Respiratory infections

Question 1

What are the classic symptoms of respiratory tract infections?

Answer 1

Coryza, rhinorrhea – Sore throat, sneezing, cough

Question 2

Define coryza.

Answer 2

Acute inflammation of the mucous membranes, marked by sneezing, lacrimation, and profuse secretion of watery mucus; usually associated with infection by one of the common cold viruses of acute allergic rhinitis.

Question 3

What are the treatments of the common cold?

Answer 3

Self-limiting – No role for cough syrup – Avoid antibiotics – Avoid aspirin in children (Reye’s syndrome)

Question 4

What are some key features of pharyngitis?

Answer 4

90% (A-G)

90% viral

A group strep

Beta heamolytic

CENTOR score

Diptheria

Exudate

FeverPain

Glomerularnephritis post-strep

Question 5

What are the complications of group A strep?

Answer 5

Question 6

How is group A strep tested for?

Answer 6

Lancefield classification for capsular antigen

Beads on a string

Question 7

What % of sore throat/ pharyngitis is viral?

Answer 7

90%

Question 8

What is the 4 Ts centor score and feverpain score testing?

Answer 8

For bacterial infection = 4Ts

Temperature

Tonsilar exudate

Tender lymph nodes

Time

Question 9

How to manage a sore throat?

Answer 9

Gargle salty water

Drink plenty of water

Eat cool and soft foods

Take paracetemol and aspirin (unless under 16 - Reye’s)

Avoid smoking

Rest

Question 10

How else can you disntinguish between sore throat being viral or baceterial?

Answer 10

The virus will cause coryza

The bacteria just stays in the throat

Yellow sputum

Question 11

What other bacteria cause pharyngitis?

Answer 11

 Corynebacterium diphtheria  Group C & G strep  Fusobacterium necrophorum

Question 12

What is Lemierre’s syndrome?

Answer 12

Lemierre’s syndrome refers to infectious thrombophlebitis of the internal jugular vein.[2] It most often develops as a complication of a bacterial sore throat infection in young, otherwise healthy adults. The thrombophlebitis is a serious condition and may lead to further systemic complications such as bacteria in the blood or septic emboli.

Lemierre’s syndrome occurs most often when a bacterial (e.g., Fusobacterium necrophorum) throat infection progresses to the formation of a peritonsillar abscess.

Question 13

What is a mneumonic for the FEVERpain score?

Answer 13

Tonsils purulent

Inflamed tonsils

Fever

In 3 days

No cough or coryza

Question 14

What are the complications of strep throat?

Answer 14

PQRS. Post-streptococcal glomerulonephritis, quinsy, rheumatic fever, scarlet fever.

Question 16

How can post-streptococcal glomerulonephritis be detected?

Answer 16

ASOtitre

Question 17

What is ASOtitre?

Answer 17

anti-streptolysin O titre

Question 18

Where is diptheria more common?

Answer 18

Eastern Europe and Bangladesh

Question 19

What are some effects of diptheria?

Answer 19

Stridor

Question 20

How might diptheria be managed?

Answer 20

Penicillin or erythromycin

Tracheostomy

Question 21

What are some key features of infectious mononucleosis?

Answer 21

Caused by EBV

Lasts for + 1 month

No contact sports allowed for 6 months

Amoxicclin can cause rash

Malaise cough fever lymph nodes

EBV

Question 22

Differentials for sore throat?

Answer 22

Laryngotracheitis/ croup

Influenza

Mononucleosis

Strep throat

Diptheria

Whooping cough

Question 23

What causes croup?

Answer 23

RSV and parainfluenza

Question 24

What are some breathing sounds linked to croup?

Answer 24

Stridor - windy sound

Croup cough - barking seal

Question 25

How is croup treated?

Answer 25

Dexamethasone

Question 26

What is shown here?

Answer 26

Steeple's sign

Question 27

What is bronchiolitis?

Answer 27

Inflammation of the bronchioles – Very common in childhood, mostly mild  Organism: viruses – 70% RSV  Epidemics in winter  Highest cause of admission 2 have antibodies (ie. have been infected)  Diagnosis – X-ray generally normal – Nasopharyngeal aspirate/swab  PCR for viral RNA

Question 28

What pathogens may cause exacerbation of COPD?

Answer 28

Organisms; – Viruses 20-40%  Rhino/RSV/flu/adeno – Bacteria 30-50%  Strep pneumo, haemophilus  Moraxella catarrhalis  Ecoli, klebsiella

Question 29

How do you treat an exacerbation of COPD?

Answer 29

Management – Bronchodilators: salbutamol & ipratropium – Steroids: prednisolone 5 days – Consider antibiotics  Amoxicillin, doxycycline  Prevention – Regular inhalers  Compliance and technique – Vaccines  Influenza  Pneumococcal – Smoking cessation  Even once COPD established

Question 30

What is bronchiolitis?

Answer 30

 Inflammation of the bronchioles – Very common in childhood, mostly mild  Organism: viruses – 70% RSV  Epidemics in winter  Highest cause of admission 2 have antibodies (ie. have been infected)

Question 31

How is early HAP treated vs late HAP?

Answer 31

 Early HAP: Co-amoxiclav  Late HAP: Piperacillin-tazobactam

Question 32

What are some causes of aspiration pneumonia?

Answer 32

Impaired swallow/gag reflex – Due to stroke, dementia, MND – Saliva, secretions, gastric contents – Chemical pneumonitis +/- infection – Recurrent: causes lobar bronchiectasis

Question 33

Features of bronchiectasis?

Answer 33

Question 34

Who is most at risk from bronchiectasis?

Answer 34

Question 35

What are the stages of whooping cough?

Answer 35

Question 36

What is pleural empyema?

Answer 36

Pleural empyema is a collection of pus in the pleural cavity caused by microorganisms, usually bacteria.[1] Often it happens in the context of a pneumonia, injury, or chest surgery.[1] It is **one of the various kinds of pleural effusion**. There are three stages: exudative, when there is an increase in pleural fluid with or without the presence of pus; fibrinopurulent, when fibrous septa form localized pus pockets; and the final organizing stage, **Thoracentesis \<7.2 USS gudance**

Question 37

What are the most common HAP infections?

Answer 37

Staph/ step/ stenotrophomonas Pseudomonas Acinetobacter Carbamenemases producing enterobacter (CPE) E.coli and klebsiella

Question 38

What is the treatment for TB?

Answer 38

Question 39

What pathogen is stained with an inidian ink stain?

Answer 39

Question 41

What are the treatments for (i) strep a, (ii) HAP, (iii) fungal infections and (iv) TB?

Answer 41

Strep - phenoxymethylpenicillin or clarithrumycin HAP - Co-amxoclav or later tazozam and pioercillin Fungal infections - co-trimexazole TB - 2 months RIPE, 4 months RI