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Y2 - Resp > Lecture 14 - LRTI And Pneumonia > Flashcards

Lecture 14 - LRTI And Pneumonia Flashcards

1
Q

What is the division between the upper respiratory tract and lower respiratory tract?

A

Bifurcation of trachea

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2
Q

What are some of the most common microbes of URT?

A

Viridans streptococci
Neisseria spp

Anaerobes candida sp

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3
Q

What are some less common URT microbes?

A

Strep. Pneumoniae
Strep. Pyogenes
Haemophilus influenzae

Pseudomonas
Escherichia coli

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4
Q

What are the defences of the respiratory tract?

A

Muco-ciliary clearance mechanisms (nasal hairs, ciliates columnar epithelium)

Cough + sneeze reflex

Respiratory mucosal immune system
Lymphoid follicles f pharynx and tonsils
Alveloar macrophages
Secretory IgA and IgG

Alveolar microbiota

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5
Q

What is the course of a typical infection in the lungs?

A

Alveolar macrophages fails to stop the pathogen
Cytokines to recruit more macrophages
Inflammation = increased permeability
More WBCs/proteins

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6
Q

What occurs outside the lungs in a typical infection?

A

Inflam mediators like cytokines into systemic circulation
Activates bone marrow to make more inflammatory cells
Inc Cardiac output
Raised body temp

Dysregulation (the signs of tissue injury/organ injury

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7
Q

What causes tissue/organ injury?

A

Dysregulation

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8
Q

What cause Dysregulation?

A

The pathogen
Host factors
Drugs

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9
Q

What is a virulence factor for Chlamydia pneumoniae?

A

Ciliostatic factor

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10
Q

What is a virulence factor for mycoplasma pneumoniae?

A

Shear cilia

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11
Q

What is a virulence factor for Strep pneumoniae?

A

Split immunoglobulin IgA

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12
Q

What are some host factors that increase Dysregulation risk?

A

Old
Lifestyle - smoking, Alcohol and drugs

Chronic lung disease (Bronchiectasis and cystic fibrosis)

Immunocomprised
Metabolic - malnourished , hypoxaemia

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13
Q

What are some drugs that increase risk of Dysregulation?

A

Protein Pump Inhibitors (PPI)
Antacids (H2 antagonist)

ACE inhibitors

Gluocorticoids

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14
Q

What are some examples of URTI?

A

Rhinitis (common cold)
Pharyngitis
Sinusitis
Epiglottis
Laryngitis

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15
Q

What type of organism nearly always cause URTIs?

A

Viruses

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16
Q

What is Acute Bronchitis?

A

Inflammation of medium sized airway

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17
Q

What is the main risk factor for Acute Bronchitis?

A

Mainly in smokers

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18
Q

What are some symptoms of acute bronchitis?

A

Cough
Fever
Increased sputum production
SOB

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19
Q

What are the findings expected to be on a CXR of a patient with acute bronchitis?

A

Normal

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20
Q

How do you treat acute bronchitis?

A

Bronchodilators

Antibiotics if its also accompanied by an infection

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21
Q

What are some causative organisms that can cause acute bronchitis?

A

Viruses

HSM (High School Muscial)
S.pneumoniae
H.influenzae
M.catarrhalis

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22
Q

What causes Chronic bronchitis?

A

NOT INFECTION

AN INFLAMMATORY PROCESS

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23
Q

What are the 2 main categories of Pneumonia?

A

Community Acquired Pneumonia (CAP)

Healthcare Acquired Pneumonia (HAP)

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24
Q

What is considered healthcare acquired pneumonia (HAP)?

A

48 hours post Admission

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25
What is the pathology of pneumonia?
Acute inflammatory response Exudate gathers in alveolia
26
What is lobar pneumonia?
Pneumonia affecting a whole lobe
27
What is bronchopneumonia?
Inflamed alveoli and surrounding patches lobule
28
What is the most common cause of typical pneumonia?
Streptococcus pneumoniae
29
What are some causes of typical pneumonia?
Streptococcus pneumoniae (commonest) Haemophilus influenzae (COPD) Morexalla catarrhalis (Remember HSM High School Muscial) Viruses MRSA
30
What ares some less common causes f pneumonia (ATYPICAL PNEUMONIA)?
Mycoplasma (common) Legionella (contaminated water) Chlamydophila pneumoniae
31
Why won’t amoxicillin work on an atypical pneumonia like mycoplasma?
No cell wall so cell wall synthesis cant be inhibited
32
How do you diagnose Community Acquired Pneumonia?
Clinical symptoms + Image finding
33
What are some clinical symptoms of CAP?
Cough Dyspnoea Pleurisy Fever Tachycardia Organ dysfunction Crackles/bronchial breathing
34
What are the 2 types of breathing?
Vesicular breathing Bronchial breathing
35
What is vesicular breathing? What is bronchial breathing?
Vesicular = normal Bronchial = loud due to fluid in alveoli
36
What do you use to assess the severity of a CAP and when a patients should be admitted?
CURB-65 score
37
What does the CURB-65 score stand for?
Confusion Urea > 7mmol/l Respiratory rate >30 Blood pressure <90 syst <60 diastolic Over 65?
38
What is the scoring system for CURB-65?
Score < 2 = fine Score 2 = admit Score 2-5 = manage as severe
39
What general investigations do you do on a patient with suspected CAP?
FBC U&E CRP CXR ABG
40
What microbiology samples should always be taken for a patient with CAP?
Sputum Blood culture Nose + throat swab Urine sample
41
What is the importance of doing a nose and throat swab?
Sputum smaple wont pick up virus since they are Intracellular
42
What organisms can be tested for in urine?
Legionella Pneumococcus
43
How do you manage a patient with Mild CAP?
Treat in community
44
How do you manage a patient with moderate CAP?
Take 4 samples Correct abx
45
How do you manage severe CAP?
Collect 4 samples Correct abx Bronchoscopic specimens
46
What are some differential diagnosis for SOB and sputum?
Penumonia HF + Pulmonary oedma PE Atelectasis Lung cancer Vasculitis Interstitial lung disease
47
What is the general approach in terms of time from for mild CAP and severe CAP?
Mild CAP = 5-7 days Severe CAP = 7-10 days
48
How is mild-moderate CAP treated?
Amoxicillin If allergic to amoxicillin give doxycycline or erythromycin/clarithromycin
49
Why is amoxicillin the drug selected mild-moderate CAP?
The most common causative organism is streptococcus pneumoniae
50
How is moderate-severe CAP treated?
Co-amoxiclav + clarithromycin/doxycycline
51
What type of antibiotic is clarithromycin?
Macrolide Macrolides inhibit protein synthesis Remember ATM (Aminoglycosides, Tetracyclines and Macrolides) all inhibit protein synthesis since protein is expensive to buy so you have to go to the ATM to get money
52
What antibiotic does not work against atypical pneumonia?
Amoxicillin
53
What are some complications of CAP?
Infection progresses: -lung abcesses -empyema -bacteraemia Bronchial obstruction
54
What is empyema?
When a pocket of pus accumulates in a body cavity E.g a lung abscess may burst
55
What are the most common causative organisms for Hospital Acquired Pneumonia (HAP)?
Staphylococcus aureus Enterobacteriaciae (e.coli and Klebsiella spp) GRAM -VEs
56
What is the safest bet first line antibiotic used to treat HAP? Why?
Co-amoxiclav Works against staphylococcus aureus and gram negatives
57
What bacteria does co-amoxiclav not work on that causes HAP?
Pseudomonas
58
What are the second lin treatments for HAP if co-amoxiclav doesn’t work?
Piperacillin/tazzobactam or meropenem They kill pseudomonas
59
What is aspiration pneumonia?
Aspiration of exogenous material or endogenous secretions into the respiratory tract leading to pneumonia
60
When does aspiration pneumonia normally occur?
Patients with Dysphagia Epilepsy Alcoholics Drowning Drug abusers
61
What is aspiration pneumonia often treated with/
Co-amoxiclav
62
What are some ways a patient can be immunocompromised and get pneumonia?
HIV: then getting Pneumocystis jirovecci, TB, atypical mycobacteria Neutropenia: then getting aspergillus.spp infection Bone marrow transplant: then getting Cytomegalovirus Splenectom: encapsulated orgs (NHS)
63
How can we prevent Pneumonia?
Immunisation: -flu -pneumococcal vaccine -23 poly alert -polysaccharide vaccine dose -13 valent conjugate vaccine Chemoprophylaxis: Give oral pencilling/erythomycin to high risk LRTI patients Smoking advice
64
Who are more at risk of LRTI?
Asplenia Dysfunctional spleen Immunodeficiency
65
If a CXR is normal with pneumonia symptoms is it pneumoni?
NO Likely acute bronchitis

Y2 - Resp (23 decks)

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