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Respiratory > Microbiology > Flashcards

Microbiology Flashcards

1
Q

What are the range of conditions associated with an upper respiratory tract infection?

A

Common cold - coryza
Sore throat - pharyngitis
Sinusitus
Epiglottis

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2
Q

What are the range of conditions associated with an lower respiratory tract infection?

A 
Acute bronchitis 
Acute exacerbation of chronic bronchitis 
Penumonia 
Influenza
Fungal infection
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3
Q

What viral diseases acn a throat swab test for?

A 
Influenza A
Influenza B 
RSV
Metpneumovirus
Rhinovirus
Coronavirus
Parainfleuza
Adenovirus 
Enterovirus
Parechovirus
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4
Q

What are some symptoms of coryza?

A

It is an acute viral infection of the nasal passages that is often accompanied bu a sore throat
It is sometimes accompanied by a mild fever and is spread by droplets and fomites. Complications can include sinusitus and acute bronchitis

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5
Q

What are symptoms of acute sinusitis?

A

Frontal headache
Retro-orbital pain
Maxillary sinus pain - build up of pus in the maxillary sinus before it can be drained
Tooth ache
Discharge
The lymphatic drainage in this area of the face is drained directly back to the brain
It is usually viral but can sometimes need antibiotics

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6
Q

What are the symptoms of strep throat?

A

Exudate
Pus
Dysphagia
Dysphonia

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7
Q

What are the symptoms of acute tonsilitis?

A

Erythematos - bright red palatine tonsils
Dysphagia
Dysphonia
Recurrent

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8
Q

What can be done to cure recurrent tonsilitis?

A

Tonsillectomy

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9
Q

What is a complication of tonsilitis?

A

Quinsy - tonsillar abscess which can be drained

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10
Q

What is diptheria?

A

A life threatening throat condition where the bacteria produce a toxic chemical that causes massive swelling in the back of the throat, asphyxiating the child/adult

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11
Q

What is acute epiglottis?

A

Life threatening condition that occurs due to obstruction

GOLDEN RULE - call for an anesthetist and give antibiotics - usually penicillin

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12
Q

What are some symptoms of acute bronchitis?

A 
Productive cough 
Fever - minority of cases
Normal chest examination 
Normal CXR
May have a transient wheeze 
Not life threatening as the infection does not migrate but will cause thickening of the bronchi due to inflammation
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13
Q

What is the treatment on acute bronchitis?

A

Usually self-limiting and antibiotics are NOT indicated in normal people
Paracetamol and fluids

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14
Q

What are the incubation times of common upper respiratory tract infections?

A 
Rhinovirus: 1-5 days 
Group A streptococci: 1-5 days
Influenza and parainfluenza: 1-4 days 
RSV: 7 days
Pertussis: 7-21 days 
Diptheria: 1-10 days 
Epstein-Barr virus: 4-6 week
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15
Q

What are the symptoms of an acute exacerbation of COPD?

A 
Chronic sputum production, bronchoconstriction, inflammation of the airways 
Usually preceded by an URTI
Increased sputum production 
Increased sputum purulence 
More wheezy
Breathless
Chest pains
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16
Q

What will be seen on examination of an acute exacerbation of COPD?

A 
Respiratory distress
Wheeze
Coarse crackles 
Cyanosed
In advanced disease- ankle oedema
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17
Q

How is an acute exacerbation of COPD managed in primary care?

A

Antibiotics - doxycyline or amoxicillin
Bronchodilator inhalors
Short course of steroids in some cases

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18
Q

When should you refer to secondary care?

A

If there is respiratory failure

They cannot cope at home with their disease

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19
Q

How is an acute exacerbation of COPD managed in secondary care?

A

Same as primary care with the addition of:
Arterial blood gases - to determine whether in type 2 resp failure
CXR to look for other diseases
Oxygen if in resp failure - but controlled if in type 2

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20
Q

What can the appearance of the lung tissue look like during pneumonia?

A

Can be cosolidated and look more red. This is called red hepatisation due to the resemblance to liver tissue rather than lung tissue

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21
Q

Histologically, what will the lung tissue look like?

A

The alveolar spaces are filled with inflammatory cells

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22
Q

What are the symptoms of pneumonia?

A 
Malaise
Anorexia 
Sweats
Rigors 
Myalgia - muscle pain
Arthralgia - joint pain 
Headache
Confusion
Cough
Pleurisy
Haemoptysis
Dyspnoea
Preceding URTI
Abdo pain- this is due to the pneumonia sitting on top of the diaphragm irritating it 
Diarrhoea
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23
Q

What are the signs of pneumonia?

A 
Fever
Rigors
Herpes labilais - cold sores 
Tachypnoea - high resp rate 
Crackles 
Rub
Cyanosis 
Hypotension
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24
Q

How can penumonia be investiaged/diagnosed?

A 
Blood culture 
Serology
Arterial gases 
Full blood count 
Urea
Liver function 
CXR
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25
Q

What is the CURB 65 severity score for community acquired pneumonia

A 
C = new onset of confusion 
U = Urea >7
R = Respiratory rate >30/min
B = Blood pressure systolic <90 or diastolic <61
65 = Aged 65 years or older
Score 1 point for each above
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26
Q

What are other severity markers for pneumonia?

A

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

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27
Q

What is the management of community acquired penumonia?

A 
Antibiotics - amoxicillin or doxycycline 
Oxygen - maintain SaO2 94-98% or 88-92% 
Fluids 
Bed rest 
No smoking
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28
Q

What are special cases of pneumonia?

A

Hospital acquired - need extended gram negative cover
Aspiration pneumomnia - anaerboic cover
Legionella - chest symptoms minimal, GI disturbance common, confusion common

29
Q

Why should you be cautious with the young?

A

They can compensate well for being unwell - the CURB can be fine but they are septic
C: Good cerebral vasculature - all the brain works
U: Good kidneys
R: Can increase Vt - increase tidal volume rather than resp rate
B: Inotropic, chronotropic, vascular responses - BP won’t fall
They will decompansate VERY quickly

30
Q

How could you overtreat the old?

A

They could be at a CURB1 before they start:
C: Poor cerebral perfusion
U: Poor renal pefusion
R: Rely on resp rate rather than increasing tidal volume
B: Poor inotropic, chronotropic and vascular responses

31
Q

When should you give IV a/b?

A

When the oral route is not available - NPO
Sensitivities - drug resistant organisms
Deep seated infections - abscesses, bone, endocarditis, meningitis
First dose - rapid increase in plasma conc

32
Q

How can lifestyle affect the chance of contracting an URTI?

A 
HIV
PWID (people who inject drugs) - staph aureus 
Alcohol/homelessness - TB, klebsiella 
Frequently hospitalised - pseudomonas 
Returning traveller - leginoells, TB
Indian sub-continent - TB
Easten europre- MDR TB, XDRTB
33
Q

What are complications of pneumonia?

A

Respiratory failure
Pleural effusion
Empyema
Death

34
Q

How can pneumonia be prevented?

A

Influenza and penumococcal vacines in people:
Over 65, with chronic chest or cardiac disease, diabetes, immunocompromised - splenectomy
Infleunza virus - health care workers

35
Q

What is empyema?

A

The collection of pus in a cavity in the body, especially in the pleural cavity

36
Q

What are the upper respiratratory tract defecnces?

A

Nasopharynx: nasal hairs, ciliated epithelia, IgA
Oropharynx: Saliva, Sloughing, Cough

37
Q

What are some common URT colonisers that are gram positive?

A

Alpha-haemolytic streptococci - strep pneumoniae
Beta-haemolytic streptococci - strep pyogenes
Staphylococcus aureus

38
Q

What are some common URT colonisers that are gram negative?

A

Haemophilus influenzae

Moraxela cararrhalis

39
Q

What are some conducting airway defences?

A 
Mucociliary escalator 
Cough 
AMP's 
Cellular and humoral immunity 
Infections occur when there are changes:
Trauma/intubation of airway
Abnormalities of defence - ciliary escalator and others as occurs in CPD and CF
Virulent pathogen/large inocolum
40
Q

What are the clinical signs of acute bronchitis?

A 
Infection and inflammation of the bronchi
Productive cough 
\+/- wheeze 
\+/- fever 
Normal chest examination and CXR
41
Q

What is the microbiology for acute bronchitis?

A

90% viral
Preceded by URT infection
Normal chest examination and CXR
Antibiotics not usually indicated

42
Q

What are the clinical signs of a acute exacerbation of COPD?

A 
Adults 
Productive cough or acute chest illness
Breathlessness 
Wheezing 
Increased sputum purulence 
Often follow viral infection or fall in temp and increase in humidity
43
Q

What is the microbiology of an acute exacerbation of COPD?

A 
30% viral alone 
50% bacterial 
Haemophilus influenzae 
Moraxella catarrhalis 
Streptococcus pneumoniae 
Gram-negative
44
Q

What are the symptoms of whooping cough?

A

Acute trachea bronchitis
Cold like symptoms for 2 weeks
Repeated violent exhalations with severe inspiratory whoop, vomiting common
Residual cough for a month or more

45
Q

What is the microbiology of petussis?

A

Bordetella pertussis
Gram negative coccobacillus
Exculsively human pathogen
Vaccine preventable

46
Q

How is bordetella pertussis diagnosed?

A

Bacterial culture
Pernasal swab (<21 days)
Serology
Clinical signs and symptoms (low numbers of organisms by onset of paroxysmal cough)
Treatment with antibiotics <21 days cough

47
Q

What are the 3 main routes of transmission?

A

Contact (touch)
Airbourne
Droplet

48
Q

What are the characteristics of airbourne particles?

A

Small particles that are less than 5 microns in size
Airbourne
Limited indications - multi-drug resistant TB, some viruses, TRI undergoing aeresol
Require standard infection control precautions and a filtering face piece 3 (FFP3)

49
Q

What are the characteristics of a droplet?

A

Larger particles, more than 5 microns in size and fall to the floor within 2m
Spread via direct contact of droplets with the mucous membranes
Droplet, then surface, then contact spread
Ideally in a single room, not in a ward

50
Q

How is CF contracted?

A

It is an inherited disease that leads to abdonrmally viscous mucus, blocking many tubular structures including conducting airways and lungs

51
Q

What are the clinical signs of CF?

A

Repeated chest infections and chronic colonisation

52
Q

What is the microbiology of CF?

A

Inefficient clearance and build-up of mucus

Staph aureus, haemophilus influenzae, strep pneumoniae, pseudomonas aeruginosa, burkholderia cepacia and many others

53
Q

What are the lung defences?

A

Normally sterile
No ciliary escalator, alveolar lining fluid which contains surfactant, Ig, complement, FFA, AMP
Alveolar macrophages and neutrophils
Phagocytosis leads to an inflammatory response

54
Q

What are the signs of community acquired pneumonia?

A 
Cough 
Increased sputum 
Chest pain 
Dyspnoea 
Fever 
CXR with infiltrates 
Acquired in the community
55
Q

What is the pathology of community acquired pneumonia?

A

Organism reaches the lungs leads to immune activation and infiltration (systemic response) leads to fluid and cellular build up in alveoli which leads to impaired gas exchange

56
Q

What is the microbiology of community acquired pneumonia?

A 
Causative organisms:
Streptococcus penumoniae 70% 
Atypicals/viruses 20% 
Hemophilus influenzae 5% 
Staphylococcus aureus 4% 
Other bacteria 1%
57
Q

What are the risk factors to getting community acquired penumonia?

A

Increasing age
Immunocompromised
Smoking

58
Q

How is community acquired pneumonia diagnosed?

A

Sputum culture - purulence

Viral PCR

59
Q

What antibiotics is streptocococcus pneumoniae?

A

Amoxicillin, doxycycline and co-trimoxazole

60
Q

What is a typical type of community acquired pneumonia?

A

Streptocococcus pneumoniae

61
Q

What is a atypical type of community acquired pneumonia?

A

Mycoplasm pneumoniae, legionella pneumonia, chlamydophila pneumonia

62
Q

What are the 4 types of pneumonia?

A

Typical vs atypical (community acquired)
Hospital associated pneumonia
Aspiration pneumonia
Pneumonia in the immunosupressed (Pneumocystis, TB)

63
Q

What can be seen in the microbiology for legionella pneumonia?

A 
Urinary antigen - pos
Legioniella PCR - pos
Culture - pos 
Routine culture - neg
Viral PCR - neg
64
Q

How is legionella pneumonia diagnosed?

A

Legionalle urinary antigen
Detects serogroup 1 only
Culture is slow on selective media
Paired serology rises in titres

65
Q

What antibiotics are given to treat legionella pneumonia?

A

Clarythromycin, erythromycin, quinolones (levofloxacin)

66
Q

What are the clinical signs on leginoella pneumonia?

A

Flu like illness which may progress to a severe pneumonia, with mental confusion, acute renal failure and GI symptoms

67
Q

What is the epidemiology of legionella pneumonia?

A

No person-to -person spread
Transmitted by inhalation of contaminated water droplets
Exposure to contaminated aerosolised water and impaired immunity put you at risk for catching legionela pneumonia

68
Q

What is staphylococcus pneumonia?

A 
Post infleunza (strep pneumo still more common that staph post influenza 
Haematogenous spread of staphylococcus aureus (CV infections)

Respiratory (24 decks)

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