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Flashcards in pulmonary infection Deck (110)
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1

D sign on CXR

empyema (pus in pleural space)

2

'swinging fever'

lung abscess

3

what is pneumonia

infection and inflammation of the alveoli (distal airspaces)

4

most common cause of pneumonia

bacteria
Streptococcus pneumonia (80%)

5

pneumocystis jjroveci and what does it present with

fungus which causes pneumonia, HIV patients, presents with dry cough

6

which organism is most likely to causes pneumonia in a patient with COPD

Haemophilus influenza

7

what symptoms is particularly associated with streptococcus pneumoniae

High fever, rapid onset and herpes labialis

8

Pneumonia straight after influenza

Staph Aureus

9

Pneumonia with a dry protracted paroxysmal cough and atypical chest signs/x-ray findings

Mycoplasma pneumonia

10

Pneumonia with Hyponatraemia and lymphopenia, infected air conditioning units

Legionella pneumoniae

11

Pneumonia in an alcoholic

Klebsiella pneumoniae

12

Signs and symptoms of pneumonia

Cough, sputum, dyspnoea, chest pain: may be pleuritic, fever

signs of systemic inflammatory response: fever, tachycardia
reduced oxygen saturation, reduced breath sounds, bronchial breathing
Dull on percussion

13

Investigations of pneumonia

CXR

14

Signs and symptoms of pneumonia

Preceding URTI
Cough- sputum, Haemoptysis
dyspnoea,
Pleuritic pain, abdominal pain, myalgia, athralgia
fever, tachycardia, malaise, anorexia, sweats, rigors
reduced SO2

reduced breath sounds, bronchial breathing
Dull on percussion, crackles, rub

Headache​+Confusion​

Diarrhoea

Herpes labialis​

Tachypnoea​

Cyanosis​

Hypotension

older people- unusual presentation
younger people- more classical presentation

15

Investigations of pneumonia and its findings

CXR- CONSOLIDATION

FBC (neutrophilia in bacterial infections)
blood cultures
U+E: check for dehydration
CRP: raised in response to infection
Arterial blood gases: if SaO2 low or the patient has pre-existing respiratory disease, eg COPD

16

Management of COPD

Antibiotics

Supportive care:
O2 therapy if the patients is hypoxaemic
IV fluids if hypotensive or dehydrated

17

How to decide how to manage patients with COA

CURB-65.

18

How to decide how to manage patients with COA

CURB-65.

Confusion
Urea (>7 mmol/L)
Respiratory rate >30
BP (systolic <90, diastolic <60)
65+

0 - managed in the community.

1 : Sa02 assessed-should be >92% for community and a CXR performed. If the CXR shows bilateral/multilobar shadowing hospital admission is advised.

2 +: Hospital

19

What organisms usually cause Lobar pneumonia, is it more likely to be hospital or community acquired and who is more likely to get it?

Caused by pneumococcus, legionella and klebsiella.

Usually community acquired and occurs in otherwise healthy young adults

20

Is pneumonia due to transudate or exudate

Exudate (fibrin rich fluid)

21

Complications that can arise from pneumonia

Organisation (fibrous scarring)
Bronchiectasis
Abscess, Empyema

22

Who gets Bronchopneumonia?
Associated organisms

Associated with pre-existing disease, like COPD, Cardiac failure, complication of viral infection or aspiration of gastric contents

Begins in airways then spreads towards alveolar lung

Organisms are more varied- Strep pneumoniae, Haemophilus Influenza
In aspiration- anaerobes, coliforms, Staphs

23

What is a Lung abscess
S+S
Common cause
Treatment

Localised collection of pus inside the lung
Causes malaise and swinging fever
Often acquired by aspiration

24

Bronchiectasis

Abnormal fixed bronchiole dilation with purulent secretions

Airway which is thick walled and larger in diameter than its accompanying pulmonary artery

If bronchus goes more than 2 /3rds of the way out towards chest wall, bronchiectasis

25

Causes of bronchiectasis

Fibrous scarring post-infection (pneumonia, TB, CF)

chronic obstruction (tumour)

upper lobe bronchiectasis in patient <40 -test for CF

Rheumatoid arthritis (connection unknown)

Youngs syndrome and kartanagers syndrome(dextrocardia) = primary cillial dysfunction (don't waft properly or low numbers)

Allergic bronchopulmonary aspergillosis - IgE antibodies against aspergillus, creates allergic inflammatory response TH2 response-mucus plugs, proximal bronchiectasis

Traction bronchiectasis associated with pulmonary fibrosis

Anyone with bronchiectasis should have immunodefiency ruled out

26

What causes TB, where does it affect and what type of reaction?

Mycobacterial infection
multi-organ
Type IV Hypersensitivity (granulomas with caseous necrosis)

M. Tuberculosis, M.Bovis

27

Cell involved in fighting tuberculosis and why it is so difficult to fight

T cell response (enhances macrophages ability to kill mycobacterium)

Mycobacteria can avoid phagocytosis- no cell wall (waxy fatty coat)

28

Primary TB vs. Secondary TB
and their location

Primary-1st exposure + up to 5 years after - carried to hilar lymph nodes, granulomatous response in nodes

Secondary-reactivated or reinfected TB (some immunity) - initially in lung apices

29

Sign of primary TB

Gohn focus in periphery of mid zone of lung and large hilar lymph nodes

30

Sign of secondary TB

Fibrosing and cavitating apical lesions