factors for penumona

A

Smoking

Ashtma & COPD

Cancer

Diabetes

Immunocomprismied

Low weight

62
Q

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

A

Pseudomonas

IV ciprofloxacin

63
Q

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

A

SEPSIS

64
Q

what are some differences between typical and atypical pneumonai

A

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

65
Q

what type of pneumonia is this:

gram stainign not useful (no cell wall)

gradual onset

systemic symtpoms

diffuse CXR findigns

A

Aytpical

66
Q

what lobe is most commonly affetcd by apsiration penumonia & why

how would the CXR look

A

Right middle lobe

Bronchus is wider and more vertical

conolidaton on the right middle lobe= ALWAYS GUESS THIS

67
Q

what are some risk factors for aspiration pneumonia

A

Stroke

NGT

Swallowing issues

MS

68
Q

has aspiratoin pnuemonia

INR is going up

why

A

on metronidazole

69
Q

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

A

Prednisalone

70
Q

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

A

sputum -> red current

CXR -> cavitating opacities

71
Q

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

A

strep prenumnonia or pseumodomas

72
Q

what is the cause of pneumonia from exoctic birds

A

chlamydia psittiaci

73
Q

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

A

WCC dropping

Oh no- Infections (13 decks)

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