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MedEd + PathSoc + Laz's Qs + Romesh Path > Microbio 12: Resp Tract Infections > Flashcards

Microbio 12: Resp Tract Infections Flashcards

1
Q

Streptococcus pneumoniae is:(type of bacteria?)

A

Gram-positive cocci in chains

Alpha-haemolytic and optochin-sensitive

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2
Q

Why is no microbiological identification of the pathogen made in most cases of CAP?

A

Difficult to obtain a good sputum sample and early treatment is usually initiated with empirical antibiotics

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3
Q

List the main organisms that cause CAP.

A

SMH
Streptococcus pneumoniae - aka pneumococcus
Moraxella catarrhalis
Haemophilus influenzae - cavitating leisons

Staphylococcus aureus
Klebsiella pneumoniae

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4
Q 
List the most prevalent pathogens causing CAP in the following age groups:
0-1months
1-6months
6m-5y
16-30y
A

0-1 months
Escherichia coli
Group B Streptococcus
Listeria monocytogenes

1-6 months
Chlamydia trachomatis
Staphylococcus aureus
RSV

6m-5y
Mycoplasma pneumoniae
Influenza

16-30y
Mycoplasma pneumoniae
Streptococcus pneumoniae

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5
Q

List the causes of CAP that fall into the following two categories:
Typical
Atypical

A

Typical:
Streptococcus pneumoniae
Haemophilus influenzae

Atypical:
Legionella
Mycoplasma
Coxiella burnetii
Chlamydia psittaci
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6
Q

What is the CURB-65 score? How is it interpreted?

A 
Confusion 
Urea > 7 mmol/L
Respiratory rate > 30/min
BP < 90 systolic, < 60 diastolic
Age> 65

Score of 2 = consider hospital admission
Score of more than 2 = severe pneumonia that may need ITU admission

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7
Q

Outline the presentation of bronchitis.

A

Cough
Fever
Increased sputum production
Increased SOB

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8
Q

Which organisms cause bronchitis?

A

Viruses

Streptococcus pneumoniae
Moraxella catarrhalis
Haemophilus influenzae

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9
Q

List some bacterial causes of cavitating lung lesions.

A

Staphylococcus aureus

Klebsiella pneumoniae

TB

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10
Q

What type of bacterium is H. influenzae?

A

Gram-negative cocco-bacilli (rod)

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11
Q

How is Legionella spread?

A

Inhalation of infected water droplets

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12
Q

What medium is Legionella grown on?

A

Buffered charcoal yeast extract

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13
Q

What is a common feature of bacteria that cause atypical pneumonia?

A

They have NO cell wall

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14
Q

List four atypical organisms.

A

Mycoplasma
Legionella
Chlamydia
Coxiella

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15
Q

Which type of antibiotics do not work on atypical bacteria?

A

Penicillins

NOTE: this is because they act on cell walls

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16
Q

Which type of antibiotics do work on atypical bacteria?

A

Antibiotics that interfere with protein synthesis (macrolides, tetracyclines)

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17
Q

List some clinical features of Legionella pneumophila infection.

A 
Confusion 
Abdominal pain 
Diarrhoea 
Lymphopaenia
Hyponatraemia
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18
Q

Urinary antigens are associated with which causes of pneumonia?

A

Streptococcus pneumoniae

Legionella pneumophila

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19
Q

Which investigation is used for Coxiella and Chlamydia psittaci?

A

Serology

NOTE: serology looks at the development of antibodies after an infection (requires paired samples). It is useful for investigating bacteria that are difficult to culture

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20
Q

What is an empyema?

A

Collection of pus within the pleural cavity

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21
Q

List some reasons for failure to respond to treatment.

A

Empyema/abscess

Proximal obstruction (e.g. tumour)

Resistant organisms

Not absorbing antibiotics

Immunosuppression

Alternative diagnosis (e.g. lung cancer)

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22
Q

What is the classical CXR feature of TB?

A

Upper lobe cavitation

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23
Q

Which types of staining are used when investigating TB?

A

Auramine staining
Ziehl-Neelsen stain - GOATED

NOTE: they are red rods

24
Q

Define hospital-acquired pneumonia.

A

A pneumonia that is onset > 48 hours after hospital admission

25
Q

List some organisms that cause HAP.

A

Enterobacteriaciae (MOST COMMON – e.g. E. coli, K. pneumoniae)

Staphylococcus aureus
Pseudomonas
Haemophilus influenzae
Acinetobacter baumanii

Fungi (e.g. Candida)

26
Q

What is Pneumocystic jirovecii pneumonia?

A

Fungus that is ubiquitous in the environment but can cause pneumonia in immunocompromised patients

27
Q

Describe the typical presentation of Pneumocystic jirovecii pneumonia.

A 
Dry cough 
Weight loss 
SOB 
Malaise 
Walk test – desaturation on exertion
28
Q

How is PCP investigated?

A

Bronchoalveolar lavage

29
Q

What is the treatment for PCP?

A

Co-trimoxazole (septrin)

30
Q

What are the main features of allergic bronchopulmonary aspergillosis?

A

Chronic wheeze
Eosinophilia
Bronchiectasis

31
Q

What is an aspergilloma? symptom?

A

Fungal ball often forming within a pre-existing cavity

May often cause haemoptysis

32
Q

How is invasive aspergillosis treated?

A

Amphotericin B

33
Q 
Which organisms cause pneumonia in the following subgroups of patients:
HIV
Neutropaenic
Bone marrow transplant
Splenectomy
A

HIV:
PCP, TB, Atypical mycobacteria

Neutropaenic:
Fungal (eg. Aspergillus)

Bone marrow transplant:
CMV

Splenectomy:
Encapsulated organisms (NHS)
34
Q

In which organisms is serology useful for reaching a diagnosis?

A

Organisms that are difficult to culture

Examples: Legionella, Chlamydia, coxiella

35
Q

Which organism is investigated using immunofluorescence? how else is this detected?

A

PCP

NOTE: PCP can also be detected using silver stain

36
Q

What is the treatment for mild-to-moderate CAP?

A

Amoxicillin

OR erythromycin/clarithromycin (if penicillin allergic)

37
Q

What is the treatment for moderate-to-severe CAP?

A

Co-amoxiclav AND clarithromycin

38
Q

What is treatment options for HAP?

Caused by MRSA or Pseudomonas?

A

Ceftazidime

If MRSA - Vancomycin
If Pseudomonas - Tazocin + Gentamicin

39
Q

A 22 year old presents with shortness of breath and a cough with associated green
sputum. Her X-ray is shows lobar pneumonia.

What is the most likely causative organism?

A) Klebsiella pneumoniae
B) Haemophilus influenzae B
C) Moraxella catarrhalis
D) Streptococcus pneumoniae
E) Staphylococcus aureus
A

D) Streptococcus pneumoniae - standard + no unique symptoms, is the most common

40
Q

A 45 year old man alcoholic presents with shortness of breath and cough. His
sputum is blood-streaked and his X-ray is shows a cavitating leison.

What is the most likely causative organism?

A) Klebsiella pneumoniae
B) Haemophilus influenzae
C) Moraxella catarrhalis
D) Mycoplasma pneumoniae
E) Staphylococcus aureus
A

A) Klebsiella pneumoniae - alcoholic + blood streaked sputum is suggestive of klebsiella pneumoniae

HiB and Staph aureus can also cause cavitating leisons but history suggests the answer above

41
Q

What is the most likely causative organism of a hospital acquired pneumonia?

A

Pseudomonas aeruginosa

42
Q

RFs for HAP?

A

Admitted for 48+ hours

Intubated + ventilated

43
Q

A 35 year old man presents to his GP with shortness of breath and a dry cough. He
has been feeling feverish and complains of myalgia. He takes potent steroids for
his eczema and lives at home alone apart from his pet dog and parrot.

What is the most likely cause of his pneumonia?
A) Bacteroides
B) Coxiella burnetti
C) Chlamydia psittaci
D) Mycoplasma pneumoniae
E) Staphylococcus aureus
A

C) Chlamydia psittaci - This is an atypical pneumonia and this pt is at risk from steroid use + parrots are a buzzword for this organism

44
Q

What pneumonia is associated w/ transverse myelitis?

A

Atypical pneumonia caused by mycoplasma pneumonia

45
Q

What pneumonia is associated w/ air conditioning / hotel stay / stil water? What biochem findings may you find?

A

Leigonella pneumonia

Hyponatraemia + Deranged LFTs

46
Q

Which pneumonia is associated w/ farm animals?

A

Coxiella burnetti

47
Q

Atypical pneumonia symptoms?

A
  • Dry cough
  • Headache
  • Abdo pain
  • Diarrhoea
48
Q

Atypical pneumonia investigations? what is specific to mycoplasma?

A
  • Sputum MCS
  • Urine antigen
  • Serology
  • Blood film (mycoplasma – may mention cold agglutins in SBAs)
49
Q

What organisms would you see causing pneumonia in a pt w/ unsafe swallow? Mx of this?

A

Aspirational pneumonia caused by anaerobes from gut flora

It’s caused by anaerobes so treat w/ Metronidazole

50
Q

Mx of atypical pneumonia?

A

Clarithromycin

51
Q

A 30 year old woman is being treated with chemotherapy for acute lymphoblastic leukemia (ALL). She has recently been complaining of shortness of breath and had an episode of blood-streaked sputum. A chest X-ray is performed and a ‘Halo sign’ can be seen

What is the organism causing this?
What is the most appropriate treatment?

A) Co-amoxiclav
B) Dexamethasone
C) Fluconazole
D) Oseltamivir
E) Amphotericin B
A

Currently immune suppressed by chemo

‘Halo sign’ refers to nodule w/ ground-glass shadowing - caused by aspergillosis

Organism = Aspergillus

This means you need an anti-fungal to treat it (Leaves options C and E)

E) Amphotericin B - anti-fungal of choice in aspergillus

52
Q

A 24 year old HIV-positive woman presents with difficulty breathing. She feels especially short of breath after walking, and her exercise tolerance is greatly reduced.

What is the most likely causative organism? What is the CXR finding in these pts? Mx?

A) Influenza A
B) Aspergillus fumigatum
C) Influenza B
D) Pneumocystis jirovecii pneumonia
E) SARS-CoV-2
A

D) Pneumocystis jirovecii pneumonia - Strong associated w/ HIV + Shows SOBOE

Ground-glass shadowing - bat’s wing

Co-trimoxazole

53
Q

Erythema nodosum + FLAWS + Haemoptysis is associated w/ which resp infection?

A

TB

54
Q

Best and most accurate test for TB? what is the growth medium used?

A

Test - Zeihl-Neelsen Stain

Culture - grown on Lowenstein-Jensen growth medium

55
Q

Mx of TB? - Mneumonic

A 
RIPE:
R - Rifampicin 6/12
I - Isoniazid 6/12
P - Pyrazinamide 2/12
E - Ethambutol 2/12
56
Q

Mx of influenza?

A

Oseltamivir

MedEd + PathSoc + Laz's Qs + Romesh Path (99 decks)

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