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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
Q

What is the pathology of pneumonia?

A

Acute inflammatory response
Exudate gathers in alveolia

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26
Q

What is lobar pneumonia?

A

Pneumonia affecting a whole lobe

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27
Q

What is bronchopneumonia?

A

Inflamed alveoli and surrounding patches lobule

28
Q

What is the most common cause of typical pneumonia?

A

Streptococcus pneumoniae

29
Q

What are some causes of typical pneumonia?

A

Streptococcus pneumoniae (commonest)
Haemophilus influenzae (COPD)
Morexalla catarrhalis (Remember HSM High School Muscial)
Viruses
MRSA

30
Q

What ares some less common causes f pneumonia (ATYPICAL PNEUMONIA)?

A

Mycoplasma (common)

Legionella (contaminated water)
Chlamydophila pneumoniae

31
Q

Why won’t amoxicillin work on an atypical pneumonia like mycoplasma?

A

No cell wall so cell wall synthesis cant be inhibited

32
Q

How do you diagnose Community Acquired Pneumonia?

A

Clinical symptoms
+
Image finding

33
Q

What are some clinical symptoms of CAP?

A

Cough
Dyspnoea
Pleurisy
Fever
Tachycardia
Organ dysfunction
Crackles/bronchial breathing

34
Q

What are the 2 types of breathing?

A

Vesicular breathing
Bronchial breathing

35
Q

What is vesicular breathing?

What is bronchial breathing?

A

Vesicular = normal

Bronchial = loud due to fluid in alveoli

36
Q

What do you use to assess the severity of a CAP and when a patients should be admitted?

A

CURB-65 score

37
Q

What does the CURB-65 score stand for?

A

Confusion
Urea > 7mmol/l
Respiratory rate >30
Blood pressure <90 syst <60 diastolic
Over 65?

38
Q

What is the scoring system for CURB-65?

A

Score < 2 = fine
Score 2 = admit
Score 2-5 = manage as severe

39
Q

What general investigations do you do on a patient with suspected CAP?

A

FBC
U&E
CRP
CXR
ABG

40
Q

What microbiology samples should always be taken for a patient with CAP?

A

Sputum
Blood culture
Nose + throat swab
Urine sample

41
Q

What is the importance of doing a nose and throat swab?

A

Sputum smaple wont pick up virus since they are Intracellular

42
Q

What organisms can be tested for in urine?

A

Legionella
Pneumococcus

43
Q

How do you manage a patient with Mild CAP?

A

Treat in community

44
Q

How do you manage a patient with moderate CAP?

A

Take 4 samples
Correct abx

45
Q

How do you manage severe CAP?

A

Collect 4 samples
Correct abx
Bronchoscopic specimens

46
Q

What are some differential diagnosis for SOB and sputum?

A

Penumonia
HF + Pulmonary oedma
PE
Atelectasis
Lung cancer
Vasculitis
Interstitial lung disease

47
Q

What is the general approach in terms of time from for mild CAP and severe CAP?

A

Mild CAP = 5-7 days

Severe CAP = 7-10 days

48
Q

How is mild-moderate CAP treated?

A

Amoxicillin

If allergic to amoxicillin give doxycycline or erythromycin/clarithromycin

49
Q

Why is amoxicillin the drug selected mild-moderate CAP?

A

The most common causative organism is streptococcus pneumoniae

50
Q

How is moderate-severe CAP treated?

A

Co-amoxiclav + clarithromycin/doxycycline

51
Q

What type of antibiotic is clarithromycin?

A

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
Q

What antibiotic does not work against atypical pneumonia?

A

Amoxicillin

53
Q

What are some complications of CAP?

A

Infection progresses:
-lung abcesses
-empyema
-bacteraemia

Bronchial obstruction

54
Q

What is empyema?

A

When a pocket of pus accumulates in a body cavity

E.g a lung abscess may burst

55
Q

What are the most common causative organisms for Hospital Acquired Pneumonia (HAP)?

A

Staphylococcus aureus
Enterobacteriaciae (e.coli and Klebsiella spp) GRAM -VEs

56
Q

What is the safest bet first line antibiotic used to treat HAP?
Why?

A

Co-amoxiclav

Works against staphylococcus aureus and gram negatives

57
Q

What bacteria does co-amoxiclav not work on that causes HAP?

A

Pseudomonas

58
Q

What are the second lin treatments for HAP if co-amoxiclav doesn’t work?

A

Piperacillin/tazzobactam or meropenem

They kill pseudomonas

59
Q

What is aspiration pneumonia?

A

Aspiration of exogenous material or endogenous secretions into the respiratory tract leading to pneumonia

60
Q

When does aspiration pneumonia normally occur?

A

Patients with Dysphagia
Epilepsy
Alcoholics
Drowning
Drug abusers

61
Q

What is aspiration pneumonia often treated with/

A

Co-amoxiclav

62
Q

What are some ways a patient can be immunocompromised and get pneumonia?

A

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
Q

How can we prevent Pneumonia?

A

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
Q

Who are more at risk of LRTI?

A

Asplenia
Dysfunctional spleen
Immunodeficiency

65
Q

If a CXR is normal with pneumonia symptoms is it pneumoni?

A

NO

Likely acute bronchitis

Y2 - Resp (23 decks)

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