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Y4 - Resp > Resp Infections > Flashcards

Resp Infections Flashcards

1
Q

CURB65 and criteria for each?

What scores mean?

A 
Confusion (<=8/10 on MSQ)
Urea (>7)
Resp rate (>=30)
BP (<=90/60)
65 (age >=)
0-2 = mild-mod
3-5 = severe
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2
Q

Treatment of mild/mod CAP?

A

Amoxicillin 5 days
(Doxycycline or Clarithromycin if allergic)

Usually treat at home

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3
Q

Treatment of severe CAP?

A

Co-amoxiclav + doxycycline
(Levofloxacin monotherapy if pen allergic)

Usually transfer to hospital

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4
Q

Treatment of severe CAP requiring ICU admittance?

A

Co-amoxiclav + clarithromycin

Levofloxacin monotherapy if pen allergic

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5
Q

Step down for all patients with severe CAP?

A

Doxycycline IV/PO 5 days

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6
Q

Treatment of non-severe HAP?

A

Amoxicillin 5 days

Doxy if pen allergic

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7
Q

Treatment of severe HAP?

Step down?

A

Amoxicillin + gentamicin
(Co-trimoxazole + gentamicin if pen allergic)

Step down: Co-trimoxazole IV/PO 7 days

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8
Q

Treatment of severe HAP with previous ICU admission or Hx of MRSA?

A

Contact microbiology

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9
Q

Treatment of non-severe aspiration pneumonia?

A

Amoxicillin + metronidazole 5 days

Doxy + metronidazole if pen allergic

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10
Q

Treatment of severe aspiration pneumonia?

Step down?

A

Amoxicillin + metronidazole + gentamicin
(replace amoxicillin with doxy or clarithromycin if pen allergic)

Step down: amoxicillin + metronidazole 7 days

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11
Q

Antibiotic treatment of acute exacerbation of COPD?

A

No antibiotics unless purulent sputum, consolidation on CXR or other signs of pneumonia

1st line - amoxicillin
2nd line - doxycycline
(5 days)

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12
Q

Antibiotic treatment of acute bronchitis?

A

Antibiotics give no significant clinical benefit - only consider in frail or elderly

1st line - amoxicillin
2nd line - doxycycline
(5 days)

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13
Q

What must you consider when prescribing clarithromycin?

A

QTc prolongation

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14
Q

Name 5 atypical pneumonias?

A 
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Legionella pneumophila
Coxiella burnetti
Viral pneumonia
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15
Q

Most common cause of pneumonia?
Specific signs/associations? (4)
CXR?

A

Strep pneumoniae (pneumococcus)
High fever, rapid onset, herpes labialis precedes, rusty sputum
Lobar consolidation

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16
Q

Who is staph aureus pneumonia common in? (2)
CXR?
Rx for MRSA?
MRSA toxin?

A

IVDU, recent influenza infection
Bilateral cavitating bronchopneumonia
Vancomycin
PVL - panton valentine leukocidin

17
Q

Who does Klebsiella pneumonia typically affect? (3)

CXR?

A

Alcoholics, diabetics, elderly

Cavitating pneumonia - often R upper lobe (most common for aspiration when recumbent)

18
Q

Who does pseudomonas pneumonia typically affect?

A

Bronchiectasis and CF patients

19
Q 
Pattern of Mycoplasma Pneumoniae infection?
Symptoms?
CXR?
Diagnosis?
Complications?
A

Occurs in epidemics (roughly every 4 years)
Flu-like Sx with dry cough, headache, myalgia
No typical CXR pattern, may show reticulo-nodular shadowing
Diagnosis by serology
Complications: haemolytic anaemia, erythema multiforme, guillain-barre syndrome, myelitis

20
Q 
Who does legionella pneumonia typically affect?
Symptoms?
CXR?
What may be seen on blood tests?
Diagnosis?
A

Recently been abroad to warm location, it typically colonises water tanks and air conditioning units

Non-specific symptoms sometimes, with cough, D&V, hepatitis, AKI, haematuria
CXR = bi-basal consolidation
Bloods = lymphopaenia, hyponatraemia, deranged LFT

Diagnosis = urine antigen, blood serology, or PCR from BAL

21
Q

What is the commonest chlamydia infection?
How does it spread?
Illness pattern?
Diagnosis?

A 
Chlamydophila pneumonia (tends to cause mild pneumonia in younger patients, similar to mycoplasma)
Person-to-person

Biphasic illness:
1 - pharyngitis, hoarseness, otitis
2 - pneumonia

Diagnosis = complement fixation test, or IgM serology

22
Q 
Who does chlamydia psitacci typically affect?
Symptoms?
Extra-pulmonary features?
CXR?
Diagnosis?
A

Those with birds (parrots, pigeons, cockatiels etc)

Symptoms = headache, fever, dry cough, lethargy, anorexia

Extra-pul = D&V, meningo-encephalitis, hepatitis, endocarditis, nephritis etc

CXR = patchy consolidation

Diagnosis = chlamydia serology

23
Q 
Who does pneumocystis pneumonia typically affect?
Symptoms/signs?
CXR?
Diagnosis?
Treatment?
A

Immunocompromised - part of normal lung flora (e.g. HIV)
Dry cough, SOB, typically absence of chest signs - exercise-induced desaturations
CXR may be normal or show bilateral hilar shadowing

Diagnosis = can be from sputum induction and expectoration (induce by nebulising hypertonic saline)
OR PCR from BAL

Rx: Co-trimoxazole and Pentamidine

24
Q

Who does coxiella brunetti (Q Fever) usually affect?
Symptom onset?
Diagnosis?

A

Sheep farmers

2-4 weeks after infection, insidious flu-like symptoms like fever, headache and myalgia
Pneumonia and hepatitis can then develop

Diagnosis by serology

25
Q

2 commonest causes of acute exacerbation of COPD?

A

Pneumococcus

H Influenzae

26
Q

3 commonest causes of HAP?

A

Pneumococcus
H Influenzae
Coliforms

Legionella can also cause HAP

27
Q

Name 4 coliforms?
What covers them?
What else does this drug give good coverage of?

A

(Gram negative)

E coli
Klebsiella
Enterobacter
Proteus

Gentamicin

Pseudomonas (also gram neg)

28
Q

What drugs have anaerobic cover?

A 
Metronidazole
Co-amoxiclav
Clindamycin
Pipperacillin-Tazobactam
Meropenem
29
Q

What are EBSL’s?
What are they resistant to?
What should be used for them?

A

Extended spectrum beta-lactamases
Resistant to all penicillins, including co-amox, pipperacillin-tazobactam and aztreonam

Rx: Temocillin, Pivmecillonam or Meropenem

30
Q

Do temocillin and aztreonam have anaerobic cover?

A

No

31
Q

When is staph aureus pneumonia particularly bad?

A

Following influenza infection

If PVL-producing staph

32
Q

What are CRE’s?

What are they resistant to?

A

Carbapenem- resistant enterobacterales

Virtually everything - pretty much untreatable

33
Q

What is VRE?

What are they resistant to?

A

Vancomycin-resistant enterococcus

Vancomycin and meropenem

34
Q

What is MRSA?
What is it resistant to?
How should it be treated?

A

Meticillin-resistant Staph Aureus

All beta-lactams (penicillins, fluclox, cephalosporins, tazocin & meropenem)

Vancomycin

35
Q

What is invasive aspergillosis?
3 types of aspergillus?
CXR?
How can it be diagnosed?

A

When aspergillus which normally colonises the lung as flora invades throughout the lung in immunocompromised patients - this can spread to disseminated infection and is a leading cause of death in the immunocompromised

A. flavus, A. fumigatus, A. terreus

CXR may show widespread infection

Diagosis by bronchoscopy and BAL

36
Q 
What is allergic bronchopulmonary aspergillosis?
Symptoms?
CXR?
Other Ix?
Rx?
A

Allergy to aspergillus spores in the lung

Symptoms similar to asthma - productive cough, wheeze, dyspnoea for months, but not very responsive to treatment

Proximal bronchiectasis

Raised eosinophils, raised IgE, positive RAST for aspergillus, raised aspergillus IgM, positive skin prick test for aspergillus

Rx: mainstay = oral prednisolone
Oral itraconazole sometimes used as 2nd line or steroid sparing agent

Y4 - Resp (6 decks)

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