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Year 3 Medicine Block > RESP: Infections > Flashcards

RESP: Infections Flashcards

1
Q
A
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2
Q

Pneumonia on a chest xray?

A

Consolidation and air bronchogram

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3
Q

Signs of pneumonia

A 
Usually signs of sepsis:
Tachycardia
Tachypnoea
Hypoxia
Hypotension
Fever
Confusion
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4
Q

Chest signs of pneumonia

A

Bronchial breath sounds-
Focal coarse crackles
Dullness to percussion

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5
Q

Severity assessment for pneumonia

A 
CURB-65 (CRB-65 in community)
C- Confusion
U- Urea> 7
R- RR> 30
B- BP < 90 systolic or < or equal to 60 diastolic
65- age greater than or equal to 65
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6
Q

What is atypical pneumonia?

A

Pneumonia caused by organisms that cannot be cultured by gram staining

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7
Q

What are bronchial breath sounds?

A

In pneumonia- harsh breath sounds equally loud on inspiration and expiration

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8
Q

What are focal coarse crackles?

A

Air passing through sputum in airways similar to using a straw blow air through a drink

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9
Q

What is CURB-65 for?

A

Predicts mortality: (1= 5% 3= 15%, score 4/5= 25%) and whether pt should be treated at hospital
0/1- consider treatment at home
greater than/equal to 2- consider treatment at hospital
greater than/equal to 3- consider intensive care assessment

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10
Q

How do you get Legionnaires’ disease?

A

Infected water supply or air condition units

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11
Q

What complication can Legionnaires’ disease cause?

i.e. note on bloods as a clue

A

Hyponatraemia–> SIADH

Lymphopenia

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12
Q

Typical Legionnaires’ exam patient?

A

Cheap hotel holiday and presents with hyponatraemia and lymphopenia

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13
Q

What are some investigations you might do for lung abscess?

A

CXR :

  • Fluid-filled space within an area of consolidation
  • air-fluid level is typically seen

sputum and blood cultures

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14
Q

Complications of mycoplasma pneumoniae?

A 
haemolytic anaemia 
Erythema multiforme 
meningioenchepalitis 
Guillan barre syndrome 
bullous myringitis: painful vesicles on the tympanic membrane
pericarditis/myocarditis
gastrointestinal: hepatitis, pancreatitis
renal: acute glomerulonephritis
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15
Q

Causative organism for fungal pneumonia?

A

Pneumocystis jiroveci

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16
Q

Who is at risk of fungal pneumonia?

A

Immunocompromised- esp HIV patients with low CD4 count

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17
Q

How does fungal pneumonia present?

A

Dry cough with sputum production
SOB on exertion
Night sweats

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18
Q

Complications of pneumonia?

A 
Sepsis
Pleural effusion
Empyema
Lung abscess
Death
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19
Q

Causes of pneumonia?

A

Streptococcus pneumoniae (accounts for around 80% of cases)
Haemophilus influenzae
Staphylococcus aureus: commonly after influenza infection
atypical pneumonias (e.g. Due to Mycoplasma pneumoniae)

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20
Q

What is a lung abscess?

A

well-circumscribed infection within the lung parenchyma

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21
Q

What are the causes / RF for a lung abscess?

A

Secondary to aspiration pneumonia e.g.
Poor dental hygiene
stroke (reduced consciousness)

infective endocarditis - haematogenous spread

direct extension - empyema

Bronchial osbtruction (secondary to lung tumour)

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22
Q

What are some of the microbial causes of lung abscess?

A

often polymicrobial

Monomicrobial causes:
Staphylococcus aureus
Klebsiella pneumonia
Pseudomonas aeruginosa

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23
Q

What are some of the symptoms of lung abscess?

A

Develop over weeks (like subacute pneumonia)

Systemic: night sweats / weight loss
Fever
productive cough (foul sputum, rarely haemoptysis)
chest pain 
SOB
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24
Q

What are some of the signs you would see on examination of a lung abscess?

A

dull percussion

bronchial breathing

clubbing may be seen

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25
What are some investigatioins you might do for lung abscess?
CXR : - Fluid-filled space within an area of consolidation - air-fluid level is typically seen sputum and blood cultures
26
How would you manage a lung abscess?
IV antibiotics Percutaneous drainage may be required Rare: surgical resection
27
What is a Parapneumonic effusion?
Parapneumonic effusions are effusions caused by an underlying pneumonia. Simple - not infected Complicated- effusion develops once infection has spread to the pleural space.
28
How is empyema, a simple parapneumonic effusion and complicated parapneumonic effusion related?
Three conditions = a spectrum of pleural inflammation in response to infection. From a simple parapneumonic effusion to empyema.
29
What are RF for empyema ?
``` recent pneumonia iatrogenic intervention in the pleural space thorax trauma Immunocompromised e.g. diabetes co-morbidities make pneumonia more likely lung disease male sex young or old age alcohol abuse ```
30
If empyema or a complicated parapneumonic effusion is diagnosed what must be done urgently?
Insert a chest drain + long course of AB if no improvement with AB and drainage - surgery or fibrinolytics
31
How do causative pathogens differ from comminity acquired and hospital acquired empyema?
Community: Streptococcus pneumoniae, and staphylococci Hospital: staphylococci (particularly MRSA)
32
What is type 1 respiratory failure?
Pa02<8kPa; PaC02 Normal
33
Causes of type 1 respiratory failure?
``` Asthma Congestive HF Pulmonary Embolism Pneumonia Pneumothorax ```
34
What is type 2 respiratory failure?
Pa02<8kPa; PaC02 > 6kPa
35
Causes of type 2 respiratory failure?
Obstructive lung disease e.g. COPD Restrictive lung disease e.g. IDL Depression of respiratory centre e.g. opiates NMJ disease e.g. Guillan barre syndrome, MND Thoracic wall disease- rib fracture
36
What is ARDS?
Increased permeability of alveolar capillaries--> fluid accumulation in alveoli- non-cardiogenic pulmonary oedema
37
Causes of ARDS?
Pulmonary: chest sepsis, aspiration, pneumonia, trauma, smoke inhalation Non-pulmonary: DIC, acute pancreatitis, drug OD
38
Presentation of ARDS?
Acute onset respiratory failure which fails to improve with supplemental O2. Symptoms of severe dyspnoea, tachypnoea, confusion and presyncope
39
Examination findings in ARDS?
fine bibasal crackles but no other signs of HF
40
Investigations for ARDS?
Cxr with bilateral alveolar infiltrates w/o any other features of HF
41
Management of ARDS
``` V serious ICU Ventilatory support Haemodynamic support DVT prophylaxis Abx only if infectious cause for ARDS ```
42
(SARS-CoV-2) can cause viral pneumonia. What is the triad of symptoms hospitalised patients get?
Hypoxia Lymphopenia Bilateral, lower zone changes on CXR
43
What is hospital management for SARS-CoV-2?
1. O2 supplementation some may need CPAP / invasive ventilation 2. Dexamethasone ( consider Tocilizumab +/- Remdesivir) 3. AB may be needed if superadded bacterial infection
44
What is Influenza?
Flu Single stranded RNA virus. most common cuaes of viral pneumonia in immunocompromised adults
45
What serotypes of inluenza are there?
Three serotypes of influenza - A, B and C Serotype- determined by surface antigens haemagglutinin and neuraminidase. These are rearranged in host organisms e.g. birds /animals = different strains e.g. Influenza A H5N1 (avian influenza)
46
How is influenza transmitted?
via respiratory secretions VVV contagious
47
How long is incubation period for influenza?
typically 1-4 days
48
How long is a pt infectious for with influenza after incubation period ?
patients can remain infectious for 7-21 days
49
What are the symptoms of influenza?
Fever ≥ 37.8°C Non-productive cough Myalgia Headache Malaise Sore throat Rhinitis
50
What are some pulmonary complications of Influenza?
Viral pneumonia, secondary bacterial pneumonia, worsening of chronic conditions e.g. COPD and asthma
51
What are some Cardiovascular complications of Influenza?
Myocarditis Heart failure
52
What are some neurological complications of Influenza?
Encephalopathy
53
What are some GI complications of Influenza?
Anorexia and vomiting are common
54
How do you diagnose Influenza?
Routine viral culture Rapid reverse transcriptase PCR tests are now available.
55
What is the management of Influenza?
1. Supportive (analgesia, antipyretic, fluids, oxygen) 2. Antiviral treatment with neuraminidase inhibitors e.g. Oseltamivir ('Tamiflu') 3. Infection control and respiratory isolation to prevent onward transmission
56
What are the vaccine options for Influenza? Who is it recommended for?
1. Inactivated vaccine tailored each year according to recent outbreaks. It provides partial protection against influenza 2. those over 65, with chronic conditions. Healthcare workers and nursing home residents.
57
What are some general clinical features of TB?
1. Fever 2. Night sweats drenching) 3. Weight loss (weeks – months) 4. Malaise
58
What are some clinical features of Respiratory TB?
cough ± purulent sputum/haemoptysis pleural effusion
59
What are some clinical features of NON- Respiratory TB?
Skin (erythema nodosum) Lymphadenopathy; Bone/joint; (stiffness, abscess, swelling) Abdominal; (pain/diarrhoea/distention) CNS (meningitis); Genitourinary; (flank pain, dysuria, polyuria) Miliary (disseminated); Cardiac (pericardial effusion)
60
What are you differentials for Haemoptysis : infection related?
Pneumonia Tuberculosis Bronchiectasis / CF Cavitating lung lesion (often fungal
61
What are you differentials for Haemoptysis : Malignancy related?
Lung cancer metastases
62
What are you differentials for Haemoptysis : Haemorrhage related?
Bronchial artery erosion Vasculitis Coagulopathy
63
What are some differentials for Haemoptysis? Other (resp = clue)
PE!
64
List some RISK FACTORS for TB ?
Past history of TB TB contact Born in a country with high TB incidence Travel to country with high incidence of TB Immunosuppression–e.g. IVDU, HIV, organ transplant, renal failure/ dialysis, malnutrition/ low BMI, DM, alcoholism
65
What are the immediate management principals for a pt with Resp TB (before investigations)
ABCDE approach Admit to side room + start infective control measure (e.g. masks + negative pressure room.)
66
What are the management principals for a pt with Resp TB (lab investigations)
1. Productive cough - 3 x sputum samples (acid-fast Ziehl-Neelsen stain) + TB culture 2. NO productive cough - consider bronchoscopy 3. Routine bloods LFTs + HIV test + vit D levels
67
What are the management principals for a pt with Resp TB (imaging)
- CXR | - Consider CT chest if suspect pulmonary TB (CXR normal / no clinical features)
68
What to do if your diagnosis is split between pneumonia and TB?
Start Antibiotics for pneumonia as per CURB-65
69
What should you do if pt is critically unwell and there is a likelihood of TB?
Start TB treatment AFTER samples sent
70
How long does TB culture take? What does this mean?
Culture takes 6-8 weeks. Means treatment often started before confirmed diagnosis. Novel PCR test (Gene Xpert) available in some centre - gives immediate info on drug sensitivites / resistance.
71
What role do specialist nurses play in TB management?
Notify pt cases to specialist nurses as they: support pt during investigation, treatment, pubic health issues AND initiate contact tracing!
72
What is standard Anti-TB therapy regimen?
FIRST 2 MONTHS: 4: (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol) NEXT 4 MONTHS 2: (Rifampicin, Isoniazid) TOTAL: 6 months minimum (can vary)
73
Why is weight important in Anti-TB therapy?
dose of anti-TB is weight dependant.
74
Which bloods is it essential to check before commencing anti-TB treatment?
LFTS
75
Which anti-TB drug requires eye test?
Ethambutol (E for eyes) need to check visual acuity before giving. Side effect - can cause Retrobullar neuritis
76
What strategies can be used to ensure compliance ?
Directly observed Therapy (DOT)
77
What investigation if suspect CNS TB?
MRI Brain
78
What are major side effects of Rifampicin?
Hepatitis rashes febril reactions orange / red secretions - sweat / urine / contact lenses Drug interactions - warfarin / COCP
79
What are major side effects of Isoniazid?
Hepatitis rashes peripheral neuropathy psychosis
80
What are major side effects of Pyrazinamide?
Hepatitis rashes vomitting arthralgia

Year 3 Medicine Block (56 decks)

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