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Respiratory > Infectious disease part 1 > Flashcards

Infectious disease part 1 Flashcards

1
Q

What is acute bronchitis?

A

Refers to inflammation of the bronchi due to viral infection.

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2
Q

Causes of acute bronchitis?

A

Influenza
Rhinoviruses
RSV (respiratory syncytial virus)

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3
Q

Risk factors for acute bronchitis?

A

Smoking
Damp or dusty environment

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4
Q

Presentation of acute bronchitis? When do you suspect acute bronchitis?

A

cough (lasts for 7-10 days, but can persist for 3 weeks)
fatigue
SOB
chest discomfort
pleuritic or retrosternal pain

coarse crepitations
wheeze

Suspect acute bronchitis in a healthy person with a cough in the absence of focal chest signs.

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5
Q

Management of acute bronchitis?

A

Stop smoking.

Selfcare:
- Honey.
- Pelargonium (a herbal medicine).
- OTC cough medicines containing guaifenesin.
- OTC cough medicines containing suppressants (except codeine) if the person does not have a persistent cough or excessive secretions.

Consider IMMEDIATE abx if >80years AND one of the following:
- hospitalisation in the previous year
- Type 1 or 2 diabetes mellitus.
- hx of congestive heart failure.
- current use of oral corticosteroids.

or >65years within two of the above
or if systemically unwell.

[AMOXICILLIN 500mg TDS for 5 days]

Symptoms can take 3 weeks to resolve.

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6
Q

What is influenza? How many serotypes? Which serotypes are responsible for epidemics/pandemics/seasonal? How is transmitted?

A

Aka flu.

Refers to an URTI caused by a single-stranded RNA virus belonging to the Orthomyxoviridae family.

Three serotypes: A, B, and C.

Influenza A – can cause pandemics and epidemics; no animal reservoir
Influenza B –causes epidemics only, animal hosts include pigs and birds
Influenza C – only found in cattle

Seasonal influenza is a mix of types A and B.

Highly contagious and transmitted via respiratory secretions.

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7
Q

Presentation of influenza?

A

Incubation period is typically 1–4 days.
Can be infectious for 7-21days.

fever ≥ 37.8°C
myalgia
headache
malaise
cough (usually unproductive)
sore throat
chills
nasal congestion
rhinitis

In children -fatigue, irritability, diarrhoea, vomiting

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8
Q

Complications of influenza?

A

Pulmonary
- viral pneumonia
- secondary bacterial pneumonia (particularly S. aureus)
- worsening of chronic conditions (eg. COPD and asthma)

Cardiovascular
- myocarditis
- heart failure

Neurological
- encephalopathy

Gastrointestinal
- anorexia
- vomiting

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9
Q

Diagnosis of influenza?

A

Indirect/direct fluorescence antibody test

Rapid PCR is now often available first line.

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10
Q

Management of infleunza?

A

Self-limiting disease
Analgesia (aspirin contraindicated in children <16years)
Hydration, rest
Stop smoking
Decongestants, saline nose drops
Throat lozenges

Antiviral treatment with neuraminidase inhibitors (eg. oseltamivir) if within 48 hours of symptom onset and at risk of complications

Isolation to prevent transmission.

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11
Q

Influenza vaccine eligibility? Type of flu vaccine for children and age?

A

You are eligible to receive a free flu jab if you:
* are >65 years
* are pregnant
* have certain medical conditions
* are very overweight
* are living in a long-stay residential care home or other
long-stay care facility
* receive a carer’s allowance
* are the main carer for an elderly or disabled person
whose welfare may be at risk if you fall ill
* are a front-line health and social care worker. It is your
employer’s responsibility to arrange vaccination.

Nasal spray
- children >6months AND long-term health condition
- children age 2-17years

Injection
- children 6-24months

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12
Q

What is bronchiolitis?

A

Refers to a widespread chest infection that primarily affects infants aged 1-12 months or under 2 years.

A type of LRTI that affects the bronchioles, causing inflammation and congestion.

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13
Q

Causes of bronchiolitis?

A

RSV (Respiratory Syncytial Virus) -most common

Rhinovirus
Parainfluenza
Influenza
Adenovirus
Coronavirus

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14
Q

Presentation of bronchiolitis?

A

Cough
Laboured breathing
Wheezing
Tachypnoea
Intercostal recession
Grunting
Nasal flaring
Chest recession
Rales (small clicking/rattling sound)

May have 1-3 days of URTI symptoms before bronchiolitis.

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15
Q

Diagnosis of bronchiolitis?

A

Clinical diagnosis
CXR (severe case, complication)

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16
Q

Management of bronchiolitis?

A

Admit to hospital if:
- toxic appearance (lethargy, dehydrated, apnoea)
- moderate to severe respiratory depression (e.g. nasal flaring, retractions, RR >70, central cyanosis)
- hypoxia (SaO2 <92%)

A&E management:
- inhaled bronchodilator
- IV fluids
- oxygen
- nasal suctioning
- intubation

Palivizumab -prophylaxis in high-risk pts
Ribavirin -antiviral therapy in severe cases

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17
Q

What is RSV (Respiratory Syncytial Virus)? What is it best known for?

A

Refers to a RNA virus of Paramyxoviridae family within the Pneumovirus genus.

Best known for causing bronchiolitis in infants.

Causes LRTI (e.g. bronchiolitis, pneumonia) in children < 2years.

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18
Q

Risk factors for RSV?

A
  • chronic lung disease (e.g., bronchopulmonary dysplasia)
  • current weight < 11lb (5 kg)
  • cyanotic congenital heart disease
  • immune compromise (e.g., severe combined
    immunodeficiency)
  • in utero exposure to tobacco smoke
  • low socioeconomic status
  • neuromuscular disease
  • premature birth (before 35 weeks of gestation
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19
Q

Presentation of RSV in children?

A

Cough
Rhinorrhoea
Low grade fever
Wheezing
Hypoxia
Mild systemic symptoms

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20
Q

Presentation of RSV in adults?

A

Sore throat
Cough
Rhinorrhoea
Malaise
Headache
Fevere

May lead to severe pneumonia, especially in the elderly or immunocompromised.

21
Q

Management of RSV?

A

Intubation and ventilatory assistance (hypoxic)
Oxygenation (SaO2 <90%)
IV fluid -offered for infants with severe respiratory difficulty (RR >80bpm; or struggling during feeding)

22
Q

What is croup? Which groups of people are more affected? Which season does it commonly occur in?

A

Also known as laryngotracheobronchitis.

Refers to an acute respiratory syndrome that affects the larynx, trachea, and bronchi.

It is characterised by inflammation and swelling that results in partial obstruction of the upper airway.

Affects children aged 6 months to 6 years, with the highest incidence in children under 3 years.

Occurs more frequently during the autumn and winter months.

23
Q

Causes of croup?

A

Parainfluenza virus (common; Human parainfluenza virus 1)
Adenovirus
Influenza
Respiratory syncytial virus (RSV)

24
Q

Presentation of croup?

A

Barking or seal-like cough
Stridor, or a high-pitched, wheezing sound (sounds worse if the child becomes upset)
Hoarse cry
Fever
Increased work of breathing, such as retractions or nasal flaring.

Before croup, coryzal symptoms present.

25
Q

Diagnosis of croup?

A

Clinical diagnosis (SaO2 <95% = significant resp impairment)

Throat swabs for viral PCR

X-ray of the neck
- show the classic “steeple sign” indicative of subglottic narrowing in severe or atypical cases.

26
Q

Management of croup?

A

Single dose dexamethasone

Admit to hospital for severe case:
- oxygen supplementation
- nebulised budesonide (if child is unable to tolerate oral steroids)

Nebulised adrenaline (if concerned about airway patency)

Minimise distress in children with croup (crying can exacerbate upper airway obstruction)

27
Q

What is pertussis (whooping cough)?

A

Refers to a highly contagious respiratory disease caused by the bacterium Bordetella pertussis.

Type of severe URTI.

28
Q

Cause of pertussis?

A

Bordetella pertussis

29
Q

Presentation of pertussis?

A

Spasmodic coughing, with a prolonged duration per episode
Inspiratory “whooping” sound
Rhinorrhoea
Post-tussive vomiting
Apnoeas, particularly in infants (breathing stops while sleeping)

30
Q

Three phases of pertussis?

A

Early catarrhal phase:
- flu like symptoms
- lasts for 1-2weeks

Spasmodic phase:
- lasts for 6-8weeks
- hacking/whooping cough

Convalescent phase:
- cough persist for 2-3 months after infection has cleared

31
Q

Diagnosis of pertussis?

A

Culture of nasopharyngeal swab (if coughing <2weeks) -GOLD STANDARD

Oral fluid swab (1-2min gum swab) for IgG (if cough >2weeks)

PCR -highly sensitive and specific for diagnosis

FBC

32
Q

Management of pertussis?

A

Admit to hospital
- infant <6months of age
- any older child who has apnoeic or cyanotic spells

Macrolides abx (e.g. clarithromycin/azithromycin) -reduce infective period

33
Q

Prevention of pertussis?

A

Vaccine

34
Q

What is acute epiglottitis? Who does it commonly affect?

A

Refers to a severe, potentially life-threatening condition characterised by inflammation and infection of the epiglottis.

Children 2-5 years.
Adults in theirs 40s and 50s.

35
Q

Causes of acute epiglottitis?

A

Streptococcus spp.
Staphylococcus aureus
Haemophilus influenzae b (Hib)
Pseudomonas

Herpes simplex virus
Thermal injuries
Presence of foreign bodies
Inflammatory response to radiotherapy

36
Q

Presentation of acute epiglottitis?

A

muffled voice (hot potatoe)
hoarse cry
stridor
drooling
fever
odynophagia
dysphagia
tripod sign (lying down exacerbates breathing difficulties)

37
Q

Diagnosis of acute epiglottitis?

A

Lateral neck x-ray
- thumbprint sign

DO NOT LOOK WITH A TONGUE DEPRESSOR

38
Q

Management of acute epiglottitis?

A

AIRWAY MANAGEMENT
- Urgent referral to ENT and anaesthetics for intubation and ventilation.

Manage fever

Refer laryngoscopy -GOLD STANDARD

IV abx (cefuroxime)
Surgical tracheostomy

39
Q

What is pleural effusion?

A

Refers to an abnormal accumulation of fluid in the pleural cavity.

40
Q

How are causes of pleural effusion classified?

A

Exudative (protein content >35 g/l)

Transudative (protein content <35 g/l)

41
Q

Examples of exudative causes of pleural effusion?

A

Caused by disease that INCREASE CAPILLARY PERMEABILITY.

E.g.
Infection
Cancer
Autoimmune
Drugs
Pulmonary embolism
Chylothroax
Asbestos

42
Q

Transudative causes of pleural effusion?

A

Caused by imbalance in the Starling forces that control the formation of interstitial fluid -hydrostatic pressure and oncotic pressure.

E.g.
Chronic heart failure
Liver disease
ESRD
Nephrotic syndrome
Pulmonary embolism

43
Q

Presentation of pleural effusion?

A

Dyspnoea
Reduced exercise tolerance
Pleuritic chest pain

Fever
Cachexia and clubbing (malignancy)
Raised JVP and ankle oedema (heart failure)
Cyanosis
Tachypnoea
Respiratory distress
Lympahdenopathy

Tracheal deviation (away from the affected side).
Reduced chest expansion on the affected side.
STONY DULL percussion on the affected side.
Reduced/absent breath sounds/
Vocal resonance reduced over the effusion/
Bronchial breathing at the upper border of the pleural effusion.

44
Q

Investigations of pleural effusion?

A

FBC (infection)
U&Es (raised creatinine)
LFTs (low albumin, raised ALT, ASP -cirrhosis)
Clotting

CXR (1ST LINE)
- reveal blunting of the costophrenic angle or white-out of lung (if large)

Thoracic US
- consolidation
- pulmonary oedema
- malignancy or infection

CT with contrast
- identify pleural thickening
- benign or malignant

45
Q

What is thoracentesis? Purpose?

A

A needle is used to drain fluid from around the lungs.

For symptoms relief.
Fluid can be analysed for diagnosis.

46
Q

What can pleural fluid be analysed for?

A

Biochemistry:
- protein level
- LDH
- glucose
- amylase

Cytology

Microbiology
- Gram stain
- culture

47
Q

Management of pleural effusion?

A

Depends on the cause, size of effusion and symptoms.

Oxygen

Reduce respiratory distress (e.g. diuretics for HF, abx for infections)
Intercostal drain (for large effusions or empyemas)

Small effusions -treat underlying cause.

Chemical pleurodesis – for recurrent or persistent pleural effusions

Tunnelled indwelling pleural catheter (regular drainage of recurrent fluid; helpful for palliative pts)

48
Q

What is empyema? IVx results show? Tx?

A

Infected pleural effusion.

Pleural aspiration shows pus, low pH, low glucose and high LDH.

Empyema is treated with a chest drain and antibiotics.

49
Q

What is Light’s criteria? What factors does it consider?

A

Determine the type of pleural effusion and thus its aetiology.

Pleural protein + serum protein >0.5 = EXUDATE
Pleural LDH + serum LDH >0.6 = EXUDATE
Pleural LDH great than 2/3 of the normal upper limit of serum LDH = EXUDATE

Respiratory (10 decks)

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