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12. Respiratory > 6. COPD and Infection > Flashcards

6. COPD and Infection Flashcards

1
Q

What is chronic obstructive pulmonary disease?

A

A chronic, slowly progressive disorder characterised by airflow obstruction, which does not change markedly over several months.

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2
Q

How are FVC and the FEV1/FVC ratio affected in COPD?

A

Normal FVC but reduced FEV1/FVC ratio.

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3
Q

How many people in the UK are affected by COPD?

A

3.7 million.

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4
Q

How many deaths are caused by COPD in the UK?

A

30000.

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5
Q

How many hospital inpatient days a year does COPD account for?

A

1 million.

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6
Q

What is COPD commonly caused by?

A

Abnormal inflammatory response of the lung to noxious particles or gases, such as cigarette smoking and atmospheric pollutants.

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7
Q

What is a rare cause of emphysema?

A

Inherited deficiency of a1-antitrypsin.

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8
Q

What are the symptoms of COPD?

A

Productive cough with white or clear sputum, wheeze, breathlessness.

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9
Q

What are the signs of COPD?

A

Could be non, or hyperventilation with prolonged expiration, accessory muscles of respiration used, hyperinflation of the lungs.

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10
Q

What should be used in history taking to assess COPD?

A

The MRC dyspnoea scale.

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11
Q

How is a chest X ray useful in the assessment of COPD?

A

Not to diagnose COPD but more to rule out other causes, like cancer.

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12
Q

What lung function tests should be used to assess COPD?

A

FEV1/FVC ratio, lung volumes, loop.

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13
Q

What can a high resolution CT scan detect in COPD?

A

Emphysema.

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14
Q

What is the basic premise of simple spirometry?

A

The patient does maximum inhalation and then breathes out as far and fast as possible through a spirometer.

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15
Q

What can simple spirometry measure?

A

Lung volumes and capacities.

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16
Q

What will the blood gas results be for type I respiratory failure?

A

Increased respiratory rate, decreased pO2, normal or decreased CO2.

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17
Q

What will the blood gas results be for type II respiratory failure?

A

Increased respiratory rate, decreased pO2, increased CO2.

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18
Q

What is oxygen therapy given as treatment for?

A

Hypoxaemia.

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19
Q

What are the features of oxygen therapy?

A

It has to be used long term (16hrs/day), and portable.

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20
Q

What is the most useful measure in management of COPD?

A

Smoking cessation, even in advanced disease, it may slow down rate of deterioration.

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21
Q

What are the pharmacological interventions for COPD?

A

Bronchodilators (B2-adrenoagonists), corticosteroids (immunosuppressive), and antibiotics (shorten exacerbations if sputum is yellow/ green).

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22
Q

What is the purpose of oxygen therapy in COPD?

A

It increases blood oxygen saturation by administering oxygen.

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23
Q

What is pulmonary rehabilitation?

A

Using exercise training to increase exercise capacity.

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24
Q

Why is pulmonary rehabilitation needed in COPD?

A

COPD causes breathlessness which makes a patient less likely to exercise, this means muscles aren’t used and waste so it is even harder to exercise causing more breathlessness and it’s a viscous cycle.

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25
Q

When is a1-antitrypsin replacement therapy useful in COPD?

A

When the cause is a1-antitrypsin deficiency.

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26
Q

What are the co-morbidities often found in patients with COPD?

A

Cardiac, metabolic, nutritional, osteoporosis, anxiety/depression.

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27
Q

What are the normal common flora in the respiratory tract?

A

Viridans streptococci, neisseria species, anaerobes, candida species.

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28
Q

What are some of the less common normal respiratory tract flora?

A

Streptococcus pneumonia, streptococcus pyogenes, haemophillus influenza, pseudomonas, and E. coli.

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29
Q

What are the natural defences of the respiratory tract against infection?

A

Cough and sneezing reflex, muco-ciliary clearance mechanisms, respiratory mucosal immune system.

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30
Q

What are the muco-ciliary clearance mechanisms of the respiratory tract against infection?

A

Cilliated columnar epithelium and nasal hairs.

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31
Q

What are the respiratory mucosal immune system mechanisms of the respiratory tract against infection?

A

Lymphoid follicles of pharynx and tonsils, alveolar macrophages, secretary IgA and IgG.

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32
Q

What are the common upper respiratory tract infections?

A

Rhinitis (common cold), pharyngitis, epiglottits, laryngitis, tracheitis, sinusitis, otitis media.

33
Q

What are the upper respiratory tract infections commonly caused by viruses?

A

Rhinovirus, coronavirus, influenza/parainfluenza, and respiratory syncytial virus.

34
Q

What bacterial super-infections can be a results of sinusitis or otitis media?

A

Mastoiditis, meningitis, brain abscess.

35
Q

What is pneumonia?

A

General term for inflammation of the gas-exchanging region of the lung, usually due to infection. It is infection of the lung parenchyma.

36
Q

What is lobar pneumonia?

A

Pneumonia localised to a particular lobe of the lung.

37
Q

What is the normal causative organism of lobar pneumonia?

A

Streptococcus pneumoniae.

38
Q

What is bronchopneumonia?

A

Pneumonia that is diffuse and patchy. The infection starts in the airways and spreads to adjacent alveoli and lung tissue.

39
Q

What are the common causative organisms of bronchopneumonia?

A

Streptococcus penumoniae, haemophilus influenza, staphylococcus aureus, anaerobes, and coliforms.

40
Q

What is aspiration pneumonia?

A

Pneumonia from aspiration of food, drink, saliva, or vomit..

41
Q

What are the common causative organism of aspiration pneumonia?

A

Oral flora and anaerobes.

42
Q

What is interstitial pneumonia?

A

Inflammation of the intersticium of the lung.

43
Q

What is chronic pneumonia?

A

Inflammation of the lungs that persists for an extended period of time.

44
Q

What are the common bacteria of community acquired pneumonias?

A

Streptococcus pneumoniae, haemophilus influenza, klebsiella pneumoniae.

45
Q

What are the atypical bacteria of community acquired pneumonias?

A

Chlamydia pneuophilia, mycoplasma pneumoniae, legionella pneumophilia.

46
Q

What is the common profile of bacteria causing hospital acquired pneumonia?

A

Gram negative enteric bacteria.

47
Q

What are the common bacteria causing hospital acquired pneumonia?

A

Pseudomonas, staphylococcus aureus, MRSA.

48
Q

What are the associated features of pneumonia caused by streptococcus penumoniae?

A

Elderly, co-morbidities, acute onset, high fever, pleuritic chest pain.

49
Q

What are the associated features of pneumonia caused by haemophilus influenze?

A

COPD.

50
Q

What are the associated features of pneumonia caused by legionella pneumophilia?

A

Recent travel, younger patient, smokers, illness, multi-system involvement.

51
Q

What are the associated features of pneumonia caused by mycoplasma pneumoniae?

A

Young, prior antibiotics, extra-pulmonary involvement.

52
Q

What are the associated features of pneumonia caused by staphylococcus aureus?

A

Post viral, intra-venous drug user.

53
Q

What are the associated features of pneumonia caused by chlamydia pneumophilia?

A

Contact with birds.

54
Q

What are the associated features of pneumonia caused by coxiella?

A

Animal contact, namely sheep.

55
Q

What are the associated features of pneumonia caused by klebsiella pneumoniae?

A

Thrombocytopenia, leucopenia.

56
Q

What are the associated features of pneumonia caused by S. milleri?

A

Dental infections, abdominal source, aspiration.

57
Q

What are the common symptoms of pneumonia?

A

Malaise, fever, and a productive cough - sputum clear, purulent (yellow/ green), rusty coloured (little blood), or stained with lots of blood. Pleuritic chest pain and breathlessness.

58
Q

What are the chest signs of pneumoniae?

A

Bronchial breath sounds, crackles, wheeze, dullness to percussion, reduced vocal resonance.

59
Q

What counts as hospital acquired pneumonia?

A

Pneumonia occurring 48hrs after hospital admission.

60
Q

What percentage of hospital acquired infections does pneumonia make up?

A

15%.

61
Q

Which patients particularly is hospital acquired pneumonia common in?

A

Ventilated or post surgical.

62
Q

How can the severity of pneumonia be assessed?

A

Using the CURB 65 score.

63
Q

What are the features of a CURB 65 score?

A 
C - new mental confusion
U - urea >7mmol/L
R - respiratory rate >30/minute
B - blood pressure systolic <90mmHg or diastolic <60mmHg
Aged 65 or over.
64
Q

What are the consequences of a CURB 65 score of 2 or more?

A

Requires hospital admission.

65
Q

What samples can be collected to investigate pneumonia?

A

Sputum, nose and throat swabs, endotracheal aspirates, broncho alveolar lavage fluid, open lung biopsy, blood culture (before antibiotics), urine, serum.

66
Q

What are the categories of microbiological investigation for pneumonia?

A

Macroscopic, microscopic, culture, PCR, antigen detection, and antibody detection.

67
Q

What are the macroscopic investigations of pneumonia?

A

Look at sputum, is it purulent or blood stained?

68
Q

What are the microscopic investigations of pneumonia?

A

Gram staining and acid fast test.

69
Q

What do culture investigations of pneumonia look for?

A

Causative bacteria or virus.

70
Q

What do PCR investigations of pneumonia look for?

A

Respiratory viruses.

71
Q

What antigens can be detected in pneumonia investigations?

A

Legionella.

72
Q

How can antibodies be detected in pneumonia investigations?

A

By serology.

73
Q

What are the common opportunistic pathogens causing pneumonias in immunosuppressed hosts?

A

Virulent infection with common organism or infection with opportunistic pathogen: viruses - cytomegalovirus (CMV), bacteria - mycobacterium avium intracellular, fungi - aspergillus, candida, pneumocystic jiroveci, or protozoa - cryptosporidia, toxoplasma.

74
Q

How are pneumonia managed?

A

Oral fluid/ IV fluids if severe to avoid dehydration. Ant-pyretic drugs to reduce fever and malaise. Stronger analgesic to deal with pleuritic pain. Oxygen is there is cyanosis. Antibiotics depending on type of pneumonia.

75
Q

What is the common antibiotic used for community acquired pneumonia and why?

A

Penicillin or related antibiotics are target organism is normally pneumococcus.

76
Q

What is the common antibiotic used for hospital acquired pneumonia and why?

A

Gram negative antibiotics like co-amoxiclav IV, as the target organism is likely gram negative.

77
Q

What are the possible outcomes for pneumonia?

A

Resolution with possible organisation (fibrous scarring), or complications like lung abscess, bronchiectasis (airways widened), or empyema (pus in pleural cavity).

78
Q

How can pneumonia be prevented?

A

With immunisation with the flu vaccine (annually to high risk patients), or pneumococcal vaccine (two vaccines). With chemoprophylaxis - oral penicillin/erythromycin to patients with higher risk of lower respiratory tract infections.

12. Respiratory (10 decks)

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