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Kat's Pathology > Respiratory Tract Infections > Flashcards

Respiratory Tract Infections Flashcards

1
Q

What are some URTIs (2)

A

Sinusitis

Tonsilitis

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2
Q

What are some LRTIs (5)

A 
Bronchitis 
Pneumonia 
Empyema 
Bronchiectasis 
Lung Abscess
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3
Q

What are some respiratory pathologies that make a patient more prone to infection (5)

A 
Poor swallow (CVA, muscle weakness, alcohol)
Abnormal ciliary function (smoking, viral infection, Kartagner's)
Abnormal mucus (CF)
Dilated airways (bronchiectasis) 
Defects in host immunity (HIV, immunosuppression)
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4
Q

18 year old woman c/o fever, cough, malaise
Diagnosed with flu by GP. No Abx

Attended A + E
Temp 38 º C
Sats 87% OA
RR 24
Chest- clear Bloods: WCC 40.8, Neut 36.3, CRP 63
CT showed densely consolidated and collapsed left lower lobe

What is the most likely organism?

A

Streptococcus pneumoniae

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5
Q

What type of bacteria is streptococcus pneumoniae

A

Gram positive cocci

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6
Q

What proportion of CAP is caused by streptococcus pneumoniae

A

30-50%

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7
Q

What are the clinical signs of a strep pneumoniae infection (3)

A

Severe pneumonia
Fever, rigors
Lobar consolidation

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8
Q

What is the most effective antibiotic for strep pneumoniae

A

Almost always penicillin sensitive

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9
Q

What is pneumonia

A

Inflammation of the lung alveoli

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10
Q

What is the mortality associated with pneumonia

A

5-10%

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11
Q

What percentage of CAP are admitted to hospital

A

20-40%

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12
Q

What is the presentation of pneumonia (6)

A 
Fever
Cough +/- sputum. 
Pleuritic chest pain 
Shortness of breath 
Rigors. 
Malaise, nausea and vomiting.

There are often localising signs and an abnormal CXR

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13
Q

How is pneumonia classified (2)

A

Community-acquired

Hospital-acquired

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14
Q

What is the most common cause of hospital acquired pneumonia

A

Ventilator associated

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15
Q

What are some underlying factors that predispose to pneumonia (4)

A

Pre-existing lung disease
immuno-compromise
Geography, seasons, epidemics
Travel, exposure to animals

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16
Q

What are the main organisms responsible for CAP (5)

A 
Streptococcus pneumoniae
Haemophilus influenzae 
Moraxella catarrhalis 
Staphylococcus aureus 
Klebsiella pneumoniae
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17
Q

What organisms cause pneumonia in 0-3months of age (3)

A

E.coli.
Group B Streptococcus
Listeria

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18
Q

What organisms cause pneumonia in 1-6monhs age (3)

A

Chlamydia trachomatis
Staphylococcus aureus
RSV

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19
Q

What organisms cause pneumonia in 6months-5 years (2)

A

Mycoplasma

Influenza

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20
Q

What organisms cause pneumonia in 16-30 years (2)

A

Mycoplasma pneumoniae

Streptococcus pneumoniae

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21
Q

What are most CAP

A

Typical 85%

Atypical 15%

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22
Q

What organisms cause typical CAP (2)

A

Streptococcus pneumoniae.

Haemophilus influenzae.

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23
Q

What organisms cause atypical CAP (4)

A

Legionella
Mycoplasma (epidemincs 4-6 years)
Coxiella burnetii (Q fever)
Chlamydia psittaci (psittacosis)

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24
Q

What are some risk factors for Q fever pneumonia (Coxiella burnetii) (3)

A

Present worldwide
Farm animals
Hepatitis

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25
Q

What increases risk of psittacosis

A

Exposure to birds

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26
Q

What are some features of psittacosis (3)

A

Splenomegaly
Rash
haemolytic anaemia

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27
Q

What are the clinical SIGNS of pneumonia (7)

A 
Pyrexia 
Tachycardia 
Tachypnoea 
Cyanosis 
Dullness to percussion, tactile vocal fremitus 
Bronchial breathing 
Crackles
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28
Q

What investigations are indicated in pneumonia (7)

A

FBC, U&E, CRP
Bacterial cultures, Sputum MC&S
CXR

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29
Q

What is the CURB65 score used for

A

Used to determine if a CAP requires hospitalisation

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30
Q

What are the components of the CURB65 score (5)

A 
Confusion 
Urea >7mmol/L
RR >30
BP <90S, >60D
>65 years
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31
Q

What CURB65 score warrants hospital admission

A

Score 2 = ?admit

Score 2-5 = mange as severe

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32
Q

What is bronchitis

A

Inflammation of medium sized airways

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33
Q

Who is prone to bronchitis

A

Smokers

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34
Q

What are the symptoms of bronchitis (4)

A

Cough
Fever
Increased sputum production
Increased shortness of breath.

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35
Q

What can you see on a CXR in bronchitis

A

Nothing - normal CXR

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36
Q

What organisms can cause bronchitis (4)

A

Viruses
S.pneumoniae
H.influenzae.
M.caterrhalis

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37
Q

How is bronchitis managed (3)

A

Bronchodilation
Physiotherapy
+/- antibiotics.

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38
Q 
56 year old man
Flu-like illness
Presented with cough and fever
Blood-stained sputum
Pyrexial
Not severely unwell
Cavitation of CXR
A

Haemophilus influenzae

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39
Q

What is haemophilus influenz

A

Gram negative coccobacillus

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40
Q

What proportion of CAP is due to h.influenzae

A

15-35%

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41
Q

Who is most at risk of h.influenzae pneumonia

A

More common in those with pre-existing lung disease

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42
Q

What must be noted with treating h.influenzae CAP

A

May produce beta-lactamase

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43
Q 
62 year old man
Presented with SOB
Family also reported recent confusion
Smoker
Satn 91% air
Chest examination normal
Na 124
CXR shows bilateral interstitial changes
A

Legionella pneumophilia

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44
Q

How do you acquire legionella CAP

A

Inhalation of infected water droplets

45
Q

What is the major complication of legionella pneumonia

A

Can cause multi-organ failure

46
Q

What culture is required to detect legionella pneumonia

A

Buffered charcoal yeast extract

47
Q

What is atypical pneumonia

A

Pneumonia caused by organisms without a cell wall

48
Q

What are some organisms which can cause atypical pneumonia (4)

A

Mycoplasma
Legionella
Chlamydia
Coxiella

49
Q

What antibiotics cannot be used in atypical pneumonias

A

Cell-wall active antibiotics do not work (e.g. penicilllins)

50
Q

What sort of antibiotics are needed in atypical pneumonias

A

Agents that work on protein synthesis

51
Q

What are some antibiotic classes that work on protein synthesis (2)

A

Macrolides

Tetracyclines

52
Q

Name two macrolides (2)

A

Clarithromycin

Erythromycin

53
Q

Name a tetracyclin

A

Doxycyclin

54
Q

What are some extra-pulmonary features of atypical pneumonias (2)

A

Hepatitis

Low sodium

55
Q

What proportion of CAPs are atypical

A

20%

56
Q

What are two key clinical features of atypical pneumonias (2)

A

Flu-like prodrome before fever and pneumonia

Extra-pulmonary complications

57
Q

How is legionella pneumonia spread

A

Aerosol spread

58
Q

Confusion, abdominal pain, diarrhoea are associated with…..

A

Legionella pneumophilia

59
Q

How is legionella pneumophilia diagnosed

A

Antigen in urine/serum

60
Q

What is the best antibiotic for legionella pneumonia

A

Macrolides (e.g. clarithromycin/erythromycin)

61
Q

How is coxiella burnetti transmitted (2)

A

Common in domestic/farm animals

Transmitted by aerosol or milk

62
Q

How is coxiella burnetii diagnosed

A

Serology

63
Q

What is the best antibiotic class to treat coxiella burnetti

A

Macrolides

64
Q

How is chlamydia psittaci spread

A

Spread from birds by inhalation

65
Q

How is chlamydia psittaci diagnoised

A

Serology

66
Q

What is the best antibiotic class for the treatmetn of chlamydia psittaci

A

Macrolides

67
Q

74 year old woman
Presented with SOB, fever and right sided pleuritic chest pain
PMH: IHD, CABG, AF
DH: Warfarin
Otherwise well
Examination: T 38.5oC
Reduced persussion note and decreased air entry right base.
Admitted, commenced on cefuroxime and doxycycline. Continued to spike fevers.

A

Empyema

68
Q

What are some causes why someone with pneumonia may not improve despite being on adequate treatment (6)

A 
Empyema/abscess
Proximal obstruction (tumour)
Resistant organism (TB)
Not receiving/absorbing antibiotics
Immunosuppression
Other diagnosis (lung cancer, cryptogenic organising pneumonia)
69
Q 
21 year old male
From Ecuador
Presented with cough, weight loss
U and E normal
Hb 10.4 
WC 9.8
LØ 1.1
HIV neg
CRP 173
Alb 31
CXR shows RUZ shadowing
A

Tuberculosis

70
Q

What are some clues for TB as a diagnosis of pneumonia (5)

A 
Ethnicity 
Prolonged prodrome 
Fevers
Weight loss 
Haemoptysis
71
Q

What is the classical appearance of TB on CXR

A

Upper lobe cavitation (but can vary considerably)

72
Q

How long does a patient have to have been in hospital to diagnose then with hospital acquired pneumonia

A

> 48 hours in hospital required before diagnosis can be made

73
Q

What are some factors that predispose to hospital acquired pneumonia (2)

A

Often previous antibiotics

Ventilator

74
Q

What is the desired investigation in suspected hospital acquired pneumonia

A

Bronchial lavage desirable to differentiate upper respiratory from lower respiratory flora

75
Q

What are the three most common causes of hospital acquired pneumonia (3)

A

Enterobacteriaciae - 31%
Staphylococcus aureas - 19%
Pseudomonas spp - 17%

76
Q 
64 year old retired general
Treated for lymph node Tb
Increasing SOB over one month
Non-productive cough
Chest examination: normal
CXR: bilateral ground glass shadowing
A

Pneumocystis carinii

77
Q

What causes pneumocystis carinii

A

Protozoan

78
Q

What are the clinical features of pneumocystis carinii (5)

A 
Insidious onset 
Dry cough 
Weight loss 
Shortness of breath 
Malaise
79
Q

What is the classical appearance of pneumocystis carinii on CXR

A

Bat’s wings

80
Q

How is pneumocystis carinii diagnosed

A

Immunoflouresence of bronchio-alveolar lavage

81
Q

What is the treatment for pneumocystis carinii

A

Septrin (co-trimoxazole)

82
Q

How can pneumocystis carinii be avoided

A

Prophylaxis septrin

83
Q

22 year old man
Chemotherapy for leukaemia
Prolonged neutropenia (<1.0)
Ongoing fevers and raised inflammatory markers
Abx: Meropenem, ciprofloxacin, vancomycin, Tazocin, gancyclovir
Interstial changes on CT

A

Aspergillus fumigatus

84
Q

What are the three forms of aspergillus fumigatus in the lung (3)

A

Allergic bronchopulmonary aspergillosis
Aspergilloma
Invasive aspergillosis

85
Q

How does allergic bronchopulmonary aspergillosis present (3)

A

Chronic wheeze, eosinophilia, bronchiectasis

86
Q

How does aspergilloma present (2)

A

Fungal ball often in pre-existing cavity.

May cause haemoptysis.

87
Q

Who is at risk of invasive aspergillosis

A

The immunocompromised

88
Q

What is the treatment for invasive aspergillosis

A

Amphotericin B

89
Q

What LRTIs are HIV patients at risk of (3)

A

PCP
TB
Atypical mycobacteria

90
Q

What is the causative organism:
Neutropenia
Immunocompromised

A

Fungi (e.g. aspergillus spp)

91
Q

What is the causative organism of pneumonia in a patient who has had a bone marrow transplant

A

CMV

92
Q

What is the causative organism in a patient who has had a splenectomy

A

Encapsulated organisms (e.g. s.pneumoniae, h.influenzae, malaria)

93
Q

What must be sent before commencing antibiotic treatment in a patient presenting with pneumonia (2)

A

Sputum/induced sputum

Blood cultures

94
Q

What organisms can be detected with a urinary antigen test (2)

A

S.pneumoniae

Legionella pneumophilia

95
Q

When should you send for a urinary antigen in CAP

A

If it is very severe

96
Q

What is the use of antibody tests (4)

A

Only useful on paired serum samples
Usually collected on presentation and 10-14 days later
Look for rise in antibody level over time
Most useful for organisms that are difficult to culture (e.g. chlamydia, legionella)

97
Q

When is immunoflouresence used (4)

A

Antibody labelled with fluorescent dye
Technique often used in Virology
PCP – Pneumocystis carinii (now renamed P. jiroveci) immunofluorescence is the only common IF test used in microbiology laboratories
May also be detected by Silver stain in cytology lab

98
Q

What antibiotics are effective in gram +ve organisms (5)

A 
Amoxycillin 
Flucloxacillin 
Co-amoxiclav=augmentin 
Cefuroxime 
Vancomycin
99
Q

What antibiotics are effective in gram -ve organisms (4)

A

Ciprofloxacin
Ceftazidime
Gentamicin
meropenem or piperacillin + taxobactam

100
Q

What antibiotics are effective against atypical organisms (2)

A

Clarithromycin/doxycycline

101
Q

What antibiotics are usually used in mild-moderate CAP (2)

A

Amoxicillin

or erythromycin/clarithromycin

102
Q

What antibiotics are usually used in moderate-severe CAP (2)

A

Needing hospital admission: augmentin (co-amoxiclav) and clarithromycin
Allergic: cefuroxime and clarithromycin

103
Q

What is first line in treating hospital acquired pneumonia (2)

A

Ciprofloxacin +/- vancomycin

104
Q

What is second line/ITU for treatment of hospital acquired pneumonia (2)

A

Piptazobactam and vancomycin

105
Q

What is used to treat MRSA hospital acquired pneumonia

A

Vancomycin

106
Q

What is used to treat pseudomonas hospital acquired pneumonia (2)

A

Piptazobactam or ciprofloxacin +/- gentamicin

107
Q 
21 year old man
No past medical history
Smoker
Drinker
Presented with cough and SOB
Satn 89% on air
Hypotensive

How would you treat this patient?

A

Treated with cef and clarithromycin
Fluid resuscitation (hypotensive)
Supplemental oxygen
Senior support requested

108
Q

How can you prevent pneumonia (2)

A

Smoking advice

Vaccination (childhood - immunisation schedule; adults: influenza annually, pneumovax every 5 year)

Kat's Pathology (105 decks)

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