URTI and LRTI and lung infections (pneumonia and TB)

Question 1

microbial aetiology of infective pneumonia

Answer 1

• URT flora - strep pneumonia, hameophilis influenzae, staph aureus - enteric saprophytes - E coli, pseudomonas - extraveous pathogens - legionella pneumophilia, TB

Question 2

stain used to look for TB

Answer 2

Ziehl-Neelsen

Question 2

what are the two examples of single organ TB

Answer 2

potts disease (spine) urogenital tract

Question 3

bacterial causes of atypical pneumonia

Answer 3

mycoplasma pneumoniae coxiella burnetti legionella spp chlamydia pneumoniae

Question 4

what organisms are the main causative agent in hospital acquired pneumonia

Answer 4

gram negatives

Question 5

rhinovirus causes

Answer 5

mainly URTI and no LRTI

Question 6

frequent aetiological agents that cause lung abscess

Answer 6

Strep pnemonia mixed anaerobes Klebsiella

Question 7

frequent aetiological agents that cause atypical pneumonia

Answer 7

mycoplasma - doesnt have a cell wall! chlamydia M catarrhalis influenza RSV adenovirus Coxiella Legionella

Question 7

pathology of interstitial pneumonia

Answer 7

alveolar septa are widened and are infiltrated by lymphocytes, plasma cells and macrophages - no inflammatory cells in alveoli (may be filled with fluid)

Question 8

frequent aetiological agents that cause the common cold

Answer 8

rhinovirus, parainfluenza virus, RSV, enterovirus, coronavirus, HMPV

Question 9

frequent aetiological agents that cause of sinusitis

Answer 9

primary: viral secondary: H influenzae and Strep pnaumoniae

Question 10

Gram stain of strep pneumonia

Answer 10

Gram positive dipplococci

Question 11

4 routes of entry of micro-organisms to cause pneumonia

Answer 11

• inhalation of pathogens in air droplets - aspiration of infected secretions from the URT - aspiration of infected particles - gastric contents, food, drink, foreign bodies - haematogenous spread

Question 11

what is secondary TB

Answer 11

reactivation of dormant infection or reinfection where a cell mediated immune response leads to extensive caseation and cavitation if the caseous material discharges into a bronchus - usually involves the upper lobe

Question 12

what is the characteristic of alveolar pneumonias

Answer 12

consolidation! When lung tissue becomes firm and solid neutrophils within the alveolar saces

Question 13

frequent aetiological agents that cause of epiglottis

Answer 13

H influenzae type b

Question 13

serological diagnosis of pneumonia is important for which organisms

Answer 13

mycoplasma pneumoniae legionella pneumonophila chlamydophila and Chlaydia species coxiella burnetti

Question 13

treatment of pneumonia

Answer 13

best guess therapy - Penicillin G/amoxycillin + doxycycline/macrolide Bacteriostatic + bacteriocidal

Question 14

characteristic of miliary TB in organs

Answer 14

numerous granulomas

Question 15

chest x-ray signs of atypical pneumonia

Answer 15

reticulonodular infiltrate (dots and dashes) throughout both long fields

Question 16

frequent aetiological agents that cause empyema

Answer 16

staph aureus, secondary to pneumonia

Question 17

what is bronchopneumonia

Answer 17

alveolar pneumonia when consolidation is patchy around bronchioles - there are some areas that are affected separated by areas that are spared. Often multiple foci, involving more than one lobe or both lungs

Question 18

frequent aetiological agents that cause otitis media

Answer 18

pnuemococci H infleunzae, M catarrhalis

Question 19

frequent aetiological agents that cause pharyngitis/tonsillitis with nasal involvement

Answer 19

adenovirus, enterovirus, parainfluenza, influenza

Question 19

definition of tuberculosis

Answer 19

a chronic granulomatous pneumonia due to infection with the bacterium mycobacterium tuberculosis

Question 20

hallmark of abscesses

Answer 20

cavitating lesion containing purulent exudate

Question 21

What two organisms live in the lungs in a latent state in some people

Answer 21

P. jirovecii M. Tuberculosis

Question 22

what does exposure to birds (wild) in a cage predispose you to get

Answer 22

Psittacosis

Question 23

what kind of calcification occurs in secondary TB

Answer 23

dystrophic

Question 25

frequent aetiological agents that cause of acute bacterial pneumonia

Answer 25

pneumococci - mainly H influenzae Staph Klebs Legionella TB chlamydophila

Question 26

common microbiota in the URT

Answer 26

viridans streptococci Neisseria spp. Corynebacterium spp., gram-negative anaerobes H influenzae A, C, D C albicans strep pneumoniae CCGHNSV

Question 27

2 patterns of infective pneumonia

Answer 27

alveolar inflammation interstitial inflammation

Question 28

which organs does miliary TB involve

Answer 28

liver, spleen, BM, brain

Question 29

clinical features of TB

Answer 29

variable weight loss, malaise, fevers, night sweats, haemoptysis, dyspnoea and chronic cough

Question 31

frequent aetiological agents that cause of acute exacerbation of chronic bronchitis

Answer 31

usually pneumoccoci and/or H. Influenzae

Question 33

frequent aetiological agents that cause pharyngitis/tonsillitis (with no nasal involvement)

Answer 33

adenovirus, influenza, enterovirus, reovirus, Strep pyogenes, Strep group C and G

Question 33

what organism is the main causative agent in community acquired pneumonia

Answer 33

strep pneumoniae

Question 34

pathology of primary TB

Answer 34

Gohn complex - gohn focus - area of inflammation in the periphery of the midzone of the lung - enlarged mediastinal and hilar lymph nodes

Question 35

occasional microbiata pathogens in URT

Answer 35

strep pyrogenes meningococci

Question 36

when does acute bronchpneumonia usually occur

Answer 36

- at the extremes of life - secondary to pre-existing chronic condition (COPD, CHF, malignancy, CF) - post-operative complication related to impaired clearance of respiratory secretions - hospital acquired - secondary infections after viral URTI

Question 37

frequent aetiological agents that cause of croup

Answer 37

parainfluenza virus influenza A RSV

Question 39

frequent aetiological agents that cause of bronchiolitis

Answer 39

RSV

Question 40

how do the lungs macroscopically look with interstitial pneumonia

Answer 40

wet, dark and heavy

Question 41

how can TB spread through the body (routes)

Answer 41

- lymphatics - coughed up --\> laryngeal - coughed up and swallowed --\> gut and intestine - haematogenous - via blood stream

Question 43

characteristics of atypical pneumonia

Answer 43

not as sick cough for a long time slower onset overall milder course

Question 45

4 stages of lobar pneumonia

Answer 45

1. congestion- proteinasous exudate into alveoli 2. red hepatization - alveoli filled with neutrophils (consolidation), RBCs squeezed out - haemorrhage 3. grey hepatization - no longer have RBCs in alveolar space - have fibrin and macrophages 4. resolution

Question 46

presentation of a patient with atypical pneumonia

Answer 46

- systemic symptoms predominate over respiratory - flu like illness - malaise, aches and pains, headache, diarrhoea - dry, non-productive cough

Question 47

complications of secondary pulmonary TB

Answer 47

- progressive spread of caseation into surround lung - erosion of BVs - haemoptysis - erosion into bronchial tree leading to cavitation and spread of infection via airways - pleural inflammation and fibrosis - lung scarring

Question 49

what is lobar pneumonia

Answer 49

when it involves entirety of single lobe - often causes adjacent inflammation of the pleura

Question 50

how does legionella grow in air conditioning towers

Answer 50

grows inside amobae inside the tower

Question 51

characteristics of typical pneumonia

Answer 51

Productive cough Fever Dyspnoea Malaise

Question 52

complications of pneumonia

Answer 52

- pleurisy - empyema - abscess - bronchiectasis - death

Question 53

why is it important that you know where a patient has acquired pneumonia from?

Answer 53

so you have an idea on how to treat them

Question 54

characteristics in the patient with lobar pneumonia

Answer 54

- abrupt onset - fever -raised WBC count - cough - pleuritic chest pain - blood stained sputum - gram positive diplococci in sputum - bacteriemia

Question 55

2 kinds of alveolar pneumonia

Answer 55

bronchopneumonia lobar pneumonia

Question 56

which organism is notorious for producing abscesses

Answer 56

staph pneumonia

Question 57

frequent aetiological agents that cause acute bronchitis

Answer 57

usually as a complication of a viral URTI