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Clinical pathology > Clinical Infections - Respiratory > Flashcards

Clinical Infections - Respiratory Flashcards

1
Q

Pharyngitis and Tonsillar Pharyngitis definition

A
  • Inflammation of the back of the throat (pharynx), resulting sore throat & fever
  • Common cause is viruses and bacteria
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2
Q

Acute tonsillar pharyngitis =

A
  • symmetrically inflamed tonsils and pharynx (+ systemic symptoms = severe infection)
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3
Q

Management of Pharyngitis and Tonsillar Pharyngitis

A
  • Centor Criteria = likelihood of sore throat being due to bacterial infection – likely if score is 3 or 4 (unlikely if less)
  • oral analgesics, more severe = antibiotics
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4
Q

Otitis Externa (OE) definition

A
  • Inflammation of the external ear canal presenting with a combination of: otalgia (ear ache), pruritus (severe itching of skin) and non-mucoid ear discharge
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5
Q

Acute OE

A
  • 90% cases bacterial
  • Ear swab or pus sample
  • Treatment = remove precipitating factors, pus and debris, analgesia then antimicrobials
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6
Q

Malignant (Necrotising) External Otitis

A
  • Affects skull base - life threatening
  • Immunocompromised
  • Severe pain, otorrhea, cranial nerve palsies
  • Management = prompt referral to ENT
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7
Q

Chronic OE

A
  • White keratin debris may fill ear canal and skin may thicken = blockage
  • Aetiology = contact dermatitis
  • Treat underlying cause
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8
Q

Otitis Media (OM) definition

A
  • Middle ear inflammation with build-up of fluid

- Common in children

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9
Q

Complicated OM =

A
  • Severe pain, perforated eardrum +/- discharge, bilateral infection, mastoiditis
  • Infection of mastoid bone/air cells
    Management = CT scan, analgesia, IV antibiotics +/- mastoidectomy
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10
Q

Treatment of Uncomplicated OM

A
  • Management = swab any pus, treat symptoms, amoxicillin
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11
Q

Pinna Cellulitis

A

Aetiology = Trauma, surgery/burns, infective agents
Complication = perichondritis (inflammation of connective tissue of the pinna)
- Management = swab of the area and blood cultures before antibiotics

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12
Q

Pneumonia definition

A
  • Infection affecting the most distal airways and alveoli with formation of inflammatory exudate
  • Bronchopneumonia and lobar pneumonia
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13
Q

Community Acquired Pneumonia (CAP)

A
  • Typical = S.pneumoniae, Enterobacteriaceae
  • Spread person to person
  • 50-70, midwinter-spring
  • CURB65 = assessment of disease
  • if CURB65 >2, do cultures
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14
Q

Hospital Acquired Pneumonia (HAP)

A
  • Develops >48 hours after admission

- Most common organism = pseudomonas

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15
Q

Ventilator Acquired Pneumonia

A
  • A subgroup of HAP; develops >48 hours after ET intubation and ventilation
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16
Q

Aspiration pneumonia

A
  • Pneumonia resulting from the abnormal entry of fluids into the lower respiratory tract – patient usually has impaired swallowing
  • Most common organism = anaerobes
17
Q

Mycoplasma pneumoniae =

A

children and young adults, present with cough

18
Q

Atypical pneumonia management

A
  • Stabilise – ABC, then prompt empirical therapy
19
Q

Legionella pneumophilia

A
  • Colonises water piping systems, present with high fevers, rigors, cough: dry initially but becomes productive, vomiting, diarrhoea,
20
Q

Chlamydophilia pneumoniae

A
  • Causes mild pneumonia or bronchitis in adolescents & young adults. Incidence highest in the elderly
21
Q

Chlamydophilia psittaci

A

Associated with exposure to birds. Consider in those with pneumonia, splenomegaly & history of bird exposure

22
Q

Viral LRTI - Influenza

A
  • Flu - Influenza A/B
  • dry couch, sore throat 2-3 weeks
  • Complication = viral pneumonia + secondary bacterial pneumonia
  • Diagnosis = viral antigen detection in respiratory samples using PCR
23
Q

Viral LRTI - VZV

A
  • significant morbidity & mortality in adults with VZV
  • Onset 1-6 days after the rash has appeared with symptoms of progressive tachypnoea, dyspnoea, and dry cough
  • chest X-ray typically reveals diffuse bilateral infiltrates
  • supportive & prompt administration of IV antibiotics
24
Q

Viral LRTI - Rhinovirus

A
  • Common cold
  • Can trigger exacerbations of asthma
  • Tests = PCR on NPA/throat swab
  • Treatment is supportive
25
Q

Viral LRTI - CMV

A
  • CMV pneumonia is a complication of CMV
  • Seen in immunocompromised
  • Tests = CXR, broncho-alveolar lavage & viral load PCR
  • Treatment = supportive, anti-virals
26
Q

LRTI with Bronchiectasis

A
  • Lungs are more vulnerable to infection
  • Suspect bronchiectasis if recurrent infections and if sputum is green
  • Treatment = effective clearance of sputum, underlying cause treated
27
Q

LRTI with Cystic Fibrosis

A
  • S.aureus in childhood and Pseudomonas aeruginosa
  • Burkholderia cepacia complex = very resistant
  • Prolonged antibiotic courses e.g. 3-4 weeks
28
Q

Vaccinations that prevent LRTI’s

A
  • Pneumococcal (S. pneumoniae) = chronic disease

- Influenza = annual in vulnerable groups

29
Q

Aspergillosis

A
  • Aspergillosis = opportunistic – seen in immunocompromised and those with respiratory pathology.
  • Presentation = allergic reaction, lung/other organ infection
30
Q

Allergic Bronchopulmonary Aspergillosis (ABPA)

A
  • Epidemiology = background of atopy, asthma and CF
  • Symptoms = worsening asthma and lung function, central bronchiectasis
  • Diagnostic features = high total IgE, specific IgE/IgG to aspergillus
  • Treatment = supportive care, corticosteroids and antifungal therapy
31
Q

Pulmonary aspergilloma

A
  • Mobile mass of aspergillus in a pre-existing lung cavity
  • Symptoms = cough, haemoptysis, weight loss, wheeze & clubbing
  • Treatment = surgical resection and antifungals
32
Q

PCP (pneumocystis jiroveci pneumonia)

A
  • An opportunistic fungal infection
  • Resistant to number of antifungals
  • Diagnosis = organisms in induced sputum, PCR to detect P. jiroveci DNA
  • Treatment = supportive care, steroids and antimicrobials. Some e.g. HIV+ = prophylaxis
33
Q

Nocardia Asteroides

A
  • Acquired through inhalation of nocardia
  • Seen mostly in immunosuppressed and those with respiratory pathology
  • Lung abscesses can form
  • Diagnosis = organisms in sputum, broncho-alveolar lavage or biopsy
  • Treatment = supportive care and antibiotics
34
Q

Mycobacterium tuberculosis

A
  • Most frequent cause of infectious death

- Inhalation of infected resp. droplets which lodge and multiply in alveoli

35
Q

Symptoms of pulmonary TB

A
  • Chronic productive cough, haemoptysis, weight loss, fever, night sweats
36
Q

What happens to a TB infection

A
  • Depending on the host’s immune response the infection will either become quiescent (inactive) or progress and/or disseminate (affect other organs) - highest risk of this/reactivation at the extremes of age and in the immunocompromised
37
Q

Diagnosis and treatment of TB

A
  • Diagnosis = supportive radiology + detection of acid-fast bacilli
  • Detection = PCR based
  • Treatment = combined chemotherapy
  • Prevention = BCG (Bacillus Calmette-Guérin vaccine)

Clinical pathology (69 decks)

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