Clinical Infections - Respiratory

Question 1

Pharyngitis and Tonsillar Pharyngitis definition

Answer 1

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

Question 2

Acute tonsillar pharyngitis =

Answer 2

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

Question 3

Management of Pharyngitis and Tonsillar Pharyngitis

Answer 3

• 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

Question 4

Otitis Externa (OE) definition

Answer 4

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

Question 5

Acute OE

Answer 5

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

Question 6

Malignant (Necrotising) External Otitis

Answer 6

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

Question 7

Chronic OE

Answer 7

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

Question 8

Otitis Media (OM) definition

Answer 8

• Middle ear inflammation with build-up of fluid

- Common in children

Question 9

Complicated OM =

Answer 9

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

Question 10

Treatment of Uncomplicated OM

Answer 10

• Management = swab any pus, treat symptoms, amoxicillin

Question 11

Pinna Cellulitis

Answer 11

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

Question 12

Pneumonia definition

Answer 12

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

Question 13

Community Acquired Pneumonia (CAP)

Answer 13

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

Question 14

Hospital Acquired Pneumonia (HAP)

Answer 14

• Develops >48 hours after admission

- Most common organism = pseudomonas

Question 15

Ventilator Acquired Pneumonia

Answer 15

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

Question 16

Aspiration pneumonia

Answer 16

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

Question 17

Mycoplasma pneumoniae =

Answer 17

children and young adults, present with cough

Question 18

Atypical pneumonia management

Answer 18

• Stabilise – ABC, then prompt empirical therapy

Question 19

Legionella pneumophilia

Answer 19

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

Question 20

Chlamydophilia pneumoniae

Answer 20

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

Question 21

Chlamydophilia psittaci

Answer 21

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

Question 22

Viral LRTI - Influenza

Answer 22

• 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

Question 23

Viral LRTI - VZV

Answer 23

• 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

Question 24

Viral LRTI - Rhinovirus

Answer 24

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

Question 25

Viral LRTI - CMV

Answer 25

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

Question 26

LRTI with Bronchiectasis

Answer 26

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

Question 27

LRTI with Cystic Fibrosis

Answer 27

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

Question 28

Vaccinations that prevent LRTI's

Answer 28

- Pneumococcal (S. pneumoniae) = chronic disease | - Influenza = annual in vulnerable groups

Question 29

Aspergillosis

Answer 29

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

Question 30

Allergic Bronchopulmonary Aspergillosis (ABPA)

Answer 30

- 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

Question 31

Pulmonary aspergilloma

Answer 31

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

Question 32

PCP (pneumocystis jiroveci pneumonia)

Answer 32

- 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

Question 33

Nocardia Asteroides

Answer 33

- 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

Question 34

Mycobacterium tuberculosis

Answer 34

- Most frequent cause of infectious death | - Inhalation of infected resp. droplets which lodge and multiply in alveoli

Question 35

Symptoms of pulmonary TB

Answer 35

- Chronic productive cough, haemoptysis, weight loss, fever, night sweats

Question 36

What happens to a TB infection

Answer 36

- 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

Question 37

Diagnosis and treatment of TB

Answer 37

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