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RW Respiratory > Infection > Flashcards

Infection Flashcards

1
Q

What is the clinical presentation of flu?

A

High fever of abrupt onset Malaise Myalgia (sore muscles) Headache Cough Prostration (flat on back, unable to do anything) - £10 note test

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2
Q

Which organisms are the cause of classical flu?

A

Influenza A and influenza B virus

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3
Q

Which virus is most likely to cause a pandemic?

A

Influenza A

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4
Q

Which organisms are the cause of flu-like illnesses?

A

Parainfluenza (among others)

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5
Q

What is the difference between classical flu influenza and homophiles influenza?

A

Classical flu is a virus and homophiles influenza is a bacteria

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6
Q

What is the management of flu?

A
  • Bed rest, fluids and paracetamol - Antivirals: oseltamivir, zanamivir
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7
Q

Endemic

A

Naturally occurs in the population (e.g. flu)

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8
Q

Epidemic

A

Outbreak of unexpected size to a given area, country or population • E.g. obesity or winter epidemic of flu pretty much every year

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9
Q

Pandemic

A

Global distribution of disease - rare and serious

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10
Q

Antigenic drift

A

Antigen has slightly changed from what it was before - Enough that the antibodies don’t quite recognise the antigen, but enough of a response that you don’t get too ill (occurs in endemics)

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11
Q

Antigenic shift

A

Antigens have completely changed

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12
Q

What are the phases of pandemics?

A

• Phases 1-3: stages where you don’t really need to worry - Flu is starting to mutate but hasn’t been transmitted to anyone else yet • Phase 4: Sustained human-human transmission • Phase 5-6: Widespread human infection • Post peak phase: Possibility of recurrent of events. Another peak, which can even be more serious than the original peak • Post pandemic: Disease resumes normal levels within a population

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13
Q

Pneumonia

A

Infection involving the distal airspaces usually with inflammatory exudation (“localised oedema”). Fluid filled spaces lead to consolidation.

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14
Q

In which group of people is CAP classically seen?

A

Otherwise healthy young adults

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15
Q

What are the complication of pneumonia?

A
  • Organisation (fibrous scarring) - Abscess - Bronchiectasis - Empyema – spread of inflammation to the pleural cavity.
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16
Q

Bronchopneumonia

A

Infection starting in airways and spreading to adjacent alveolar lung. Occurs in people who can’t clear organisms.

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17
Q

Lung abscess

A

Cavitating lesion in the lung with localised collection of pus. Associated with chronic malaise and fever.

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18
Q

Bronchiectasis

A

Abnormal fixed dilatation of the large airways (bronchi) due to fibrous scarring after infection in the lung (pneumonia, tuberculosis, cystic fibrosis)

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19
Q

What is the pathophysiology of bronchiectasis?

A

Infection organises rather than resolves, scar tissue is formed, airway is pulled open and the dilatation becomes fixed. Once the airways are larger than a certain diameter, they begin to produce secretions and these will accumulate. Static secretions are a fertile ground for infections.

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20
Q

What condition is bronchiectasis often associated with?

A

Cystic fibrosis

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21
Q

What kind of reaction is TB?

A

Delayed (Type IV) hypersensitivity - granulomas with necrosis

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22
Q

What is the pathophysiology of TB?

A

Inhaled organism phagocytosed and carried to hilar lymph nodes. Immune activation (few weeks) leads to a granulomatous response in nodes (and also in lung) usually with killing of organism. In a few cases infection is overwhelming and spreads

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23
Q

Where does secondary TB tend to be localised?

A

Apices of lung

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24
Q

What are the signs and symptoms of TB?

A

Weight loss, night sweats, cough, haemoptysis, breathless, upper zone crackles, headache, drowsy, peritonitis

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25
Q

What is the treatment for TB?

A

2 months of 4, 4 months of 2: RIPE: Rifampicin, Isoniazid, Pyrazinmide, Ethambutol

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26
Q

Which respiratory infections can occur in the URT?

A

Common cold (coryza) Pharyngitis Sinusitis Epiglottitis

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27
Q

Which respiratory infections can occur in the LRT?

A

Acute bronchitis Acute exacerbation of chronic bronchitis Pneumonia Influenza

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28
Q

What is the common cold (coryza) and how is it spread?

A

Acute viral infection of the nasal passages often accompanied by sore throat. Spread by droplets and fomites.

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29
Q

Which viruses are associated with the common cold?

A

Rhinoviruses, coronaviruses and adenoviruses

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30
Q

What is sinusitis?

A

Viral (or bacterial/fungal) infection of paranasal sinuses, usually preceded by coryza.

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31
Q

What is rhinitis and what are the different types?

A

Sneezing attacks, nasal blockage/discharge occurring >1hr on most days. Can either be seasonal/intermittent (hay fever or perennial/persistent.

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32
Q

What is pharyngitis?

A

Endemic adenovirus infection, causing reddened oropharynx and soft palate and inflamed tonsils. (sore throat)

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33
Q

What is acute epiglottitis?

A

Life-threatening airway obstruction in children aged 2-7yrs caused by H. influenzae.

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34
Q

What is influenza?

A

Flu symptoms caused by Influenza A (pandemics) and Influenza B (localised outbreaks). Not a cold!

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35
Q

What is bronchitis?

A

“Cold which goes to the chest” – acute infection of bronchi causing them to become inflamed. Usually arises from Strep. pneumoniae/H. influenzae infections, or in people with COPD

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36
Q

What should you not use in epiglottitis?

A

Don’t use a laryngoscope in acute epiglottitis, because exacerbate the swelling

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37
Q

What is diphtheria and what is it characterised by?

A

Potentially fatal contagious bacterial infection that mainly affects the nose and throat. Characterised by pseudo membrane forms which can cut off the airways

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38
Q

What is the incubation time for rhinovirus?

A

1-5 days

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39
Q

What is the incubation time for group A strep?

A

1-5days

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40
Q

What is the incubation time for influenza and parainfluenza?

A

1-4 days

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41
Q

What is the incubation time for influenza and Ebstein barr virus?

A

4-6 weeks

42
Q

What is pertussis and what is its incubation time?

A

Whooping cough - 7-21 days

43
Q

What are the clinical features of acute exacerbation of COPD?

A

Green sputum is key • Increased sputum production • Increased sputum purulence • More wheezy • Breathless

44
Q

What is the management of acute exacerbation of COPD?

A

• Antibiotic. e.g. doxycycline or amoxicillin • Bronchodilator inhalers • Short course of steroids in some cases • Refer to hospital if • Evidence of respiratory failure or not coping at home

45
Q

Red hepatisation of the lung

A

When the lung turns a darker red and looks like liver. With pneumonia, RBCs are released into the interstitium

46
Q

What are the symptoms of pneumonia?

A

• Cough • Pleurisy • Haemoptysis • Dyspnoea • Preceding URTI • Abdominal pain • Diarrhoea • Malaise • Anorexia • Sweats • Rigors • Myalgia (muscle pain) • Arthralgia (joint pain) • Headache • Confusion

47
Q

What is the definition of pneumonia?

A

Signs and symptoms of a lower respiratory tract infection, with a new infiltrate on a CXR

48
Q

What is the CURB 65 score?

A

C - New onset of confusion U - Urea >7 R - Respiratory rate >30/min B - Blood pressure Systolic

49
Q

What are the complications of pneumonia?

A

• Respiratory failure • Pleural effusion • Empyema • Death

50
Q

What is different about the management of HAP?

A

Need extended gram negative cover

51
Q

What is different about the management of aspiration pneumonia?

A

Need anaerobic cover

52
Q

What is different about legionella pneumonia?

A

• Chest symptoms may be minimal • GI disturbance is common • Confusion common

53
Q

In what group of people does klebsiella pneumonia occur?

A

elderly/diabetics/alcoholics

54
Q

In what group of people does pneumocystis pneumonia occur?

A

The immunosuppressed

55
Q

What is the most common organism causing pneumonia?

A

Strep pneumonia

56
Q

What investigations would you do for pneumonia?

A

Bloods (WCC, CRP) Sputum and blood cultures Atypical serology eg. mycoplasma or legionella CXR

57
Q

Which type of pneumonia are you primarily considering with 23 year old asthmatic women who has been feeling ‘under the weather’ for 2 week with lethargy and dry cough with central burning chest pain on coughing?

A

Mycoplasma pneumonia

58
Q

Which type of pneumonia are you primarily considering with 26 year old nursery nurse with frequent chest infections and had lots of antibiotics over many months and productive sputum?

A

Haemophilus influenzae - common in those with bronchiectasis particularly nursery nurses

59
Q

Which type of pneumonia are you primarily considering with IV drug users?

A

Staph aureus

60
Q

What are examples of antivirals?

A

• oseltamivir • zanamivir

61
Q

How is flu confirmed in the lab?

A

Direct detection of the virus via PCR or antibody detection

62
Q

Which organism infection causes Q fever?

A

Coxiella burnetti

63
Q

What are the 3 most common atypical pneumonias?

A

Mycoplasma, coxiella and chlaminphila psittaci

64
Q

What is the treatment for Mycoplasma, coxiella and chlaminphila psittaci (3 most common atypical pneunomias)?

A

Tetracycline and macrolides (eg clarithromycin)

65
Q

In what group of people does bronchiolitis most commonly present?

A

1-2 years children

66
Q

Which virus most commonly causes bronchiolitis?

A

Respiratory Syncytial Virus

67
Q

Which virus was first isolated in 2001 and associated with Acute Respiratory Tract Infections?

A

Metapneumovirus

68
Q

What is the main way for detecting any virus?

A

PCR

69
Q

Chlamydia trachomatis

A

STI which can cause infantile pneumonia - can be passed onto child during vaginal childbirth

70
Q

Which are of the body is inflamed in rhinitis?

A

The nose

71
Q

What is the treatment for acute epilglottitis?

A

Ceftriaxone

72
Q

Which kinds of organisms colonise the upper respiratory tract?

A

Gram-positive • α-haemolytic streptococci, including Strep pneumonia • ß-haemolytic streptococci e.g. Strep progenies • Staphylococcus aureus Gram-negative, including • Haemophilus influenza • Moraxella catharalis

73
Q

How does the conducting airway (trachea and bronchi) resist colonisation and infection?

A

• Mucociliary escalator • Cough • AMP’s • Cellular & humoral immunity

74
Q

Which organism is associated with whooping cough (pertussis)?

A

Bordetella pertussis (gram positive coccobacillus)

75
Q

How do you diagnose pertussis?

A

• Bacterial culture - Pernasal swab (charcoal) • PCR - Pernasal swab (

76
Q

How does the respiratory zone (terminal airways and alveoli) remain sterile and avoid infections?

A

alveolar lining fluid containing surfactant, Ig, complement, FFA, AMP as well as alveolar macrophages and neutrophils

77
Q

How is legionella pneumonia spread?

A

No person-to-person spread. Transmitted by inhalation of contaminated water droplets, therefore associated with factories or in unused shower heads in hotels etc

78
Q

How can you detect legionella pneumonia?

A

• Legionella urinary antigen • Culture • Paired serology • Now PCR available direct from Sputum

79
Q

What is the treatment for legionella pneumonia?

A

Clarithromycin or erythromycin

80
Q

What poses the greatest risk for hospital acquired pneumonia?

A

Endotracheal  intubation with mechanical ventilation, as this breaches airway defences, impairs cough & mucociliary clearance and facilitates microaspiration of secretions that pool above the endotracheal tube cuff

81
Q

What are the most commonly associated organisms for CAP?

A

Strep pneumoniae, haemophylius influenzae, staph aureus and atypical

82
Q

What are the most commonly associated organisms for HAP?

A

Gram-negative (including E. coli, Klebsiella spp. Pseudomonas spp), CAP organisms, S. aureus and anaerobes

83
Q

Which group of people is - Pneumocystis jirovecii pneumonia (PCP) associated with?

A

Immunocompromised

84
Q

What is the treatment for - Pneumocystis jirovecii pneumonia (PCP)?

A

Co-trimoxazole or pentamidine

85
Q

Aspergillus

A

Chest infection resulting from the inhalation of fungal spores, usually aspergillum fumigatus

86
Q

What is the treatment for aspergillus?

A

Amphotericin B, Voriconazole or Surgery

87
Q

What is the test for TB?

A

Ziehl-neelson stain as it is a an acid alcohol fast bacilli, or PCR or culture

88
Q

What are the advantages and disadvantages of each of the tests for TB?

A

Culture is the most sensitive but it is very slow. Mycobacterial PCR is fast but expensive. Ziehl-neelson is cheap and fast, but no indication of species of sensitivity

89
Q

True or False: TB can infect almost any organ

A

True

90
Q

Why do you need to treat TB for 6 months?

A

Because it continues to replicate

91
Q

What are some of the causes of immunodeficieny than can result in chronic infection?

A
  • Immunoglobin deficiency eg. IgA deficiency, hypogammaglobulinaemia, CVID - Hyposplenism - Immune paresis - HIV
92
Q

What is the difference between immunodeficiency and immunosuppression?

A

Immunodeficiency is the results of specific diseases etc whereas immunosuppression is a form of treatment given by steroids, methotrexate, monoclonal antibodies etc

93
Q

What conditions can result in abnormal cilia and thus result in chronic infections?

A

Kartagener’s syndrome (cilia can’t move) or Young’s syndrome (no cilia at all)

94
Q

What conditions can result in abnormal secretion and thus result in chronic infections?

A

Cystic fibrosis or channelopathies

95
Q

What is an intrapulmonary abscess and what causes it?

A

Localised suppuration assoc. with cavity formation on CXR/CT. Caused by aspiration, TB, Stap/Klebs cavitating pneumonia, septic emboli, foreign body inhalation

96
Q

Bronchiectasis

A

Abnormal permanent dilatation of airways, resulting inflammation and thickening of walls. Mucociliary transport mechanism is impaired and thus recurrent bacterial infections ensue.

97
Q

What is the most common cause of bronchiectasis?

A

Cystic fibrosis

98
Q

What would you see on CXR of bronchiectasis?

A

Dilated and thickened bronchi

99
Q

What are the symptoms of bronchiectasis?

A

• Recurrent infections/antibiotics • Productive cough (yellow-green sputum, can become haemoptysis) • Halitosis (bad breath) • Recurrent febrile episodes, malaise • Clubbing • Coarse crackles, pneumonic episodes

100
Q

What is the management of bronchiectasis?

A

• Pneumococcal vaccine • Postural drainage! • Antibiotics (mild: cefaclor/ciprofloxacin, flucloxacillin if S. aureus; persistent: ceftazidime) • Bronchodilators + anti-inflammatory agents

101
Q

Cystic fibrosis

A

Autosomal recessive disorder in which there is a defect in the CFTR gene, a critical chloride channel resulting in abnormally viscous mucous – blockages of many tubular structures including conducting airways & lungs.

102
Q

What is the carrier rate of CF?

A

1 in 25

RW Respiratory (17 decks)

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