Infections Flashcards
1
Q
What are upper respiratory tract infections?
A
Common cold (coryza), sore throat (pharyngitis), sinusitis, epiglottitis, tonsillitis and quinzy, diphtheria
2
Q
What are complications of the common cold?
A
Acute bronchitis and sinusitis
3
Q
What are some organisms causing the common cold?
A
Adenovirus, respiratory syncytial virus, rhinovirus
4
Q
What is the severe type of sinusitis?
A
Erythroid
5
Q
What is a sign of epiglottitis and what should you never do?
A
Drooling- never open mouth as they will choke
6
Q
What is quinzy?
A
Tonsil abscess
7
Q
What makes diphtheria life threatening?
A
Toxin production
8
Q
What are lower respiratory tract infections?
A
Acute bronchitis, COPD exacerbations, influenza, pneumonia
9
Q
What are signs of acute bronchitis?
A
Cough, fever, possible wheeze
10
Q
What is the treatment for acute bronchitis?
A
No antibiotics generally, maybe in those with a chronic lung disease
11
Q
What happens in a COPD exacerbation?
A
Increased sputum, wheeze and dyspnoea
12
Q
What are signs of a COPD exacerbation?
A
Respiratory distress, wheeze, coarse crackles, cya nosed, ankle oedema
13
Q
What is the treatment for an acute exacerbation of COPD?
A
Amoxicillin (or doxycycline), steroids and bronchodilators
14
Q
What additional things would be added to the treatment of a COPD exacerbation in secondary care?
A
CXR, ABG, oxygen if there is respiratory failure
15
Q
What are symptoms of influenza?
A
Fever, malaise, myalgia, headache, cough, prostration
16
Q
What are 8 signs of pneumonia?
A
Fevers, rigorous, herpes labialis, tachypnoea, crackles, rub, cyanosis, hypertension
17
Q
What symptoms are particularly common in legionella?
A
GI disturbance and confusion
18
Q
Besides CURB65, what are other severity markers of pneumonia?
A
Severe high or low temperature, WBC count <4 or >30, cyanosis and multi-lobar involvement
19
Q
What investigations do you do to diagnose pneumonia?
A
Blood culture, serology, CXR, ABG, FBC, urea, liver function
20
Q
How do you manage CA pneumonia?
A
Antibiotics, bed rest, fluids, oxygen, no smoking
21
Q
What are complications of pneumonia?
A
Respiratory failure, pleural effusion, empyema, fibrous scarring, abscess, bronchiectasis, death
22
Q
What is the further management needed for HA pneumonia?
A
Further gram negative cover
23
Q
What is the further management needed for aspiration pneumonia?
A
Further anaerobic cover
24
Q
What type of organisms tend to colonise the upper respiratory tract?
A
Gram + alpha haemolytic strep, beta haemolytic strep, gram negatives
25
What is an example of a gram positive alpha haemolytic strep?
Streptococcus pneumoniae
26
What is an example of a beta-haemolytic strep?
Streptococcus pyogenes
27
What are examples of gram - bacteria colonising the upper respiratory tract?
Haemophilus influenzae, moraxella catharalis
28
What bacteria causes TB?
Mycobacterium tuberculosis
29
What type of bacteria is m. tuberculosis?
Acid alcohol fast bacilli
30
How do you treat TB?
2 months rifampicin, isoniazid, pyrazinamide and ethambutol (RIPE), 4 months RI
31
What are the 3 'influenza' viruses?
Influenza A/B (classical), parainfluenza virus (flu-like illness), haemophilus influenzae (a bacterium and not a direct cause of flu)
32
How do you treat influenza?
Bed rest, fluids, paracetamol, possibly antivirals e.g. olselamivir
33
What type of influenza is involved in pandemics?
Type A
34
What is the main cause of bronchiolitis?
Respiratory syncytial virus
35
How do you treat bronchiolitis?
Supportive therapy
36
What organism is known to cause infantile pneumonia?
Chlamydia trachomatis
37
What is chlamydia pneumoniae?
A mild respiratory tract infection
38
What causes epiglottitis?
Haemophilus influenzae type B
39
How do you treat epiglottitis?
Ceftriaxone
40
Who is epiglottitis more common in?
Immune compromised/suppressed
41
What are some bacteria causing a COPD exacerbation?
Haemophilus influenzae, moraxella catarrhalis, streptococcus pneumoniae (also some gram -'s)
42
When do you treat a COPD exacerbation?
Whenever there is increased sputum purulence, new changes on CXR or pneumonia
43
What are some organisms involved in CF?
strep pneumoniae, haemophilus influenzae, staph aureus, burkholderia Cepacia, pseudomonas auriginosa
44
What are symptoms of whooping cough?
Cold like symptoms for 2 weeks, paroxysmal coughing, vomiting
45
What causes whooping cough and what kind of bacteria is this?
Bartedella pertussis- gram - cocco bacillus
46
When should you give antibiotics for a whooping cough?
If the cough has lasted <21 days
47
How is whooping cough diagnosed?
Culture from swab or PCR, serology, history and exam
48
What are the top 5 organisms causing CAP?
1) Strep. pneumoniae
2) Haemophilus. influenzae
3) Mycoplasma. pneumoniae
4) Staphylococcus. aureus
5) Gram -'s e.g. Coxiella. burnetti
49
What are some atypical organisms causing CAP?
Legionella, moraxella. catarrhalis, chlamydia
50
What CAP causing organism is most common in children and young people?
Mycoplasma pneumoniae
51
What does mycoplasma pneumoniae show on a CXR?
Reticulo-nodular shadowing/patchy consolidation of 1 lobe
52
What does staph. aureus show on a CXR?
Bilateral cavitation bronchopneumonia
53
Where does legionella commonly come from?
Colonised hot water tanks
54
What does legionella show on a CXR?
Bi-basal consolidation
55
What are some examples of aspiration pneumonia as well as the common ones?
Klebsiella pneumoniae, E.coli, pseudomonas auriginosa
56
Who is Klebsiella pneumoniae common in and where is it commonly found?
Alcohol abuse- often in the upper lobes
57
What is the common bacteria in the immunocompromised?
Pneumocystis Jirovecii (PCP)
58
How do you treat PCP?
Co-trimoxazole
59
What else is common in immunocompromised?
Aspergillis
60
What are the 2 most common causes of HAP?
Staph aureus and gram - enterobacteria
61
What are other causes of HAP?
Pseudonomas, Klebsiella, Bacteroides, Clostridia
62
What is common in bronchiectasis?
Pseudonomas
63
What is TB infection?
The immune system has not completely cleared the disease
64
What is TB disease?
Showing symptoms of TB
65
How do diseases of lower lung lobes usually come about?
Through the bloodstream
66
How do diseases of upper lung lobes usually come about?
Through inhaled pathogens
67
What are 11 features of TB?
Weight loss, fevers, night sweats, malaise, pain, bowel obstruction, headache, fits, drowsy, cough
68
What confirms a diagnosis of TB?
Staining characteristics, culture
69
What will the radiology for TB show?
Upper lobe predominance with cavity formation?
70
What can happen when taking rifampicin?
It can cause other current medication not to work very well
71
Where does TB live in the body?
In macrophages
72
How long does it take to be non-infectious from TB?
1-2 weeks
73
What does single agent resistance usually target in TB and how is treatment changed?
Usually just affects isoniazid- treatment is prolonged
74
Was is commonly affected by MDR in TB?
Rifampicin and isoniazid
75
What are signs of latent TB?
No evidence of active TB, evidence of previous TB infection, calcification on x-ray
76
What tests can be used to test for previous TB exposure?
Interferon gamma release assay, mantoux test
77
What are TB drugs associated with and who is this more common in?
Disturbance of liver function- more common in women
78
What people have the highest rates of TB?
HIV
79
What are some viruses which can cause pneumonia?
Influenza, parainfluenza, measles, varicella-zoster, respiratory syncytial virus
80
What is lobar pneumonia?
Consolidation involving a whole lung lobe?
81
What organism most commonly causes lobar pneumonia?
Strep. pneumoniae
82
Who is lobar pneumonia more commonly found in?
Otherwise healthy young adults
83
What is the basic pathology behind lobar pneumonia?
Fibrin rich fluid, neutrophil infiltration, macrophage infiltration, resolution
84
What is bronchopneumonia?
Starts in the airways and spreads to adjacent alveolar lung
85
What context is bronchopneumonia most commonly seen in?
People with pre-existing disease
86
What is important to remember about the organisms causing bronchopneumonia?
They can be more varied
87
What type of pneumonia can commonly lead to abscess?
Aspiration pneumonia
88
What is bronchiectasis?
Abnormally fixed dilation of the bronchi usually due to fibrous scarring followed by infection
89
What accumulates in bronchiectasis?
Purulent secretions
90
What type of reaction is TB?
Delayed type IV hypersensitivity reaction- granulomas with necrosis
91
How does TB exert pathogenicity?
Avoids phagocytosis and stimulates a host T cell response
92
What happens in primary TB?
The inhaled organism is phagocytosed and carried to hilar lymph nodes
93
What happens in secondary TB?
Reinfection or reactivation of the disease in a person with some immunity.
94
Where does the disease tend to be in secondary TB?
Usually localised at the apices but can spread to the airways and bloodstream
95
Where does primary TB tend to be?
There is a small focus in the periphery of the midzone and large hilar lymph nodes
96
What is an important differential diagnosis in secondary TB?
Cancer
97
What makes TB reactivate?
Decreased T cell function or immunosuppressive therapy
98
What virus is common in the immunosuppressed?
Cytomegalovirus
99
What fungi is common in the immunosuppressed?
Aspergillus, candida, pneumocystis
100
What medication counts as being immunosuppressed?
Steroids and cancer treatment
101
What are differentials for a pulmonary infection?
Lung cancer, abscess, empyema, bronchiectasis, CF
102
What are risk factors for developing chronic lung infections?
Immunosuppressed/immunodeficiency, abnormal host defence, repeated insult, immunoglobulin deficiency
103
What does IgA deficiency predispose to?
Recurrent acute infections, not chronic
104
What does an intrapulmonary abscess present with?
Weight loss, lethargy, weakness, cough
105
What is common in people with an intrapulmonary abscess?
A preceding illness
106
What are some pathogens causing intrapulmonary abscess?
Bacterial (strep, staph, e-coli, gram -'s) or fungi (aspergillus)
107
What can be causes of septic emboli and who is this common in?
Right sided endocarditis, infected DVT, septicaemia, common in PWID
108
What is empyema?
Pus in the pleural space
109
What are empyemas common following?
Pneumonia, and there is often a progression from effusion to empyema
110
What type of organisms cause empyema? What is the exception to this?
Usually aerobic organisms, anaerobic in severe pneumonia or poor dental hygiene
111
What tests are done for empyema?
CXR- will show white out 'D sign', CT and ultrasound
112
How do you treat empyema?
Broad spectrum IV antibiotics (amoxicillin, metronidazole) initially followed by oral antibiotics directed towards the specific organism for at least 14 days
113
How would you describe the bronchi in bronchiectasis?
Inflamed and easily collapsible
114
What does bronchiectasis present as?
Recurrent 'chest infections' and antibiotic prescriptions with no or little response . There is also persistent sputum production and a cough
115
How do you test for bronchiectasis?
High resolution CT
116
What is the presentation of bronchial sepsis?
Similar to bronchiectasis but with no evidence of that following tests
117
Who is bronchial sepsis common in?
Young people or adults in healthcare or older people with COPD or other airway diseases
118
What should the diagnosis of a chronic infection always lead to?
A check for underlying immunodeficiency
119
What is the main cause of the problem in CF?
A defect in the cystic fibrosis transmembrane conductance regulator- a chloride channel found in lumen cells
120
What does the CFTR channel do in normal people?
Transport of chlorine into the lumen of the lungs- it is ATP regulated and inhibits sodium and some other channels
121
What happens when the CFTR channel fails?
Sodium and water leaks into other cells which causes dehydration of the lumen.
122
What are the consequences of dehydration of the lumen in CF?
Salty sweat, intestinal blockage, fibrotic pancreas, failure to thrive, recurrent bacterial lung infections, absence of vas deferens
123
How many different classes of CFTR mutations are there and which is the worst?
5 different classes- Class I is the worst as there is no CFTR synthesis
124
What are some signs of CF in adulthood?
Upper lobe bronchiectasis, colonisation with staph, infertility and low weight
125
What treatment do you give if a CF patient is colonised with staph aureus?
Flucloxacillin oral or septrin oral
126
What treatment do you give if pseudomonas colonises a CF patient?
Oral azithromysin, nebulised colomycin, tobramycin and aztreonam and inhaled tobramycin
127
What can exacerbations of CF be managed by?
Antibiotics, physiotherapy, adequate hydration and increased dietary input
128
How many antibiotics should be given to CF patients and why?
Always 2 to reduce resistance
129
What antibiotics do you give to a CF patient with cepacia?
Temocillin
130
What is the G551D mutation in CF?
A class III mutation; there is a normal CFTR but a non-functioning channel
131
What drug can help in G551D mutations and why is it rarely used?
Ivacaftor- it is extremely expensive
