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Respiratory System > Lower Respiratory Tract Infections And Pneumonia > Flashcards

Lower Respiratory Tract Infections And Pneumonia Flashcards

1
Q

What types of microorganisms are microbiome of the upper respiratory tract?

A 
Strep viridans 
Neisseria species
Anaerobes 
Candida species 
(Strep pneumoniae)
(Strep pyogenes)
(Haemophilus influenzae)
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2
Q

Describe some of the first defences of the respiratory tract

A

Muco-ciliary clearance
Cough and sneezing reflex
Mucosal immune system - lymphoid follicles of pharynx and tonsils, alveolar macrophages, secretory IgA and IgG

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3
Q

Name some general types of problems that can compromise respiratory defences

A 
Poor swallowing 
Abnormal ciliary function 
Abnormal mucus
Dilated airways 
Defects in host immunity
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4
Q

Name some common upper respiratory tract infections

A 
Rhinitis 
Pharyngitis 
Laryngitis 
Sinusitis 
Otitis media
Epiglottitis 
Tracheitis
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5
Q

What are the most common viruses of the respiratory system?

A

Rhinovirus
Coronavirus
Influenza
Respiratory syncytial virus (RSV)

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6
Q

Bacterial super-infections in the respiratory tract can lead to …

A

Mastoiditis
Meningitis
Brain abscess

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7
Q

Name some common lower respiratory tract infections

A 
Bronchitis 
Bronchiolitis 
Bronchiectasis 
Pneumonia 
Empyema 
Lung abscess
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8
Q

Describe acute bronchitis

A

Inflammation of the medium sized airways
Mainly in smokers
Cough, fever, increased sputum, shortness of breath
CXR = normal

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9
Q

What are the types of organisms causing acute bronchitis?

A

Viruses
Strep pneumoniae
H influenza

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10
Q

What is the treatment of acute bronchitis?

A

Bronchodilation
Physiotherapy
+/- antibiotics

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11
Q

What is pneumonia and its presentation?

A 
Inflammation of lung alveoli 
Fever
Cough (+/- sputum)
Pleuritic chest pain 
Shortness of breath 
Rigors
Malaise/nausea/vomiting
Often localising signs and abnormal CXR
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12
Q

What are the different ways of classification of pneumonia?

A 
By clinical setting (CAQ, HAQ)
By presentation (acute, chronic)
By organism (bacterial, viral, fungal)
By lung pathology (lobar, broncho, interstitial)
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13
Q

What is pneumonitis?

A

Non-infective inflammatory disease

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14
Q

Describe the pathogenesis of pneumonia

A

Acute inflammatory response
Exudation of fibrin rich fluid
Neutrophil infiltration
Macrophage infiltration

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15
Q

What underlying factors predispose to pneumonia?

A 
Pre-existing lung disease
Immunocompromsied
Geography, seasons, epidemics 
Travel 
Exposure to animals
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16
Q

What are the typical community causes of pneumonia?

A

Strep pneumoniae

H influenzae

17
Q

What should you look for on examination of someone with pneumonia?

A 
Pyrexia
Tachycardia
Tachypnoea
Bronchial breathing 
Cyanosis 
Dullness to percussion 
Tactile vocal fremitus 
Crackles
18
Q

What investigations should you do in someone with suspected pneumonia?

A 
FBC
Urea and electrolytes
CXR
CRP 
Arterial blood gases
19
Q

What microbiological samples/investigations could you order in pneumonia?

A 
Sputum culture
Blood culture
Broncho-alveolar lovage fluid (BAL)
Nose and throat swabs
Urine
Serum (antibody test)
20
Q

What does the CURB-65 score for pneumonia assess?

A 
Confusion 
Urea > 7 mmol/L
Resp rate >30
BP <90 s / <60 d
> 65 years 
(Score of 2+ means admit to hospital)
21
Q

What is the antibiotic treatment for mild-moderate pneumonia?

A

Amoxicillin

Doxycycline/erythromycin/clarithromycin

22
Q

What is the antibiotic treatment for moderate to severe pneumonia?

A

Co-amoxicillin and clarithromycin/doxycycline

23
Q

What are the possible outcomes of acute bacterial pneumonia?

A

Resolution with some organisation (fibrous scarring)
Lung abscess (liquefactive necrosis)
Bronchiectasis
Empyema

24
Q

Which organisms cause atypical pneumonia?

A 
Organisms without a cell wall
Mycoplasma 
Legionella 
Chlamydia 
Coxiella
25
Q

Why do we need different treatments for atypical pneumonia?

A

Cell wall active antibiotics don’t work eg. Penicillins

As the organisms don’t have cell walls

26
Q

What Abx do we use for atypical pneumonia?

A

Macrolides (eg. Erythromycin/clarithromycin)

Tetracyclines (eg. Doxycycline)

27
Q

Describe viral pneumonia

A

Damage to cells lining the airways/alveoli by virus and immune cells
Fluid filled air spaces - interferes with gas exchange
Can get severe necrosis
Patchy or diffuse ground glass opacity of CXR

28
Q

Which viruses can cause viral pneumonia?

A

Influenza/parainfluenza
RSV
Adenovirus

29
Q

Describe the causes the hospital acquired pneumonia

A 
Staph aureus 
Enterobacteriaciae 
Pseudomonas species
Haemophilus influenzae
Fungi
30
Q

What treatments do we use to treat HAQ pneumonia?

A

First line = co-amoxiclav

Second line = pipperacilin/tazobactam/meropenem

31
Q

Describe aspiration pneumonia

A

Exogenous or endogenous material
Common in patients with neurological dysphagia, epilepsy, alcoholics and drowning
Mixed infection of strep viridans and anaerobes
Treat with co-amoxiclav

32
Q

Describe some prevention methods for pneumonia

A

Flu vaccine
Pneumococcal vaccine
Chemoprophylaxis - oral penicillin/erythromycin
Stop smoking

Respiratory System (13 decks)

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