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HDID 2 > 42. Respiratory Tract Infections > Flashcards

42. Respiratory Tract Infections Flashcards

1
Q

upper vs lower respiratory tract?

A

upper has bacteria lower is normally sterile

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2
Q

the respiratory system actively clears infectious particles…give role of each:

  • nares
  • epiglottic reflex
  • cough
  • mucus secreting and ciliated cells
  • alveolar macrophages
  • nonspecific and specific immune response
  • lymph
A
  • nares: filtration
  • epiglottic reflex: prevents aspiration
  • cough: particle expulsion
  • mucus secreting and ciliated cells: entrap and expel particles
  • alveolar macrophages: ingest and kill bacteria
  • nonspecific and specific immune response: antibodies, opsonins, complement
  • lymph: drainage
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3
Q

otitis media pathogenesis?

A
  1. eustacian tube obstruction
  2. air absorbed into middle ear (low pressure)
  3. fluid collects
  4. bacteria proliferate
  5. release of inflammatory mediators
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4
Q

acute otitis media epidemiology?

A

common in young kids

peak during URI season

RFs: fam hx, prematurity, anatomic abn, immune defic, group daycare, secondhand smoke

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5
Q

AOM signs and sxs?

A

non specific:

  • fever
  • irritability, headache, anorexia, vomiting, diarrhea

local signs:

  • otalgia
  • otorrhea
  • hearing loss
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6
Q

AOM vs OME?

A

AOM:

  • symptomatic
  • tx w/Abx
  • more inflammatory

OME: (otitis media w/effusion)

  • present 1-3 months after AOM
  • asymptomatic
  • no Abx
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7
Q

AOM bugs?

A

S. pneumoniae
H. influenzae
M. catarrhalis

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8
Q

Rx for AOM?

A

Amoxicillin (high dose for S.pneumo altered PBP) maybe w/clavulanate if suspect H.flu (eg conjunctivitis)

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9
Q

mastoiditis?

A

complication of AOM

  • middle ear cavity and mastoid ear spaces are continuous
  • purulent material accumulates in the mastoid cavities
  • boggy, swollen mastoid
  • ear displaced

= osteomyelitis

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10
Q

sinusitis vs common cold

A

common cold:

  • viral
  • rhinorrhea
  • getting better in a week

sinusitis:

  • bacterial infection of paranasal sinuses
  • Abx
  • rhinorrhea
  • localizing signs to sinus area
  • severe headache or focal pain
  • ill and highly febrile for a long time
  • sinusitis has a longer duration
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11
Q

sinusitis risk factors?

A

obstruction
- URI, allergy, foreign body

impeded ciliary function
- URI, immotile cilia syndrome

Abn mucous production
- URI, CF, decongestant use

immunodeficiency

breach of sinuses (cleft palate, dental infections, swimming)

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12
Q

sinusitis pathogens in kids?

A

S.pneumoniae
H.influenzae (non-typeable)
M. catarrhalis

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13
Q

chronic sinusitis bugs?

A

staphylococci
anaerobes

haemophilus
pneumococcus
moraxella

etc

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14
Q

dx of sinusitis?

A

clinical exam

sinus aspiration

radiograph or CT (fro recurrent episodes, suspected complications, unclear diagnosis)

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15
Q

tx of acute sinusitis?

A

spontaneous resolution 4-60%

kids: amoxicillin +/- clavulanate
adults: amox/clav or cephalosporin or quinolone (coverage of S. aureus more impt in adults)

expect improvement in 2-3 days (otherwise re-eval)

IV abx for severe disease

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16
Q

complications of sinusitis?

A

orbital cellulitis

17
Q

pharyngitis epi?

A

viral infection is 90% (self-limiting and no tx necessary)

common pathogen in bacterial: S. pyogenes

pharyngitis caused by S. pyogenes primarily effects ppl 5-10 y/o

18
Q

GAS pharyngitis clinical manifestations?

A

FEVER

headache, abdominal sxs

exudative pharyngitis

tender cervical lymphadenopathy

scarlet fever rash

ABSENT cough, coryza, conjunctivitis

19
Q

GAS dx?

A

throat swab

rapid strep test

if ^^ negative, do cx

20
Q

judicious use of Abx in pharyngitis?

A

clinical suspicion AND lab testing

don’t treat presumptively

PCN = drug of choice

21
Q

strep pharyngitis complications?

A

suppurative: peritonsillar abscess, retropharyngeal abscess
nonsuppurative: acute rheumatic fever (preventable), glomerulonephritis

22
Q

pna epi?

A

extremes of age most susceptible

6th leading cause of death in the US

2-3 million adults affected annualy

23
Q 
define: 
pna?
pneumonitis?
effusion?
empyema?
A

pna: inflammation and consolidation of the lung (alveolar unless otherwise specified)
- lobar
- lobar or bronchial
- interstitial

pneumonitis: inflammation of the lung
effusion: fluid
empyema: exudate or pus (WBC, fibrin, serum)

24
Q

signs and sxs of pneumonia?

A

respiratory:

  • tachypnea (infant w/RR = 60)
  • cough and sputum production
  • dyspnea and work on breathing: flaring, grunting, retractions
  • crackles
  • tubular (decreased) breath sounds
  • dullness to percussion
  • increased (or decreased) vocal fremitus (toy truck)

nonspecific:

  • FEVER
  • headache
  • malaise
  • GI complains

pain:

  • pleuritic
  • referred
25
Q

risk factors for bacterial PNA?

A

anatomic:

  • tracheo-esophageal fistula
  • sequestration of lung

aspiration

  • reflux
  • comatose state
  • anesthesia

alterations in mucous clearance
- CF

immunodeficiency

nosocomial exposure

26
Q

bacterial pna characteristics?

A

abrupt onset

high fever

low or high WBC (15K)

neutrophil predominance w/bands

lobar dist

higher risk for empyema

27
Q

bacterial pna pathogens?

A

s. pneumoniae
h. influenzae
s. aureus

28
Q

bacterial pneumonia dx by culture?

A
  • blood culture positive in bacterial pneumonia
29
Q

atypical pneumonia characteristics?

A

school-aged kids

“walking pna”

subacute onset

“flu-like” sxs

extrapulmonary sxs

normal or high WBC w/LYMPHOCYTE PREDOMINANCE

CXR w/ diffuse and/or interstitial involvement

30
Q

atypical pna pathogens?

A

viruses
M. pneumoniae
C. pneumoniae
L. pneumophila

31
Q

mycoplasma pneumoniae?

A

common cause of atypical pneumonia

special features:

  • rash
  • cold agglutinins (50-70%)

dx w/serologies of cold agglutinins

treat w/ MACROLIDES

32
Q

legionella pneumophila?

A

legionnaire’s disease

fear the severe presentation!

  • progressive even when on abx
  • prevelant pna in the ICU

age >50

aerosolized water droplets

EXTRAPULMONARY MANIFESTATIONS

SPUTUM PURULENT w/NO ORGANISMS

urine legionella Ag test

tx w/MACROLIDES

33
Q

severe pna characteristics?

A

rapidly progressive

ANTECEDENT INFLUENZA INFECTION (S.aureus)

effusion, empyema, pneumothorax

pneumatoceles (usu develop later)

34
Q

severe pneumonia causes?

A

S. pneumo is the most common cause of bacterial pneumonia, incl severe pna, but in a hospitalized pt, worry about S.aureus and CA-MRSA

atypical pathogens, esp legionella, can also cause severe pna, so in the ill pt, empiric tx should cover both typicals and atypicals

35
Q

CA-PNA tx?

A

outpt, low risk:

  • previously healthy, no abx in past 3 months
  • bugs: S. pneumo, H. flu, Mycoplasma
  • Abx: Azithromycin

outpt, high risk or inpt:

  • comorbidities, abx in past 3 months
  • bugs, same but greater concern for macrolide resistant S.pneumo
  • Abx: use a new class of drug, respiratory flouroquinolone OR azithromycin plus beta-lactam

ICU:

  • bugs: all others PLUS legionella, MRSA…if immunosuppressed maybe pseudomonas & gram (-) orgs
  • abx: 3rd generation cephalosporin or ampicillin/sulbactam PLUS respiratory fluoroquinolone OR azithromycin, consider vanc, consider pseudomonas coverage

HDID 2 (32 decks)

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