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Path - Microbiology > Resp tract infections > Flashcards

Resp tract infections Flashcards

1
Q

list some LRTI?

A 
Bronchitis
Pneumonia
Empyema
Bronchiectasis
Lung abscess
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2
Q

list some URTIs?

A

sinusitis

tonsillitis

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3
Q

list some things can compromise normal respiratory defences?

A

Abnormal ciliary function - smoking
Abnormal mucus - cystic fibrosis

Dilated airways: bronchiectasis
Defects in host immunity - HIV

Poor swallow - weak muscles

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4
Q

18 yr old woman
LLL pneumonia
Unwell
Raised WCC + CRP

most likely organism? and why?

A

strep pneumoniae

because is most common cause of CAP

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5
Q

Characterise S. pneumoniae resp infection?

A

Acute onset
Severe pneumonia
Fever, rigors
Lobar consolidation*

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6
Q

Pneumonia

A

inflammation of the lung alveoli

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7
Q

how does pneumonia present?

A

Fever
Cough
Pleuritic chest pain
Shortness of breath

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8
Q

list organisms most implicated In CAP - atypical and typical ?

A

§ TYPICAL (85%)
□ Streptococcus pneumoniae
□ Haemophilus influenzae

§ ATYPICAL (15%)
□ Legionella
□ Mycoplasma
□ Coxiella burnetii (Q fever)
® Exposure to farm animals
□ Chlamydia psittaci (Psittacosis)
Exposure to birds, splenomegaly, rash, haemolytic anaemi

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9
Q

list come examination findings for pneumonia?

A 
○ Pyrexia 
		○ Tachycardia 
		○ Tachypnoea 
		○ Cyanosis 
		○ Dullness to percussion
		○ Bronchial breathing 
		○ Crackles
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10
Q

what is the score used to triage pneumonia patients?

A 
• CURB-65
		○ Confusion 
		○ Urea > 7 mmol/L 
		○ RR > 30 
		○ BP < 90 systolic, < 60 diastolic 
		○ 65+ years 
	○ Interpretation
		§ 2 = consider admitting 
		§ 2-5 = manage as SEVERE pneumonia and consider ITU admission
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11
Q

which are the most common pathogens causing respiratory infection in the very vey young?

A

0-1 mths- E.coli, GBS, Listeria

1-6mths- Chlamydia trachomatis, S aureus, RSV

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12
Q

define Bronchitis

A

Inflammation of medium sized airways.

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13
Q

who gets bronchitis?

A

smokers mainly

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14
Q

symptoms of bronchitis?

xray will show what?

A

Cough, fever, increased sputum production, increased shortness of breath.

CXR: normal

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15
Q

common organisms causing bronchitis?

A

S. pneumoniae
H. influenzae
M. catarrhalis

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16
Q

treatment for bronchitis?

A

○ Bronchodilation
○ Physiotherapy
○ +- Antibiotics

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17
Q

when is rusty sputum produced?

A

lobar pneumonia

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18
Q

Classical Causes of Cavitation on CXR

A

○ Staphylococcus aureus
○ Klebsiella pneumoniae
○ TB

can be h.influenzae if older

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19
Q

Consider H. influenzae as an important cause of community acquired pneumonia in which group?

A

specially in the elderly and adults WITH COPD

so pre-existing lung disease

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20
Q

a patient presents with pneumonia type symptoms and is

Hyponatraemic !
Confusion !
Diarrhoea !
Abdominal pain !

CXR - Bilateral interstitial change

What is the likely organism?

A

Legionella

don’t be a clown know this one!

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21
Q

how to culture legionella?

A

buffered charcoal yeast extract

-> urinary antigen too - not culture though

22
Q

legionella Can cause multi-organ failure. how can this be linked to low sodium?

A

hypervolaemic hyponatraemia - which is the organ failures

23
Q

Atypical pneumonia’s are caused by which organisms?

A

Mycoplasma
Legionella
Chlamydia
Coxiella

don’t have cell walls

24
Q

which abc can you NOT use for atypical pneumonia’s?

which can you use?

A

Cell-wall active antibiotics e.g. penicillins don’t work

can use:
Macrolides (clarithromycin / erythromycin)
Tetracyclines (doxycycline)

25
Q

which pneumonia’s have Extrapulmonary features for example low sodium?

A

atypical ones

26
Q

which pneumonia’s have a Flu-like prodrome before fever & pneumonia

A

atypical ones

27
Q

Legionella pneumophilia is spread by?

A

aerosol’s

28
Q

which pneumonia presents with Lymphopenia?

A

Legionella pneumophilia

29
Q

Rx for Legionella pneumophila

A

Macrolides (clarithromycin / erythromycin)

30
Q

Chlamydia psittaci route of transmission?

A

birds - inhalation

  • macrolides
31
Q

coxiella burnetti route of transmission?

A

aerosol/milk

  • macrolides
32
Q

what is an empyema?

risk factors?

A

Empyema is defined as a collection of pus in the pleural cavity, gram-positive, or culture from the pleural fluid.

Empyema is usually associated with pneumonia but may also develop after thoracic surgery or thoracic trauma.

33
Q

reasons for Failure to improve on treatment?

A 
Empyema / abscess - needs drainage
Resistant organism (incl. Tb)
Proximal obstruction (tumour)

Not receiving / absorbing Abx
Immunosuppression

34
Q

the following are classic for what;

Fevers
Weight loss !
Haemoptysis
CXR: Classically upper lobe cavitation

A

TB

35
Q

infections can be classified as HAI after what time period?

A

> 48 hours in hospital.

36
Q

what can help to differentiate upper respiratory from lower respiratory flora?

A

bronchial lavage

37
Q

most common cause of nosocomial pneumonia?

A

enterobacteriacae:

Gram-negative bacteria of a large family that includes Escherichia coli, Klebsiella, Salmonella, Shigella

38
Q

Dry cough, weight loss,

bat’s wing” – bilateral ground glass on CXR is caused by which organism?

A

Pneumocystis jirovecii

39
Q

young man
Chemotherapy for leukaemia

Neutropenic
Interstial change on CT

caused by which organism?
rx?

A

Aspergillus fumigatus - invasive aspergillosis

Rx - Amphotericin B

40
Q

3 presentations of Aspergillus fumigatus?

A

Allergic bronchopulmonary aspergillosis
-Chronic wheeze, eosinophilia

Aspergilloma
- Fungal ball often in pre-existing cavity , haemoptysis

Invasive aspergillosis
- Immunocompromised

41
Q

in immunosuppression, neutropenia puts you at risk of which infections?

A

fungi e.g. Aspergillus spp

42
Q

in immunosuppression, HIV puts you at risk of which infections?

A

PCP*, TB, atypical mycobacteria

*pneumocystitis jerovici

43
Q

in immunosuppression, Bone marrow transplant puts you at risk of which infections?

A

CMV

44
Q

in immunosuppression, Splenectomy: puts you at risk of which infections?

A

encapsulated organisms

e.g. S. pneumoniae, H. influenzae, malaria

45
Q

In LRTI what ivx to send before abx?

A

Sputum/induced sputum (i.e. with nebulisers)

Blood cultures

46
Q

urine antigen tests can be done for?

but when to do them though?

A

S. pneumoniae
Legionella pneumophila

send for severe community-acquired pneumonia

47
Q

mild/moderate CAP rx?

A

Amoxicillin

48
Q

Moderate-severe CAP rx?

A

co-amoxiclav AND clarithromycin.

49
Q

Treatment for HAP;

A. 1st line mild
B. ITU

A

A. First line: Ciprofloxacin +/- vancomycin.

B. Second line/ITU: Piptazobactam AND vancomycin

50
Q

Treatment for MRSA HAP?

A

Vancomycin

51
Q

Treatment for Pseudomonas HAP?

A

Piptazobactam

Path - Microbiology (27 decks)

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