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Resp > Lrti And Pneumonia > Flashcards

Lrti And Pneumonia Flashcards

1
Q

What are the microbial flora of the upper resp tract

A

Common
Viridans streptococci Neisseria spp Anaerobes Candida sp

Less common
Streptococcus
pneumoniae
Streptococcus pyogenes
Haemophillus influenzae

Other
Pseudomonas, Escherichia coli

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2
Q

What are the defences of the respiratory tract

A

• Muco-ciliary clearance mechanisms nasal hairs, ciliated columnar epithelium of the respiratory tract
• Cough & the sneezing reflex
• Respiratory mucosal immune system
Lymphoid follicles of the pharynx and tonsils, alveolar macrophages, secretary IgA and IgG

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3
Q

How can registry defences be compromised

A 
Poor swallow (CVA, muscle weakness, alcohol) - Anything that affects epiglottis  - anything that weakens muscles - affect tone of larynx and upper airways -aspirate secretions - flora from the mouth can go to lungs
Abnormal ciliary function (smoking,
viral infection)
Abnormal mucus (cystic fibrosis)
Dilated airways:  bronchiectasis
Defects in host immunity
HIV, Immunosuppression
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4
Q

What are some upper rts=is

A

Ss

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5
Q

What are some lower rtsi

A

Bronchitis, pneumonia, bronchiolitis, emphysema, bronchiectasis, 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 
• Organisms:
– viruses 
– S. pneumoniae 
– H. influenzae 
– M. catarrhalis
• Bronchodilation; Physiotherapy; +/- Antibiotics-  remove music from chest
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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 infection remains controversial
Conglomerates with cost. At higher risk of infection. ??

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8
Q

What is pneumonia

A 
• Inflammation of the lung alveoli 
• Patients are unwell
20-40% admitted to hospital
mortality 5-10% 
• Presentation
– Fever 
– Cough 
– Pleuritic chest pain 
– Shortness of breath
• Often localising signs and abnormal CXR
Associated effusion?
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9
Q

Describe the classification of pneumonia

A

• By clinical setting (e.g. Community acquired, Hospitals acquired)
• By presentation (acute and chronic)
• By organism (Bacterial, Viral, fungal)
• By lung pathology (lobar pneumonia, bronchopneumonia, interstitial pneumonia)
Pneumonitis: non infective inflammatory disease

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10
Q

Describe teh appareance of the lung sin pneumonia

A

Ss

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11
Q

What is CAP and which organisms are associated with it

A 
Community acquired pneumonia (CAP)
• No microbiological ID made in most
cases. Main organisms:
– Streptococcus pneumoniae
– Haemophilus influenzae
– Moraxella catarrhalis
– Staphylococcus aureus
– Klebsiella pneumoniae
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12
Q

What are the causes o CAP

A
  • Typical Organisms / Manifestations (85%)
  • S. pneumoniae
  • H. influenzae
  • Atypical manifestations of cap / Manifestations (15%) - Atypical -most lack a cell wall - teh antibiotics aimed at gram +ves with a cell wall DO NOt work on these bc they have no cell wall
  • Legionella – contaminated water sources
  • Mycoplasma- epidemics 4-6 yrs
  • Coxiella burnetii (Q fever)-worldwide, farm animals, hepatitis
  • Chlamydia psittaci (Psittacosis) exposure to birds, splenomegaly, rash, haemolytic anaemia
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13
Q

What are the symptoms of pneumonia

A

• Shortness of breath • Cough +/- sputum (yellow, rusty, current
jelly) • Fever • Rigors • Pleuritic chest pain • Malaise, nausea & vomiting

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14
Q

What is seen upon examination of pneumonia

A

• Pyrexia
• Tachycardia • Tachypnoea • Cyanosis • Dullness to percussion, tactile vocal
fremitus • Bronchial breathing • Crackles

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15
Q

What are the investigations for pneumonia

A

• Full Blood Count, • Urea & Electrolytes • C Reactive Protein • Arterial Blood Gases • Chest X Ray

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16
Q

Describe teh investigations of new Monica in terms of microbiological instigation

A

• Sputum / Induced sputum
• Blood culture
• Broncho Alveolar Lavage fluid (BAL) - Wash out lungs with fluid, wash it away, sam plefluid
• Nose & Throat swabs or NPAs (viruses)
• Urine (antigen test for legionella /
pneumococcus)
• Serum (antibody test) acute & convalescent sera (usually collected at presentation and 10-14 days later)

17
Q

Wha needs to be considered when deciding management

A 
• CURB-65 score
– Confusion
– Urea >7 mmol/l
– Respiratory Rate >30
– Blood Pressure <90 systolic <60 diastolic
– >65 years 
• Score 2 = ?admit 
• Score 2-5 = manage as severe
18
Q

Desceire tha antibiotic treatment

A 
• Depends on probable infection:
– Community vs hospital acquired?
– Severity of illness?
– Personal risk factors
– Ventilator associated?
If severe  Coamocyclav and doxycyclin Anaesthetic? Lost muscle tone 
Ventilators - higher risk of pseudomonas
19
Q

Describe the empiric therapy for cap`

A 
• Each hospital has its own guideline 
• Mild-moderate:
– Amoxicillin
– Or doxycycline or erythromycin /
clarithromycin
• Moderate-severe:
– Needing hospital admission:
co-amoxiclav AND clarithromycin /
doxycycline
20
Q

What are the outcomes of acute bacterial pneumonia

A

• Resolution
Organisation (fibrous scarring)
• Complications
Lung abscess Bronchiectasis Empyema (pus in the pleural cavity)

21
Q

What could have developed if the patient is not improving upon treatment

A 
• Empyema / abscess
• Proximal obstruction (tumour)
• Resistant organism (incl. Tb)
• Not receiving / absorbing  Abx
• Immunosuppression
• Other diagnosis
– Lung cancer – Cryptogenic organising pneumonia
Do another cxr, ct to check bronchioles
22
Q

What is s pneumonia

A 
• Gram +ve cocci (pairs – diplococci) 
• 30-50% of CAP 
• Acute onset
– Severe pneumonia
– Fever, rigors
– Lobar consolidation 
• Treat with Benzyl penicillin or amoxicillin
23
Q

Describe pneumonia due to atypical organisms

A

• Pneumonia caused by organisms without a cell wall
– Mycoplasma – Legionella – Chlamydia – Coxiella
• Cell-wall active antibiotics e.g. penicillins don’t work
• Need agents that work on protein synthesis
– Macrolides (clarithromycin / erythromycin)
– Tetracyclines (doxycycline)
• Extrapulmonary features – e.g. hepatitis; low sodium

24
Q

Describe viral pneumonia

A

• Damage to cells lining the airways / alveoli by the virus Influenza, and mmune cells Parainfluenza,
• Fluid filled air spaces Respiratory Syncytial interferes with gas exchange virus (RSV)
• Mild to severe Adeno virus,
• Severe viral pneumonia necrosis / haemorrhage into the lung parenchyma – picture similar to adult respiratory
distress syndrome (ARDS)
• Patchy or diffuse ground glass opacity on chest X ray
Inflammation is diffuse and all around lung. Looks limiter to adult RDS

25
Q

What viruses can cause pneumonia

A

Ss

26
Q

What is hap

A

• > 48 hours in hospital
• Often previous antibiotics - more resistant
• +/- ventilator
• Infectious vs non-infectious causes
of abnormal CXR / lung function.
• Bronchial lavage desirable to differentiate upper respiratory from lower respiratory flora.

27
Q

What can cause hap

A
  • Staphylococcus aureus
  • Enterobacteriaciae
  • Pseudomonasspp
  • Haemophilus influenzae
  • Acinetobacter baumanii
  • Fungi (Candida sp.)
  • Other
28
Q

What is used to treat hap

A

• First line: Co-amoxiclav • Second line/ITU: Pipperacilin /
tazobactam Or Meropenem

29
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
  • At risk groups - nursing home residents and drug overdose
  • Mixed infection - viridans streptococci & anaerobes
  • Treat with Co-amoxiclav - first time
30
Q

Describe immunosupression and lrt I

A

• HIV: PCP, TB, atypical mycobacteria
• Neutropenia: fungi e.g. Aspergillus spp
• Bone marrow transplant: CMV
• Splenectomy: encapsulated organisms
– e.g. S. pneumoniae, H. influenzae, malaria
• “Anything can do anything”

31
Q

Describe teh prevention of hap

A

• Immunization
Flu vaccine – given annually to high risk patients
Pneumococcal vaccine – every five years
23 polyvalent polysaccharide vaccine dose
13 valent conjugate vaccine
Given to patients with co-morbities - increase risk of invasive pneumococcal disease
• Chemoprophylaxis
Oral penicillin / erythromycin to patients with
higher risk of lower respiratory tract infections
(i.e. asplenia, dysfunctional spleen,
immunodeficiency)
• Smoking advice

Resp (19 decks)

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