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ESA 3 - Respiratory System > LRTI And Pneumonia > Flashcards

LRTI And Pneumonia Flashcards

1
Q

What are some common microbial flora of the upper respiratory tract?

A

Viridans streptococci
Neisseria
Anaerobes
Candidia

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2
Q

How does our body stop bacteria invading and causing infections?

A

Muco-ciliary clearance mechanisms, nasal hairs and ciliated columnar epithelium of the respiratory tract.

Respiratory mucosal immune system. Lymphoid follicles of the pharynx and tonsils, alveolar macrophages, secretory IgA and IgG.

Cough and sneezing reflex

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3
Q

How can you compromise respiratory defences?

A

Poor swallow (muscle weakness, alcohol)

Abnormal ciliary function (smoking, viral infection)

Abnormal mucus (CF)

Dilated airways (bronchiectasis)

Defects in host immunity - immunosuppression, HIV

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4
Q

What can severe otitis media cause?

A

Mastoiditis, meningitis and brain abscesses. Don’t miss it!

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5
Q

What are some lower respiratory tract infections?

A 
Bronchitis 
Pneumonia
Bronchiolitis 
Bronchiectasis 
Empyema
Lung abscess
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6
Q

What is acute bronchitis?

A

Inflammation of medium sized airways

Mainly in smokers

Cough, fever, increased sputum production, increased shortness of breath

CXR: normal

Organsisms:
Steptococcus pneumoniae
Haemophilius influenzae
Moraxella catarrhalis

Bronchodilation using physiotherapy and (maybe) antibiotics.

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7
Q

What is chronic bronchitis?

A

NOT primarily infective

Exacerbations have been associated with many organisms, but the role of infections remains controversial

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8
Q

What is pneumonia?

A

Inflammation of the lung alveoli

Patients are unwell - 20-40% admitted to hospital and mortality is 5-10%

Presentation:
Fever
Cough
Pleuritic chest pain
Shortness of breath

Localising signs and abnormal CXR

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9
Q

How can you classify pneumonia?

A

Clinical setting -Community acquired, hospital acquired

Presentation -acute vs chronic

Organism -bacterial, viral, fungal

Lung pathology -lobar pneumonia, bronchopneumonia, interstitial pneumonia

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10
Q

What organisms more commonly cause communit acquired pneuma>

A 
Strep pneumoniae (common)
Haemophilus influenzae (common) 
Moraxella catarrhalis
Staph aureus
Klebsiella pneumoniae
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11
Q

What atypical organisms can cause CAP?

A

Legionella - water
Mycoplasma -epidemics
Coxiella burnetti (Q fever) -farm animals
Chlamydia psittaci - birds, spenomegaly, rash, haemolytic anaemia

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12
Q

What are he symptoms for community acquired pneumonia?

A 
Shortness of breath
Cough +/- sputum
Fever
Rigors
Pleuritic chest pain
Malaise, nausea and vomiting
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13
Q

What do you examine for in community acquired pneumonia?

A 
Pyrexia
Tachycardia
Tachypnoea
Cyanosis
Dullness to percussion
Bronchial breathing
Crackles
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14
Q

What investigations do you do for community acquired pneumonia?

A 
FBC
U&E
CRP
ABG
CXR
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15
Q

What microbiological samples / investigations do you do if the patient isn’t getting better?

A 
Sputum / induced sputum 
Blood culture
Broncho alveolar Lavage
Nose and Throat swabs or NPAs (viruses)
Urine 
Serum antibody
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16
Q

How do you manage pneumonia?

A

CURB-65 score -admit or not

Antibiotics-different depending on infection

17
Q

What is the CURB-65 score?

A

This is a score used to predict mortality in community acquired pneumonia.

18
Q

What antibiotic are used for mild-moderate pneumonia?

A

Amoxicillin or doxycycline /erythromycin / clarithromycin (if allergic)

19
Q

What antibiotic are used for moderate-severe pneumonia?

A

Co-amoxiclav and clarythromycin.

This is when patients need hospital admission

20
Q

What could become complications fo acute bacterial pneumonia?

A

Lung abscess
Bronchiectasis
Empyema

21
Q

What do you think about if the patient fails to improve upon treatment?

A 
Empyema / abscess 
Proximal obstruction (tumour)
Resistant organism (TB)
Not receiving or absorbing antibiotics 
Immunosuppression 
Other diagnosis -lung cancer
22
Q

Discuss streptococcus pneumonia

A 
Gram positive diplococci
a haemolysis
Causes 30-50% of CAP
Acute onset:
-Severe pneumonia, fever, riggers, lobar consolidation 
Treat with amoxicillin or IV penicillin
23
Q

Why do you need different antibiotics for organisms that are atypical?

A

Because they don’t have a cell wall so beta lactams the work by destroying the cell wall do not work.

You need agents that work on protein synthesis

  • Macrolides (erythromycin)
  • Tretracyclines (doxycycline)

Also may have extra pulmonary features such as hepatitis low Na.

24
Q

What is viral pneumonia?

A

Damage to cells lining the airways / alveoli by the virus and immune cells.

Fluid filled air paces interferes with gas exchange

Mild to severe

Severe viral pneumonia causes necrosis / haemorrhage (similar to ARDS)

Patchy or diffuse ground glass opacity on CXR

25
Q

What is hospital acquired pneumonia?

A

Developed after 48 hours in hospital
Often previous antibiotics
+/- ventilator
Can have infectious or non–infectious causes of abnormal CXR and lung function.
Bronchial lavage is desirable to differentiate upper from lower respiratory flora

26
Q

What organisms commonly cause hospital acquired pneumonia?

A

Staph aureus
Pseudomonas
Haemophilus influenzae
Acinetobacter baumanii

27
Q

How do you treat hospital acquired pneumonia?

A

Co-amixiclav

If worse (ITU): Pipperacilin / tazobactam or Meropenem

28
Q

What is aspiration pneumonia?

A

Aspiration of exogenous material or endogenous secretions into the respiratory tract.

Common in patients with neurological dysphagia (strokes), epilepsy, alcoholics, drowning

You care at risk if you live in a nursing home or have had an overdose.

Mixed infection - viridians streptococci and anaerobes

Treat with co-amoxiclav

29
Q

What patients are classified as immunosuppressed and what bacteria do you worry could have infected them?

A

HIV: PCP, TB, atypical mycobacteria

Neutropenia: fungi e.g. aspergillus

Bone marrow transplant: cytomegalovirus

Splenectomy: encapsulated organism (S. pneumoniae, H. influenzae, N. Meningitidis)

30
Q

How do you prevent pneumonia?

A

Immunisation -flu, pneumococcal

Chemoprophylaxis -penecillin /erythromycin

Smoking cessation advice

ESA 3 - Respiratory System (24 decks)

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