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MHD VI: Pulm > 12.2: Respiratory Tract Infections > Flashcards

12.2: Respiratory Tract Infections Flashcards

1
Q

What is most common infection in US?

A
  • URI with 75M visits per year
  • Seasonal
  • Majority are viral and self limiting
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2
Q

Types of URIs?

A
  1. Rhinitis
  2. sinusitis
  3. otitis
  4. pharyngitis
  5. laryngotracheitis
  6. epiglottitis
  7. bronchitis
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3
Q

Treatment of something that is viral and self limited?

A

Dont need treatment whatsoever

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4
Q

What is rhinitis?

A
  • Runny nose
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5
Q

Common causes of rhinitis?

A
  1. Rhinovirus
  2. Coronavirus
  3. Parainfluenza
  4. 50% of time no cause as we dont look
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6
Q

How is sinusitis diagnosed?

A
  • Clinically
  • Fever, congestion, sinus tenderness, poor drainage
  • Once inflamed sinuses dont drain well
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7
Q

What is pharyngitis?

A
  • Sore throat

- 70% viral

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8
Q

Causes and signs of strep?

A

‐ Group A and B beta hemolytic strep

  1. Fever
  2. Patchy tonsillar exudates
    * treatment prevents complications (rheumatic fever, post strep GN), Does not change the acute illness
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9
Q

Signs of epiglottitis?

A
  1. Fever
  2. Systemic toxicity
  3. Drooling
  4. Positive blood culture
  5. Loss of airway: refer to ENT
    * **Look very sick
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10
Q

Causes of epiglottitis?

A
  1. H flu
  2. Group A strep
  3. H parainfluenza
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11
Q

What is acute bronchitis?

A
  • Self limited inflammation of large airways

- Symptoms of cough / purulent sputum > 5 days

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12
Q

What is pertussis?

A

Whooping cough in child

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13
Q

Acute bronchitis treatment?

A
  • Symptomatic: rest / tylenol

- Antibiotics not effective

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14
Q

How do cough drops work?

A
  • Swallowing suppresses cough

- Cough drops and syrups make you swallow

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15
Q

Definition of pneumonia?

A
  • Infection / inflammation of lower airway
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16
Q

Predisposing factors of Pneumonia?

A
  1. Old age
  2. Pulmonary disease
  3. Smoking
  4. Recent virus
  5. Diabetes
  6. Chronic renal disease
  7. ID
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17
Q

Symptoms of pneumonia?

A

Should have all of these

  1. Cough
  2. Sputum
  3. Fever
  4. SOB
  5. Consolidation on exam
  6. Elevated WBC
  7. Change of mental status in elderly can be only sign
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18
Q

What is CAP?

A

“Community acquired pneumonia”

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19
Q

Diagnostic tests for CAP?

A
  1. CXR
  2. Sample pleural effusion if present
  3. Rapid flu test if flu season
  4. Yield is low on blood and sputum culture: not often done
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20
Q

Typical presentation of CAP?

A
  1. Cough / sputum
  2. Fever
  3. Shaking chills
  4. Lobar infiltrate
  5. Gram stain with PMNs and orgs.
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21
Q

Most common causes of CAP?

A
  1. Streptococcus pneumoniae: most common
  2. H influenzae
  3. Moraxella catarrhalis
  4. Staph aureus
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22
Q

Classic symptoms of strep Pneumonia?

A
  1. Acute onset fever
  2. RUSTY SPUTUM
  3. Shaking chill
  4. SOB
  5. Pleuritic chest pain
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23
Q

Shape of strep pneumo?

A
  • Lancet shaped diplococcus
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24
Q

Common presentation of CAP atypical?

A
  1. Milder symptoms: “walking pneumonia”
  2. Subacute onset
  3. Negative gram stain
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25
Q

Common causes of atypical pneumonia?

A
  1. Mycoplasma
  2. Chlamydia
  3. Legionella
  4. Virus
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26
Q

Another name for legionnaires disease?

A

“Pontiac fever”

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27
Q

Symptoms of legionnaires pneumophila?

A
  1. Headache
  2. Myalgia
  3. High fever
  4. Cough with sputum
  5. Fatigue
    * **Can progress to multi organ failure
28
Q

Where is legionnaires found?

A
  • Artificial aquatic environments: cooling tower
  • Infected by inhaling or drinking infected water
  • Not person to person spread
29
Q

How to diagnose legionella?

A
  • Urinary legionella antigen
30
Q

How are viruses identified in respiratory infection?

A

Respiratory PCR

31
Q

Common virus in resp infection?

A
  1. Influenza
  2. RSV
  3. Adeno
  4. Parainfluenza
32
Q

Symptoms of influenza?

A
  1. High fever
  2. Cough
  3. Sore throat
  4. Headache
  5. Myalgias
33
Q

How to treat influenze in flu season?

A
  1. Test
  2. Isolate
  3. Start therapy if within 48 hours
34
Q

Therapy for influenza?

A
  1. Oseltamivir
  2. Zanamivir
    * **If w/ in 48 hours of onset
35
Q

Signs of CAP in peds?

A
  1. Tachypnea
  2. Fever
  3. Cough
  4. Dyspnea
36
Q

Causes of CAP in peds?

A
  1. Under 2: Viral, RSV
  2. 5 - 10: mycoplasma
  3. 10 - 16: s. pneumo / Chlamydophila
37
Q

What to think of in alcoholics?

A

Oral anaerobes

38
Q

What to think of in COPD / smoker?

A
  1. H flu

2. Marxella

39
Q

What to think of in aspiration?

A

Oral anaerobes

40
Q

What to think of in bird droppings?

A

Histoplasma

41
Q

What to think of in birds?

A

Chlamydia

42
Q

What to think of in rabbits?

A

Francisella tularemia

43
Q

What to think of in farm animals or cats?

A

Coxiella: Q fever

44
Q

What to think of in hotels or cruise ships?

A

Legionella

45
Q

Therapy of outpatient CAP?

A

– Macrolide: Z pack
- Doxycycline
– If co‐morbid or recent antibiotics: resp. fluoroquinolone

46
Q

Therapy in inpatient non ICU CAP?

A

– Respiratory fluoroquinolone

– B lactam + macrolide

47
Q

Therapy in inpatient ICU CAP?

A
  • B lactam +macrolide or fluoroquinolone
48
Q

Therapy in inpatient CAP if pseudomonas is concern cuz have recently been in hospital?

A

– Antipseudomonal B lactam + respiratory
fluoroquinolone, or
– Antipseudomonal B lactam + macrolide +
aminoglycoside

49
Q

Duration of CAP treatment?

A
  • Usually at least 5 Days
50
Q

What to think of if empiric CAP therapy doesn’t work?

A
  1. Wrong organism guess
  2. Wrong dosing
  3. Slow response from co morbidity
51
Q

What is hospital acquired pneumonia?

A
  • Acquire while in hospital for other reason

- Occurs in 1% of people

52
Q

Symptoms in hosp acquired pneumonia?

A
  1. Fever
  2. New infiltrate
  3. Leukocytosis
  4. Change in sputum
53
Q

Pathology of hospital acquired pneumonia (HAP)?

A
  • Patients become colonized with gram negative rods they subsequently aspirate
  • Defenses are lower from other illness
54
Q

Risk factors for HAP?

A 
• Mechanical Ventilation
• Chronic Lung disease
• CHF
• Age > 60
• Head trauma
• Shock
• Decreased mental
status/coma
55
Q

Risk factors for MDR HAP?

A
  • Antibiotics within 90 d
  • Inpatient for >5d
  • Residence in NH
  • Dialysis
  • Immunosuppression
56
Q

What use if worried about MRSA?

A

Vancomycin

57
Q

What is Chronic pneumonia?

A
  • Subacute onset of symptoms for up to six weeks

- Slowly worsening: slow growing orgs

58
Q

Causes of chronic pneumonia?

A
  • Mycobacterium (TB or atypical)
  • Nocardia
  • Actinomyces
  • Endemic fungi (histo, blasto, cocci): where were they?
  • Coxiella
  • Tularemia
  • Anatomic problem
59
Q

What is a lung abscess?

A
  • Infection leading to tissue destruction and cavitation
  • Usually caused by polymicrobial infection from mouth
  • Caused by aspiration usually
  • Also strep pneumonia or septic emboli
60
Q

How to treat lung abscess?

A
  • Usually long course clindamycin until cavity closes

- DO NOT DRAIN: you will spread infection

61
Q

What is empyema?

A
  • Spread of infection from lung to pleural space

- Antibiotics alone isn’t enough, need to drain

62
Q

What is parapneumonic pleural effusion?

A
  • Inflammation in lung causes inflammation in pleural space and fluid movement in
  • Infection DOES NOT MOVE IN
63
Q

What can cause neutrophil problems? What are you at risk for?

A
  • Gram negative rods
    1. Chemo
    2. Leukemia
    3. Chronic granulomatous disease
64
Q

What cause T cell dysfunction?

A
  1. Aids
  2. T cell lymphoma
  3. Transplant meds
  4. Digeorge
65
Q

Orgs with T cell disease?

A
  1. Fungi
  2. Viral
  3. Pneumocystis
66
Q

What causes B cell deficiency?

A

– Splenectomy, chronic lymphocytic lymphoma, Non
Hodgkin’s Lymphoma, Myeloma, gamma globulin
deficiencies

MHD VI: Pulm (20 decks)

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