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Respiratory AM > Respiratory infection > Flashcards

Respiratory infection Flashcards

1
Q

What are the 3 types of microorganism pathogenicity?

A

Primary- these will always make you sick
Facultative- require some”help” to infect host
Opportunistic- will infect only immunocompromised

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2
Q

What are some examples of upper respiratory tract infections? 6

A 
Common cold
Sore throat
Croup (acute laryngeotracheobronchitis)
Laryngitis
Sinusitis
Acute epiglottitis
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3
Q

What are some examples of lower respiratory tract infections?

A

Bronchitis
Bronchiolitis
Pneumonia

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4
Q

What is a respiratory tract defence mechanism in the lungs?

A

Macrophage mucociliary escalator system

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5
Q

How does the MMES work?

A

Cilia ‘beat’ and transport mucus and fluid on the surface out of the lungs, and a cough then clears mucus from the throat

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6
Q

What is the function of alveolar macrophages in the MMES?

A

Phagocytose pathogens and use mucus to transport cell debris up to throat

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7
Q

What happens if the MMES fails?

A

Secretions and foreign materials are retained in the lung

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8
Q

What are the 3 ways in which pneumonia can be classified?

A

Microbiologically
Anatomically
Aetiologically

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9
Q

What are the different ways of classifying pneumonia useful for?

A

Anatomical- understand how it looks and where it is
Aetiological- understand circumstance in which pneumonia occurred and predict likely infecting agents
Microbiological- determining appropriate treatment

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10
Q

What are the aetiological classes of pneumonia?

A 
Community acquired
Hospital acquired
In the immunocompromised
Atypical
Aspiration 
Recurrent
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11
Q

What are the different patterns of pneumonia?

A 
Bronchopneumpnia
Segmental
Lobar
Hypostatic
Aspiration
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12
Q

What is bronchopneumonia?

A

Patchy infection of the small airways

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13
Q

Describe the spread of bronchopneumonia

A

Doesn’t spread far

Often bilateral

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14
Q

What causes lobar pneumonia to spread throughout an entire lobe?

A

Aggressive organisms cause a large tissue reaction, creating more inflammatory exudate that washes bacteria throughout the lobe

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15
Q

What can happen if the pleura are involved in pneumonia?

A

Pleurisy
Pleural effusion
Empyema

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16
Q

What are the outcomes of pneumonia?

A

Pleural involvement
Lung abscess
Bronchiectasis
Scar tissue formation

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17
Q

How can pneumonia case bronchiectasis?

A

MMES doesn’t work and the area becomes infected

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18
Q

What types of scar tissue can form from pneumonia and how?

A

Mass lesion

COP- small points of scar tissue where there was pus

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19
Q

What can cause recurrent lung infection?

A

Local bronchial obstruction
Local pulmonary damage
Generalised lung disease
Non-respiratory caused e.g. immunocompromised or aspiration

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20
Q

What is the airflow in the upper respiratory tract like and why?

A

Turbulent to allow for saturation

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21
Q

What is the airflow in the trachea like and why?

A

Laminar to allow air to flow into he lungs

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22
Q

What is the airflow like in the acini and why?

A

Turbulent to allow for gas diffusion

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23
Q

What is normal PaO2?

A

10.5-13.5 kPa

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24
Q

What is abnormal PaO2?

A

<8 kPa

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25
Q

What is normal PaCO2?

A

4.8-6 kPa

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26
Q

What is abnormal PaCO2?

A

> 6.5 kPa

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27
Q

What are the 4 abnormal states associated with hypoxaemia?

A

V/Q imbalance
Diffusion impairment
Alveolar hypoventilation
Shunt

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28
Q

What reaction do the lungs have to hypoxia?

A

In areas that are under ventilated, vessels constrict as a protective mechanism

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29
Q

What causes hypoxaemia in COPD?

A

V/Q imbalance due to airway obstruction
Alveolar hypoventilation due to decreased respiratory drive
Diffusion impairment due to loss of alveolar surface area
Shunt during acute exacerbation

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30
Q

What is chronic car pulmonary?

A

Hypertrophy of right ventricle due to disease affecting structure and/or function of the lung

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31
Q

What is rhinitis?

A

Stuffy, runny nose caused by irritation of mucous membranes in the nose

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32
Q

What is the progression of rhinitis?

A

Usually self limiting and last 2-7 days

Can progress to pneumonia, meningitis, septicaemia

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33
Q

What is otitis media?

A

Ear infection, causing pin and a red, bulging drum

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34
Q

What is the progression and treatment of otitis media?

A

Self limiting, usually lasts 3-4 days

Antibiotics ineffective, treat with analgesics

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35
Q

What are the 2 causes of tonsillitis an pharyngitis and what are the treatments?

A

Viral- no treatment

Bacterial- 10 days penicillin

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36
Q

How do you differentiate between viral and bacterial tonsilitis?

A

Throat swab and culture

This usually takes too long, so “wait and see” as viral only lasts 2-3 days

37
Q

How do you tell between croup and epiglottitis?

A

Croup- child is “well”, strider, hoarse voice, barking cough

Epiglottitis- child very unwell, stridor, leaning forward, drooling, temperature and tachycardia

38
Q

What is the treatment of croup?

A

Oral dexamethasone

39
Q

What are the symptoms of pneumonia?

A 
Malaise
Fever
Chest pain
Cough
Purulent sputum
Dyspnoea
Often headache presenting symptom
40
Q

What are the signs of pneumonia?

A 
Pyrexia
Tachpnoea
Central cyanosis in severe
Dullness on percussion of affected lobe
Bronchial breath sounds
Inspiratory crepitations
Increased vocal resonance
41
Q

What are the necessary investigations for pneumonia?

A 
Serum biochemistry and full blood count
Chest xray
Blood cultures
Throat swab
Urinary legionella antigen
Sputum microscopy and culture
42
Q

What are the common microbiological causes of pneumonia?

A

Strep, pneumonia
Haemophilus influenzae
All viruses

43
Q

What is the pneumonia severity scoring system?

A 
Confusion
Urea- blood urea > 7
Respiratory rate > 30
Blood pressure- diastolic < 60
65- over
44
Q

What is the treatment for pneumonia?

A

CURB 0-1- amoxicillin or clairithromycin
CURB 2- amoxicillin and clairithromycin/levofloxacin
CURB 3-5- Coamoxiclav and clairithromycin or levofloxacin
Oxygen
IV fluids
CPAP
Intubation and ventilation

45
Q

What are the complications of pneumonia?

A 
Septicaemia
Acute kidney injury
Empyema
Lung abscess 
Haemolytic anaemia
ARDS
46
Q

What is the differential diagnosis for pneumonia?

A 
Pneumonia
TB
Lung cancer
Pulmonary embolism
Pulmonary vasculitis
Cardiac failure
47
Q

What is empyema?

A

Pockets of pus inside the lungs

48
Q

What are the signs and symptoms of empyema?

A

Chest pain
Lack of energy
High swinging fever

49
Q

How do you diagnose empyema?

A

CT thorax
Pleural ultrasound
Pleural aspiration- pH<7.2

50
Q

What is the treatment of empyema?

A

Chest drain
IV antibiotics
Surgery if not responding

51
Q

What are the symptoms of lung abscess?

A

Lethargy
Weight loss
High, swinging fever

52
Q

How do you diagnose a lung abscess?

A

CT thorax

Sputum culture

53
Q

How do you treat a lung abscess?

A

Prolonged antibiotics

Chest drain

54
Q

What are the causes of bronchiectasis?

A 
Idiopathic
Immotile cilia syndrome
Cystic fibrosis
Childhood infections
Hypogammaglobulinaemia
Allergic bronchopulmonary aspergillosis
55
Q

What are the symptoms of bronchiectasis?

A 
Chronic cough
Daily sputum production
Wheeze
Dyspnoea
Tiredness
Flitting chest pains
Haemoptysis
56
Q

What are the signs of bronchiectasis?

A

Clubbing

Coarse inspiratory crepitations

57
Q

How do you diagnose bronchiectasis?

A 
CT thorax
Sputum culture
Serum immunoglobulins
Total IgE and aspergillosis precipitins
CF genotyping
58
Q

What is the treatment for bronchiectasis?

A

Chest physio
Antibiotics
Inhaled therapy- B2 agonist and corticosteroid

59
Q

How are microscopy and culture of sputum used to diagnose chest infections?

A

Gram stain sputum for organisms and pus

Culture for respiratory pathogens (Strep pneumonia, H influenzae, moraxella catarrhalis)

60
Q

How do you diagnose TB?

A

ZN or auramine phenol stain
Acid and alcohol fast bacilli
Extended culture for mycobacteria

61
Q

How is antigen detection used for microbiological diagnosis of chest infection?

A

Detect specific antigen immunologically

Legionella and pneumococcal antigens can be detected in urine, and viruses in nasopharyngeal secretions

62
Q

How is latex agglutination used for microbiological diagnosis of chest infection?

A

Latex particles are coated in monoclonal antibodies specific for organism in question and mixed with clinical specimin
Visible clumping if present

63
Q

How is ELISA used for microbiological diagnosis of chest infection?

A

Specific antibody detects antigen and linked enzyme produces colour change

64
Q

How is DNA detection used for microbiological diagnosis of chest infection?

A

Polymerase chain reaction of throat swab or other respiratory sample

65
Q

What is serological diagnosis?

A

Measure host antibody response to an organism

66
Q

When is serological diagnosis made?

A

Difficult to culture/detect organisms

67
Q

What are the principles of serological diagnosis?

A

IgM marker for current infection
IgG marker for previous infection
Rising titre

68
Q

What causes TB?

A

Mycobacterium TB

Mycobacterium bovis- bovine TB

69
Q

What is the typical structure an growth of mycobacteria?

A

Non notice bacillus
Slow growth and progression
Aerobic
Very thick cell wall

70
Q

Why is the cell wall of mycobacteria important?

A

Thick wall resistant to acids, alkalis, detergents and neutrophil and ,macrophage destruction

71
Q

How is TB transmitted?

A

Inhalation of cough/sneeze droplets

72
Q

How is bovine TB transmitted?

A

Ingestion of infected cows’ milk

Mycobacterium deposited in cervical and intestinal lymph nodes

73
Q

What is the body’s immunological response to TB?

A

Macrophages recognise the bacteria and ingest it
Antigens are presented to T helper cells, which activate the macrophages and allow them to ‘kill’ the TB
This releases toxins and can cause tissue damage

74
Q

What is the body’s response to an accumulation of immune cells in TB?

A

Accumulation of macrophages, epithelia and Langhan’s causes a granuloma- specifically central caveating necrosis in TB

75
Q

In primary infection of TB, what usually happens?

A

Usually no symptoms

Initial lesion spreads to draining hilar lymph nodes, which then heals with or without a scar

76
Q

In primary infection of TB, what happens in the minority?

A

Infection progresses and focus continues to enlarge
Enlarged hilar lymph nodes compress bronchi and there is lobar collapse
Enlarges lymph nodes discharge into bronchus

77
Q

What is post primary infection?

A

Reactivation of mycobacterium from latent primary infection disseminated by blood stream around the body or a new reinfection from outside source

78
Q

What are the differences in symptoms between primary and post primary infection?

A

Fever malaise, weight loss, night sweats in post primary- systematically unwell
Primary often shows no symptoms

79
Q

How is TB diagnosed?

A

3 sputum specimens on successive days- sputum smear, culture and PCR
Chest xray

80
Q

What investigations are carried out for TB if sputum is negative?

A

CT thorax
Bronchoscopy
Pleural aspiration and biopsy

81
Q

What are you looking for on a TB chest xray?

A

Patchy shadowing

Cavitation and calcification

82
Q

What is treatment of TB?

A

Multiple drug therapy for at least 6 months
Rifampicin and isoniazid for 6 months
Ethambutol and pyrazinamide for the first 2

83
Q

What must be done after diagnosing TB?

A

Legally report

HIV test

84
Q

What are the side effects of rifampicin?

A

Orange urine and tears
Induced liver enzymes- prednisone, anticonvulsants and the pill ineffective
Hepatitis

85
Q

What are the side effects of isoniazid?

A

Hepatitis

Peripheral neuropathy

86
Q

What are the side effects of ethambutol?

A

Optic neurpathy

87
Q

What are the side effects of pyrazinamide?

A

Gout

88
Q

What is the process of TB screening in under 16s?

A

Tuberculin test
If +, chest xray
If -, repeats after 6 weeks and give BCG

89
Q

What is the process of screening in over 16s?

A

Chest xray
If -, discharge and reassure
If +, Investigate for TB

Respiratory AM (10 decks)

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