respiratory infection

Question 1

where does the respiratory tract start and end?

wha are the different types of pathogen?

Answer 1

nose to alveolus

pathogen:
- virus
- bacteria
- other (other bacteria, mycobacterium, fungus, parasite

Question 2

differential

Answer 2

Interstitial pneumonia ‘ia’, inhalation, allergy

Question 3

what are different types of respiratory infection:

URTI?
LRTI?

what are 4 other types?

Answer 3

URTI= rhinitis, pharyngitis, tonsilitis, laryngitis

LRTI= laryngo-tracheo bronchitis (LTB), bronchiolitis, pneumonitis

• pneumonia/bronchopneumonia
• empyema (not emphysema)
• bronchiectasis
• lung access

Question 4

what 3 things can respiratory infections be exacerbations be of?

Answer 4

• COPD, asthma
• bronchiectasis
• fibrotic lung disease

Question 5

what are the principals of treatment?

what is infection outcome?

Answer 5

• source control
• consider the pathogen
• consider the host
• consider the severity

infection = pathogen x host

Question 6

what is the basic practise of respiratory infections?

Answer 6

• basic microbiology
• respiratory microbiology
  (commensal organisms vs respiratory pathogens, the lung microbiome, why do we get pneumonia)

Question 7

what is the 2nd basic practise of respiratory infection?

Answer 7

basic antibiotic biology.

• respiratory antibiotics:
  (soldier the spectrum, route of administration, bioavailability, duration)
  ( consider goal of treatment- cure, control, maintenance= immune modulation)

Question 8

what is the 3rd basic practise of respiratory infections?

Answer 8

basic immunology

Question 9

what is sepsis?

what is septic shock?

Answer 9

a life threatening organ dysfunction caused by a dysregulated host response to infection.

septic shock = a subset of patients with profound circulatory, cellular and metabolic abnormalities.
MAP <65 mmHg, lactate >2mmol/l
hypotensions despite fluid resuscitation, requiring vasopressors.

Question 10

what are the different organisations of standards of care?

Answer 10

BTS (guidelines of practise)
NICE (pneumonia guidelines)

British infection association (BIA) guidelines.

Question 11

what are the international guidelines in the standard of care?

Answer 11

• European respiratory society
• ATS/IDSA guidlines

Question 12

treatment for URTI?

Answer 12

• supportive, not antibiotics
• special diagnosis - stridor, croup, quinsy

consider the underlying diagnosis -allergy, polyps, immunity
consider ENT review and direct nasendoscopy

Question 13

treatment of LRTI?

Answer 13

• (supportive)
• maybe antibiotics
• consider related mobility - URT, LRT asthma, chronic cough
• make a back up plan (consider CXR, antibiotics, referral)

Question 14

treatment of pneumonia?

Answer 14

• (supportive)
• antibiotics
• choose spectrum antibiotics over 5/7/10 days
• consider underlying diagnosis- allergy, polyps, immunity, co-morbidities =, bronchiectasis, COPD
• admission into hispotal

Question 15

treatment for empyema?

Answer 15

• antibiotics
• drain
• supportive (any cormorbidities, psycho-social, pain, oxygen)
• consider the underlying diagnosis- pathogen, immunity?
• surgery, thoracoscopy?

Question 16

treatment of bronchiectasis?

Answer 16

• antibiotics
• clearance

long term chronic disease = management plan, specialist nurse, GP’s, motivated patient, preventative therapies, rescue therapies

consider exacerbation of be vs pneumonia vs progression

Question 17

treatment of lung abscess and cavitation?

Answer 17

• antibiotics
• treatment will be defined by cause

identify the pathogen
- surgery?

Question 18

pneumonia- community acquired:

definition
incidence
aetiology
sex
geography
pathology
symptoms and signs
prognosis

Answer 18

defincition= clinical features + radiology

incidence = 1% adults; 5-10% of GP presentation with LRTI

aetiology = virus, bacteria, co-infection

sex= same in the incidence, possibly slightly worse outcomes F>M

geography= relevant in aetiology and outcomes

pathology = consolidation, pus, necrosis (neutrophils, lymphocytes, eosinophils)

symptoms and signs = cough with phlegm, SOB, fever

prognosis = consider CURB65: <1% -> 50%; consider CAP/HAP

Question 19

what is curb65?
are blood test required?

Answer 19

to predict mortality secondary to community acquired pneumonia

• blood tests are not required
  This is a test to establish the the severity of pneumonia
  C= confusion
  U= urea >7
  R= respiratory >30
  B= blood pressure systolic <90
  >65

Question 20

how do you work out how long someone should be on antibiotics?

Answer 20

• it depends!
• depends on the pathogen (consider sensitive streptococcus pneumonia vs staphylococcus aureus pneumonia)

it depends on the disease - consider pneumonia + vanity + bacteraemia + signal change in bone

• depends on the host response!

Question 21

how long do you give antibiotics for:
pneumonia?
deep seated infection?
empyema?
cavitation?

Answer 21

Question 22

what is emphyma?

Answer 22

pockets of pus in the lung

Question 23

what is bronchiectasis?

Answer 23

permanent dilation of the bronchi and bronchioles following damage to the airway and infection.
it will lead to mucus plugging.

Question 24

what is pneumonia?

Answer 24

an infection causing inflammation of the alveoli and terminal bronchioles.
This will lead to consolidation of the bronchopulmonary segment or lobe.

Question 24

symptoms of pneumonia?

Answer 24

high fever sputum sore body

Question 25

tests for pneumonia

Answer 25

blood test sputum culture CXR

Question 26

what is a lung abscess

Answer 26

liquidative necrosis of lung parenchyma due to infection. the will lead to creation of a cavity filled with fluid and debris.