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Respiratory Medicine > Respiratory Infections > Flashcards

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
Q

What are typical CAP organisms?

A

Strep pneumoniae
HiB
Staph A
Klebsiella pneumoniae

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26
Q

What are atypical CAP organisms? (Atypical presentations)

A

Mycoplasma pneumonia (young person/close contact)

Legionella pneumophilia
(faulty AC - hypoNA, abnormal LFTs)

Chlamydia psittaci
(HIV, birds)

Chlamydia pneumoniae
Coxiella burnetti
Pneumocystis jirovecli

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27
Q

What are common causative organisms for HAP?

A 
Staph A (IV drug use)
Pseudomonas aeruginosa
Klebisella (chronic alcoholic)
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28
Q

Which organisms can cause cavitating lung lesions seen on CXR?

A

Staph

Klebsiella

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29
Q

What type of bacteria is strep?

A

Gram +ve cocci

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30
Q

What are the symptoms of atypical pneumonia?

A

Dry cough

Extra-pulmonary symptoms
Low grade fever
Headache
Diarrhoea
Myalgia
Hepatitis
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31
Q

What is seen on a CXR in pneumonia?

A

Alveolar opacification
Air bronchograms
Consolidation

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32
Q

What are the empirical ABs used in CA pneumonia?

A

Amoxcillin (typical cover)
Clarithromycin (atypical cover, if penicillin allergy)
Doxycycline (if penicilin allergy)

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33
Q

What are the empirical ABs used in HA pneumonia?

A

1st line - Co-amoxiclav
MRSA: IV Vanc

Aspiration: Amoxicillin + Metronidazole

34
Q

What is bronchiectasis?

A

Chronic lung condition

Irreversible dilation of bronchi and bronchioles

35
Q

What are common causes bronchiectasis?

A

TB most common worldwide

Cystic Fibrosis most common in the western world

36
Q

What are some other causes of bronchiectasis?

A 
Post-infection
Chronic aspiration e.g. GORD, Dysphagia
Chronic inflammation
e.g. RA, IBD
Immunodeficiency

Congenital

Underlying condition e.g. Asthma, COPD, ILD

37
Q

What rare syndrome is associated with bronchiectasis?

A

Kartagner’s syndrome

triad = bronchiectasis, sinusitis, situs inversus

38
Q

What are the symptoms of bronchiectasis?

A

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
Q

What are clinical signs associated with bronchiectasis?

A

Clubbing

Coarse crackles in lower lung zones

40
Q

What are the 7 respiratory causes of clubbing?

A 
Bronchiectasis
Lung Cancer 
TB
ILD
Lung abscess
Emphysema
Cystic Fibrosis
41
Q

What are the investigations for bronchiectasis?

A

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
Q

What is seen on a HRCT in bronchiectasis?

A

Signet ring sign

43
Q

What is the conservative management for bronchiectasis?

A

Importantly, Airway clearance:

  • Chest physio (nebulized saline, oscillation devices)
  • Postural drainage

Also:

  • Exercise + Diet
  • Vaccinations
  • Smoking cessation
  • Airway clearance
44
Q

What is the pharmacological management for bronchiectasis?

A

Steroids/Bronchodilators
IV ABs for acute exacerbation
If pseudomonas –> ciprofloaxcin
*be careful of achilles tendon rupture

45
Q

What is TB?

A

Chronic infectious disease
Affects multiple organs
Caused by myobacterium tuberculosis

46
Q

Where in the lungs is TB most common?

A

Upper lobes

More well ventilated

47
Q

What are the two forms of TB?

A

Latent - TB contained in ‘caseating granulomas’
Can switch if immunocompromised or with age

Active - transmissible and requires treatment

48
Q

What are RFs for TB?

A 
HIV
Immunosuppressive meds
Overcrowding
Homelessness
Africa/South Asia
Travel
49
Q

What are the pulmonary symptoms of TB?

A 
Productive cough
Dyspnoea
SOB
Late stages - Haemoptysis 
Pleural effusion
50
Q

What are the constitutional symptoms of TB?

A

FLAWS
Lymphadenopathy
Erythema Nodosum

51
Q

What is erythema nodosum?

A

Erythema nodosum is swollen fat under the skin causing bumps and patches that look red or darker than surrounding skin

52
Q

What other condition is erythema nodusum seen in?

A

IBD

53
Q

What are some symptoms of extra-pulmonary TB?

A 
Meningitis
Periotonitis
Ascites
Pericardial effusion
Constrictive pericarditis
Normocytic anaemia
Pott's disease
Spinal cord compression
Infertility
Addison's 
Sterile pyuria
54
Q

What investigations are done in TB?

A

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
Q

What is seen on a CXR in TB?

A

Bi-hilar lymphadenopathy
Consolidation (patchy/heterogenous)
Upper lobe scarring
Cavitating lesions

56
Q

What would be found on a lymph node biopsy in TB?

A

Casseating granulomas

57
Q

What conditions cause non-casseating granulomas?

A

Crohn’s

Sarcoidosis

58
Q

How do you test for latent TB?

A

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
Q

What is milary TB and what is seen on a CXR?

A

Nodular shadowing

Dissemination of TB throughout body

60
Q

What medications are used to treat TB?

A

RIPE

Rifampicin
Isonazid
Pyrazinamide
Ethambutol

R+I for 6 months
P+E for 2 months

61
Q

What are the side effects of the TB drugs?

A

Rifampicin - Red/Orange secretions

Isoniazid - Peripheral neuropathy + Vitamin B6 deficiency

Pyrazinamide - Hyperuricaemia (gout)

Ethambutol - Eye, RG colour blindness

62
Q

What is acute brochitis?

A

Self-limiting chest infections
Results from inflammation of the trachea and major bronchi
Usually resolves in 3 weeks

63
Q

How do patients with acute bronchitis present?

A 
cough: may or may not be productive
sore throat
rhinorrhoea
wheeze
\+/- low grad fever
normal chest exam
64
Q

How do you differentiate between acute bronchitis and pneumonia?

A

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
Q

What are the investigations done for acute bronchitis?

A

Clinical diagnosis

CRP high if available can guide whether or not to use ABs

66
Q

What is the management for acute bronchitis?

A 
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
Q

What are characteristic features of influenza infection?

A

Upper and Lower respiratory tract symptoms

  • Rhinorrhea
  • Cough
  • Fever
  • Chills
  • Headache
  • Myalgia
68
Q

How is influenza diagnosed?

A

Clinically

69
Q

How is influenza managed?

A

Anti-pyretic/Analgesia e.g. paracetamol or ibuprofen

70
Q

What are differentials for a generally dry acute cough?

A 
COPD exacerbation
Acute pulmonary odema
Lower respiratory tract infection
Rhinitis/Sinusitis
Drug induced e.g. ACEi
71
Q

What are differentials for an acute productive cough?

A

Lower resp
COPD excerbation
Exacerbation of bronchiectasis
TB

72
Q

What are differentials for a generally dry chronic cough?

A

COPD
Poorly controlled asthma
GORD
Lung cancer

73
Q

What are differentials for a productive chronic cough?

A

Bronchiectasis
Lung cancer
TB
Recent aspiration

74
Q

What life threatening differentials are you thinking about with an acute cough?

A

Acute exacerbation of COPD
Lower resp infection
Acute pulmonary oedema
Always think pneumothorax or PE even though cough is rare

75
Q

What is a sub-acute cough? Causes?

A

3-8 weeks
Post-infectious cough
New med e.g. ACEi (ramipril)

76
Q

What are different terms that fall under the umbrella term

A

Acute bronchitis
Exacerbation of COPD
CAP
Atypical pneumonia

77
Q

What is the differences for diagnosing acute bronchitis vs. pneumonia?

A

On X-ray bronchitis does not show consolidation

On auscultation there are no focal changes

78
Q

What are the features of acute bronchitis?

A

Fever
Chesty cough
Common after URTI
ABs only if clinically deteriorating

79
Q

What are the features of exacerbation of COPD?

A 
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
Q

What are the features of CAP?

A

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
Q

What are the features of abnormal pneumoniae?

A 
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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