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CR Year 3 > Cardio-Resp Infections > Flashcards

Cardio-Resp Infections Flashcards

1
Q

Normal flora in URT

A

Viridans streptococci

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2
Q

Temporary colonisers in URT

A

Staph aureus

Candida

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3
Q

Pathogens in URT

A

Strep Pneumonia
Corynebacterium diptheria
Haemophilus Influenzae
Group A Strep

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4
Q

Common URTI viruses

A 
rhinovirus
influenza
coronavirus
adenovirus
RSV
coxsackie
enterovirus
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5
Q

Common URTI bacteria

A

Strep pyogenes- group A
Strep pneumoniae
Haemophilus influenzae

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6
Q

Influenza symptoms

A

Fever
Coryza
systemic symptoms- headache, malaise, myalgia, arthralgia
+/- GI symptoms

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7
Q

Influenza investigation

A

Primary care- not needed

Secondary care- nasopharyngeal swab for flu PCR

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8
Q

Influenza treatment

A

Within 48 hrs of start of symptoms

Oseltamivir 75mg bd oral/NG for 5 days

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9
Q

Pharyngitis- viruses

A

7 common URTI viruses
EBV
CMV
HSV

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10
Q

Pharyngitis- bacteria

A

Group A, B, C Streptococci
Mycoplasma pneumoniae
Neisseria gonorrhoea
Corynebacterium diptheriae

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11
Q

Pharyngitis symptoms

A

Sore throat
Fever
Tonsillar exudate
Tender cervical nodes

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12
Q

Pharyngitis centor criteria

A 
Tonsillar exudate
Tender cervical LN
Absence of cough
h/o fever
--> if 3/4- 50% chance
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13
Q

Pharyngitis antibiotic sensitivity

A

All are penicillin sensitive

Majority erythromycin sensitive (for penicillin allergic people)

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14
Q

Pharyngitis Treatment

A

Penicillin V 500mg QDS or 1g BD for 5-10 days

OR clarithromycin 500mg BD for 5 days

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15
Q

Pharyngitis complications

A

Rheumatic fever

Glomerulonephritis

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16
Q

Amoxicillin + EBV

A

Often causes rashes

–> doesn’t mean they have allergy

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17
Q

Amoxicillin and sore throat

A

DO NOT GIVE

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18
Q

Acute Otitis media viruses

A

Common URTI viruses

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19
Q

Acute Otitis media bacteria

A 
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Mycoplasma pneumoniae
Streptococcus pyogenes
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20
Q

Acute otitis media- children

A

No antibiotics unless:

  • <2 years
  • symptoms persist >48 hours
  • high fevers
  • bilateral
  • otorrhea
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21
Q

Acute otitis media antibiotics

A

Amoxicillin 5-7 days (or co-amoxiclav)

OR clarithromycin 5-7 days

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22
Q

Acute otitis media complications

A

Decreased hearing
Mastoiditis
Brain abscess

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23
Q

Sinusitis viral

A

Common URTI viruses

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24
Q

Sinusitis bacterial

A

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

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25
Q

Sinusitis treatment

A

Treatment usually not necessary
Consider penicillin V or clarithromycin
Co-amoxiclav is systemically unwell

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26
Q

LRTI

A

Pneumonia - community acquired (typical or atypical), hospital acquired, aspiration
Exacerbations of chronic bronchitis
Bronchiectasis + cystic fibrosis
Empyema

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27
Q

Community Acquired Pneumonia- typical

A

Strep pneumoniae
Haemophilus influenzae
Staph aureus
M tuberculosis

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28
Q

Community Acquired Pneumonia- Atypical

A

Mycoplasma pneumoniae
Legionella
Chlamydia pneumoniae
Chlamydia psittaci

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29
Q

Pneumococcal pneumonia RFs

A

Influenza
Alcohol
Smoking/COPD
HIV

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30
Q

Pneumococcal pneumonia- resistance

A

Antibiotic resistance increasing

Always take a travel history- lots of country have resistant strains against amoxicillin

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31
Q

Atypical pneumonia

A

Mycoplasma pneumoniae

Legionella species

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32
Q

Mycoplasma

A

Smallest
No cell wall
Not affected by cell wall antibiotics

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33
Q

M pneumoniae

A 
Autumn-winter
Epidemics
Dry cough
\+/- pharyngitis, rhinorrhea, otalgia
\+/- hepatitis, meningitis
34
Q

M pneumoniae antibiotics

A

Macrolides (e.g. clarithromycin)
Quinolones (e.g. levofloxacin)
Tetracyclines (e.g. doxycycline)

35
Q

Legionella spp microbiology

A

> 50 species
Gram -ve rods
Slow growth (3-5 days)

36
Q

Legionella spp antibiotics

A

Cell wall antibiotics not effective

Quinolones>macrolides>tetracyclines effective

37
Q

S aureus pneumonia with abscess RFs

A

Colonisation of URT

Viral URTI

38
Q

S aureus pneumonia with abscess- PVL toxin strains causes

A

Severe disease

Necrotising/abscess formation

39
Q

CURB-65

A 
Confusion
Urea > 7mmol/l
Respiratory rate >30/min
BP (systolic <90 or diastolic< 60)
Age> or =65
40
Q

CURB-65 Score 0-1

A

Low severity
Risk of death <3%
Outpatient

41
Q

CURB-65 Score 2

A 
Moderate severity
Risk of death 9%
Admit
Microbiological investigations 
IV Rx
42
Q

CURB-65 Score 3-5

A

High severity
Risk of death 15-40%
Urgent admission

43
Q

CURB-65 0-1 treatment

A

Oral amoxicillin 500mg TDS OR doxycycline 100mg OD

44
Q

CURB-65 2 treatment

A

IV benzylpenicillin 1.2g QDS & doxycycline 100mg BD

45
Q

CURB-65 >2 treatment

A

IV co-amoxiclav 1.2g TDS & doxycycline 100mg BD
OR
IV ceftriaxone 2g OD & doxycycline 100mg BD

46
Q

CAP Summary

A

Mild- po amoxicillin
Moderate- IV benzylpenicillin + doxycycline
Severe- IV co-amoxiclav + doxycycline
h/o travel- IV ceftriaxone & doxycycline

47
Q

Hospital Acquired Pneumonia

A

> 48 hrs after admission or within 2 weeks of admission

48
Q

Hospital Acquired Pneumonia predisposing factors

A

Abnormal conscious state/intubation & ventilation

Immunosuppression

49
Q

HAP microbiology

A

as for CAP + gram negative organisms (e. coli, klebsiella, pseudomonas)

50
Q

HAP mild/moderate

A

doxycycline

51
Q

HAP severe

A 
early onset (<5 days)- co-amoxiclav)
late onset (>5 days)- piperacillin-tazobactam
52
Q

Aspiration pneumonia aetiology

A

Bacteria from URT/stomach
Low virulence
Polymicrobial (aerobic streptococci + anaerobes)

53
Q

Aspiration pneumonia treatment options

A

Amoxicillin + metronidazole
Levofloxacin + metronidazole
Co-amoxiclav
Piperacillin-tazobactam

54
Q

Exacerbation of COPD

A

Acute- due to inflammation in airways

Worsening of symptoms- SOB, Cough, Sputum

55
Q

Possible triggers for ECOPD

A 
Viruses
COPD
Bacteria
Pollution
CCF
VTE
Aspiration
56
Q

Infective ECOPD- bacteria

A

Haemophilus influenzae  Moraxella catarrhalis  Streptococcus pneumoniae
Pseudomonas aeruginosa  Chlamydia pneumoniae

57
Q

Infective ECOPD- viral

A 
Rhinovirus
Influenza/parainfluenza
Adenovirus
RSV
Metapneumovirus
Coronavirus
58
Q

IECOPD Antibiotics

A

Effective if h/o >2 of:

  • increased dyspnoea
  • increased sputum purulence
  • increased sputum volume
59
Q

IECOPD Empirical treatment

A

Doxycycline or clarithromycin

60
Q

IECOPD Specific treatment

A

Duration- 5 days
If relapse within 3 months, alternative agent
If consolidation on CXR then treat as CAP/HAP

61
Q

Bronchiectasis

A

Abnormal dilatation of major bronchi + bronchioles
Chronic daily cough with viscid sputum production
CT- bronchial wall thickening + luminal dilatation

62
Q

Cystic fibrosis

A

Congenital

Abnormal secretions resulting in chronic infections + bronchiectasis

63
Q

Bronchiectasis + CF Treatment

A

Guided by sputum culture
If no pseudomonas- clarithromycin of doxycycline or co-amoxiclav
If pseudomonas- po ciprofloxacin or IV pip-taz

64
Q

Bronchiectasis + CF prophylaxis

A 
Chest physio/postural drainage
Oral azithromycin (for recurrent only)
Inhaled abx (nebulised gentamicin, tobramycin, colistin
65
Q

Empyema

A

Complicated parapneumonic effusion (effusion into pleural space adjacent to bacterial pneumonia)
Usually small
Usually resolve with pneumonia treatment

66
Q

Complicated parapneumonic effusion

A

Bacteria involve pleural space

Empyema develops

67
Q

Empyema treatment

A

Drainage

Antibiotics until XR resolution (2-4 weeks)

68
Q

Prevention of Resp Infections

A

VACCINATIONS
Influenza 
Pneumococcal  Haemophilus influenzae  Pertussis 
Diptheria

69
Q

Infective Endocarditis RF

A

Iatrogenic- infected cannula

IVDA (often leads to right side endocarditis)

70
Q

Infective endocarditis pathogens

A

High pathogenicity organisms
Staphylococcus aureus  Strep pneumoniae 
yeast

71
Q

Infective endocarditis- abnormal native valve

A

rheumatic fever 
degenerative (calcific) disease 
congenital defects (especially turbulent flow) 
mitral valve prolapse (5-10 x risk)

72
Q

Infective endocarditis- abnormal valve bacteria

A

Often low virulence

oral (viridans) streptococci  Enterococcus spp. 
HACEK group of organisms
Occasionally …Coxiella burnetii, Chlamydia spp, Mycoplasma spp., Bartonella spp.

73
Q

Infective endocarditis- prosthetic valve

A

1st year after surgery- risk approx. 1-2%
Commonly- staph aureus, coagulase negative staph
After 1 year post-surgery- risk <0.5%
Commonly- oral streptococci, enterococcus spp.

74
Q

Infective Endocarditis treatment principles

A 
Vegetation impenetrable by phagocytes 
Surgical backup essential 
Synergistic combination often required 
Intravenous therapy essential – duration? 
Duration?  
- 4 weeks native valve IE  
- 6 weeks prosthetic valve IE 
Need to know aetiology of infection  
- MIC of organism guides therapy
75
Q

Infective endocarditis antibiotic sensitivity testing

A 
Disc diffusion tests
MIC tests (E test)
76
Q

Infective endocarditis antibiotic sensitivity testing- MIC

A

Minimum inhibitory concentration = lowest concentration of an antimicrobial that will inhibit the visible growth of a microorganism after overnight incubation

77
Q

Infective endocarditis antibiotic sensitivity testing- MBC

A

minimum bactericidal concentration = lowest concentration of antimicrobial that will prevent the growth of an organism after subculture on to antibiotic-free media.

78
Q

Empirical therapy for endocarditis

A

Only if severe endocarditis
Native valve- vancomycin + gentamicin OR vancomycin + meropenem
Prosthetic valve- Vancomycin + gentamicin + rifampicin

79
Q

IE directed therapy

A

Staphylococcus- flucloxacillin 4 hourly (MRSA- vancomycin)
Streptococci- benzyl penicillin 4 hourly (penicillin resistance- vancomycin + gentamycin)
Enterococci- amoxicillin 4 hourly + gentamicin

80
Q

Prosthetic valve IE course

A

6 weeks
Poor prognosis
Add oral rifampicin to treat biofilm

81
Q

Endocarditis summary

A

uncommon but may high morbidity & mortality 
difficult to diagnose 
4-6 weeks of IV antibiotic therapy 
surgery occasionally needed 
valve replacement carries risks of new infection 
Antimicrobial prophylaxis is generally no longer indicated but this is controversial

CR Year 3 (7 decks)

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