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Medicine year 1 > Respiratory infection > Flashcards

Respiratory infection Flashcards

1
Q

Describe pneumonia

A

an infection of the lung parenchyma involving fluid filled distal airspaces

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2
Q

What types of organisms can cause pneumonia (3)

A

Viruses
Bacteria
Fungi

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3
Q

Describe the development of pneumonia (4)

A

Alveoli are filled with neutrophils
Exudate in the alveoli consists of neutrophils, macrophages, and fibrin
Exudate begins to organise
The exudate can be resolved or scar

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4
Q

in what way does the exudate begin to organise in progression of pneumonia

A

it becomes a more formed mass of macrophages and fibroblasts

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5
Q

What can happen in resolution of pneumonia exudate (2)

A

it can be broken down be enzymes then resorbed Or phagocytosed

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6
Q

How does scaring occur (pneumonia)

A

further fibrosis occurs

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7
Q

What are the complications of pneumonia (4)

A

fibrous scarring
Abscess formation
Empyema
Bronchiectasis

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8
Q

Describe abscess formation in the context of pneumonia (2)

A

localised collection of pus
Which results in necrosis of the lung parenchyma

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9
Q

What are the symptoms of abscess formation due to pneumonia (2)

A

chronic malaise
Fever

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10
Q

Describe empyema in the context of pneumonia (3)

A

collection of pus in the pleural cavity
Which can organise
Leading to fibrous adhesions in the pleural cavity

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11
Q

What is bronchiectasis

A

abnormal and fixed dilation of bronchi and bronchioles

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12
Q

What can accumulate in dilated airways due to bronchiectasis

A

Purulent secretions

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13
Q

describe lobar pneumonia

A

confluent consolidation of most of the lung lobe

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14
Q

What is the most common causative organism of lobar pneumonia

A

streptococcus pneumonia

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15
Q

What is bronchopneumonia (3)

A

patchy, widespread consolidation of the lungs
beginning in the terminal airways then spreading to adjacent alveolar lung
Often bilateral and basal

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16
Q

What are common causative organisms of bronchopneumonia (5)

A

strep, pneumoniae
Haemophilia influenza
Staphylococcus
Anaerobes
Coliforms

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17
Q

Describe tuberculosis (3)

A

Primary infection begins in lung
Chronic infection can be at many body sites
A mycobacterial infection

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18
Q

How does pathogenicity of mycobacterium occur

A

They are able to avoid phagocytosis and stimulate a host T-cell response

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19
Q

What type of hypersensitivity is associated with tuberculosis

A

Type 4 (delayed)

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20
Q

Describe miliary TB (2)

A

results from haematogenous dissemination
Multiple tiny foci are spread throughout the lungs and other organs

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21
Q

What are the types of TB (2)

A

primary
Secondary

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22
Q

Describe primary TB (4)

A

Occurs due to first exposure/up to 5 years after
Inhaled organism undergoes phagocytosis then is carried to hilar lymph nodes
Immune activation occurs
Granulomatous response occurs in nodes and lungs

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23
Q

What is Ghon focus (2)

A

small focus of consolidation in lung
Near pleura/lower part of upper lobe/upper part of lower lobe

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24
Q

Describe secondary tuberculosis (4)

A

reinfection or reactivation of disease
Initially remains localised
Spreads via airways and/or blood stream
Causes fibrosis and cavitating apical lesions

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25
Q

What can lead to reactivation of tuberculosis

A

Decreased T-cell function

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26
Q

Where does secondary TB initially remain

A

apices of lungs

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27
Q

Describe histology of secondary tuberculosis (2)

A

Granulomas
Caseous necrosis

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28
Q

What stain can be used to highlight mycobacteria

A

Zielh Nielsen stain

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29
Q

How is tuberculosis diagnoses in immunocompromised patients (3)

A

high index of suspicion
Bronchi-alveolar lavage
Cytology biopsy

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30
Q

What conditions of the upper respiratory tract exist (4)

A

Coryza/common cold
Pharyngitis/sore throat
Sinusitis
Epiglottitis

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31
Q

What conditions of the lower respiratory tract exist (6)

A

acute bronchitis
Acute exacerbation of COPD
Pneumonia
Influenza
COVID 19
Fungal infection

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32
Q

Describe symptoms of strep throat (5)

A

exudate
Pus
Sore throat
Dysphagia
Dysphonia

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33
Q

Describe symptoms of tonsillitis (4)

A

swollen throat
Erythrematous
Dysphagia
Dysphonia

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34
Q

How is tonsillitis treated

A

Tonsillectomy

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35
Q

Describe a complication of tonsillitis (2)

A

Quinsy
A peri-tonsillar abscess which can be drained

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36
Q

Describe coryza (2)

A

an acute viral infection of the nasal passages
Spread by droplets and fomites

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37
Q

What are the symptoms of coryza (2)

A

Sore throat
Mild fever

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38
Q

What are the symptoms of sinusitis (5)

A

frontal headache
Retro-orbital pain
Maxillary sinus pain
Tooth ache
Discharge

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39
Q

How is acute sinusitis treated (3)

A

nasal decongestants
Nasal steroids
Pseudo-ephedrine

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40
Q

What additional symptom is associated with acute sinusitis

A

Purulent nasal discharge

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41
Q

What are the symptoms of acute bronchitis (3)

A

fever
Productive cough
Transient wheeze

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42
Q

What are the symptoms/sings of acute exacerbation of COPD

A

Sputum increased
Sputum purulence increased
Wheeze
Breathlessness
Respiratory distress
Coarse crackles
Ankle oedema
Cyanosis

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43
Q

How are acute exacerbations of COPD managed (outpatient) (3)

A

antibiotics (doxycycline, amoxicillin)
Bronchodilator inhalers
Steroids (short period)

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44
Q

How are acute exacerbations of COPD managed (inpatient) (5)

A

arterial blood gas
CXR
Oxygen (if hypoxia)
Rest
Pulmonary rehab

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45
Q

What are the signs of pneumonia

A

Pyresis
Rigours
Herpes labialis
Tachypnoea
Crackles
Rub
Cyanosis
Hypotension

46
Q

What investigations are used for pneumonia

A

blood culture
Serology
Arterial blood gas
FBC
Urea
Liver function
CXR
CURB 65 score

47
Q

What are the severity markers for pneumonia (4)

A

temperature
Cyanosis
White blood cell count
Involvement of multiple lung lobes

48
Q

how is pneumonia managed (5)

A

antibiotics
Oxygen
Fluids
Bed rest
Smoking cessation

49
Q

what antibiotics are typically used to treat community acquired pneumonia (2)

A

amoxicillin
Doxycycline

50
Q

Describe mycoplasma pneumonia (2)

A

no cell wall - therefore resitant to beta-lactam antibiotics
Protracted paroxysmal cough

51
Q

What are the clinical indicators of lower respiratory tract infection (3)

A

elevated CRP
Elevated pro-calcitonin
Elevated or low white blood cell count

52
Q

When would IV antibitoics be used to treat respiratory infection (4)

A

If oral route is unavailable
Sensitivity
Deep seated infections
First dosage

53
Q

Describe cystic fibrosis (4)

A

Genetic disease
Abnormally viscous mucus
Which blocks structures
Resulting in repeated chest infections and chronic colonisation

54
Q

What causes cystic fibrosis

A

an autosomal recessive mutation in the gene coding for the CFTR protein

55
Q

Describe the classes of CFTR defects

A

five - functional protein, not enough
Four - protein is right shape, can open, but not enough chlorine let through
Three - protein is right shape, won’t open
Two - protein made but wrong shape
One - massive protein defect

56
Q

What is the action of CFTR when it works (3)

A

Pumps chloride ions into secretions
Chloride ions draw water into secretions
Water thins the secretions

57
Q

What are the respiratory symptoms of cystic fibrosis (6)

A

Recurrent respiratory infections
Chronic cough with sputum
Dyspnoea
Nasal polyps
Haemoptysis
Filled sinuses

58
Q

What are the GI symptoms of cystic fibrosis (4)

A

Low BMI
Bowel obstruction
Problems with pancreas (stool)
Gallbladder and liver disease

59
Q

What are the other symptoms of cystic fibrosis (2)

A

salty sweat
Bilateral absence of vas deferens

60
Q

What are the signs of cystic fibrosis (4)

A

Cyanosis
Clubbing
Hyperinflation of chest
Bilateral coarse crackles

61
Q

What investigations are used for cystic fibrosis (2)

A

sweat test
Genetic testing for CFTR mutations

62
Q

How are the respiratory symptoms of cystic fibrosis managed (4)

A

chest physiotherapy
Sputum samples
Prophylactic antibiotics
CFTR modulators

63
Q

How are the pancreatic symptoms of cystic fibrosis managed (2)

A

CREON
Diabetes monitoring

64
Q

How are the bowel symptoms of cystic fibrosis managed (2)

A

laxatives
fluids

65
Q

How are the liver symptoms of cystic fibrosis managed

A

TIPSS is used for portal hypertension

66
Q

How are exacerbations of cystic fibrosis managed (4)

A

Chest physiotherapy
Antibitoics
Increased dietary input
Hydration

67
Q

What are the special cases of pneumonia (4)

A

mycoplasma a
Hospital acquired
Aspiration
Legionella

68
Q

How is hospital acquired pneumonia treated (2)

A

amoxicillin
Gentamicin

69
Q

How is aspiration pneumonia treated (3)

A

anaerobic cover required
Amoxicillin
Metronidazole

70
Q

How is legionella pneumonia treated

A

Levofloxacin

71
Q

What pneumonia symptoms are associated with older patients (3)

A

Confusion
Diarrhoea
Reduced mobility

72
Q

what symptoms of pneumonia are associated with younger patients (4)

A

cough
Sputum
Fever
Pain

73
Q

What is an Intrapulmonary abscess

A

liquefactive necrosis with confined cavitation
resulting from a pulmonary infection

74
Q

What do multiple Intrapulmonary abscesses indicate

A

bacteraemia

75
Q

What are the risk factors for Intrapulmonary abscesses (4)

A

Immunosuppression
Immunodeficiency
Abnormal innate immunity
Repeated insult

76
Q

Describe the symptoms of Intrapulmonary abscesses (3)

A

lethargy/tiredness/weakness
Cough ± sputum
Vomiting

77
Q

describe the signs of intrapulmonary abscesses (3)

A

indolent
Weight loss
Pneumonia that worsens despite treatment

78
Q

What investigations can be used to identify intrapulmonary abscesses (3)

A

Ultrasound
CT
CXR

79
Q

How are intrapulmonary abscesses managed (2)

A

broad spectrum antibiotics
Surgical drainage

80
Q

What is the hallmark of septic emboli

A

Multiple fluid filled cavities at the right base of the lungs

81
Q

What is empyema

A

pus in the pleural space

82
Q

Which stages of progression of effusion to empyema require chest tube drainage (2)

A

complicated parapneumonic effusion
Empyema

83
Q

Describe bronchiectasis and its effects (3)

A

localised an irreversible dilation of the bronchial tree
Makes bronchi dilated, inflamed, and easily collapsible
Causes airflow obstruction
Causes impaired clearance of secretions

84
Q

What conditions is bronchiectasis associated with (4)

A

Cystic fibrosis
Lung infection
Kartagener’s syndrome
Immunodeficiencies

85
Q

Describe the Pathophysiology of bronchiectasis (3)

A

excessive inflammatory response occurs, causing fibrosis
The airways dilate as surrounding scar tissue contracts
Dilation leads to mucus stasis

86
Q

What bacteria are associated with bronchiectasis (2)

A

Haemophilus influenza
Pseudomonas aeruginosa

87
Q

What are the symptoms of bronchiectasis (4)

A

Chronic productive cough
Fever
Malaise
Haemoptysis

88
Q

What are the signs of bronchiectasis (5)

A

clubbing
Recurrent infections
Coarse crackles
Reduced/absent breath sounds
No/reduced response to antibiotics

89
Q

Describe chronic bronchial sepsis

A

Condition with all hallmarks of bronchiectasis showing no bronchiectasis on a CT scan

90
Q

What investigations are used to diagnose bronchiectasis (4)

A

CT
FBC, urea, lft
IgG/IgM/IgA (IgE)
Standard/mycobacterial cultures

91
Q

How does bronchiectasis present on a CT scan (2)

A

Airways are thickened and dilated
Tram line shadowing

92
Q

How is bronchiectasis managed (4)

A

smoking cessation
Flu + pneumococcal carvings
Antibiotics
Physiotherapy

93
Q

Describe antibiotic treatment of bronchiectasis (2)

A

antibiotic choice depends on sputum culture
If colonised with persistent bacteria, oral macrolide/gentamicin(etc) is given

94
Q

What physiotherapy is used to manage bronchiectasis

A

ACBT
Huffing
Autonomous drainage

95
Q

What can be used as anti-inflammatory treatment for bronchiectasis

A

Low dose macrolides

96
Q

What are examples of special cases of bronchiectasis (2)

A

primary ciliary dyskinesia
Cystic fibrosis

97
Q

What type of hypersensitivity is TB associated with

A

type four (granulomas and necrosis)

98
Q

Describe Pathophysiology of TB (3)

A

pathogen is phagocytosed in alveoli and carried to hilar lymph nodes
Immune activation occurs
A granulomatous response occurs in lymph nodes

99
Q

What are the pulmonary symptoms of TB (3)

A

cough
Haemoptysis (not every case)
Dyspnoea

100
Q

what is the main diagnostic test for TB

101
Q

How does TB present on a CXR (5)

A

shadows
Lesions
Consolidation
Bilateral hilar lymphadenopathy
Miliary shadowing

102
Q

Describe the histology of TB

A

granulomata with centra caseous necrosis

103
Q

What treatment is used for active TB

A

rifampicin+isoniazid+pyrazinamide+ethambutol for 2 months

Rifampicin+isoniazid for 4 months

104
Q

How is latent TB treated

A

Rifampicin+isoniazid for 3 months
Or
Isoniazid for 6 months

105
Q

Which immune response is activated in Pathophysiology of TB

A

Th1-biased adaptive immunity (CMI)
Involves enhanced effector mechanisms

106
Q

What are examples of non-tuberculosis mycobacterium (2)

A

MAC
M.abscessus

107
Q

How are NTMs diagnosed (4)

A

respiratory symptoms
Positive sputum culture
PCR
Radiology: bronchiectasis in anterior lung

108
Q

How is non severe MAC managed

A

Rifampicin, ethambutol, and azithromycin 3x a week

109
Q

How is severe MAC managed

A

Rifampicin, ethambutol, and azithromycin daily

110
Q

How is macrolide resistant MAC treated

A

Rifampicin, ethambutol, and isoniazid daily

111
Q

Where are NTM found

A

infected soil and water

Medicine year 1 (21 decks)

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