General Stack on Respiratory Infection Flashcards
List the range of upper respiratory tract infections
1) Common cold (coryza)
2) Sore throat (pharyngitis)
3) Sinusitis
4) Epiglottitis
What test should be done on someone with an exacerbation of COPD and flu-like symptoms?
Viral Throat Swab
Symptoms and treatment of strop throat?
SYMPTOMS -exudate -pus -sore throat -dysphagia -dysphonia TREATMENT -antibiotics
Characteristics of tonsillitis?
- swollen tonsils
- erythematous
- dysphagia
- dysphonia
- recurrent
What is quincy and how do you treat it?
It’s a complication of tonsillitis
Is a tonsilar abscess
Drained by surgeon under general anasthetic
Why can quincy be life threatening?
The infection is very close to the carotid artery and so can spread to the brain
A kid comes in with a sore throat, temperature, difficulty in swallowing & breathing, stridor and a hoarse voice. What do you do?
NOTHING DO NOT TOUCH THE KID.
Call an anaesthetist & explain you think it may be epiglottitis- a medical emergency.
Keep the child and parents calm, dont let the kid lie down and do NOT go anywhere near his/her throat!!!!!!!!
List the range of lower respiratory tract infections
- Acute bronchitis
- Acute exacerbation of COPD
- Pneumonia
- Influenza
- Fungal Infection
A patient presents with a frontal headache, maxillary sinus pain, tooth ache and discharge. Possible diagnosis?
Sinusitis
They may also have retro-orbital pain
Describe acute sinusitis and treatment
-preceded by a common cold
-purulent nasal discharge
-TREATMENT
-mostly viral aetiology
-usually self-limited &
resolves in 10 days
-nasal decongestant
(oxymetazoline)
-nasal steroids
-pseudo-ephedrine
-SOME need antibiotics
How can you spot diptheria? (keeping in mind its rarity due to vaccination)
a characteristic pseudo-membrane
A patient presents with a productive cough, a transient wheeze but normal CXR and chest examination. You also find out from the history that they had a cold very recently (well done Sherlock!) What is the likely diagnosis?
Acute Bronchitis
- patients may also have a fever although this is only in the minority of cases
- it is usually viral and self limiting in normal people
- BUT can lead to significant morbidity in patients with chronic lung disease
What are the signs and symptoms of COPD?
Firstly, its a variable disease.
- chronic sputum production
- bronchoconstriction
- inflammation of airways
- breathlessness
- chest pains
- exacerbations
- infective
- non-infective
A patient with COPD comes in complaining of increased sputum production&purulence and increased breathlessness . You examine them and find coarse crackles and a wheeze. Whats the likely diagnosis?
Acute Exacerbation of COPD. Symptoms: -increased sputum production -increased sputum purulence -more wheezy -breathlessness Examination Signs: -respiratory distres -wheeze -coarse crackles -may be cyanosed -in advanced disease (worsening) ankle oedema
How do you manage acute exacerbations of COPD in primary care?
-antibiotic e.g. dooxycycline or amoxicillin
-bronchodilator inhalers
-short course of steroids in some cases
-can refer to hospital if:
-evidence of resp.
failure
-not coping at home
Which infection is the biggest killer in under50s in the UK?
Pneumonia
What are the symptoms of pneumonia? (15)
Abdominal pain Anorexia Arthralgia Confusion Cough Diarrhoea Dyspnoea Headache Heamoptysis Malaise Myalgia Pleurisy Preceding URTI Rigors Sweats
What are the signs of pneumonia?
- Fever
- Rigors
- Herpes Labialis (common due to alteration in immune system)
- Tachypnoea
- Crackles
- Rub
- Cyanosis
- Hypotension
What’s a useful thing to do when checking for cyanosis in the mouth?
Place your fingers next to the patients tongue so you can get a colour comparison
What investigations can you carry out/order to confirm/deny a possible pneumonia case?
- blood culture
- serology
- arterial gases
- full blood count
- urea
- liver function
- chest X-Ray
When using CXR in a possible case of pneumonia what should you always remember?
The symptoms might arrive before it shows up on a CXR. A CXR may not show pneumonia but 2 days later a repeat CXR does.
How do you calculate a CURB65 score?
C: New onset confusion U: Urea >7 R: Resp rate >30/min B: Blood pressure systolic <90 OR diastolic <61 65: aged 65 or older
Score 1 point for each of above
Add 10% mortality to patient with COPD
Mortality increases as CURB65 score increases
What disease is a CURB65 score calculated?
Community Acquired Pneumonia
What are the approximate mortalities for CURB65 score?
0-1= <5% mortality
2-3=<10% mortality
4-5= 15-30% mortality
What are some of the other severity markers for pneumonia?
Temperature <35 or >40
Cyanosis PaO2 <8kPa
WBC <4 or >30
Mutli lobar involvment
How would you manage a case of community acquired pneumonia?
-antibiotics
-amoxicillin
-doxycycline
-see ‘antibiotic man’
-oxygen
-maintain SaO2 94-98%
or 88-92%
-fluids
-bed rest
-no smoking
IV access is associated with a risk of further infection so they are to be used when…
Oral route is not available
Drug resistant organisms
Deep seated infections
e.g. abscesses, bone, endocarditis, meningitis
First dose
rapid increase in plasma concentrations
When do sputum samples matter?
- when resistant organism suspected
- TB or NTM suspected
- failure to improve on standard therapies
- high risk individuals
What should you ask yourself when predicting the organism?
- young or old?
- severity?
- immuno-competent vs immuno-compromised
- chronic illness?
- lifestyle?
What lifestyle Q&As are associated with which types of pneumonia?
- HIV
- PCP (pneumocystis pneumonia)
- PWID (IVDU)
- staph aureus - Alcohol/Homeless
- TB
- Klebsiella
- Frequently hospitalised
- Pseudomonas
- Returning Traveller
- Legionella
- TB
- Indian Sub-continent
- TB
- Eastern Europe
- MDR TB
- XDR TB
Complications of pneumonia
- Respiratory failure
- Pleural effusion
- Empyema
- Death
Methods to prevent pneumonia
- Influenza & pneumococcal vaccines
- >65
- chronic chest or cardiac disease
- diabetes
- immunocompromised
e. g. splenectomy - Influenza vaccine
- health care workers
