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Infectious respiratory disorders Flashcards

1
Q

Cause of acute bronchitis

A

Usually viral (influenza, rhinovirus or RSV / respiratory synctival virus) but can be bacteria

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2
Q

Sx and signs and risk factors for acute bronchitis

A

Cough
May have pleuritic or retrosternal pain
May have coarse crepitations or wheeze
Cough lasts for 7-10 days but may persist for 3 weeks

Smoking is a RF

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3
Q

Management for acute bronchitis

A

Consider 7 days delayed antibiotic use - amoxicillin 500mgs TDS for 5 days
Symptoms resolve with rest and paracetamol after 3 weeks

Immediate Abx if over 80 yrs or hospitalised over past yr

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4
Q

Signs and symptoms of influenza

A

Fever
Malaise
Headache
Cough - unproductive
Chills
Myalgia
Nasal congestion

Fatigue, irritability, diarrhoea and vomiting in children

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5
Q

Influenza treatment

A

Self limiting
Paracetamol / ibuprofen
Fluids
Rest
Avoid smoking
Decongestants
Lozenges
Saline nose drops

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6
Q

How is the flu vaccine given to children

A

Nasal spray if under 6 months with long term health condition
Injection between 6 months and 24 month
Nasal spray between 2-17 yrs

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7
Q

Pneumonia risk factors

A

Infants and elderly
Smoking
Alcohol excess - aspiration pneumonia
Obstructive - COPD
Bronchiectasis
Immunosuppression
Hospitalisation

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8
Q

Name all the common and uncommon pathogens that cause pneumonia

A

Most common - streptococcus pneumonia
Common - staphylococcus aureus, mycoplasma pneumonia, haemophilia influenza

Uncommon - klebsiella pneumonia, strep pyogenes, pseudomonas, aeruginosa, coxiella burnetti, chlamydia psittaci, actinomyces israeli

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9
Q

Symptoms of pneumococcal pneumonia / strep pneumonia

A

Cough
Purulent sputum
Fever
Aches and pains
Vomiting
Anorexia
Pleuritic chest pain
Dyspnoea

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10
Q

Complications of pneumococcal pneumonia/ strep pneumonia

A

Organisation of exudate
Pleural effusion
Lung abscess
Bacteraemia may cause ENDOCARDITIS, MENINGITIS, ARTHIRITIS, OTITIS MEDIA

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11
Q

Management of pneumococcal pneumonia

A

Penicillin
Cephalosporin

Do CURB65 score Ito see if we need to admit

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12
Q

What parameters are in the CURB65 score

A

Confusion
Urea
RR over 30
BP - systolic under 90 or diastolic under 60
Age - 65 and over

Admit if score is 2-5

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13
Q

Investigations for pneumonia

A

CURB65 - to see if admission is needed
Sputum gram stain - gram positive cocci suggests streptococcus pneumonia

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14
Q

What is atypical pneumonia and its causes

A

Caused by less common pathogens which are NOT DETECTABLE ON GRAM STAIN
- mycoplasma pneumoniae
- chlamydophila pneumoniae
- legionella pneumoniae

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15
Q

Mycoplasma presentation and complications

A

Insidious presentation with dry cough, sore throat and flu like symptoms

Myocarditis, meningo-encephalitis, maculopapular rash, haemolytic anaemia

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16
Q

Mycoplasma pneumonia investigation findings

A

Chest X ray findings
- homogenous dense lobar consolidation
- patchy consolidation
- nodular opacity
- bilateral parahilar infiltration

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17
Q

Mycoplasma pneumonia treatment

A

Macrolides - Erythromycin / clarithromycin
Doxycyclines - Tetracycline

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18
Q

Legionella pneumonia presentation and complications (complications may present as symptoms in exam questions)

A

Contaminated air condition
Coughs
Chills
High Temperature
Myalgia
Nausea
Diarrhoea
Vomiting

Complications - confusion, hepatitis, renal impairment - PROTEINURIA, HYPONATRAEMIA, confusion, lung abscess, empyema, hypotension

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19
Q

Legionella pneumonia investigations

A

CXR
Blood cultures
LEGIONELLA SEROLOGY/URINE ANTIGEN

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20
Q

Legionella pneumonia management

A

Erythromycin 14 - 21 days
Rifampicin BD in combination for severely ill patients

Some cases don’t respond and may die due to respiratory failure

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21
Q

Chlamydia pneumonia presentation

A

Pharyngitis
Hoarseness
Otitis media followed by pneumonia

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22
Q

Chlamydia pneumonia diagnosis / investigations

A

Chlamydial PCR of nasopharyngeal swab or sputum or pleural fluid

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23
Q

Chlamydia pneumonia treatment

A

Tetracycline
Macrolides - AZITHROMYCIN - first line
Fluoroquinolones

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24
Q

Common causative pathogens of nosocomial pneumonia (hospital acquired pneumonia)

A

Pseudomonas aeruginosa
Staphylococcal aureus
Enterobacteriaceae e.g. Klebsiella, e.coli, enterobacter

Anaerobic organisms acquired in under 48 hrs of admission to hospital

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25
Q

What is staphylococcal aureus pneumonia and it’s cause

A

Widespread infection with ABSCESS formation

Secondary to influenza virus infection in immunocompromised people

Can also come from staphylococcal septicaemia where puncture sites introduce the infection e.g. intravenous drug users

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26
Q

Staphylococcal aureus pneumonia management

A

Flucloxacillin
Erythromycin

27
Q

Klebsiella pneumonia presentation

A

High fever
Rigor
Pleuritic pain
Purulent, gelatinous or blood stained (haemoptysis) sputum

Alcoholism
Diabetes
COPD
Elderly

28
Q

Klebsiella pneumonia investigation findings and management

A

Massive consolidation and excavation of one or more lobes (often upper lobes) on CXR

Cefuroxime

29
Q

What causes pseudomonas aeruginosa pneumonia

A

Pseudomonas aeruginosa bacteria - common pathogen in Bronchiectasis and cystic fibrosis and hospital acquired infection especially in intensive therapy unit or post surgery

30
Q

Pseudomonas pneumonia diagnosis and management

A

Sputum culture

Antipseudomonal penicillin e.g. ticarcillin, piperacillin
Ceftazadime
Meropenem
Ciprofloxacin

31
Q

Which type of pneumonia occurs in immunosuppressed people

A

Pneumocystic jirovecii pneumonia

32
Q

Pneumocystic jirovecii presentation

A

Dry cough
Exertional dyspnoea and desaturation
Fever
Bilateral crepitations

33
Q

Pneumocystic jirovecii pneumonia diagnosis / investigations

A

Sputum
Bronchoalveolar lavage

CXR normal or bilateral perihilar interstitial shadowing

34
Q

Pneumocystic jirovecii pneumonia treatment

A

High dose co-trimoxazole, pentamidine
Steroid if hypoxaemia
Prophylaxis if low CD4 count

35
Q

What investigations need to be done for patients admitted with pneumonia

A

FBC for WBC
U+Es for urea
LFTs for albumin

Sputum culture
Chest X-Ray
Blood cultures

36
Q

What is acute bronchiolitis and what is it caused by

A

LRTI in children (usually under 2) that affects bronchioles

Respiratory syncytial virus (RSV) - most common cause
Rhinovirus
Parainfluenza
Influenza
Adenovirus
Coronavirus

37
Q

Acute bronchiolitis presentation and clinical findings

A

Persistent cough
Tachypnoea
Chest recession
Wheezing
Rales
Preceded by URTI symptoms - nasal congestion / rhinorrhoea 1-3 days before!!!!
Under 2

Clinical findings - bilateral diffuse expiratory wheezing and no crackles (infection not in lobes)

38
Q

Acute bronchiolitis diagnosis and management

A

Clinical diagnosis

Usually resolves within 1-2 weeks

Admit if hypoxia, lethargy, dehydration, respiratory distress e.g. Nasal flaring, cyanosis etc…
After admission treat with inhaled bronchodilator, IV fluids and oxygen

39
Q

RSV risk factors

A

Chronic lung disease
Under 5kg
Cyanotic congenital heart disease
Immunocompromised
Exposure to tobacco smoke in utero
Premature birth

40
Q

Symptoms of RSV

A

Cough
Rhinorrhoea
Low grade fever
Wheezing
Occasional hypoxia
Malaise

41
Q

RSV management

A

Supportive - hydration and oxygenation

42
Q

What is croup

A

Barking cough
Upper respiratory tract infection in infants and toddlers

43
Q

Croup presentation

A

Infant / toddler
Barking cough - inspiratory stridor
Hoarse cry
Coryzal

44
Q

Cause of croup

A

Parainfluenza viruses

45
Q

Croup investigations and management

A

Clinical diagnosis - modified westley scoring system for croup

Supportive management but if severe
- dexamethasone
- nebulised budesonide or adrenaline

46
Q

Cause and presentation of pertussis / whooping cough

A

Cough with paroxysms
Post cough emesis

Before vaccination received
Caused by bordatella pertussis

47
Q

Pertussis / whooping cough investigation and management

A

Nasopharyngeal swab - serology for anti pertussis toxin IgG - PCR

Admit and oxygen if cyanosis
Macrolides - clarithromycin / azithromycin - reduces infective period

48
Q

Acute epiglottitis presentation

A

Muffled voice (hot potato)
Hoarse cry
Stridor
Drooling
Fever
Painful/inability to swallow
Tripod sign

49
Q

Acute epiglottitis investigation and management

A

DONT LOOK
Lateral neck X-RAY - thumbprint sign

Emergency referral - airway management, laryngoscopy, IV antibiotics, surgical tracheostomy, manage fever

50
Q

What is tuberculosis caused by and risk factors

A

Mycobacterium tuberculosis

Close contact with TB pt
Homeless or drug users
HIV positive or immunocompromised
Elderly

51
Q

Tuberculosis symptoms

A

Night sweats
Cough
Weight loss
Loss of appetite
Tiredness
Haemoptysis
Breathlessness
Pleuritic pain

52
Q

Active TB diagnosis / investigations !!!

A

Chest X-RAY
3 consecutive Sputum sample and culture (one in early morning) - acid fast bacilli smear, mycobacterial cultures and NAAT

Decreased breath sounds
Consolidation in upper lobes
Hilar lymphadenopathy

53
Q

What is miliary tuberculosis

A

Disseminated disease through haematogenous spread

54
Q

Latent TB diagnosis / investigations

A

Tuberculin skin test - Mantoux test (positive if skin induration over 5mm after injecting tuberculin into forearm)
Interferon gamma release assay (IGRA)

55
Q

Latent TB management

A

Further investigations to exclude active TB
- chest x ray - for granulomas/nodules
- physical examination
- sputum for mycobacterium culture and NAT and acid fast bacilli smear

If confirmed not active
- Isoniazid (with pyridoxine - vit B6 to prevent peripheral neuropathy side effect or isoniazid) and Rifampicin for 3 months
Or
- isoniazid (with pyridoxine - vit B6) for 6 months

56
Q

Active TB treatment !!!!

A

If no CNS involvement (spinal tuberculosis), start treatment without waiting for culture results
Must continue course without missing a single day or will need to start all over again
Notify to public health England

Isoniazid with pyridoxine, Rifampicin, pyrazinamide and ethambutol for 2 months (RIPE)

Then isoniazid with pyridoxine and Rifampicin for a further 4 months

57
Q

Rifampicin precaution and warning

A

No hormonal contraception for 8 weeks after Rifampicin

Side effects
- urine turns red, sweat and tears may also be red

58
Q

Complications of TB

A

Pleural effusion
Empyema (collection of pus)
Pneumothorax
Laryngitis
Enteritis
Mycetoma with aspergillus fumigatus (fungus ball)
Cor pulmonale - if lots of fibrosis
Death

59
Q

What is the difference between pleural effusion and pleural oedema

A

Pleural effusion - excess fluid around lungs in pleural
Pleural oedema - fluid inside alveoli (inside lung)

60
Q

Types of pleural effusion

A

Transudative - only fluid
Exudative - proteins and LDH in fluid

61
Q

Causes of Transudative pleural effusion

A

Chronic heart failure
Liver disease
Nephrotic syndrome
Pulmonary embolism
End stage kidney disease

62
Q

Causes of Exudative pleural effusion

A

Infection
Cancer
Autoimmune
Drugs
Pulmonary embolism

63
Q

Pleural effusion diagnosis and treatment

A

Seen on chest X-RAY
Diagnosed and managed with thoracentesis

Respiratory (5 decks)

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