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Mi - LRTI Flashcards

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1
Q

contrast URTI and LRTI

A

URTI = sinusitis / tonsilitis
LRTI = bronchitis / pneumonia / empyema / bronchiectasis / lung abscess

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2
Q

list 5 ways the airway can be compromised

A

poor swallow
abnormal ciliary function
dilated airways
HIV
immunosuppression

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3
Q

18F PC: fever, cough, malaise
Presented at A&E with:
sats 87
temp 38
RR 24
WCC high - neuts high
CRP high
CXR shows consolidation R lower lobe
CT shows collapsed R lower lobe
Dx & most likely organism?

A

R lower lobe pneumonia
streptococcus pneumoniae

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4
Q

what does strep pneumoniae look like

A

diplococci
purple (gram stain +)

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5
Q

why can strep pneumonia look green on the agar plate

A

alpha haemolysis as its sensitive to optochin

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6
Q

what % of CAP is caused by strep pneumoniae

A

30-50%

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7
Q

what is strep pneumoniae sensitive to almost always

A

penecillin

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8
Q

what is pneumonia

A

inflammation of the lung alveoli (LRTI)

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9
Q

what is the mortality % of pneumonia

A

5-10%

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10
Q

what % of people with pneumonia are admitted

A

20-40%

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11
Q

how can you tell where in the lung the pneumonia is

A

localising Sx
abnormal CXR

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12
Q

PC of pneumonia

A

fever
pleuritic chest pain
cough
SoB
malaise
N&V

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13
Q

what is HAP associated with

A

ventilators

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14
Q

RFs for developing pneumonia

A

lung disease
immunocompromise
geography / seasonal / epidemics
travel
exposure

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15
Q

bacterial causes of CAP

A

strep pneumoniae
Hameophilus influenzae
Moraxella catarrhalis
Staph aureus
klebsiella pneumoniae

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16
Q

what 2 bugs cause the most CAP and what % of CAP do they cause

A

strep pneumoniae
haemophilus influenzae
85%

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17
Q

bacterial causes of HAP

A

legionella mycoplasma
coxiella burnetti
chlymidia psitticae

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18
Q

what is coxiella burnetti also known as

A

Q fever

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19
Q

who gets chlymidia psitticae

A

people with birds

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20
Q

what do people with chlymidia psitticae get (physical sign)

A

splenomegaly

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21
Q

what pneumonia pathogens affect neonates (0 to 1 month)

A

E coli
group B strep (GBS)
Listeria

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22
Q

what pneumonia pathogens affect 1-6 month olds

A

Chlymidia trachomatia
RSV
Staph aureus

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23
Q

what pneumonia pathogens affect 6 months - 5 year olds

A

Mycoplasma
Influenza

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24
Q

what pneumonia pathogens affect 5+ year olds

A

strep pneumoniae

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25
Ix for pneumonia
FBC, U&Es, CRP blood cultures sputum MC&S ABGs CXR
26
why are ABGs done in pneumonia
detect hypoxia
27
what score is used to determine who should be admitted with pneumonia
CURB65
28
components & cut offs of CURB65
confusion urea >7 RR >30 BP <90S or<60D >65 years old 2+ admit 2-5 severe
29
what is bronchitis
inflammation of medium sized airways
30
who gets bronchitis
smokers kids with RSV
31
Sx of bronchitis
cough fever increased sputum SoB
32
what does the CXR of bronchitis show
nothing its normal
33
what causes bronchitis
viruses - RSV, COVID, influenza CAP bacteria
34
Mx of bronchitis
bronchodilators physiotherapy
35
what stain is used to detect haem influenzae
chocolate agar
36
what does H influenzae look like
coccibacilli gram - (pink)
37
what % of CAP is caused by H influenzae
18-35%
38
who gets H influenzae CAP
people with lung disease
39
what caution must be taken with treating H Influenzae
be careful with beta lactams as it may produce beta lactamase
40
62M SoB & recent confusion smoker Bloods: low Na CXR: bilateral interstitial changes Dx?
Legionella
41
Sx of legionella
confusion abdo pain low sodium low lymphocytes
42
how do you get legionella
inhalation of infected water droplets from aerosols / air con
43
how do you diagnose legionella
Ag in urine
44
what do you culture legionella on
buffered charcoal yeast extract
45
what is legionella sensitive to
macrolides
46
what do the atypical CAP organisms have in common
no cell wall
47
name the CAP atypicals
mycoplasma legionella chlymidia Coxiella
48
what ABx work with atypicals
clari doxycycline
49
what extrapulmonary features can be present with atypicals
hepatitis low Na
50
what % of CAP are atypicals
20%
51
what is clinical course of atypicals
flu like prodrome fever pneumonia
52
who gets coxiella burnetti
people with pets / farm animals
53
how is coxiella burnetti spread
aerosol / infected milk
54
how do you diagnose coxiella burnetti
serology
55
what is coxiella burnetti sensitive to
macrolides
56
who gets chlymidia psittaci
people with birds
57
how is chlymidia psittaci spread
inhalation of infected droplets
58
how is chlymidia psittaci diagnosed
serology
59
what is chlymidia psittaci sensitive to
macrolides
60
74F SoB, fever, R pleuritic chest pain O/E reduced percussion, reduced air entry at R base CXR - consolidation R base Admitted, given beta lactams, atypical cover but continued to spike fevers and have raised CRP Dx?
Empyema with collapsed lung
61
what causes are behind why resp patients fail to improve when on a Tx
Empyema / abscess tumour resistance eg TB not absorbing the ABx immunosuppression
62
what clues in the history suggest TB
ethnicity prolonged prodrome fever weight loss haemoptysis
63
CXR of TB
upper lobe cavitation but high variability
64
when can HAP be diagnosed
>48 hours in hospital
65
who gets HAP
previous ABx ventilator users
66
what type of bacteria usually cause HAP
gram -
67
bacterial causes of HAP
staph aureus enterpbacteria pseudomonas candida
68
% of HAP caused by staph aureus
19%
69
% of HAP caused by enterobacteria
31%
70
% of HAP caused by pseudomonas
17%
71
% of HAP caused by candida
7%
72
who gets candida HAP
immunosuppressed
73
64M in hopsital for months, treated for lymph node TB, has SoB. CXR shows bilateral patchy ground glass shadowing. Dx?
PCP - pneumocystis jirovecii
74
what is pneumocystis jirovecii
protazoa ubiquitous in environment
75
Sx of pneumocystis jirovecii
INSIDIOUS dry cough weight loss SoB malaise
76
what does the CXR of pneumocystis jirovecii show
bats wing sign ground glass shadowing
77
how is pneumocystis jirovecii clinically diagnosed
walking test - their O2 sats will drastically fall after walking
78
how is pneumocystis jirovecii properly diagnosed
immunoflurescence on BAL or PCR
79
Tx of pneumocystis jirovecii
septrin (co-trimoxazole)
80
how can you prevent someone from getting pneumocystis jirovecii & who would you give this to
prophylactic septrin if immunosuppressed
81
who typically gets pneumocystis jirovecii
HIV pts cancer pts immunosuppressed pts
82
22M chemo for leukaemia. Prolonged neutropenia, fevers, raised CRP despite ABx. CT thorax: infiltration, interstitial change Dx and pathogen?
Aspergillosus aspergillus fumigatus
83
what is aspergillosus
allergic bronchopulmonary disease due to aspergillus
84
what does the agar plate look like for aspergillus
flowering spores of aspergillus
85
what LRTI is associated with HIV
PCP TB atypical mycobacteria
86
what LRTI pathogen is associated with neutropenia
fungi eg aspergillus
87
what LRTI virus is associated with BM transplant
CMV
88
what LRTI is associated with splenectomy
encapsulated bacteria eg strep pneumoniae, H.influenzae
89
possible Ix for LRTI
sputum blood culture BAL / pleural fluid Ag or AB test immunoflurescnce PCR
90
what is BAL and when is it used
broncheoalveolar lavage ITU
91
which pathogens are diagnosed by Ag test
strep pneumoniae legionella
92
what is important to remember when taking BCs for Dx of LRTI
do it before ABx

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