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Respiratory Infections Flashcards

1
Q

What is bronchitis?

A

Bronchitis: Infection of the bronchi

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2
Q

What is bronchiolitis?

A

Bronchiolitis: Infection of the bronchioles

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3
Q

What is Pneumonia?

A

Pneumonia: Infection of the alveoli

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4
Q

How can pneumonia be acquired?

A

Community
Hospital
Ventiltor

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5
Q

Why, physiologically, does pneumonia present a more challenging disease than bronchitis and bronchiolitis?

A

Aveoli earer blood supply- directly disrupts gas exchange via cellular infiltration or fluid leakage into the airspace over substantial area of the respiratory tract
Prevent uptake of O2 and removal of CO2

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6
Q

What is the first immune cell recruited to the site during acute bacterial pneumonia?

A

Neutrophil

Rapid release of neutrophil chemokine such as IL-8

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7
Q

How might immune response change during prolonged pneumonia?

A

Prolonged inflammation will result in accumulation of lymphocytes (T cells) and macrophages in neutrophils

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8
Q

What is the most common form of pneumonia?

A

Bacterial
Can also be viral or fungal
Streptococcus pneumoniae accounts for 80% of cases

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9
Q

What are other microorganisms that can cause pneumonia?

A 
Haemophilus influenzae
Staphylococcus aureus
Mycoplasma pneumoniae
Legionella pneumophilia 
Klebsiella pneumonia
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10
Q

What are the symptoms of pneumonia?

A 
Cough
Fever
Sputum
Dyspnoea 
Chest pain - can be pleuritic
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11
Q

What are the sign of pneumonia?

A 
Fever
Tachycardia
Reduced O2
Reduced breath sounds and bronchial breathing on auscultation
Dull percussion
Asymmetrical chest expansion
Increaed vocal resonance
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12
Q

What investigations are done in pneumonia?

A

CXR

Bloods:

  • FBC showing neutrophilia
  • U+Es check for dehydration
  • Raised CRP

ABG if low stats or underlying resp. disease e.g. COPD

Sputum and blood culture in moderate/high severity before ABs

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13
Q

How is pneumonia managed?

A

ABs

Supportive- O2 therapy if stats drop to 94%, IV fluids

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14
Q

How is risk stratified in pneumonia?

A

CURB-65

Confusion
Urea
Resp Rate
BP
>65 years
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15
Q

What are the parameters of the CURB-65 score?

A 
Confusion = Abbreviated mental test score < 8/10
Urea = >7mmol/L
RR = >30
BP = < 90mmHg systolic and/or  <60mmHg diastolic
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16
Q

What are the outcomes for different CURB-65 scores? (Secondary care)

A

0 or 1 = home treatment w/ oral amoxicillin

2 = Consider inpatient treatment or hospital supervised oupatient

> 3 = Inpatient admission Consider ITU admission for 4 or 5

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17
Q

What are the mortality risk associated with CURB-65 scores?

A

0 or 1 = <3%
2 = 3-15%
>3 = more than 15%

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18
Q

What should be considered in acute confirmed CAP presenting in hospital?

A

Switch from empirical ABs to Pathogen-targeted therapy

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19
Q

What is used to treat Mycoplasma pneumoniae
and
Chlamydophila pneumoniae?

A

Clarithromycin

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20
Q

What is used to treat Legionella species?

A

Fluoroquinolone

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21
Q

What is used to treat Streptococcus pneumoniae?

A

Amoxicillin oral
OR
Benzypenicillin IV

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22
Q

What is used to treat Staphylococcus aureus: non-MRSA?

A

Flucloxacillin IV

with or without

Rifampicin (Oral or IV)

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23
Q

What is used to treat Staphylococcus aureus: MRSA?

A

Vancomycin IV

with or without

Rifampicin (Oral or IV)

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24
Q

Which atypical organism is associated with faulty air conditioning symptoms?

A

Legionella

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25
What are typical CAP organisms?
Strep pneumoniae HiB Staph A Klebsiella pneumoniae
26
What are atypical CAP organisms? (Atypical presentations)
Mycoplasma pneumonia (young person/close contact) Legionella pneumophilia (faulty AC - hypoNA, abnormal LFTs) Chlamydia psittaci (HIV, birds) Chlamydia pneumoniae Coxiella burnetti Pneumocystis jirovecli
27
What are common causative organisms for HAP?
``` Staph A (IV drug use) Pseudomonas aeruginosa Klebisella (chronic alcoholic) ```
28
Which organisms can cause cavitating lung lesions seen on CXR?
Staph | Klebsiella
29
What type of bacteria is strep?
Gram +ve cocci
30
What are the symptoms of atypical pneumonia?
Dry cough ``` Extra-pulmonary symptoms Low grade fever Headache Diarrhoea Myalgia Hepatitis ```
31
What is seen on a CXR in pneumonia?
Alveolar opacification Air bronchograms Consolidation
32
What are the empirical ABs used in CA pneumonia?
Amoxcillin (typical cover) Clarithromycin (atypical cover, if penicillin allergy) Doxycycline (if penicilin allergy)
33
What are the empirical ABs used in HA pneumonia?
1st line - Co-amoxiclav MRSA: IV Vanc Aspiration: Amoxicillin + Metronidazole
34
What is bronchiectasis?
Chronic lung condition | Irreversible dilation of bronchi and bronchioles
35
What are common causes bronchiectasis?
TB most common worldwide | Cystic Fibrosis most common in the western world
36
What are some other causes of bronchiectasis?
``` Post-infection Chronic aspiration e.g. GORD, Dysphagia Chronic inflammation e.g. RA, IBD Immunodeficiency ``` Congenital Underlying condition e.g. Asthma, COPD, ILD
37
What rare syndrome is associated with bronchiectasis?
Kartagner's syndrome | triad = bronchiectasis, sinusitis, situs inversus
38
What are the symptoms of bronchiectasis?
Chronic, productive cough > 8 weeks Large amounts of green, think, foul-smelling sputum Haemoptysis Dyspnoea Fever Weight loss Non-pleuritic chest pain Recurrent chest infections
39
What are clinical signs associated with bronchiectasis?
Clubbing | Coarse crackles in lower lung zones
40
What are the 7 respiratory causes of clubbing?
``` Bronchiectasis Lung Cancer TB ILD Lung abscess Emphysema Cystic Fibrosis ```
41
What are the investigations for bronchiectasis?
Observations Sputum MCS Bloods: - FBC for high WCC - U+Es - Raised CRP - LFTs - ABG if dyspnoea - Culture if suspected sepsis Imaging: - CXR - Gold standard = High resolution computed tomography
42
What is seen on a HRCT in bronchiectasis?
Signet ring sign
43
What is the conservative management for bronchiectasis?
Importantly, Airway clearance: - Chest physio (nebulized saline, oscillation devices) - Postural drainage Also: - Exercise + Diet - Vaccinations - Smoking cessation - Airway clearance
44
What is the pharmacological management for bronchiectasis?
Steroids/Bronchodilators IV ABs for acute exacerbation If pseudomonas --> ciprofloaxcin *be careful of achilles tendon rupture
45
What is TB?
Chronic infectious disease Affects multiple organs Caused by myobacterium tuberculosis
46
Where in the lungs is TB most common?
Upper lobes | More well ventilated
47
What are the two forms of TB?
Latent - TB contained in 'caseating granulomas' Can switch if immunocompromised or with age Active - transmissible and requires treatment
48
What are RFs for TB?
``` HIV Immunosuppressive meds Overcrowding Homelessness Africa/South Asia Travel ```
49
What are the pulmonary symptoms of TB?
``` Productive cough Dyspnoea SOB Late stages - Haemoptysis Pleural effusion ```
50
What are the constitutional symptoms of TB?
FLAWS Lymphadenopathy Erythema Nodosum
51
What is erythema nodosum?
Erythema nodosum is swollen fat under the skin causing bumps and patches that look red or darker than surrounding skin
52
What other condition is erythema nodusum seen in?
IBD
53
What are some symptoms of extra-pulmonary TB?
``` Meningitis Periotonitis Ascites Pericardial effusion Constrictive pericarditis Normocytic anaemia Pott's disease Spinal cord compression Infertility Addison's Sterile pyuria ```
54
What investigations are done in TB?
Sputum MCS x3, 1 early morning AFB (Acid-Fast Stain) most common is Ziehl-Neelsen TB culture takes 6-8 weeks FBC (high WCC, anaemia), Raised CRP, ABG CXR
55
What is seen on a CXR in TB?
Bi-hilar lymphadenopathy Consolidation (patchy/heterogenous) Upper lobe scarring Cavitating lesions
56
What would be found on a lymph node biopsy in TB?
Casseating granulomas
57
What conditions cause non-casseating granulomas?
Crohn's | Sarcoidosis
58
How do you test for latent TB?
Only show TB exposure, used to screen close contacts Tuberculin skin test (Mantoux test) Immune reaction > 15mm is positive Can be affected by BCG vaccine Interferon Gamma release assay V specific If either test is +ve do a CXR
59
What is milary TB and what is seen on a CXR?
Nodular shadowing | Dissemination of TB throughout body
60
What medications are used to treat TB?
RIPE Rifampicin Isonazid Pyrazinamide Ethambutol R+I for 6 months P+E for 2 months
61
What are the side effects of the TB drugs?
Rifampicin - Red/Orange secretions Isoniazid - Peripheral neuropathy + Vitamin B6 deficiency Pyrazinamide - Hyperuricaemia (gout) Ethambutol - Eye, RG colour blindness
62
What is acute brochitis?
Self-limiting chest infections Results from inflammation of the trachea and major bronchi Usually resolves in 3 weeks
63
How do patients with acute bronchitis present?
``` cough: may or may not be productive sore throat rhinorrhoea wheeze +/- low grad fever normal chest exam ```
64
How do you differentiate between acute bronchitis and pneumonia?
History - sputum, wheeze and breathlessness maybe absent in AB but at least 1 in P Examination - Normal chest exam in AB. Pneumonia (dullness, crepitations, bronchial sounds) . Systemic features more present in P.
65
What are the investigations done for acute bronchitis?
Clinical diagnosis | CRP high if available can guide whether or not to use ABs
66
What is the management for acute bronchitis?
``` Analgesia Fluid intake ABs if systemically unwell, comorbid, CRP 20-100mg/L delayed prescription but >100mg/dL immediate Doxycycline preferred Amoxicillin for pregnancy and children ```
67
What are characteristic features of influenza infection?
Upper and Lower respiratory tract symptoms - Rhinorrhea - Cough - Fever - Chills - Headache - Myalgia
68
How is influenza diagnosed?
Clinically
69
How is influenza managed?
Anti-pyretic/Analgesia e.g. paracetamol or ibuprofen
70
What are differentials for a generally dry acute cough?
``` COPD exacerbation Acute pulmonary odema Lower respiratory tract infection Rhinitis/Sinusitis Drug induced e.g. ACEi ```
71
What are differentials for an acute productive cough?
Lower resp COPD excerbation Exacerbation of bronchiectasis TB
72
What are differentials for a generally dry chronic cough?
COPD Poorly controlled asthma GORD Lung cancer
73
What are differentials for a productive chronic cough?
Bronchiectasis Lung cancer TB Recent aspiration
74
What life threatening differentials are you thinking about with an acute cough?
Acute exacerbation of COPD Lower resp infection Acute pulmonary oedema Always think pneumothorax or PE even though cough is rare
75
What is a sub-acute cough? Causes?
3-8 weeks Post-infectious cough New med e.g. ACEi (ramipril)
76
What are different terms that fall under the umbrella term
Acute bronchitis Exacerbation of COPD CAP Atypical pneumonia
77
What is the differences for diagnosing acute bronchitis vs. pneumonia?
On X-ray bronchitis does not show consolidation | On auscultation there are no focal changes
78
What are the features of acute bronchitis?
Fever Chesty cough Common after URTI ABs only if clinically deteriorating
79
What are the features of exacerbation of COPD?
``` Increased cough Sputum Dyspnoea No focal signs Background of COPD Usually viral pathogen ABs if > 2 episodes of worsening dyspnoea, increased sputum prulence, increased sputum volume ```
80
What are the features of CAP?
Strep Pneumoniae Inflammatory, infectious disease of lung parenchyma Clinical or radiological evidence of focal consolidation Cough, sputum, dyspnoea and pleuritic pain Fever, tachypnoea, tachycardia, consolidation, confusion
81
What are the features of abnormal pneumoniae?
``` Young adults, often travel history Constitutional symptoms 10-20 day incubation Chest signs might be absent Extra-pulmonary features common ```

Respiratory Medicine (12 decks)

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