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Endo, Cardio and Neuro > Respiratory infections > Flashcards

Respiratory infections Flashcards

1
Q

What is the typical presentation of upper respiratory tract infections?

A 
Cough
Sneezing
Runny/stuffy nose
Sore throat
Headache
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2
Q

What is the typical presentation of a lower respiratory tract infection?

A 
Productive cough
Muscle aches
Wheezing
Breathlessness
Fever
Fatigue
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3
Q

What is the typical presentation of pneumonia?

A

Chest pain
Blue tinge on lips
Severe fatigue
High grade fever

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4
Q

what are the main medical history risk factors for respiratory infection?

A 
COPD, asthma
heart disease
liver disease
diabetes mellitus
HIV, malignancy, hypertension
complement/Ig deficiencies
aspiration risk fctors
previous pneumonia
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5
Q

what are the demographic/lifestyle risk factors for respiratory infections?

A

under 2 yrs old, over 65
smoking cigarettes
excess alcohol consumption

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6
Q

what are the social risk factors for respiratory infections?

A

contact with children under 15
poverty
overcrowding

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7
Q

what are the medication risk factors for respiratory infections?

A

immunosuppressants e.g steriods
inhaled corticosteroids
proton pump inhibitors

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8
Q

what are the common bacterial causative agents? (in order)

A 
streptococcus pneumoniae
mycoplasma pneumoniae
staphylococcus aureus
haemophilus influenzae
mycobacterium tuberculosis
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9
Q

what are the common viral causative agents? (in order)

A 
human rhinovirus
influenza A/B
human metapneumovirus
respiratory syncytial virus (infancy)
coronaviruses
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10
Q

what sort of organism is streptococcus pneumoniae?

A

gram positive
extracellular
opportunistic

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11
Q

what organisms are most typical for ventilator associated pneumonia?

A

pseudomonas aerginosa

staphylococcus aureus

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12
Q

what organism represents 40-50% of community acquired pneumonia?

A

streptococcus pneumoniae

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13
Q

what are the mechanisms of damage from acute bacterial pneumonia?

A

inflammation and swelling of alveoli
cellular and extracellular infiltrate, type 1 cells damaged
therefore gas exchange barrier damaged & ineffective

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14
Q

how is bacterial pneumonia graded? in hospital

A 
CURB 65 one point for each
Confusion
respiratory rate (>30/min)
blood pressure (<90 sys/ 60 dia)
65 years or older
urea - 7mmol/L
3+ points = aggressive treatment
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15
Q

how is a CURB 65 score of 0 treated?

A

in community - amoxicillin

in hospital - doxycycline PO

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16
Q

how is a CURB65 score of 1/2 treated?

A

community - amoxicillin + clarythromycin

17
Q

how is a CURB65 score of 3-5 treated?

A

community - benzyl penicillin IV, clarythromycin oral

hospital - tazocin IV +/- gentamicin IV

18
Q

how do penicillins treat pneumonial infections?

A

beta lactams

bind to proteins in bacterial cell wall to prevent transpeptidation

19
Q

how do macrolides treat pneumonial infections?

A

bind to bacterial ribosome to prevent protein synthesis

20
Q

how do you acquire pnuemonia?

A

mostly from own microbiome
skin, gastrointestinal tract, nose, oropharynx
opportunistic pathogens

21
Q

what is the mechanism of damage for viral respiratory infections?

A

damage to epithelium - cilia loss, loss of barrier defence, chemoreceptors
mediator release
cellular inflammation
local immune memory

22
Q

how do severe viral infections develop?

A

highly pathogenic strains
host absence of prior immunity - innate immunodeficiency, T cell, B cell memory
predisposing illnesses/conditions

23
Q

how do respiratory epithelial cells protect against viral infection?

A

tight junctions - prevent systemic infection
mucous lining, cilial clearance - prevents attachment + promotes clearance
antimicrobials - recognise, neutralise, degrade pathogens and profucts
pathogen recognition receptors
interferon pathways - upregulation of anti-viral proteins and apoptosis

24
Q

what are serotypes?

A

viruses which cannot be recognised by serum/antibodies that recognise another virus - implications for protective immunity

25
Q

where in the respiratory tract is there a high frequency of IgA-plasma cells?

A

oronasopharynx

epithelial cells express poly IgA receptor allowing export of IgA to mucosal surface

26
Q

where in the respiratory tract is enriched for IgG-plasma cells?

A

alveoli/bronchioles

thin walled alveolar space allows transfer of plasma IgGs into alveolar space

27
Q

what is the immunity for influenza?

A

no reinfection by same strain

imperfect vaccines - vaccine induced immunity rapidly decreases, mainly homotypic, annual vacc required

28
Q

what is the immunity for RSV like?

A

recurrent reinfection with similar strains (2 serotypes also)
no vaccine - poor immunogenicity, vaccine enhanced disease

29
Q

what are the risk factors for RSV bronchiolitis in infancy?

A

premature birth

congenital heart and lung disease

30
Q

what are the symptoms of RSV bronchiolitis in infancy?

A 
nasal flaring
hypoxemia and cyanosis
croupy cough (barking)
expiratory wheezing, prolonged expiration
tachypnoea
chest wall retractions
31
Q

what are the supportive treatments used for viral and bacterial infections?

A 
oxygen
fluids
analgesia
nebulised saline
chest physio
32
Q

what are the prophylactic treatments for viral infection?

A

viral vector vaccines
mRNA vaccines
major surface antigen vaccines

33
Q

what are the main therapeutic treatments for viral infections?

A

anti inflammatories - dexamethasone (steroid), toclizumab, sarilumab (anti IL-6R/ anti IL-6)
anti virals - remdesivir (broad spec), paxlovid, casirivimab

34
Q

how does remdesivir act?

A

blocks RNA-dependent RNA polymerase activity

35
Q

how does paxlovid act?

A

antiviral - protease inhibitor

36
Q

how do infections and chronic lung disease interplay?

A

viral bronchiolitis associated with asthma development
rhinoviruses most common asthma and COPD exacerbations
high likelihood of secondary bacterial pneumonia after viral infection

Endo, Cardio and Neuro (22 decks)

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