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Respi LE3 > Adult Respiratory Conditions > Flashcards

Adult Respiratory Conditions Flashcards

1
Q

What percentage of URTIs are caused by viral pathogens?

A

85-90% of URTIs are caused by viral pathogens.

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2
Q

Name three URTIs that are treated with antimicrobials.

A

Acute bacterial rhinosinusitis, GAS pharyngitis, and pertussis.

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3
Q

Describe the three clinical presentations that predict acute bacterial rhinosinusitis.

A

Persistent symptoms ≥10 days without improvement, severe symptoms (high fever, purulent nasal discharge, facial pain) for ≥3-4 consecutive days, and worsening symptoms following initial improvement (‘double sickening’).

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4
Q

What is the drug of choice for bacterial rhinosinusitis and what is its recommended duration of therapy?

A

Amoxicillin-clavulanate; 5-7 days.

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5
Q

Name the causative agent of pharyngitis that requires antimicrobial treatment.

A

Group A Streptococcus (GAS).

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6
Q

List five physical findings in a patient with GAS pharyngitis.

A

Fever, tonsillopharyngeal erythema and exudates, palatal petechiae, tender and enlarged anterior cervical lymph nodes, absence of cough.

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7
Q

Aside from penicillin, what are the four alternative drugs for GAS pharyngitis?

A

Cephalexin, cefadroxil, clindamycin, macrolides.

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8
Q

Name the causative agent of pertussis and describe how it contributes to infection persistence.

A

Bordetella pertussis; produces pertussis toxin that suppresses the immune system.

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9
Q

Enumerate the three phases of pertussis infection and their corresponding durations.

A

Catarrhal phase (1-2 weeks), Paroxysmal phase (2-3 months), Convalescent phase (1-2 weeks).

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10
Q

What is the preferred macrolide treatment for pertussis in infants less than one month old?

A

Azithromycin.

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11
Q

Differentiate the clinical presentation of the common cold from the flu.

A

Common Cold: Clear runny nose prominent at the outset. Flu: Higher and more persistent fever.

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12
Q

Why are first-generation antihistamines preferred over second-generation ones for allergic rhinitis and UACS?

A

Due to their strong drying effect from anticholinergic properties.

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13
Q

What is a possible adverse effect of prolonged use of intranasal corticosteroids for severe UACS and allergic rhinitis?

A

Rhinitis medicamentosa, a rebound congestion.

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14
Q

What is the mechanism of action of proton pump inhibitors in treating GERD?

A

Block the final step in gastric acid production, reducing acidity.

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15
Q

Name two conditions that present with reversible airflow obstruction.

A

Asthma and cough variant asthma.

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16
Q

How do you differentiate cough variant asthma from classic asthma in terms of management?

A

Cough variant asthma is managed with bronchodilators and corticosteroids during attacks, while classic asthma requires maintenance therapy.

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17
Q

What are the ‘3 Cs’ recommended to prevent the spread of flu?

A

Cover your cough, Clean your hands, Contain germs.

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18
Q

Enumerate the ‘3 Cs’ that should be avoided to prevent COVID-19 infection.

A

Closed spaces, Crowded places, Close-contact settings.

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19
Q

Differentiate acute from chronic bronchitis based on the duration of cough.

A

Acute bronchitis: 1-3 weeks; Chronic bronchitis: at least 3 months in a year for two consecutive years.

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20
Q

Name three bacterial causes of acute bronchitis.

A

Bordetella pertussis, Chlamydia pneumoniae, Mycoplasma pneumoniae.

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21
Q

Aside from clinical presentation, what diagnostic tool is used to confirm acute bronchitis?

A

Absence of clinical findings suggestive of pneumonia, asthma, COPD, or other causes of chronic cough.

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22
Q

Name the common pathogens found in the dilated airways of patients with bronchiectasis.

A

Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus pneumoniae.

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23
Q

What are the radiographic findings associated with bronchiectasis?

A

Ring shadows, ‘tram-line’ opacities, tubular and branching opacities.

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24
Q

Enumerate five underlying conditions that can lead to recurrent infections and bronchiectasis.

A

Immunodeficiency states, abnormal secretion clearance, cystic fibrosis, Young’s syndrome, alpha-1 antitrypsin deficiency.

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25
Q

What are the three goals in treating bronchiectasis?

A

Treat underlying conditions and lung infections, remove mucus from the lungs, prevent complications.

26
Q

Aside from pharmacologic treatment, what are two non-pharmacologic interventions for managing bronchiectasis?

A

Chest physiotherapy, postural drainage.

27
Q

In cases of life-threatening, severe bleeding in bronchiectasis, what are the two treatment options?

A

Arteriographic embolization, open reduction of bleeders.

28
Q

What are the four stages of typical community-acquired pneumonia (CAP)?

A

Congestion, red hepatization, grey hepatization, resolution.

29
Q

What type of sputum is indicative of progression from the stage of congestion to red hepatization in CAP?

A

Rust-colored sputum.

30
Q

What does each letter in the CURB-65 mnemonic for CAP assessment represent?

A

Confusion, Urea > 7 mmol/L, Respiratory rate ≥ 30, Blood pressure ≤90/≤60 mmHg, Age ≥ 65.

31
Q

A patient presents with confusion, urea > 7 mmol/L, and a respiratory rate ≥ 30. What is their CURB-65 score and corresponding risk classification?

A

Score: 3; High-risk pneumonia.

32
Q

What are the first-line antimicrobial choices for low-risk CAP in patients without comorbidities?

A

Amoxicillin or macrolides (e.g., clarithromycin, azithromycin).

33
Q

When would you add a macrolide or tetracycline to the treatment regimen of low-risk CAP in a patient with stable comorbidities?

A

When there are symptoms and signs of possible atypical infections.

34
Q

What is the recommended antimicrobial treatment for moderate-risk CAP without MDRO infection?

A

Extended-spectrum beta-lactam (e.g., ampicillin-sulbactam) or third-gen cephalosporin PLUS a macrolide.

35
Q

Differentiate the first-line therapy from the alternative therapy for high-risk CAP without risk for MDRO.

A

First-line: β-lactam + macrolide. Alternative: β-lactam + respiratory fluoroquinolone.

36
Q

Enumerate the patient risk factors for MRSA infection.

A

Prior MRSA colonization/infection, IV antibiotic therapy within 90 days.

37
Q

What antimicrobial should be added to the regimen of high-risk CAP patients with risk for MRSA infection? Provide three options.

A

Vancomycin, linezolid, clindamycin.

38
Q

What are the three criteria for clinical stability used to guide the duration of CAP treatment?

A

Resolution of vital sign abnormalities, ability to eat, normal mentation.

39
Q

Name three bacterial causes of atypical pneumonia.

A

Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila.

40
Q

What diagnostic tool is used to confirm atypical pneumonia, particularly in severe cases?

A

PCR.

41
Q

Describe the common radiographic findings for Chlamydia pneumoniae.

A

Patchy or reticulonodular opacities, often perihilar, may extend to interlobar septa and pulmonary interstitium.

42
Q

Name three possible complications of Chlamydia pneumoniae infection.

A

Encephalitis, myocarditis, chronic infection.

43
Q

What are the two surface proteins that help distinguish influenza A subtypes from the common cold?

A

Hemagglutinin (H) and Neuraminidase (N)

44
Q

Which influenza A subtype is responsible for the Spanish Flu pandemic of 1918 and the Swine Flu outbreak of 2009?

A

H1N1

45
Q

Aside from H1N1, what other Influenza A subtype is currently circulating among humans?

A

H3N2

46
Q

What is the mechanism of action of oseltamivir/zanamivir in treating influenza?

A

Neuraminidase inhibitors that prevent the release of virions from infected cells

47
Q

What is the maximum time frame after the onset of influenza symptoms within which oseltamivir/zanamivir must be taken to be most effective?

A

Within 2 days of symptom onset

48
Q

What are the “3 Cs” recommended by the World Health Organization (WHO) to prevent aerosol transmission of the flu?

A

Cover your mouth, clean your hands, contain your germs

49
Q

What are the ‘new 3 Cs’ to avoid in the context of COVID-19?

A

Confined spaces, crowded places, close-contact settings

50
Q

What diagnostic tool is used to confirm Streptococcus pyogenes as the cause of pharyngitis?

A

Rapid antigen detection test (RADT)

51
Q

What is the drug of choice for GAS pharyngitis?

A

Penicillin G/Penicillin V/Amoxicillin

52
Q

What condition should be suspected if a patient’s common cold symptoms worsen after an initial improvement, with fever, headache, and increased nasal discharge?

A

‘Double-sickening,’ suggestive of bacterial rhinosinusitis

53
Q

What are the three criteria that predict a bacterial etiology for rhinosinusitis?

A
  1. Persistent symptoms lasting ≥ 10 days with no improvement; 2. Severe symptoms with high fever and purulent discharge or facial pain for ≥ 3-4 days; 3. Worsening symptoms after initial improvement from a viral URTI that lasted 5-6 days (‘double sickening’)
54
Q

For how long should a patient with bacterial rhinosinusitis be treated with amoxicillin-clavulanate empirically?

A

5-7 days

55
Q

What bacterial agent should be targeted when choosing empiric therapy for rhinosinusitis?

A

Haemophilus influenzae

56
Q

What virulence factor of Bordetella pertussis is responsible for suppressing the immune system and contributing to the persistence of infection?

A

Pertussis toxin

57
Q

Which phase of pertussis is characterized by the hallmark ‘whooping cough’?

A

Paroxysmal phase

58
Q

What is the recommended treatment for pertussis?

A

Macrolides (e.g., erythromycin, azithromycin, clarithromycin)

59
Q

What condition is characterized by reversible airflow obstruction and uncontrollable cough spasms, often with a history of hypersensitivity or a family history of asthma?

A

Cough variant asthma

60
Q

What are the radiographic findings associated with bronchiectasis?

A

Ring shadows and ‘tram-line’ opacities

61
Q

What is the CURB-65 score used for?

A

Assessing the severity and risk of community-acquired pneumonia (CAP)

62
Q

List the components of the CURB-65 score.

A

Confusion, Urea > 7 mmol/L, Respiratory Rate ≥ 30, Blood pressure ≤ 90/80 mmHg, Age > 65 years

Respi LE3 (9 decks)

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