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Clinical Pathology > CP10 respiratory infections > Flashcards

CP10 respiratory infections Flashcards

1
Q

What are 4 common illnesses that cause an acute sore throat?

A

Pharyngitis
Tonsillitis
Infectious mononucleosis (EBV)
Suspect epiglottitis

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2
Q

What in the history helps you diagnose what is causing an acute sore throat?

A

Speed of onset
Difficulty breathing/speaking
Ability to swallow/eat/drink
Associated neck swelling +/- pain
Symptoms of systemic infection e.g. fever, chills, malaise
Travel history

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3
Q

What is the most common infectious cause of a sore throat?

A

Viruses

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4
Q

What are 2 common types of pathogens that cause acute sore throats?

A

Virus
Bacteria

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5
Q

What 2 criteria help identify patients with a sore throat that need antibiotics?

A

FeverPAIN criteria and centor criteria

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6
Q

What is included in the FeverPAIN criteria?

A

Fever in previous 24 hrs
Purulence (pus on tonsils)

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7
Q

What is included in the centor criteria?

A

Is there a presence of:
Fever
Tonsillar exudate
Tender lymphadenopathy
Cough

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8
Q

What a clinical history of an acute sore throat…

…What is the aetiology?

…What is the diagnosis?

…What are appropriate investigations and treatment?

A

Bacterial or viral infection

Pharyngitis, tonsillitis, mono/glandular fever

Monospot if suspect EBV, can do throat swab, blood cultures (if septic) full blood count, urea, electrolytes and liver function tests - treat with antibiotics

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9
Q

What is the clinical history of mono/glandular fever?

What is the aetiology?

What is the diagnosis?

What is the management/ treatment?

A

Often asymptomatic but can cause fever, tonsillitis, pharyngitis and cervical lymphadenopathy.

EBV

Glandular fever

AVOID amothocilin

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10
Q

What is the clinical history of epiglottis?

What is the aetiology?

What is the diagnosis?

What is the management/ treatment?

A

Sore throat, fever, muffled voice, drooling, stridor, children sit leaning forward

Caused by hemophillus influenza (vaccine reduced incidence), strep pneuomoniae and group A strep

Epiglottis

Don’t examine throat as can close airway. Do blood cultures and epiglottis swaps once airway is supported. Oxygenate, IV antibiotics and analgesia.

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11
Q

What is a common cause of chronic/persistent sore throat?

A

Gastro-oesophageal reflux

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12
Q

What is the clinical history of otitis externa?

What is the aetiology?

What is the diagnosis?

What investigations are done and what is the management/ treatment?

A

Acute = Otalgia, pruritus, non-mucoid discharge.
Chronic= pruritis, discomfort,

Acute = usually bacterial (can be fungal)
Chronic = bacteria - usually pseudomonas aeruginosa or staph aureus

If persisted longer than 3 weeks, chronic OE, less than three weeks acute OE

Investigated with otoscopic exam, history, ear swab. If necrotising also with a CT temporal bone and bone biopsy, blood cultures of systemically unwell. Treat with ear drops (can be antibiotic, corticosteroid, antifungal or acidic)

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13
Q

What is the clinical history of malignant/necrotising otitis externus?

What is the aetiology?

What is the diagnosis?

What is the management/ treatment?

A

Severe pain, otorrhoea, granulation tissue in canal floor, potentially cranial nerve palsies

Bacterial infection spread

It is an infection - not a cancer

6 week course of IV antibiotics e.g. fluroquinolone +/- a penicillin, topical antibiotic/corticosteroids, rarely surgical debridement

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14
Q

What is the clinical history of otitis media (OM)?

What is the aetiology?

What is the diagnosis?

What is the management/ treatment?

A

Uncomplicated acute= mild pain that lasts <72 hours with no ear discharge nor fever about 39 Celsius or any other severe systemic symptoms
Complicated acute= severe ear pain + perforated eardrum +/- purulent discharge. Bilateral infection with associated mastoiditis.

Viruses and bacteria (e.g. strep pneumoniae, haemophilus influenza & moraxella catarrhalis) - very common in children

Uncomplicated acute, complicated acute or chronic OM (chronic if symptom duration = >6 weeks)

Swab for any pus. If no systemic illness only treat symptoms e.g. with analgesia. If unwell then treat with amoxicillin or clarithromycin

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15
Q

What is the clinical history of mastoiditis ?

What is the aetiology?

What is the diagnosis?

What is the management/ treatment?

A

Fever, pain posterior to ear +/- local erythema over the mastoid bone, oedema of the pinna (aka the auricle) +/- a posterior and downward displacement.

Complication of acute otitis media

Mastoiditis - requires CT head

Treatment = analgesia, IV antibiotics +/- mastoidectomy

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16
Q

What is the clinical history of pinna cellulitis?

What is the aetiology?

What is the diagnosis?

What is the management/ treatment?

A

Pain, erythema and swelling of auricle + hot to touch

Trauma e.g. a piercing, surgery, burns or bacteria (pseudomonas aeruginosa +/- staphylococcus aureus)

Pinna cellulitis or Perichondritis if only affects upper part of outer ear

Antibiotics e.g. Ciprofloxacin + Flucloxacillin/vancomycin

17
Q

What is the clinical history of bacterial pneumonia?

What is the aetiology?

What is the diagnosis?

What is the management/ treatment?

A

Symptoms = Productive cough, SoB, mucopurulent sputum, pleuritic chest pain, fatigue, fever/chills
Signs= tachypnoea tachycardia, hypotension, dull lungs on percussion with reduced air entry and bronchial breathing (not always crackles)

Caused by typical (have cell wall and easily culturable in lab) or atypical (no/atypical cell wall and often non-culturable) bacteria - usually s.pneumoniae or haemophilus influenzae (both typical)

Bronchopneumonia or lobar pneumonia. Community acquired pneumonia (CAP) or hospital acquires pneumonia (HAP), ventilation acquired pneumonia (VAP), aspiration pneumonia

CAP = Sputum culture, blood cultures, check for urinary antigens, PCR or serology for viral pathogens, mycoplasma pneumoniae or chlamydia species, HIV test (especially for recurrent CAP), manage using ABC (airway, breathing, circulation)

18
Q

What are common atypical bacteria causing bacterial pneumonia?

A

Chlamydia pneumoniae
Mycoplasma pneumoniae
Legionella pneumophila

19
Q

How is severity of pneumonia measure/monitored?

A

With CURB score
(C= confusion, U= urea >7mmol/l, R = RR > 30 breaths per min, B = BP where systolic = <90 or diastolic = <60 mmHg)

20
Q

What are some viruses causing pneumonia in healthy people?

In immunocompromised people?

A

Influenza A and B
Adenovirus
VZV
+ RSV and parainfluenza in children
+ measles, HSV, CMV and HHV-6 in immunocompromised

21
Q

What is the clinical history of influenza?

What is the aetiology?

What is the diagnosis?

What is the management/ treatment?

A

Fever, headache, myalgia, dry cough, sore throat

Influenza A and B

Flu - can progress to primary viral pneumonia or secondary bacterial pneumonia

Treated with hydration, analgesics, antivirals like tamiflu for some.

22
Q

What is the clinical history of VSV pneumonia?

What is the aetiology?

What is the diagnosis?

What is the management/ treatment?

A

Rash, progressive tachypnoea, dyspnoea and dry cough

Complication of VZV infection

VZV pneumonia

Investigated with chest X-ray and treated with breathing support and IV acyclovir

23
Q

What is the clinical history of rhinovirus?

What is the aetiology?

What is the diagnosis?

What is the management/ treatment?

A

Symptoms of common cold

Rhinovirus

Common cold which can cause LTRI or trigger asthma exacerbations

Supportive

24
Q

What is the clinical history of CMV?

What is the aetiology?

What is the diagnosis?

What is the management/ treatment?

A

Usually asymptomatic but on initial infection can have cold like symptoms including high temp, myalgia, fatigue, sore throat and swollen glands

CMV

Cytomegalovirus

Usually no treatment unless have congenital CMV, immunocompromised or have had a stem cell or organ transplant then given antivirals

25
Q

What is the clinical history of LRTI with bronchiactasis?

What is the aetiology?

What is the diagnosis?

What is the management/ treatment?

A

Chronic cough, mucopurulent sputum production and recurrent infection

S.aureus, H.influenza, P.aeruginosa or viruses

LRTI

Antibiotics, effective clearance of respiratory secretions, nutritional support, annual flu vaccine

26
Q

What is the clinical history of LRTI with CF?

What is the aetiology?

What is the diagnosis?

What is the management/ treatment?

A

General LRTI symptoms

S.aureus, P.aeruginosa, Burkholderia cepacia, non-TB mycobacteria, fungi

LRTI with acute exacerbation of CF

Prolonged antibiotics, postural drainage, deep breathing, coughing, exercise, aerosolised DNAase, influenza and pneumococcal vaccination - in serious cases with lung transplant

27
Q

What is the clinical history of allergic bronchopulmonary aspergillosis?

What is the aetiology?

What is the diagnosis?

What is the management/ treatment?

A

Worsening asthma and lung function in individuals with a PMHx of atopy, asthma or CF

An allergic reaction to exposure to aspergillus causing high IgE levels specific to aspergillus

ABPA

Corticosteroids and antifungal therapy

28
Q

What is the clinical history of aspergilloma?

What is the aetiology?

What is the diagnosis?

What is the management/ treatment?

A

Cough, haemoptysis, weight loss, wheeze, nail clubbing- sometimes can be asymptomatic

Aspergillus colonises/ forms a mobile mass in pre-existing lung cavity left by previous TB or sarcoidosis

Aspergilloma

Chest x-ray or CT, test for aspergillus IgG antibody +/- aspergillus antigen and sputum culture used for diagnosis

Can resolve spontaneously but also treated with surgical resection +/- antifungals

29
Q

What is the clinical history of pneumocystis jirovecii pneumonia (PCP)?

What is the aetiology?

What is the diagnosis?

What is the management/ treatment?

A

Pneumonia with gradual onset of fever, dyspnoea, non-productive cough and reduced exercise tolerance and exercise induced hypoxia

Fungus, which lacks ergosterol wall thus not susceptible to anti fungals, transmitted via airborne particles

Pneumocystis jiroveci pneumonia

Investigations include PCR, bronchi-alveolar lavage and blood test for beta-D-glucan

Treated with antimicrobials e.g. co-trimoxaxolem steroids and supportive care and primary prophylaxis in risk groups e.g. those with HIV whose CD4 is <200

30
Q

What is the clinical history of nocardia asteroides?

What is the aetiology?

What is the diagnosis?

What is the management/ treatment?

A

Variable clinical presentations so hard to diagnose

Nocardia bacteria inhaled and can cause lung abscesses

Nocardia asteroides

Supportive (ABC) and long term antibiotics (several months) - usually co-trimoxazole

31
Q

What is the clinical history of mycobacterium tuberculosis?

What is the aetiology?

What is the diagnosis?

What is the management/ treatment?

A

Chronic productive cough, haemoptysis, weight loss, fever, night sweats - 90% of primary infections are asymptomatic and can reactive in later life and become symptomatic

Inhalation of respiratory droplets of mycobacterium tuberculosis causes formation of ghon focus in alveoli

TB or miliary TB if disseminated

Diagnosed with clinical features + supportive radiology + sputum sample which is positive for acid fast bacilli or M. Tuberculosis culture. IGRA and tuberculin skin tests can also be used,

Treated with combined chemotherapy and BCG vaccine given to children and infants in high risk areas

Clinical Pathology (65 decks)

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