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Respiratory > Infections > Flashcards

Infections Flashcards

1
Q

What are upper respiratory tract infections?

A

Common cold (coryza), sore throat (pharyngitis), sinusitis, epiglottitis, tonsillitis and quinzy, diphtheria

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2
Q

What are complications of the common cold?

A

Acute bronchitis and sinusitis

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3
Q

What are some organisms causing the common cold?

A

Adenovirus, respiratory syncytial virus, rhinovirus

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4
Q

What is the severe type of sinusitis?

A

Erythroid

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5
Q

What is a sign of epiglottitis and what should you never do?

A

Drooling- never open mouth as they will choke

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6
Q

What is quinzy?

A

Tonsil abscess

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7
Q

What makes diphtheria life threatening?

A

Toxin production

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8
Q

What are lower respiratory tract infections?

A

Acute bronchitis, COPD exacerbations, influenza, pneumonia

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9
Q

What are signs of acute bronchitis?

A

Cough, fever, possible wheeze

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10
Q

What is the treatment for acute bronchitis?

A

No antibiotics generally, maybe in those with a chronic lung disease

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11
Q

What happens in a COPD exacerbation?

A

Increased sputum, wheeze and dyspnoea

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12
Q

What are signs of a COPD exacerbation?

A

Respiratory distress, wheeze, coarse crackles, cya nosed, ankle oedema

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13
Q

What is the treatment for an acute exacerbation of COPD?

A

Amoxicillin (or doxycycline), steroids and bronchodilators

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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

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15
Q

What are symptoms of influenza?

A

Fever, malaise, myalgia, headache, cough, prostration

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16
Q

What are 8 signs of pneumonia?

A

Fevers, rigorous, herpes labialis, tachypnoea, crackles, rub, cyanosis, hypertension

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17
Q

What symptoms are particularly common in legionella?

A

GI disturbance and confusion

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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

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19
Q

What investigations do you do to diagnose pneumonia?

A

Blood culture, serology, CXR, ABG, FBC, urea, liver function

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20
Q

How do you manage CA pneumonia?

A

Antibiotics, bed rest, fluids, oxygen, no smoking

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21
Q

What are complications of pneumonia?

A

Respiratory failure, pleural effusion, empyema, fibrous scarring, abscess, bronchiectasis, death

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22
Q

What is the further management needed for HA pneumonia?

A

Further gram negative cover

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23
Q

What is the further management needed for aspiration pneumonia?

A

Further anaerobic cover

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24
Q

What type of organisms tend to colonise the upper respiratory tract?

A

Gram + alpha haemolytic strep, beta haemolytic strep, gram negatives

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25
Q

What is an example of a gram positive alpha haemolytic strep?

A

Streptococcus pneumoniae

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26
Q

What is an example of a beta-haemolytic strep?

A

Streptococcus pyogenes

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27
Q

What are examples of gram - bacteria colonising the upper respiratory tract?

A

Haemophilus influenzae, moraxella catharalis

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28
Q

What bacteria causes TB?

A

Mycobacterium tuberculosis

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29
Q

What type of bacteria is m. tuberculosis?

A

Acid alcohol fast bacilli

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30
Q

How do you treat TB?

A

2 months rifampicin, isoniazid, pyrazinamide and ethambutol (RIPE), 4 months RI

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31
Q

What are the 3 ‘influenza’ viruses?

A

Influenza A/B (classical), parainfluenza virus (flu-like illness), haemophilus influenzae (a bacterium and not a direct cause of flu)

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32
Q

How do you treat influenza?

A

Bed rest, fluids, paracetamol, possibly antivirals e.g. olselamivir

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33
Q

What type of influenza is involved in pandemics?

A

Type A

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34
Q

What is the main cause of bronchiolitis?

A

Respiratory syncytial virus

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35
Q

How do you treat bronchiolitis?

A

Supportive therapy

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36
Q

What organism is known to cause infantile pneumonia?

A

Chlamydia trachomatis

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37
Q

What is chlamydia pneumoniae?

A

A mild respiratory tract infection

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38
Q

What causes epiglottitis?

A

Haemophilus influenzae type B

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39
Q

How do you treat epiglottitis?

A

Ceftriaxone

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40
Q

Who is epiglottitis more common in?

A

Immune compromised/suppressed

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41
Q

What are some bacteria causing a COPD exacerbation?

A

Haemophilus influenzae, moraxella catarrhalis, streptococcus pneumoniae (also some gram -‘s)

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42
Q

When do you treat a COPD exacerbation?

A

Whenever there is increased sputum purulence, new changes on CXR or pneumonia

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43
Q

What are some organisms involved in CF?

A

strep pneumoniae, haemophilus influenzae, staph aureus, burkholderia Cepacia, pseudomonas auriginosa

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44
Q

What are symptoms of whooping cough?

A

Cold like symptoms for 2 weeks, paroxysmal coughing, vomiting

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45
Q

What causes whooping cough and what kind of bacteria is this?

A

Bartedella pertussis- gram - cocco bacillus

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46
Q

When should you give antibiotics for a whooping cough?

A

If the cough has lasted <21 days

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47
Q

How is whooping cough diagnosed?

A

Culture from swab or PCR, serology, history and exam

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48
Q

What are the top 5 organisms causing CAP?

A

1) Strep. pneumoniae
2) Haemophilus. influenzae
3) Mycoplasma. pneumoniae
4) Staphylococcus. aureus
5) Gram -‘s e.g. Coxiella. burnetti

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49
Q

What are some atypical organisms causing CAP?

A

Legionella, moraxella. catarrhalis, chlamydia

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50
Q

What CAP causing organism is most common in children and young people?

A

Mycoplasma pneumoniae

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51
Q

What does mycoplasma pneumoniae show on a CXR?

A

Reticulo-nodular shadowing/patchy consolidation of 1 lobe

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52
Q

What does staph. aureus show on a CXR?

A

Bilateral cavitation bronchopneumonia

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53
Q

Where does legionella commonly come from?

A

Colonised hot water tanks

54
Q

What does legionella show on a CXR?

A

Bi-basal consolidation

55
Q

What are some examples of aspiration pneumonia as well as the common ones?

A

Klebsiella pneumoniae, E.coli, pseudomonas auriginosa

56
Q

Who is Klebsiella pneumoniae common in and where is it commonly found?

A

Alcohol abuse- often in the upper lobes

57
Q

What is the common bacteria in the immunocompromised?

A

Pneumocystis Jirovecii (PCP)

58
Q

How do you treat PCP?

A

Co-trimoxazole

59
Q

What else is common in immunocompromised?

A

Aspergillis

60
Q

What are the 2 most common causes of HAP?

A

Staph aureus and gram - enterobacteria

61
Q

What are other causes of HAP?

A

Pseudonomas, Klebsiella, Bacteroides, Clostridia

62
Q

What is common in bronchiectasis?

A

Pseudonomas

63
Q

What is TB infection?

A

The immune system has not completely cleared the disease

64
Q

What is TB disease?

A

Showing symptoms of TB

65
Q

How do diseases of lower lung lobes usually come about?

A

Through the bloodstream

66
Q

How do diseases of upper lung lobes usually come about?

A

Through inhaled pathogens

67
Q

What are 11 features of TB?

A

Weight loss, fevers, night sweats, malaise, pain, bowel obstruction, headache, fits, drowsy, cough

68
Q

What confirms a diagnosis of TB?

A

Staining characteristics, culture

69
Q

What will the radiology for TB show?

A

Upper lobe predominance with cavity formation?

70
Q

What can happen when taking rifampicin?

A

It can cause other current medication not to work very well

71
Q

Where does TB live in the body?

A

In macrophages

72
Q

How long does it take to be non-infectious from TB?

A

1-2 weeks

73
Q

What does single agent resistance usually target in TB and how is treatment changed?

A

Usually just affects isoniazid- treatment is prolonged

74
Q

Was is commonly affected by MDR in TB?

A

Rifampicin and isoniazid

75
Q

What are signs of latent TB?

A

No evidence of active TB, evidence of previous TB infection, calcification on x-ray

76
Q

What tests can be used to test for previous TB exposure?

A

Interferon gamma release assay, mantoux test

77
Q

What are TB drugs associated with and who is this more common in?

A

Disturbance of liver function- more common in women

78
Q

What people have the highest rates of TB?

A

HIV

79
Q

What are some viruses which can cause pneumonia?

A

Influenza, parainfluenza, measles, varicella-zoster, respiratory syncytial virus

80
Q

What is lobar pneumonia?

A

Consolidation involving a whole lung lobe?

81
Q

What organism most commonly causes lobar pneumonia?

A

Strep. pneumoniae

82
Q

Who is lobar pneumonia more commonly found in?

A

Otherwise healthy young adults

83
Q

What is the basic pathology behind lobar pneumonia?

A

Fibrin rich fluid, neutrophil infiltration, macrophage infiltration, resolution

84
Q

What is bronchopneumonia?

A

Starts in the airways and spreads to adjacent alveolar lung

85
Q

What context is bronchopneumonia most commonly seen in?

A

People with pre-existing disease

86
Q

What is important to remember about the organisms causing bronchopneumonia?

A

They can be more varied

87
Q

What type of pneumonia can commonly lead to abscess?

A

Aspiration pneumonia

88
Q

What is bronchiectasis?

A

Abnormally fixed dilation of the bronchi usually due to fibrous scarring followed by infection

89
Q

What accumulates in bronchiectasis?

A

Purulent secretions

90
Q

What type of reaction is TB?

A

Delayed type IV hypersensitivity reaction- granulomas with necrosis

91
Q

How does TB exert pathogenicity?

A

Avoids phagocytosis and stimulates a host T cell response

92
Q

What happens in primary TB?

A

The inhaled organism is phagocytosed and carried to hilar lymph nodes

93
Q

What happens in secondary TB?

A

Reinfection or reactivation of the disease in a person with some immunity.

94
Q

Where does the disease tend to be in secondary TB?

A

Usually localised at the apices but can spread to the airways and bloodstream

95
Q

Where does primary TB tend to be?

A

There is a small focus in the periphery of the midzone and large hilar lymph nodes

96
Q

What is an important differential diagnosis in secondary TB?

A

Cancer

97
Q

What makes TB reactivate?

A

Decreased T cell function or immunosuppressive therapy

98
Q

What virus is common in the immunosuppressed?

A

Cytomegalovirus

99
Q

What fungi is common in the immunosuppressed?

A

Aspergillus, candida, pneumocystis

100
Q

What medication counts as being immunosuppressed?

A

Steroids and cancer treatment

101
Q

What are differentials for a pulmonary infection?

A

Lung cancer, abscess, empyema, bronchiectasis, CF

102
Q

What are risk factors for developing chronic lung infections?

A

Immunosuppressed/immunodeficiency, abnormal host defence, repeated insult, immunoglobulin deficiency

103
Q

What does IgA deficiency predispose to?

A

Recurrent acute infections, not chronic

104
Q

What does an intrapulmonary abscess present with?

A

Weight loss, lethargy, weakness, cough

105
Q

What is common in people with an intrapulmonary abscess?

A

A preceding illness

106
Q

What are some pathogens causing intrapulmonary abscess?

A

Bacterial (strep, staph, e-coli, gram -‘s) or fungi (aspergillus)

107
Q

What can be causes of septic emboli and who is this common in?

A

Right sided endocarditis, infected DVT, septicaemia, common in PWID

108
Q

What is empyema?

A

Pus in the pleural space

109
Q

What are empyemas common following?

A

Pneumonia, and there is often a progression from effusion to empyema

110
Q

What type of organisms cause empyema? What is the exception to this?

A

Usually aerobic organisms, anaerobic in severe pneumonia or poor dental hygiene

111
Q

What tests are done for empyema?

A

CXR- will show white out ‘D sign’, CT and ultrasound

112
Q

How do you treat empyema?

A

Broad spectrum IV antibiotics (amoxicillin, metronidazole) initially followed by oral antibiotics directed towards the specific organism for at least 14 days

113
Q

How would you describe the bronchi in bronchiectasis?

A

Inflamed and easily collapsible

114
Q

What does bronchiectasis present as?

A

Recurrent ‘chest infections’ and antibiotic prescriptions with no or little response . There is also persistent sputum production and a cough

115
Q

How do you test for bronchiectasis?

A

High resolution CT

116
Q

What is the presentation of bronchial sepsis?

A

Similar to bronchiectasis but with no evidence of that following tests

117
Q

Who is bronchial sepsis common in?

A

Young people or adults in healthcare or older people with COPD or other airway diseases

118
Q

What should the diagnosis of a chronic infection always lead to?

A

A check for underlying immunodeficiency

119
Q

What is the main cause of the problem in CF?

A

A defect in the cystic fibrosis transmembrane conductance regulator- a chloride channel found in lumen cells

120
Q

What does the CFTR channel do in normal people?

A

Transport of chlorine into the lumen of the lungs- it is ATP regulated and inhibits sodium and some other channels

121
Q

What happens when the CFTR channel fails?

A

Sodium and water leaks into other cells which causes dehydration of the lumen.

122
Q

What are the consequences of dehydration of the lumen in CF?

A

Salty sweat, intestinal blockage, fibrotic pancreas, failure to thrive, recurrent bacterial lung infections, absence of vas deferens

123
Q

How many different classes of CFTR mutations are there and which is the worst?

A

5 different classes- Class I is the worst as there is no CFTR synthesis

124
Q

What are some signs of CF in adulthood?

A

Upper lobe bronchiectasis, colonisation with staph, infertility and low weight

125
Q

What treatment do you give if a CF patient is colonised with staph aureus?

A

Flucloxacillin oral or septrin oral

126
Q

What treatment do you give if pseudomonas colonises a CF patient?

A

Oral azithromysin, nebulised colomycin, tobramycin and aztreonam and inhaled tobramycin

127
Q

What can exacerbations of CF be managed by?

A

Antibiotics, physiotherapy, adequate hydration and increased dietary input

128
Q

How many antibiotics should be given to CF patients and why?

A

Always 2 to reduce resistance

129
Q

What antibiotics do you give to a CF patient with cepacia?

A

Temocillin

130
Q

What is the G551D mutation in CF?

A

A class III mutation; there is a normal CFTR but a non-functioning channel

131
Q

What drug can help in G551D mutations and why is it rarely used?

A

Ivacaftor- it is extremely expensive

Respiratory (16 decks)

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