Lower respiratory tract infections Flashcards by Aditi Mukherjee

What does prostration mean?

lying on ground

not able to move

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What is upper respiratory?

nose, mouth, larynx, trachea, sinus

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What is lower respiratory?

bronchial tubes, lungs etc.

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What are common upper respiratory tract infections?

COMMON COLD:
rhinovirus
coronavirus
parainfluenza
respiratory Syncitial Virus 
influenza Virus
adenovirus

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What severe illnesses can first seem like a common cold?

Strep A infection
pneumonia
malaria
early stages of chicken pox, measles, meningitis

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What is the incubation period?

time from when person gets infected to when symptoms start to show (1-3 days)

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Why does illness peak in winter?

more crowding indoors

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How does illness spread?

inhalation

surface contamination

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How do sinusitis, otitis media, and tracheobronchitis happen?

damage to mucosa

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What is otitis media?

inflammatory disease of middle ear

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What is croup?

a barking cough that sounds like a seal (you can hear examples online)
a hoarse voice
difficulty breathing
a rasping sound when breathing in

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How do you diagnose pneumonia?

can get from flu

diagnose through serology (look at bloods), immunofluorescence microscopy, PCR

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What is oseltamivir?

antiviral

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What are the 3 types of flu that affect humans?

influenza virus A (most common),B,C

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What type of virus is influenze?

RNA

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What is the structure of influenza virus?

has spikes on its surface made of glycoproteins
glycoproteins are neuraminidase (N) and hemagglutinin (H)-there are many subtypes of the H and N glycoproteins (H1N1 and H3N1 are the most common ones going around)

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What are the 2 ways the flu can change?

point mutation- occurs every year- leading to antigenic drift
genetic assortment (complete new virus strain from animals)- occurs few times in a century.

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What is fetor oris?

smelly breath

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Which organisms can cause pharyngitis (sore throat)?

strep pyogenes (group A strep)
Epstein barr virus (causes glandular fever)
other bacteria-(group C G strep, arcanobacterium, diphtheria very rarely)

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In a sore throat, what does exudate indicate?

possibly bacterial cause- maybe group A strep virus

How do you investigate pharyngitis?

throat culture
monospot or EBV serology to look for Epstein barr virus
ASOT (for group A strep)

How do you diagnose group A strep?

do a culture- get results the next day:

yellow spots seen in blood agar plate (bc group A strep is beta haemolytic ie completely ruptures and destroys red blood cells)
it will react with a chemical called group A antiserum
it will show to be sensitive to an antibiotic called bacitracin

What is the difference between stridor and wheeze?

stridor -this is when the patient breathes in and a sound is heard

wheeze- opposite to stridor- breathes out and a sound can be heard

What can happen if the epiglottis is inflamed?

swollen and inflamed epiglottis= blocking the respiratory tract
patient drool bc too hard to swallow
stridor heard because of turbulent flow of air every time the child breathes in

What is acute epiglottis?

disease | swollen epiglottis

What is the cause of acute epiglottis?

haemophilus influenzae B, which is vaccinated against-the incidence of epiglottitis is reducing due to the vaccination

Who does acute epiglottis normally affect?

children between half a year and 6 years old−there are other bugs involved in this which will cause it in adults

What is common to happen to the epiglottis in acute epiglottis?

epiglottis can go into spasm at anytime shouldn't poke around epiglottis- can kill patient should do tracheotomy

How doe you treat acute epiglottis?

ceftriaxone

What is croup known as?

acute viral laryngo-tracheobronchitis

In what agegroup is croup common?

in children between 3 months to 3 years

What is the cause of croup?

it is caused by many viruses especially parainfluenza virus and respiratory syncytial virus

How is croup cured?

it is usually self resolving in 3-4 days but may require admission and even ventilation treatment=steam and a single dose of steroids

What is the pathophysiology of croup?

normally the larynx and trachea is bounded by cartilage which keeps them static, so that when we breath in they stay open and the air goes in however, the baby’s trachea doesn’t have cartilage around it until about 6 years and so when it gets a bit inflamed, it comes together like a paper straw leading to coughing inspiration reduces pressure in trachea−the trachea collapses−thus leading to stridor (seal like sound)

What is purulent sputum?

green sputum

When is C reactive protein produced?

by the liver during infection

What can cause community acquired pneumonia (CAP)?

- maybe no cause - streptococcus pneumoniae was the reason - haemophilus influenzae - legionella - mycoplasma - coxiella

What lab tests can you do for CAP?

sputum blood culture serum urine

How do you treat CAP?

admit the patient, and give 35% oxygen in order to get sats to 98% •IV fluidsmay be given •ibuprofen may be given for pleuritic chest pain (pain on breathing in) •antibiotics will be given −iv clarithromycin will treat atypical organisms (not strep pneumoniae) −oral doxycycline (if patient can take oral tablets) will treat strep pneumoniae −iv benzylpenicillin will also treat strep pneumoniae •if the patient is found to be positive for strep pneumoniae, the patient will be switched to oral doxycycline

If a patient has COPD, what is commonly seen in an X ray?

flat diaphragm | over expanded lungs

What is COPD?

here the airways do not work very well, the cilia aren’t beating and removing nasty bugs coming in which leads to acute infections

What are the symptoms of COPD?

sputum (chronic) | chronic bacteria colonization

What investigations are done for COPD?

blood cultures urinary antigen test sputum

How do you treat COPD?

maintain oxygenation treat the underlying cause by giving antibiotics −oral amoxycillin treat airway with bronchodilators and corticosteroids hydrate and give the patient nutrition

Which type of bacteria is mostly acquired in the hospital?

gram negative organisms

What is the first line of treatment for gram negative organism disease?

gentamycin and benzo penicillin

What is ventilator associated pneumonia caused by?

pseudomonous

What is aspiration pneumonia caused by?

getting stuff from stomach up into the lungs during vomiting | or swallowing mechanism isn’t working

What happens in urinary antigen test?

Urinary Antigen Test = Can test for pneumococcus and legionella, it is very quick (results on same day) and the result is not affected by antibiotics. It is better than doing a culture. Limitations however are that we don't get the actual bacteria = we don't know what it is sensitive to.