Adult Respiratory Conditions Flashcards
What percentage of URTIs are caused by viral pathogens?
85-90% of URTIs are caused by viral pathogens.
Name three URTIs that are treated with antimicrobials.
Acute bacterial rhinosinusitis, GAS pharyngitis, and pertussis.
Describe the three clinical presentations that predict acute bacterial rhinosinusitis.
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’).
What is the drug of choice for bacterial rhinosinusitis and what is its recommended duration of therapy?
Amoxicillin-clavulanate; 5-7 days.
Name the causative agent of pharyngitis that requires antimicrobial treatment.
Group A Streptococcus (GAS).
List five physical findings in a patient with GAS pharyngitis.
Fever, tonsillopharyngeal erythema and exudates, palatal petechiae, tender and enlarged anterior cervical lymph nodes, absence of cough.
Aside from penicillin, what are the four alternative drugs for GAS pharyngitis?
Cephalexin, cefadroxil, clindamycin, macrolides.
Name the causative agent of pertussis and describe how it contributes to infection persistence.
Bordetella pertussis; produces pertussis toxin that suppresses the immune system.
Enumerate the three phases of pertussis infection and their corresponding durations.
Catarrhal phase (1-2 weeks), Paroxysmal phase (2-3 months), Convalescent phase (1-2 weeks).
What is the preferred macrolide treatment for pertussis in infants less than one month old?
Azithromycin.
Differentiate the clinical presentation of the common cold from the flu.
Common Cold: Clear runny nose prominent at the outset. Flu: Higher and more persistent fever.
Why are first-generation antihistamines preferred over second-generation ones for allergic rhinitis and UACS?
Due to their strong drying effect from anticholinergic properties.
What is a possible adverse effect of prolonged use of intranasal corticosteroids for severe UACS and allergic rhinitis?
Rhinitis medicamentosa, a rebound congestion.
What is the mechanism of action of proton pump inhibitors in treating GERD?
Block the final step in gastric acid production, reducing acidity.
Name two conditions that present with reversible airflow obstruction.
Asthma and cough variant asthma.
How do you differentiate cough variant asthma from classic asthma in terms of management?
Cough variant asthma is managed with bronchodilators and corticosteroids during attacks, while classic asthma requires maintenance therapy.
What are the ‘3 Cs’ recommended to prevent the spread of flu?
Cover your cough, Clean your hands, Contain germs.
Enumerate the ‘3 Cs’ that should be avoided to prevent COVID-19 infection.
Closed spaces, Crowded places, Close-contact settings.
Differentiate acute from chronic bronchitis based on the duration of cough.
Acute bronchitis: 1-3 weeks; Chronic bronchitis: at least 3 months in a year for two consecutive years.
Name three bacterial causes of acute bronchitis.
Bordetella pertussis, Chlamydia pneumoniae, Mycoplasma pneumoniae.
Aside from clinical presentation, what diagnostic tool is used to confirm acute bronchitis?
Absence of clinical findings suggestive of pneumonia, asthma, COPD, or other causes of chronic cough.
Name the common pathogens found in the dilated airways of patients with bronchiectasis.
Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus pneumoniae.
What are the radiographic findings associated with bronchiectasis?
Ring shadows, ‘tram-line’ opacities, tubular and branching opacities.
Enumerate five underlying conditions that can lead to recurrent infections and bronchiectasis.
Immunodeficiency states, abnormal secretion clearance, cystic fibrosis, Young’s syndrome, alpha-1 antitrypsin deficiency.
What are the three goals in treating bronchiectasis?
Treat underlying conditions and lung infections, remove mucus from the lungs, prevent complications.
Aside from pharmacologic treatment, what are two non-pharmacologic interventions for managing bronchiectasis?
Chest physiotherapy, postural drainage.
In cases of life-threatening, severe bleeding in bronchiectasis, what are the two treatment options?
Arteriographic embolization, open reduction of bleeders.
What are the four stages of typical community-acquired pneumonia (CAP)?
Congestion, red hepatization, grey hepatization, resolution.
What type of sputum is indicative of progression from the stage of congestion to red hepatization in CAP?
Rust-colored sputum.
What does each letter in the CURB-65 mnemonic for CAP assessment represent?
Confusion, Urea > 7 mmol/L, Respiratory rate ≥ 30, Blood pressure ≤90/≤60 mmHg, Age ≥ 65.
A patient presents with confusion, urea > 7 mmol/L, and a respiratory rate ≥ 30. What is their CURB-65 score and corresponding risk classification?
Score: 3; High-risk pneumonia.
What are the first-line antimicrobial choices for low-risk CAP in patients without comorbidities?
Amoxicillin or macrolides (e.g., clarithromycin, azithromycin).
When would you add a macrolide or tetracycline to the treatment regimen of low-risk CAP in a patient with stable comorbidities?
When there are symptoms and signs of possible atypical infections.
What is the recommended antimicrobial treatment for moderate-risk CAP without MDRO infection?
Extended-spectrum beta-lactam (e.g., ampicillin-sulbactam) or third-gen cephalosporin PLUS a macrolide.
Differentiate the first-line therapy from the alternative therapy for high-risk CAP without risk for MDRO.
First-line: β-lactam + macrolide. Alternative: β-lactam + respiratory fluoroquinolone.
Enumerate the patient risk factors for MRSA infection.
Prior MRSA colonization/infection, IV antibiotic therapy within 90 days.
What antimicrobial should be added to the regimen of high-risk CAP patients with risk for MRSA infection? Provide three options.
Vancomycin, linezolid, clindamycin.
What are the three criteria for clinical stability used to guide the duration of CAP treatment?
Resolution of vital sign abnormalities, ability to eat, normal mentation.
Name three bacterial causes of atypical pneumonia.
Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila.
What diagnostic tool is used to confirm atypical pneumonia, particularly in severe cases?
PCR.
Describe the common radiographic findings for Chlamydia pneumoniae.
Patchy or reticulonodular opacities, often perihilar, may extend to interlobar septa and pulmonary interstitium.
Name three possible complications of Chlamydia pneumoniae infection.
Encephalitis, myocarditis, chronic infection.
What are the two surface proteins that help distinguish influenza A subtypes from the common cold?
Hemagglutinin (H) and Neuraminidase (N)
Which influenza A subtype is responsible for the Spanish Flu pandemic of 1918 and the Swine Flu outbreak of 2009?
H1N1
Aside from H1N1, what other Influenza A subtype is currently circulating among humans?
H3N2
What is the mechanism of action of oseltamivir/zanamivir in treating influenza?
Neuraminidase inhibitors that prevent the release of virions from infected cells
What is the maximum time frame after the onset of influenza symptoms within which oseltamivir/zanamivir must be taken to be most effective?
Within 2 days of symptom onset
What are the “3 Cs” recommended by the World Health Organization (WHO) to prevent aerosol transmission of the flu?
Cover your mouth, clean your hands, contain your germs
What are the ‘new 3 Cs’ to avoid in the context of COVID-19?
Confined spaces, crowded places, close-contact settings
What diagnostic tool is used to confirm Streptococcus pyogenes as the cause of pharyngitis?
Rapid antigen detection test (RADT)
What is the drug of choice for GAS pharyngitis?
Penicillin G/Penicillin V/Amoxicillin
What condition should be suspected if a patient’s common cold symptoms worsen after an initial improvement, with fever, headache, and increased nasal discharge?
‘Double-sickening,’ suggestive of bacterial rhinosinusitis
What are the three criteria that predict a bacterial etiology for rhinosinusitis?
- 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’)
For how long should a patient with bacterial rhinosinusitis be treated with amoxicillin-clavulanate empirically?
5-7 days
What bacterial agent should be targeted when choosing empiric therapy for rhinosinusitis?
Haemophilus influenzae
What virulence factor of Bordetella pertussis is responsible for suppressing the immune system and contributing to the persistence of infection?
Pertussis toxin
Which phase of pertussis is characterized by the hallmark ‘whooping cough’?
Paroxysmal phase
What is the recommended treatment for pertussis?
Macrolides (e.g., erythromycin, azithromycin, clarithromycin)
What condition is characterized by reversible airflow obstruction and uncontrollable cough spasms, often with a history of hypersensitivity or a family history of asthma?
Cough variant asthma
What are the radiographic findings associated with bronchiectasis?
Ring shadows and ‘tram-line’ opacities
What is the CURB-65 score used for?
Assessing the severity and risk of community-acquired pneumonia (CAP)
List the components of the CURB-65 score.
Confusion, Urea > 7 mmol/L, Respiratory Rate ≥ 30, Blood pressure ≤ 90/80 mmHg, Age > 65 years
