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Medicine Phase 2a Respiratory > Infection > Flashcards

Infection Flashcards

1
Q

Management of pneumonia

A

Assess using ABC
Treat hypotension/shock from infection
Assess for dehydration (common if acutely unwell and fever) - consider IV fluid support
Investigations to assess severity
Antibiotics
Analgesia for pleuritic chest pain e.g. paracetamol 1g/6h or NSAID

If no improvement e.g. hypoxic despite oxygen then consider CPAP to recruit lung parenchyma and improve oxygenation. But if patient is hypercapnic, they will require ventilation. If no changes in PaCO2 or hypoxia, refer to ICU

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2
Q

Investigations for severity of pneumonia (management of pneumonia)

A

CXR
Oxygen saturation and ABG if SaO2 <92% or severe pneumonia
FBC, U and E, LFT, CRP
Blood cultures (CURB-65 criteria at least 2)
Sputum cultures (CURB-65 criteria at least 3 or if 2 and not had antibiotics)
Urine pneumococcoal antigen (CURB-65 criteria at least 2) or Legionella antigen (CURB-65 criteria at least 3)
Viral throat swabs (consider) and mycoplasma serology
Pleural fluid aspirated for culture (CURB-65 criteria at least 2)
IF immunocompromised or on ICU, consider bronchoscopy or bronchoalveolar lavage

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3
Q

Describe each part of CURB-65 score

A

Confusion (abbreviated mental test less than 9)
Urea >7mmol/L
Respiratory rate (at least 30/min)
Blood pressure (<90/60mmHg)

Age (at least 65)

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4
Q

Indications depending on CURB-65 score

A

0-1: home treatment if possible
At least 2: hospital therapy
At least 3: indicates severe pneumonia and should consider ICU referral

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5
Q

What is pneumonia

A

Infection of lung parenchyma caused by a lower respiratory tract infection

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6
Q

Epidemiology of pneumonia

A

Community-acquired pneumonia is 5-11 per 1000 adults

Of these 1-3 per 1000 will require hospitalisation and mortality is those hospitalised is up to 14%

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7
Q

Most common organism causing pneumonia

A

Streptococcus pneumoniae (60-75%)

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8
Q

Organisms that can cause pneumonia

A

Streptococcus pneumoniae
Haemophilus influenzae
Mycoplasma pneumoniae
Staphylococcus aureus (found more commonly in ICU patients)
Legionella species and Chlamydia psittaci
Gram-negative bacilli, often hospital-acquired or immunocomprimised e.g. Pseudomonas (especially those with COPD)
Viruses

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9
Q

What % of pneumonia cases are caused by viral infections (including influenza)

A

15%

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10
Q

Symptoms of pneumonia (name 4)

A 
*Fever
Rigors
Malaise
Anorexia
*Dyspnoea
*Cough with purulent sputum (classically rusty with pneumococcus)
Haemoptysis
*Pleuritic chest pain
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11
Q

Signs of pneumonia (name 4)

A

*Percussion - dull
*Auscultation - crackles, bronchial breathing
*Septicaemia - Rigors
*Respiratory failure - Cyanosis, Tachypnoea
Herpes labialis (pneumococcus)
Confusion
Tachycardia
Hypotension
Signs of consolidation (diminished expansion, increased vocal resonance)
Pleural rub

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12
Q

Complications of pneumonia

A 
Pleural effusion
Empyema
Lung abscess
Respiratory failure
Septicaemia
Pericarditis
Myocarditis
Cholestatic jaundice
AKI
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13
Q

What is an acute ooryza

A

Permenant dilation and thickening of the airways

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14
Q

Aetiology of acute ooryza

A

Infection by rhinovirus: spread by droplets and close personal contact

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15
Q

Pathophysiology of acute ooryza

A

Virus binds to ICAM-1 receptors -> releases inflammatory mediators by unknown mechanism

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16
Q

Epidemiology of acute ooryza

A

Extremely prevalent.

Multiple regional strains.

17
Q

Clinical presentation of acute ooryza

A

Incubation period of 12hrs - 5 days.

Then, malaise, mild pyrexia, sore throat and watery nasal discharge.

18
Q

Treatment of acute ooryza

A

Symptomatic.

Nasal decongestants, ibuprofen for malaise.

19
Q

Epidemiology of TB

A
  1. 6 mil new cases/yr (37% unexpected/undiagnosed)
  2. 3% and 20% of previously treated are drug resistant
  3. 5 million deaths/yr
20
Q

What % of TB cases have a co-infection with HIV

A

12%

21
Q

True or False:

Leading cause of death worldwide (1.5 million/year)

A

True

22
Q

Epidemiology of TB specific to UK

A

~8000/year or 12 per 100000
73% born outside UK
70% in deprived areas
30% with pulmonary disease (wait>4months from symptoms to treatment)

23
Q

What bacteria causes TB

A

Mycobacterium tuberculosis

24
Q

Pathophysiology of acute TB infection

A

Occurs when containment by immune system (macrophages and T-cells) is inadequate.
Can arise from primary infection or re-activation of previously latent disease.

25
Q

How is TB transmitted

A

Via inhalation of aerosol droplets containing bacterium.

Means only pulmonary disease is communicable.

26
Q

Pathophysiology of latent TB infection

A

Infection without disease due to persistent immune system containment (i.e. granuloma formation prevents bacteria growth and spread).
Positive skin/blood testing shows evidence of infection but patient is asymptomatic and non-infectious.

27
Q

Risk factors of re-activation by TB or latent TB

A 
New infection (<2 years)
HIV
Organ transplantation
Immunosuppression (includes corticosteroids)
Silicosis
Illicit drug use
Malnurition
High-risk settings (homeless shelter, prison)
Low socio-economic status
Haemodialysis
28
Q

Most common site in body of TB disease

A

Lungs (pulmonary) - 52%

29
Q

Other sites (not lungs) in body of TB infection

A 
Extra-thoracic lymph nodes (24%)
Intra-thoracic lymph nodes (12%)
Pleural (9%)
Gastrointestinal (6%)
Spine, Other bone, Miliary, Meningitis, GU
30
Q

Treatment of pneumonia

A 
BAPP
Breathing: Maintain oxygen saturation levels
Antibiotics: treat underlying cause
Pain = give analgesics
Pneumococcal vaccines for those at risk
31
Q

Possible methods of invasion in pneumonia

A

Inhibition of IgA
Pneumolysins - inhibit ciliary beating
Damage of epithelial cells by prior infection
Use of platelet aggregating factor receptor pathway to reach the alveoli

32
Q

People at higher risk of pneumonia and thus get a pneumococcal vaccine

A

Diabetics
Immunosuppressed
>65 years old

33
Q

Complications of pneumonia

A 
Respiratory failure (due to ARDS)
Septic shock (release of cytokines in blood)
Pleural effusion
Empyema
Lung abscess
Hypotension
34
Q

Cause of respiratory failure from pneumonia

A

Acute Respiratory Distress Syndrome

35
Q

Cause of hypotension from pneumonia

A

Dehydration

Sepsis

36
Q

Ix of pneumonia

A

CXR (shows infiltrates)
Sputum sample analysis (causative organism)
Monitor oxygen sats
Bloods - Raised WCC and inflammatory markers
Urinary antigen test - pneumococcal or Legionella antigen
Arterial blood gas (ABG)

Medicine Phase 2a Respiratory (22 decks)

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