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Respiratory > Lower Respiratory Tract Infections > Flashcards

Lower Respiratory Tract Infections Flashcards

1
Q

What is acute bronchitis?

A

Thickening of the bronchial walls due to infection

Often preceded by a common cold

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2
Q

What are the clinical features of acute bronchitis?

A 
Productive cough
Fever
Normal chest examination 
Normal chest x ray
Transient wheeze
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3
Q

How is acute bronchitis treated?

A

Usually viral and self limiting- paracetamol and fluids

Antibiotics are NOT needed in the majority of cases

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4
Q

When may antibiotics be needed to treat acute bronchitis

A

Patients with chronic lung disease- it can cause significant morbidity

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5
Q

What is the risk of fatal pneumonia?

A

5-10%

30% if bacteraemic

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6
Q

What are the symptoms of pneumonia?

A

Malaise, Annorexia, Sweats, Rigors, Myalgia, Arthralgia, Headache, Confusion, Cough, Pleurisy, Haemoptasis, Dysphonia, Abdominal pain, diarrhoea

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7
Q

What can preceed a pneumonia?

A

An upper RTI

A UTI

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8
Q

How can pneumonia cause abdominal pain?

A

Sitting on top of the diaphragm

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9
Q

What would you expect to find on examination in a pneumonia patient?

A

Fever, rigors, herpes labialis, tachypnoea, crackles, rub, bronchial breath sounds, cyanosis, hypotention

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10
Q

Why may you see cold sores in a pneumonia patient

A

Herpes labialis remains dormant in the body. With pneumonia the immune system will be diverted leading to a flare up of cold sores/ herpes simplex

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11
Q

What investigations are required if pneumonia is suspected?

A 
Blood and sputum culture
Viral throat swab
CXR
ABGs
Serology and urine (legionella only)
Full blood count 
Urea and liver function
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12
Q

What does CURB 65 score stand for?

A 
C- new onset of CONFUSION
U- UREA > 7 (kidney failure)
R- RESP RATE >30
B- BLOOD PRESSURE <90 systolic of <61 diastolic 
65- age 65 or older
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13
Q

What does a curb 65 score of 0-2 imply?

A

Moderate pneumonia

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14
Q

What does a curb 65 score of >2 imply?

A

Severe pneumonia- higher mortality risk

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15
Q

What are other markers of severity for pneumonia?

A

Temperature <35 or >40
Cyanosis PaO2 <8kPa
WBC <4 or >30
Multi lobar involvement

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16
Q

Which are the most resistant strains of baceria causing pneumonia?

A

Legionella nad Staph aureus

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17
Q

What is the most common cause of pneumonia

A

Strep pneumoniae

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18
Q

Pneumonia: young person.

Whats the cause?

A

Mycoplasma pneumonia- protracted paroxysmal cough

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19
Q

Pneumonia: CF patient.

Whats the cause?

A

Pseudomonas aeruginosa

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20
Q

Pneumonia: PWID.

Whats the cause?

A

Staph aureus

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21
Q

Pneumonia: returned from spain.

Whats the cause?

A

Legionella pneumophilia

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22
Q

Pneumonia: COPD.

Whats the cause?

A

Haemophilus influenzae

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23
Q

Pneumonia: alcoholic.

Whats the cause?

A

Klebsiella pneumoniae

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24
Q

Pneumonia: bird keeper.

Whats the cause?

A

Chlamydia psittaci

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25
Q

What is mycoplasma pneumoniae resistant to?

A

All beta lactam antibiotics as they do not have a cell wall

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26
Q

When would you use IV antibiotics to treat pneumonia?

A

Nil by mouth
Sensitivities- resistant to oral antibiotics
Deep seated infections- abscesses (bones, pelvis)
First dose IV to increase the plasma concentration
Generally oral antibiotics are very good

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27
Q

What are the complications of pneumonia?

A

Respiratory failure
Pleural effusion
Empyema- infection in the pleural space
Abcess

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28
Q

What is an empyema?

A

An infection in the pleural space

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29
Q

Who is entitled to the pneumococcal vaccine?

A

Over 65’s
Anyone with a chronic chest or cardiac disease
Anyone who is immunocomprimised- eg splenectomy

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30
Q

What type of antibiotics do hospital acquired pneumonias require?

A

Gram negative cover

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31
Q

What type of antibiotics are needed for aspiration pneumonia?

A

Anaerobic cover

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32
Q 
What is the incubation times for:
Rhinovirus?
Strep group A?
Influenza and parainfluenza?
RSV?
Pertussis?
Diphtheria?
Epsin Barr virus?
A 
Rhinovirus = 1-5 days
Strep group A = 1-5 days
Influenza and parainfluenza = 1-4 days
RSV = 7 days
Pertussis = 7-10 days
Diphtheria = 1-10 days
Epsin Barr virus= 4-6 weeks
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33
Q

What does pertussis cause?

A

Whooping cough- 100 day cough

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34
Q

What does the Epsin Barr virus cause?

A

Glandular fever

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35
Q

What are the 3 main risk factors for chronic pulmonary infection?

A

1) Abnormal host response = immunodeficiency or immunosupression
2) Abnormal innate host defence = damaged bronchial mucosa, abnormal cilia, abnormal secretions
3) Repeated insult = Aspiration or indwelling material (NG tube)

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36
Q

Which drugs cause immunosupression?

A 
Steroids 
Monoclonal antibodies 
Chemotherapy 
Cyclophosphamide
Methotrexate
Azathioprine
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37
Q

What are the common imunodeficiencies?

A

IgA deficiency- increased incidence of acute infections- not chronic
Hypogammaglobulinaemia- rare- increased risk of acute and chronic infections
CVID (common variable immunodeficiency)- common and recurrent infections
SPAD (specific polysaccharide antibody deficiency)
Hypospenism- no spleen, antibiotics for life
HIV
Immune paresis

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38
Q

What causes a damaged bronchial mucosa?

A

Smoking, recent infection, malignancy

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39
Q

What causes abnormal cilia?

A

Kartenager’s syndrome, Young’s syndrome

40
Q

What causes abnormal secretions?

A

CF and channelopathies

41
Q

What causes recurrent aspiration?

A

NG feeding, poor swallow, pharyngeal pouch

42
Q

What are the forms of chronic respiratory infection?

A 
Intrapulmonary abscess
Bronchiectasis
Empyema
CF
Chronic bronchial sepsis
43
Q

What are the common organisms causing intra pulmonary abscesses?

A

Streptococcus pneumoniae, Staph aureus, E coli, gram negatives and aspergillus fungi

44
Q

What is suggested by multiple abscesses?

A

Bacteraemia

45
Q

What is an empyema and what is the treatment?

A

Infection within the pleural space = Pus

Chest drain, antibiotics IV initially, oral antibiotics for 14 days directed at causative organism

46
Q

If a patient has pleural fluid build up due to pneumonia, do they have an empyema?

A

No- the fluid must be infected

47
Q

What are the characteristics and treatment for a simple parapneumonic effusion?

A

Clear fluid, pH >7.2, LDH <1000, Glucose >2.2

Resolve on its own- monitor

48
Q

What are the characteristics and treatment for a complicated parapneumonic effusion?

A

pH <7.2, LDH >1000, Glucose <2.2

Chest drain

49
Q

What organisms cause empyemas?

A

Often aerobic because oxygen readily difuses into the pleual space
Strep Milleri, Staph aureus (gram positive)
E coli, pseudomonas, H. influenzae, Kelbsiellae (gram negatives)

50
Q

How is an empyema diagnosed?

A

CXR (consider lateral) persistent effusion with loculations

Ultrasound- targeted sampling of pleural fluid

51
Q

How do you distinguish between an empyema and an abscess?

A

CT scan

52
Q

What is Bronchiectasis?

A

Localised, irreversile dilation of the bronchial tree

Involved bronchi are dilated, inflamed and easily collapsible

53
Q

What does bronchiectasis cause?

A

Air flow obstruction as airways lose rigidity

Impaired clearance of secretions as cilia don’t work

54
Q

What is the common presentation for bronchiectasis?

A

Recurrent chest infections with lots of antibiotic prescriptions but with no or a short response
persistent sputum production, especially in the morning

55
Q

How is bronchiectasis diagnosed?

A

High resolution CT

Signet ring sings where the bronchiole is larger than the accompanying pulmonary artery

56
Q

What is the cause of bronchiectasis?

A 
50% idiopathic 
CF
Kartanager's syndrome
Young's syndrome 
immunodefficiency 
Rheumatoid arthritis
ABPA- allergic broncho pulmonary aspergillosis
Pulmonary fibrosis 
Yellow nail syndrome 
Mounier-Khun syndrome
57
Q

What is chronic bronchial sepsis?

A

Clinical bronchiectasis but without the radiological signs

58
Q

Who gets chronic bronchial sepsis?

A

Younger females involved in child care or older with COPD

59
Q

How is chronic bronchial sepsis treated?

A

Reactive antibiotics- send for a sputum culture and give antibiotics appropriate to the most recent positive culture.
Influenza and pneumococcal vaccines
If colinised, give prophylactic antibiotics (nebulised gentamycin or colomysin) or pulsed or alternating antibiotics

60
Q

Low dose macrolife antibiotics have been shown to reduce exacerbation rates in bronchiectasis. True or flase?

A

True. Give a very low dose of clarithromycin od or azithromycin 3 times a week.

61
Q

How is prognosis determined in bronchiectasis?

A

Bronchiectasis severity index

62
Q

When is lung abscess development more common?

A

Aspiration pneumonia

63
Q

What is lobar pneumonia?

A

Consolidation involving one complete lung lobe

64
Q

What is bronchopneumonia?

A

Infection starting in airways and spreading to adjacent alveolar lung.
Patchy consolidation

65
Q

What are the opportunistic pathagens in the imunocompramised host?
All these infection involve an MDT

A 
Virus = Cytomegalovirus- CMV
Bacteria = Mycobacterium avian intracellulare
Fungi = aspergillus, candida, pneumocystis
protozoa = cryptsporidia and toxoplasma
66
Q

What is the difference between colonisation and infection?

A

Colonisation means the bacteria live in a particular area but they do not cause an infection necessarily

67
Q

What host defences are found in the nasopharynx?

A

Nasal hairs, cilliaed epithilium and IgA which is found on the epithilial surface

68
Q

What host defecnces are found in the oroparynx?

A

Saliva, coughing

69
Q

What is sinisitis?

A

Infection of the paranasal sinuses

70
Q

What is pharyngitis?

A

Infection of the pharynx, tonsils and uvula

71
Q

What are the common colonisers of the nose and mouth? Gram negative and gram positive.

A 
Gram positive 
1) strep pneumoniae- alpha haemolytic 
2) Streppyogens- Beta haemolytic 
3) Staph aureus 
Gram negative
1) H. influenzae
2) Naraxella catarrhalis
72
Q

What are the host defecnces in the conducting airways?

A

Mucocillary escalator
Cough
AMPs- complex matrix of proteins and cytokines
Cellular and humoral immunity

73
Q

Which organism causes whooping cough?

A

Bordetella pertussis- gram neg cocobacillus

74
Q

How long are people with whooping cough contagious for?

A

3 weeks

75
Q

How is whooping cough diagnosed?

A 
Pernasal swab:
Cultured on charcoal blood agar 
PCR
Serology
Test will only be positive while the patient is infectious- during this time antibiotics can be given
76
Q

What is the definition of a droplet and what PPE is needed for a droplet infection?

A

Particles greater than 5 microns that fall to ground within 2m
PPE = Face mask, apron, gloves. Ideally single room

77
Q

What is the definition of an airborne infection and what PPE is needed for a droplet infection?

A

Particles less than 5 microns that travel long distances

PPE = Filter face piece 3, apron, gloves. Side room

78
Q

What are the host defences in the lower respiratory tract?

A

This is normally a sterile area.
Alveolar lining fluid containing surfactant, immunoglobulins, complement, FFA and AMPs
ALveolar macrophages and neutrophils

79
Q

What is the treatment for legionella?

A

Clarythromycin, Erythromycin, Quinolones (levofloxacin)

80
Q

Does legionella have a cell wall?

A

No. Beta lactam antibiotics are not effective

81
Q

What are the antibiotics to aviod to prevent C Diff?

A

Clindamycin, cepthalosporins, Co ammoxiclav, Ciprofloxacin

82
Q

What is Legionella?

A

Environmental gram negative bacteria
Obligate intracellular organism- resides in aomebas
No person to person spread
Associated with forty air con and saunas

83
Q

What is the rash associated with mycoplasma pneumoniae?

A

Irethima multi formae

Target rash

84
Q

What is Q fever and how is it spread?

A

Coxiella Burnetii pneumonia

Infected sheep and goats- occupationally acquired

85
Q

What causes pyrexia of unknown origin?

A

Coxiella Burnetii pneumonia

Q Fever

86
Q

What is bronchiolitis and who does it commonly effect?

A

Viral infection of the bronchioles

Children aged 0-2

87
Q

What are the symptoms of bronchiolitis?

A

Fever, cough, clod and wheeze

Severe = grunting, sternal indrawing, low PaO2

88
Q

What are the complications of bronchiolitis?

A

respiratory of cardiac failure (esp if baby was premature or has pre existing respiratory or cardiac disease

89
Q

What causes bronchiolitis and how is it diagnosed?

A

RSV- Respiratory Syncytial Virus (80%) Metapneumovirus

Nasal swab and PCR

90
Q

How are lots of babies with bronchiolitis cared for?

A

Cohort nursing

91
Q

Give an example of an STI causing infantile pneumonia and how its diagnosed?

A

Chlamydia trachomatis

PCR in urine of mother or nasal/throat swab of baby

92
Q

What is MERS CoV and where is it prevalent?

A

Middle East Respiratory Syndrome Coronovirus

Saudia Arabia

93
Q

What does Chlamydophilia pneumoniae cause

A

Mild respiratory infections, may be picked up on a test for psittacosis.

94
Q

What are the current PCR tests in Tayside?

A 
Influenza A
Influenza B
Parainfluenza 1-4
Coronavirus (4 species) causes the common cold
Enterovirus
Metapneumovirus
Adenovirus
RSV
Rhinovirus
Mycoplasma pneumonia
95
Q

What is C diff?

A

Gram positive spore forming bacteria

Respiratory (26 decks)

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