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YR5 Microbiology > Crash Course TB + LRTI > Flashcards

Crash Course TB + LRTI Flashcards

1
Q

Describe the stages of TB

A

Primary: Initial infection, often in childhood, often asymptomatic

Latent: Suppressed, hangs around in foci

Post-primary: Reactivation of latent, often d.t. immunosuppression

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2
Q

Give 3 classes of common symptoms of TB

A

Constitutional: weight loss, fever, night sweats

Pulmonary: Productive cough, haemoptysis

Lymphadenitis: scrofula (cervical)

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3
Q

What is a ghon focus?

A

Competent immune system suppresses TB: macrophages form ball around TB = caseating granuloma
(Tuberculoma)

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4
Q

What is Miliary TB?

A

Disseminated haematogenous spread
Miliary seed appearance in lungs

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5
Q

What is Potts disease?

A

TB of the spine
Back pain
Vertebral collapse
Iliopsoas abscess

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6
Q

What is TB meningitis?

A

TB infiltration into the brain (Leptomeningeal enhancement)

Subacute meningitis- meningeal Sx but slow onset over a period of time

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7
Q

How does genitourinary TB present?

A

Sterile pyuria- leukocytes on urine dip but no organism detected

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8
Q

What is the gold standard investigation for active TB?

A

X3 sputum culture
Sputum culture on Lowenstein-Jensen media

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9
Q

What may be seen on imaging in TB?

A

CXR: upper lobe cavitation

CT: consolidation, Ghon focus

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10
Q

What is a faster test performed for active TB?

A

Sputum smear + Ziehl-Neelson stain for acid fast bacilli

(can also use auramine rhodamine stain)

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11
Q

What may be seen on histology in TB?

A

caseating granuloma (Haematoxylin + eosin stains)

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12
Q

What is the gold standard test for exposure to TB?

A

IGRA
Elispot/ Quantiferon
+ve if exposure (active or latent)

Does NOT cross react with BCG

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13
Q

Which TB test cannot distinguish between exposure to TB and BCG vaccine?

A

Tuberculin skin tests: Mantoux/ Heaf

Also requires 2 visits

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14
Q

What is the treatment for TB?

A

Rifampicin (6)
Isoniazid (6)
Pyrazinamide (2)
Ethambutol (2)

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15
Q

What drug should be given with Isoniazid? Why?

A

Pyridoxine (Vit B6)

To prevent peripheral neuropathy

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16
Q

What is the MOA of Rifampicin?

A

Inhibits RNA polymerase

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17
Q

What is the MOA of Isoniazid?

A

Decreased mycolic acid synthesis (part of cell wall)

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18
Q

What is the MOA of Pyrazinamide?

A

Unknown

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19
Q

What is the MOA of Ethambutol?

A

Decreased polymerisation of cell wall

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20
Q

Give 3 side effects of Rifampicin

A

Orange / red secretions
CYP450 induction
Raised transaminases

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21
Q

Give 2 side effects of Isoniazid

A

Peripheral neuropathy (B6 deficiency)
Hepatotoxicity

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22
Q

Give 2 side effects of Pyrazinamide

A

Hyperuricaemia
Hepatotoxicity

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23
Q

Give a side effect of Ethambutol

A

Optic neuritis
(Pain, vision loss, 1 eye)

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24
Q

Give 3 second line drugs for TB

A

Amikacin
Quinolones
Linezolid

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25
Q

Give 3 drugs to use in multi drug resistant TB

A

Quinolones
Aminoglycosides
Cycloserine

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26
Q

What is in the BCG vaccination?

A

Live attenuated M. Bovis

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27
Q

What drugs are used for latent TB?

A

Just Rifampicin + Isoniazid

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28
Q

Give 4 risk factors for mycobacterium TB

A

Travel
HIV
Close contacts
IVDU

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29
Q

Give 3 risk factors for non-tuberculous mycobacterium

A

> 65
Immunosuppression
Environmental exposure (water, soil)

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30
Q

What does mycobacterium leprae invade?

A

Schwann cells + Histiocytes

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31
Q

What are the 2 types of mycobacterium leprae?

A

PAUCIbacillary tuberculoid

MULTIbacillary lepromatous

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32
Q

Give 4 features of paucibacillary tuberculoid leprosy

A

Few skin lesions
Hairless plaques
Loss of sensation
Robust T cell response

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33
Q

Give 4 features of multibacillary lepromatous leprosy

A

Multiple skin lesions
Thickened dermis
Lion like face
Poor T cell response

34
Q

Give 4 features of Mycobacterium ulcerans

A

Slow growing

Insect transmission/ bite

Early: painless nodules
-> Bairnsdale ulcer/ Buruli ulcer

Slow progression into ulceration + deformity

35
Q

Give 4 features of mycobacterium avium (MAC)

A

Slow growing

Commonly found in soil, food, water

May invade bronchial tree or pre-existing bronchiectasis/ cavities (CF, COPD, Aspergillosis etc) if immunocompromised

  • May cause mycobacteraemia → consider in patients with HIV + longstanding diarrhoea
36
Q

Give 4 features of mycobacterium marinarum

A

Slow growing
Swimming pool/ aqaurium owners
Single or clusters of papules on hands
“Swimming pool granuloma”

37
Q

List 3 fast growing NTM

A
  • Mycobacterium abscessus
  • Mycobacterium chelonae
  • Mycobacterium fortuitum
38
Q

What is Bronchitis?
Who is it most commonly seen in?
What is the typical cause?
What are the X-ray findings?
How will the patient present?

A

Inflammation of medium sized airways
Smokers + young kids
Viral
Minimal CXR findings
Patient not too unwell- supportive Tx

39
Q

What is pneumonia?
What are the X-ray findings?
What is the typical cause?
How will the patient present?

A

Infection of lung parenchyma
Consolidation on CXR
Bacterial
Patients look sick

40
Q

What is a lung abscess?
How does a patient present?
What is often the cause?
How is it managed?

A

Pus filled cavetating lesion in parenchyma
Constitutional Sx: FLAWs, swinging fever, weeks ongoing
Complication of pneumonia (consider if not responding to Abx)
Needs drainage

41
Q

What is a lung empyema?
What is often the cause?
How is it managed?

A

Pus filled collection in a space that already exists e.g. pleural space
= Infective pleural effusion
Complication of pneumonia
Needs drainage

42
Q

How is pneumonia classified?

A

CAP: develop in community
HAP: develop >48h after hospital admission
VAP: develop on ventilator

43
Q

What is the diagnosis? What can be seen here?

A

Bronchitis
Thickening of central bronchi

44
Q

What is the diagnosis? What can be seen here?

A

Pneumonia
Right middle lobe consolidation

45
Q

What is the diagnosis? What can be seen here?

A

Empyema
Looks like pleural effusion- loss of costophrenic angles + meniscus on top

46
Q

What is the diagnosis? What can be seen here?

A

Abscess
Well circumscribed lesion within parenchyma
Air spaces within
Cavity walled off with fluid inside

47
Q

Give 4 features of typical pneumonia presentation

A

Systemically unwell
Rapid onset
LOBAR consolidation on CXR
Responds to penicillins

47
Q

Give 2 features atypical pneumonia presentation

A

Flu-like prodromes, often dry cough, myalgias
Respond to macrolides

48
Q

What is the most common typical pneumonia? Give 3 features

A

Streptococcus pneumonia
Rusty coloured sputum
Gram +ve Diplococcus
+ve Urine antigen test

49
Q

List 3 typical pneumonias

A

Streptococcus pneumoniae (aka pneumococcus)
Haemophilus influenzae B (Cavitating lesions)
Moraxella catarrhalis

50
Q

In which patient group is haemophilia influenzae pneumonia more common? What type of organism is this?

A

COPD
Gram -ve coccobacillus

51
Q

In which patient group is mortadella catarrhalis pneumonia more common? What type of organism is this?

A

Smokers
Gram -ve coccus

52
Q

What is the treatment of a mild CAP?

A

Amoxicillin

53
Q

What are the elements of CURB-65?

A

Confusion – AMTS < 9
Urea > 7mmol/L
Resp. rate > 30
BP < 90/60
65 or older

0-1: Treat at home- amoxicillin
2: Admit- co-amoxicillin + clarithromycin
3+: Admit, co-amoxicillin + clarithromycin, consider ITU

54
Q

Give 4 causes of atypical pneumonia and their associated exposures

A

Mycoplasma pneumoniae: young people close proximity e.g. halls

Legionella pneumophila: A/C, plumbers, travellers

Chlamydia psittaci: Pet birds

Coxiella burnetti: Farm animals

55
Q

Give 4 features of legionella pneumophila

A

Hepatitis
Hyponatraemia
Lymphopaenia
+ve urine antigen test

56
Q

Give 2 signs of mycoplasma pneumoniae

A

Jaundice (cold AIHA)
Erythema multiform (Target shaped rash)

57
Q

Give 4 symptoms of atypical pneumonias

A

Dry cough
Headache
Abdo pain
Diarrhoea

58
Q

Which atypical pneumonias cause a culture -ve endocarditis?

A

Chlamydia psittaci
Coxiella burnetti

59
Q

What investigations are required for atypical pneumonia?

A
  • Sputum MCS
  • Urine antigen
  • Serology
  • Blood film: mycoplasma- cold agglutins
60
Q

What is the treatment for atypical pneumonia?

A

Clarithromycin

61
Q

Give 3 common organisms causing HAP

A

Pseudomonas aeruginosa

Staphylococcus aureus (Cavitating lesions)

Klebsiella pneumoniae (ALCOHOLICS) (Cavitating lesions)

62
Q

Give 3 features of S. aureus pneumonia

A

Often post- viral influenza
Cavitating lesions (abscess)
Grame +ve cocci in bunches

63
Q

Give 4 features of Klebsiella pneumoniae

A

a/w Alcoholics + aspiration
Haemoptysis
Cavitating lesions
Gram -ve rods, anaerobic

64
Q

What is the treatment of HAPs?

A

Ciprofloxacin + Vancomycin

Severe: Piperacillin/ tazobactam + Vancomycin

65
Q

What is the treatment if confirmed MRSA pneumonia?

A

Vancomycin

66
Q

What is the treatment if confirmed pseudomonas pneumonia?

A

Piperacillin/ tazobactam

67
Q

Give 3 organisms that cause pneumonia in HIV patients

A

Pneumocystis jirovecii
TB
Cryptococcus neoformans

68
Q

Splenectomy patients are more susceptible to which organisms causing pneumonia?

A

Encapsulated organisms
Neisseria
Haemophilus
Streptococcus

69
Q

Cystic fibrosis patients are more susceptible to which organisms causing pneumonia?

A

Pseudomonas aeruginosa
Burkholderia cepacia

70
Q

Infection with which organism is a contraindication for lung transplant in CF patients?

A

Burkholderia cepacia

71
Q

Give 2 risk factors for aspergillum pneumonia

A

Immunocompromised (Neutropenia)
Asthma

72
Q

What must be checked before starting monoclonal therapy?

A

TB status as can cause TB reactivation

73
Q

What is the diagnosis? Describe what is seen

A

PCP
Honeycombing, big cystic spaces

74
Q

What is the diagnosis? Describe what is seen

A

PCP
Batwing shadowing- ground glass shadowing

75
Q

What is seen on CXR in aspergillus pneumonia?

A

Halo sign

76
Q

What is the treatment for aspergillus pneumonia?

A

Amphotericin B

77
Q

Give 2 symptoms of pneumocystis jirovecii pneumonia

A

Dry cough
SOBOE (insidious onset)

78
Q

What is the treatment for pneumocystis jirovecii pneumonia

A

Co-trimoxazole

79
Q

What antibiotics should be used for anaerobes causing pneumonia ?

A

Metronidazole

YR5 Microbiology (23 decks)

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