THORACIC Section 4: INFECTION - Bacterial

Question 1

Features

Lobar Consolidation
Favors lower lobes.

Answer 1

Strep Pneumo

Question 2

Can be severe in sickle cell patients post splenectomy. The most common cause of pneumonia in AIDS patient.

Answer 2

Strep Pneumo

Question 3

Bronchopneumonia - patchy opacities

Answer 3

Staph A.

Question 4

Often bilateral, and can make abscess. Can be spread via the blood in endocarditis patients

Answer 4

Staph A

Question 5

Hemorrhagic lymphadenitis, mediastinitis, and hemothorax

Answer 5

Anthrax

Question 6

Classic Look: Mediastinal widening with pleural effusion in the setting of bio-terrorism

Answer 6

Anthrax

Question 7

Buzzword: “Bulging Fissure” from exuberant inflammation.

Answer 7

Klebsiella

Question 8

More likely to have pleural effusions, empyema, and cavity than conventional pneumonia.

Alcoholic and Nursing Home Patients.
Step 1 Buzzword was “currant jelly sputum”

Answer 8

Klebsiealla

Question 9

Usually bronchitis, sometimes bilateral lower lobe bronchopneumonia

Answer 9

H. Influenza

Question 10

Seen in COPDers, and people without a spleen

Answer 10

H. Flu

Question 11

Seen in COPDers, and people without a spleen

Answer 11

H. Influenza

Question 12

Patchy opacities,
with abscess formation

Answer 12

Pseudomonas

Question 13

ICUers on a ventilator (also CF and Primary Ciliary Dyskinesia). Pleural effusions are common, but usually small

Answer 13

Pseudomonas

Question 14

Peripheral and sublobar airspace opacity. Only cavitates in immunosuppressed patients.

Answer 14

Legionella

Question 15

Seen in COPDers, and around crappy air conditioners. X-ray tends to lag behind resolution of symptoms.

Answer 15

Legionella

Question 16

Anaerobes, with airspace opacities. They can cavitate, and abscess is not uncommon

Answer 16

Aspiration

Question 17

Airspace in peripheral lower lobes. Can be aggressive and cause rib osteomyelitis/ invade the adjacent chest wall.

Answer 17

Actinomycosis

Question 18

Classic story is dental procedure gone bad, leading to mandible osteo, leading to aspiration.

Answer 18

Actinomycosis

Question 19

Fine reticular pattern on CXR, Patchy airspace opacity with tree-in-bud

Answer 19

Mycoplasma

Question 20

Most common community-acquired pneumonia in 5 to 20-year-old.
Association with Swyer-James syndrome (SJS) - classic look = unilateral lucent lung.

Answer 20

Mycoplasma

Question 21

CXR Pneumonia Follow-up

1. Young person
2. Elderly

Answer 21

In a younger person - most people will say 6 weeks.

However, in an “elderly” patient - the follow-up interval should be extended to 3 months.