Resp Week 3 Flashcards
What are the 3 types of lung infections?
they can be primary, faculitative or oppertunistic
Define bronchitis
Large airway inflammation
Define bronchiolitis
Small airway inflammation
Define pneumonia
Establishment of infection in the soft lung tissue
What are the 4 different pneumonia patterns?
- Bronchopneumonia
- Segmental
- Lobar
- Hypostatic
Describe bronchopneumonia
Infection of the lungs which is multifocal
Describe segmental pneumonia
One or more part of the lung involved
Describe lobar pneumonia
Same process as segmental but to different extent
Describe hypostatic pnuemonia
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
Describe the consequences of pneumonia
Pleurisy, pleural effusion and empyema
Organisation (mass leison)
Lung abscess
Bronchiectasis
Describe the respiratory tracts defence mechanisms
- 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
What is bronchiectasis
Patholigical dilatation of bronchi due to:
- Severe infective episode
- Reccurent infections
- Proximal bronchial obstruction
- Lung parenchymal destruction
What are some common viral agents?
- Adenovirus
- Influenza A,B
- RSV
- Rhinovirus
- Paraflu I, III
Describe croup
The inflammation of the larynx and trachea in children, associated with infection and causing breathing difficulties
What are the most common URTI’s
- Croup
- Acute tonsilitis
- Otitis media
What can rhinitis prodrome to?
Pneumonia
Bronchiolitis
Meningitis
Septicaemia
What is otis media?
An infection of the middle eat that causes inflammation and a build up of fluid behind the eardrum
Describe the clinical relevance of Otis media
- Common, self limiting primary viral infection
- Secondary infection with Pneumococcus / Haemophilous influenzae
- Causes spontaneous rupture of ear drum
- Antibiotic treatment doesn’t usually help
What are the side effects of Augmentin?
- high rates of diarrhoea
- Nappy Rash
Why must you be hesistant in the prescription antibiotics for URTIs
- Abx may take 2-3 days to work
- Side effects are bad
- End point is the same as for treatment compared no treatment
What is the dilemma posed by treating tonsillitis and pharyngitis
- Need to determine if infection is viral or bacterial
- Either do nothing or prescribe 10 days of penicillin
DO NOT PRESCRIBE AMOXICILLIN
How do you treat croup?
Oral dexamethasone
What causes croup?
Para’flu 1
What is epiglottitis
Inflammation of the epiglottis - uncommon but can be fatal, needs to be treated fast
What is the treatment for epiglottitis
Intubation and broad spectrum abx
What are the symptoms for croup?
Coryza
Stridor
Hoarse voice
barking cough
What are the symptoms for epiglottitis
Stridor
Drooling
Describe tracheitis
= Infection of the trachea
- Uncommon
- Described as ‘croup which does not get better’
- Fever
- ‘Barking cough’
- Treat with Augmentin
Describe Bronchitis
- 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
Describe bronchiolitis
=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
Describe the treatment of pneumonia in children
Oral amoxycillin is first line
Oral macrolide second choice
Only IV if vomiting
Compare LRTIs and Bronchiolitis
LRTI - In all ages - More rapid onset of symptoms - Fever Bronchiolitis - Aged <12 months - 3 days before reached peak - Fever Rarely >38 degrees
Would you prescribe abx for tracheitis, if so which one?
Yes, augmentin
Would you prescribe abx for bronchitis, if so which one?
No
Would you prescribe abx for pneumonia, if so which one?
Yes, if symptoms are moderate, Oral amoxicillin, then oral macrolide, only Iv if vomiting
Would you prescribe abx for bronchiolitis, if so which one?
No
Would you prescribe abx for empyema, if so which one?
Yes, IV abx (and perhaps chest drainage)
What are common lower respiratory tract issues?
- Acute bronchitis
- Exacerbation of COPD
- Pneumonia
- Empyema
- Lung abscess
- Bronchiectasis
Describe acute bronchitis
=Inflammation of the bronchi
- Temporary <3 weeks
- Cough and sputum
- Usually viral
- Supportive management
What are the symptoms of a COPD exacerbation?
- Changes in colour of sputum
- Fevers
- Increased breathlessness
- Wheeze
- cough
What are some of the causes of
COPD exacerbation?
Stretococcus pneumoniae
Haemophilus influenzae
Moraxella cararrhalis
Viral
What is the treatment for an exacerbation of COPD
Steroids Abx: - Amoxicillin - Doxycycline - Co-trimoazole - Clarithromycin Nebulisers if severe
What are the 3 different forms of pneumonia (anatomically classed)
Bronchopnueomia
Lobar pneumonia
Interstitial pneumonia
What are the symptoms of pneumonia
- Fever, rigors, myalgia
- Cough and sputum
- Chest pain (pleuritic)
- Haemoptysis
(rusty brown sputum = streptococcus pneumoniae)
What are the signs of pneumonia
- Tachypnoea
- Tachycardia
- Reduced expansion
- dull percussion
- Bronchial breathing
- Crepitations
- Vocal resonance
What investigations are used in pneumonia?
Bloods
CXR
Sputum culture
Legionella urinary antigen
What are the typical community acquired bacteria which cause pneumonia?
Strep-pneuoniae
Haemophilus influenza
Myocplasma pneumoniea (tends to come round every 4-5 years with extra pulmonary complications)
What is legionella pneuophilla associated with?
Fresh water and air conditioning
What is chlamydia pneumonia associated with?
Coronary heart disease
What is chlamydia psittaci associated with?
BIRDS BRO. #pigeonsarenotreal
What is moraxella catarrhalis associated with?
COPD
What is staphlococcal aureus associated with?
typically comes after flu infection
What are the typical nosocomial infections that cause pneumonia?
Enterobacteria
Staph aureus
Pseudomonas aerigunosa
Klebsiella pneuomia
What is Pseudomonas aerigunosa associated with?
Green foul smelling sputum
What is Klebsiella pneumonia associated with?
Aspiration events, more common in alcoholics
What is used to score severity in pneumonia?
CURB 65
Describe the parameters of CURB 65
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
What is the procedure for hospital admission from the CURB 65 Score?
0-1 = low risk, can be treated in community 2 = moderate risk, hospital treatment required 3-5 = high risk and need for ITU
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)
Abx - amoxicillin
abx if penicillin allergic - clarithromycin or doxycycline
Duration - five days
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)
Abx - Amoxicillin + Clarithromycin
Abx if penicillin allergic - Levofloxacin
Duration - 5-7 days
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)
abx = Co-amoxiclav + clarithromycin
abx ic penicillin allergic = levofloxacin + co-trimoxazole
duration = 7-10 days
What are the causes of bronchiectasis?
- Idiopathic
- Childhood infection
- CF
- Cilliary dyskinesia
- Hypogammaglobulinaemia
- Allergic broncho-pulmonary aspergillosis (ABPA)
What are the symptoms of bronchiectasis?
Chronic productive cough SOB Reccurent LRTI Haemoptysis Finger clubbing Crepitations Wheeze Obstructive spirometry
Define an endemic
The constant presence and or usual prevalence of a disease or infectious agent in a population within a geographic area
Define Epidemic
An increase, often sudden , in the number of cases of a disease above what is normally expected in that population in that area
Define outbreak
Carries the same definition of epidemic, but is often used for a more limited geographical area
Define Pandemic
An epidemic that has spread over several countries or continents usually affecting a large number of people
Describe the mycobacteria that causes TB
- Ubiquitous in the soil and water
- Non motile
- Very slow growing
- Aerobic (predilection for apices of lungs)
What is unique about the mycobacterium that causes TB
Has a very thick fatty cell wall
- Resistant to acids, alkali and detergents
Describe the transmission of TB
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
Why is outdoor TB eliminated
Due to the UV radation and dilation in open air
What is the exception of how TB can spread?
Mycobacterium bovis, which can be spread by consumption of unpasteurised infected cows milk
Describe the primary infection of TB
- 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
What are the 3 outcomes after a TB infection?
Cleared -> cured
Contained -> Latent
Progressive disease
Describe what happens if TB progresses
- 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
Describe the pharmacological management of TB
- 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
