chest infection Flashcards

1
Q

list URTI

A
rhinitis
sinusitis
pharyngitis
tonsillitis (Quinsy)
laryngitis
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2
Q

list LRTI

A

laryngo-trachea-bronchitis (LTB)
bronchiolitis
pneumonitis (may or may not be infection)

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3
Q

what is empyema

A

plural infection. plural space fills with fluid/pus

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4
Q

what is bronchiectasis

A

recurring damaged airways susceptible to infection

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5
Q

what is difficult to differentiate between when looking at exacerbations

A

infectious or inflammatory response?

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6
Q

source control important

A

consider the pathogen, host and severity

outcome = pathogen and host

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7
Q

basic microbiology

A

respitatory microbiology: commensal organism vs respiratory pathogen

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8
Q

basic antibiotic biology

A

consider spectrum, route of administration, bioavailabilty, duration

consider goal of treatment - cure, control, maintenance, ‘immune-modulation’

cant sterilise the lungs

mechanisms -> understand bactericidal and bacteriostatic

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9
Q

basic immunology

A

local defences, innate and adaptive

innate: phagocytosis, complement, CRP (measure / acute phase response)

adaptive (cell-mediated and humoral response)

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10
Q

sepsis

A

a life-threatening organ dysfunction caused by a dysregulated host response to infection

pathogen x host = outcome

sepsis wins! if someone has it, it is your main concern

MAP <65mmHg, lactate >2mmol/l

hypotension despite fluid resuscitation, requiring vasopressors

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11
Q

treatments for URTI

A

supportive mainly

consider underlying diagnosis - allergy, polyps, immunity

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12
Q

treatments for LRTI

A

supportive, maybe need antibiotics

consider related morbidity - URT, LRT, asthma, chronic cough

make back-up plan - consider CXR, antibiotics, referral

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13
Q

pneumonia

A

have to abnormality of XR
AB’s -even if likely virus

consider underlying diagnosis

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14
Q

empyema

A

AB’s
drain
supportive
definitive treatment = surgery

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15
Q

bronchiectasis

A

airway clearance! (drain pus)
then AB’s
long term management plan

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16
Q

lung abscess, cavitation

A

AB’s
treatment defined by pathogen/cause
surgery

17
Q

X-ray can show

A

LRTI:

  • mucus plugging (pneumonia)
  • pneumonia (e.g. right or left lower lobe)
18
Q

aspergillosis pneumonia (has had pneumonia, got emphysema and bronchiectasis)

A

aspergilloma is a growth (fungus ball) that develops in an area of past lung disease or lung scarring such as TB or lung abscess. SOB, cough (blood, lumps, mucus), wheeze, pyrexia)

19
Q

granulomatous polyangiitis (GPA)

A

inflammation not infection

steroids and cytotoxic drug

20
Q

community acquired pneumonia

A

viral, bacterial (step, H.inf), or co-infection

cough, phlegm, SOB, fever

consider clinical features and radiology and CURB65 (reflects 30day mortality)

21
Q

how long should you give AB’s?

A

don’t know

depends on pathogen (some take days to kill), disease and host response

22
Q

how long is treatment for pneumonia, deep seated infection, empyema, cavitation?

A

pneumonia - 5-7days; 3 days may be sufficient (pneumococcus)

deep seated infection - 14days

empyema - 4-6weeks

cavitation - pyogenic >6weeks, TB 6months, NTM 18months

23
Q

hospital acquired pneumonia

A

different pathogens different outcomes

24
Q

what has the biggest impact?

A

vaccination

25
differential diagnosis of pneumonia
- organising pneumonia - bronchoalveolar carcinoma (BAC) - vasculitis
26
summary
consider the severity of the infection, the cause of the infection and the best treatment strategy for that person use resources widely - blood tests, sputum, review in hospital, CXR...sputum, CT PET, 16s rRNA sequencing consider a range of alternative explanations in pneumonia - the DD work with colleagues for both the individual and the wider community
27
future directions
rapid diagnostics, rapid drug sensitivities, improved community support, immunomodulatory therapy, biomarkers to assess response, sequencing