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Y1Systems > Resp Week 3 > Flashcards

Resp Week 3 Flashcards

1
Q

What are the 3 types of lung infections?

A

they can be primary, faculitative or oppertunistic

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2
Q

Define bronchitis

A

Large airway inflammation

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3
Q

Define bronchiolitis

A

Small airway inflammation

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4
Q

Define pneumonia

A

Establishment of infection in the soft lung tissue

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5
Q

What are the 4 different pneumonia patterns?

A
  • Bronchopneumonia
  • Segmental
  • Lobar
  • Hypostatic
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6
Q

Describe bronchopneumonia

A

Infection of the lungs which is multifocal

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7
Q

Describe segmental pneumonia

A

One or more part of the lung involved

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8
Q

Describe lobar pneumonia

A

Same process as segmental but to different extent

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9
Q

Describe hypostatic pnuemonia

A

Localisation of the infectious process in the lower zones of both lungs and relates to other diseases such as COPD and Cardiac failure, where excess secretions accumulate in the lungs (lower zones) which increases chances of infection

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10
Q

Describe the consequences of pneumonia

A

Pleurisy, pleural effusion and empyema
Organisation (mass leison)
Lung abscess
Bronchiectasis

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11
Q

Describe the respiratory tracts defence mechanisms

A
  • General immune system (hummoral and cellular immunity)
  • Respiratory tract secretions
  • Upper resp tract can act as a ‘filter’ to stop larger microorganisms
  • Macrophage mucocillary escalator system
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12
Q

What is bronchiectasis

A

Patholigical dilatation of bronchi due to:

  • Severe infective episode
  • Reccurent infections
  • Proximal bronchial obstruction
  • Lung parenchymal destruction
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13
Q

What are some common viral agents?

A
  • Adenovirus
  • Influenza A,B
  • RSV
  • Rhinovirus
  • Paraflu I, III
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14
Q

Describe croup

A

The inflammation of the larynx and trachea in children, associated with infection and causing breathing difficulties

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15
Q

What are the most common URTI’s

A
  • Croup
  • Acute tonsilitis
  • Otitis media
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16
Q

What can rhinitis prodrome to?

A

Pneumonia
Bronchiolitis
Meningitis
Septicaemia

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17
Q

What is otis media?

A

An infection of the middle eat that causes inflammation and a build up of fluid behind the eardrum

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18
Q

Describe the clinical relevance of Otis media

A
  • Common, self limiting primary viral infection
  • Secondary infection with Pneumococcus / Haemophilous influenzae
  • Causes spontaneous rupture of ear drum
  • Antibiotic treatment doesn’t usually help
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19
Q

What are the side effects of Augmentin?

A
  • high rates of diarrhoea

- Nappy Rash

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20
Q

Why must you be hesistant in the prescription antibiotics for URTIs

A
  • Abx may take 2-3 days to work
  • Side effects are bad
  • End point is the same as for treatment compared no treatment
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21
Q

What is the dilemma posed by treating tonsillitis and pharyngitis

A
  • Need to determine if infection is viral or bacterial
  • Either do nothing or prescribe 10 days of penicillin
    DO NOT PRESCRIBE AMOXICILLIN
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22
Q

How do you treat croup?

A

Oral dexamethasone

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23
Q

What causes croup?

A

Para’flu 1

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24
Q

What is epiglottitis

A

Inflammation of the epiglottis - uncommon but can be fatal, needs to be treated fast

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25
Q

What is the treatment for epiglottitis

A

Intubation and broad spectrum abx

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26
Q

What are the symptoms for croup?

A

Coryza
Stridor
Hoarse voice
barking cough

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27
Q

What are the symptoms for epiglottitis

A

Stridor

Drooling

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28
Q

Describe tracheitis

A

= Infection of the trachea

  • Uncommon
  • Described as ‘croup which does not get better’
  • Fever
  • ‘Barking cough’
  • Treat with Augmentin
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29
Q

Describe Bronchitis

A
  • Common
  • Endobronchial infection
  • Loose rattly cough started with URTI
  • Post-tussive vomit
  • Chest free of wheeze/Crepitations
  • Mostly self limiting conditioning
  • May damage cilia, causing substances to pool, which may lead to further infection
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30
Q

Describe bronchiolitis

A

=Infection for small airways, not large

  • Affects 30-40% of infants
  • Usually RSC, others include paraflu III, HMPV
  • Nasal stiffness, tachypnoea, poor feeding
  • Crackles and or wheeze
  • <12 months old, one off infection
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31
Q

Describe the treatment of pneumonia in children

A

Oral amoxycillin is first line
Oral macrolide second choice
Only IV if vomiting

32
Q

Compare LRTIs and Bronchiolitis

A 
LRTI
- In all ages
- More rapid onset of symptoms 
- Fever
Bronchiolitis
- Aged <12 months
- 3 days before reached peak
- Fever Rarely >38 degrees
33
Q

Would you prescribe abx for tracheitis, if so which one?

A

Yes, augmentin

34
Q

Would you prescribe abx for bronchitis, if so which one?

A

No

35
Q

Would you prescribe abx for pneumonia, if so which one?

A

Yes, if symptoms are moderate, Oral amoxicillin, then oral macrolide, only Iv if vomiting

36
Q

Would you prescribe abx for bronchiolitis, if so which one?

A

No

37
Q

Would you prescribe abx for empyema, if so which one?

A

Yes, IV abx (and perhaps chest drainage)

38
Q

What are common lower respiratory tract issues?

A
  • Acute bronchitis
  • Exacerbation of COPD
  • Pneumonia
  • Empyema
  • Lung abscess
  • Bronchiectasis
39
Q

Describe acute bronchitis

A

=Inflammation of the bronchi

  • Temporary <3 weeks
  • Cough and sputum
  • Usually viral
  • Supportive management
40
Q

What are the symptoms of a COPD exacerbation?

A
  • Changes in colour of sputum
  • Fevers
  • Increased breathlessness
  • Wheeze
  • cough
41
Q

What are some of the causes of

COPD exacerbation?

A

Stretococcus pneumoniae
Haemophilus influenzae
Moraxella cararrhalis
Viral

42
Q

What is the treatment for an exacerbation of COPD

A 
Steroids
Abx:
- Amoxicillin
- Doxycycline
- Co-trimoazole
- Clarithromycin
Nebulisers if severe
43
Q

What are the 3 different forms of pneumonia (anatomically classed)

A

Bronchopnueomia
Lobar pneumonia
Interstitial pneumonia

44
Q

What are the symptoms of pneumonia

A
  • Fever, rigors, myalgia
  • Cough and sputum
  • Chest pain (pleuritic)
  • Haemoptysis
    (rusty brown sputum = streptococcus pneumoniae)
45
Q

What are the signs of pneumonia

A
  • Tachypnoea
  • Tachycardia
  • Reduced expansion
  • dull percussion
  • Bronchial breathing
  • Crepitations
  • Vocal resonance
46
Q

What investigations are used in pneumonia?

A

Bloods
CXR
Sputum culture
Legionella urinary antigen

47
Q

What are the typical community acquired bacteria which cause pneumonia?

A

Strep-pneuoniae
Haemophilus influenza
Myocplasma pneumoniea (tends to come round every 4-5 years with extra pulmonary complications)

48
Q

What is legionella pneuophilla associated with?

A

Fresh water and air conditioning

49
Q

What is chlamydia pneumonia associated with?

A

Coronary heart disease

50
Q

What is chlamydia psittaci associated with?

A

BIRDS BRO. #pigeonsarenotreal

51
Q

What is moraxella catarrhalis associated with?

A

COPD

52
Q

What is staphlococcal aureus associated with?

A

typically comes after flu infection

53
Q

What are the typical nosocomial infections that cause pneumonia?

A

Enterobacteria
Staph aureus
Pseudomonas aerigunosa
Klebsiella pneuomia

54
Q

What is Pseudomonas aerigunosa associated with?

A

Green foul smelling sputum

55
Q

What is Klebsiella pneumonia associated with?

A

Aspiration events, more common in alcoholics

56
Q

What is used to score severity in pneumonia?

A

CURB 65

57
Q

Describe the parameters of CURB 65

A 
One point for every worrying factor
C=confusion
U=Blood urea>7mmol/L
R=Resp rate >30
B=Systolic BP <90, Diastolic BP <60
65 = if aged 65 or over
58
Q

What is the procedure for hospital admission from the CURB 65 Score?

A 
0-1 = low risk, can be treated in community
2 = moderate risk, hospital treatment required
3-5 = high risk and need for ITU
59
Q

What is the treatment of a patient presenting with pneumonia, with a CURB score of 0-1 (include an alternative for a penicillin allergy and a duration of administration)

A

Abx - amoxicillin
abx if penicillin allergic - clarithromycin or doxycycline
Duration - five days

60
Q

What is the treatment of a patient presenting with pneumonia, with a CURB score of 2 (include an alternative for a penicillin allergy and a duration of administration)

A

Abx - Amoxicillin + Clarithromycin
Abx if penicillin allergic - Levofloxacin
Duration - 5-7 days

61
Q

What is the treatment of a patient presenting with pneumonia, with a CURB score of 3-5 (include an alternative for a penicillin allergy and a duration of administration)

A

abx = Co-amoxiclav + clarithromycin
abx ic penicillin allergic = levofloxacin + co-trimoxazole
duration = 7-10 days

62
Q

What are the causes of bronchiectasis?

A
  • Idiopathic
  • Childhood infection
  • CF
  • Cilliary dyskinesia
  • Hypogammaglobulinaemia
  • Allergic broncho-pulmonary aspergillosis (ABPA)
63
Q

What are the symptoms of bronchiectasis?

A 
Chronic productive cough
SOB
Reccurent LRTI
Haemoptysis
Finger clubbing
Crepitations
Wheeze
Obstructive spirometry
64
Q

Define an endemic

A

The constant presence and or usual prevalence of a disease or infectious agent in a population within a geographic area

65
Q

Define Epidemic

A

An increase, often sudden , in the number of cases of a disease above what is normally expected in that population in that area

66
Q

Define outbreak

A

Carries the same definition of epidemic, but is often used for a more limited geographical area

67
Q

Define Pandemic

A

An epidemic that has spread over several countries or continents usually affecting a large number of people

68
Q

Describe the mycobacteria that causes TB

A
  • Ubiquitous in the soil and water
  • Non motile
  • Very slow growing
  • Aerobic (predilection for apices of lungs)
69
Q

What is unique about the mycobacterium that causes TB

A

Has a very thick fatty cell wall

- Resistant to acids, alkali and detergents

70
Q

Describe the transmission of TB

A

Airborne (pulmonary and laryngeal TB spreads, others not so much)

  • Someone with TB in their lungs coughs/sneezes/yells.sings
  • Someone else breaths that bacteria in
  • Usually requires prolonged close contact
71
Q

Why is outdoor TB eliminated

A

Due to the UV radation and dilation in open air

72
Q

What is the exception of how TB can spread?

A

Mycobacterium bovis, which can be spread by consumption of unpasteurised infected cows milk

73
Q

Describe the primary infection of TB

A
  • No preceding exposure or immunity
  • Mycobacteria spread via lymphatics to draining hilar lymphnodes
  • Usually no symptoms, can be fever, malaise, erthema nodsum, rarely chest signs
    IN THE MAJORITY (85%)
  • initial lesion + local lymph nodes
  • Heals with or without scar, may calcify
  • Associated with development of immunity to tuberculoprotien
74
Q

What are the 3 outcomes after a TB infection?

A

Cleared -> cured
Contained -> Latent
Progressive disease

75
Q

Describe what happens if TB progresses

A
  • Primary infection progresses to TB bronchopneumonia
  • Primary focus continues to enlarge (cavitation)
  • Enlarged hilar lymph nodes compress bronchi, lobar collapse
  • Enlarged lymph node discharges into bronchus
    Poor prognosis
76
Q

Describe the pharmacological management of TB

A
  • Multiple Drug therapy is essential
  • Single agent treatment leads to drug resistant organisms in 14 days
  • Therapy musct continue for at least 6 months
  • Legal requirement to notify all cases
  • Tests for HIV, HEP B and C
    4: 2/2:4, 1st number = number of drugs, 2nd = duration in months

Y1Systems (24 decks)

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