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CRRAB 2 > Respiratory Infections > Flashcards

Respiratory Infections Flashcards

1
Q

Respiratory System Defenses [5]

A
  1. mucociliary lining of the nasal cavity
  2. change of direction of the airway from the sinuses to the pharynx
  3. Alveolar macrophases eliminate microorganisms in the lungs
  4. The ciliary elevator
  5. Normal Flora competition (staph aureus)
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2
Q

What anti-microbial compounds does nasal cavity mucus contain? [3]

A
  1. Lysozyme
  2. Lactoferrin
  3. IgA antibodies
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3
Q

Where is the mucociliary elevator located?

A

bronchi, bronchioles, and nose

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4
Q

What is the mucociliary elevetor composed of?

A
  1. mucus-producing goblet cells

2. ciliated epithelium

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5
Q

How does the mucociliary elevator work?

A

The cilia are continually beating, pushing mucus up and out into the throat.

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6
Q

What does smoking do to the mucociliary escalator?

A

paralyzes the cilia

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7
Q

What conditions must be true for pathogens to initiate disease? [4]

A
  1. must be sufficient dose of microorganisms
  2. infectious particles must be airborne
  3. airborne particles must be viable in the air
  4. organism must be deposited on tissue susceptible to infection in the host
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8
Q

Rhinitis (common cold): type of organism [1] and types [2]

A
  • virus

- Adenoviruses and coronaviruses

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9
Q

When does rhinitis cause cough?

A

If it infects the lower respiratory tract

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10
Q

Treatment of rhinitis?

A

supportive therapy

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11
Q

Rhinovirus structure [3] and virulence factor [2]

A
  1. SS+ (class IV) RNA virus, Nonsegmented genome
  2. non-enveloped
  3. Icosahedral nucelocapsid

Virulence factor:

  1. intracellular adhesion molecule 1 (ICAM-1) –> attached to cells in nasal passages and the pharynx.
  2. localized inflammation and lytic infection occurs resulting in ciliated epithelial cells being destroyed.

40-50% of cases

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12
Q

Coronavirus structure [3] prevalence of Rhinitis

A

SS+ (Class IV) RNA virus, nonsegmented genome

enveloped,

helical nucleocapsid

10% of cases

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13
Q

Rhinovirus disease course

A

peak symptoms at 2-5 days post infection

cells are completely regenerated by day 14 post infection

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14
Q

Influenza Virus C illness [1], structure [4]

A

causes rhinitis

SS- (Class V) RNA virus, SEGMENTED Genome

enveloped

helical nucleocapsid

orthomyxoviridae

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15
Q

Coxsackievirus A+B illness [1], structure [5]

A

Causes rhinitis

SS+ (class IV) RNA virus

non-enveloped

icosahedral nucleocapsid

picronaviridae

enterovirus

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16
Q

Paramyxovirus (parainfluenza virus) illness [1], structure [4]

A

causes rhinitis

SS- (class V) RNA Virus, NON-segmented genome

helical nucleocapsid

enveloped

parmyxoviridae

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17
Q

Mastadenovirus (adenovirus) illness [1], structure [4]

A

Causes rhinitis

DS linear DNA (group 1) DNA virus

nonenveloped

icosahedral nucleocapsid

adenoviridae

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18
Q

Most common causes of conjunctivitis [3]

A
  1. H. Influenza
  2. Adenoviruses
  3. S. pneumoniae
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19
Q

Acute rhinosinusitits pathology

A

inflammation or infection of the mucosa of the nasal passages and at least one of the paransasal sinuses that typically last no longer than 4 weeks

> 11 million cases in US each year

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20
Q

Acute rhinosinusitis sx [10]

A

sneezing

rhinorrhea

Nasal congestion with postnasal drip

aural fullness (pressure in the ear)

facial pressure

headache

sore throat

cough

fever

muscles aches

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21
Q

What do viral upper respiratory infections predispose individuals to?

A

bacterial secondary infections.

Bacterial infections can also follow dental extractions and rhinitis due to allergies

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22
Q

sinusitis (rhinosinusitis) dx

A

clinical signs and symptoms. Viral and bacterial causes are difficult to differentiate

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23
Q

How to dx bacterial rhinosinusitis in adults?

A

rhinosinusitis persisting beyond 7 days
OR
any duration of severe symptoms that include facial swelling or tooth pain

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24
Q

How to dx bacterial rhinosinusitis in kids?

A

rhinosinusitis lasting longer than 10 to 14 days
OR
any duration of severe symptoms that include a fever of >39 (>102F) with facial swelling or pain

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25
Q

What are the common causes of community acquired acute bacterial rhinosinusitis? [2] other causes? [3]

A 
common
-strep. pneumoniae
-haemophilus influenzae
others
-strep pyogenes
-staph aureus
-moraxella catarrhalis
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26
Q

What is the recommended tx for rhinosinusitis: viral and bacterial

A

Viral: symptomatic tx
Bacterial: abx tx

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27
Q

What illnesses does strep pneumoniae cause? [2]

A
  • rhinosinusitis

- pneumonia

28
Q

What illnesses does strep pyogenes cause? [2]

A
  • rhinosinusisits

- pharyngitis

29
Q

What is the most common cause of fungal sinusitis? How is it diagnosed?

A
  • Aspergillus fumigatus

- identified after antibacterial drugs fail to clear the sinus infection

30
Q

How is fungal sinusitis treated in immunocompromised individuals?

A

mechanical removal of fungal pathogen

31
Q

What are the symptomatic treatments for viral sinusitis? [3]

A
  • oral hydration with nasal saline washes and steam (this is evidence based)
  • acetaminophen and decongestants
  • mucolytics
32
Q

What are the antibiotic treatments for bacterial sinusitis? [2]

A

1st line: amoxicillin (augmentin)
or
azithromycin

33
Q

What is the most common bacterial cause of acute pharyngitis?

A

strep pyogenes

34
Q

Bacterial pharyngitis (Strep pyogenes) virulence factors [6]

A

attaches to mucosal epithelial cells using its:

  • M protein (counteracts host defenses)
  • lipoteichoic acid
  • fibronectin-binding protein (protein F)
  • Capsule is composed of hyaluronic acid (HA) which prevents phagocytosis by macrophages
  • protease (hydrolizes peptide bonds)
  • hylauronidase (allows bacterial to use hyaluronan as a carbon source)
35
Q

Sx unique to viral pharyngitis [5]

A
  • conjunctivitis
  • cough
  • hoarseness
  • imflammation of the mucus membrane
  • diarrhea
36
Q

sx unique to bacterial pharyngitis [7]

Are these sx confirmatory for strep pyogenes?

A
  • fever***
  • sudden onset of severe pain upon swallowing***
  • headache
  • nausea
  • vomiting and abdominal pain may be present
  • Red tonsils with or without exudate***
  • enlarged cervical lymph nodes***

No

37
Q

How is strep pyogenes dx?

A

rapid strep test (antigen detection)

strep pyogenes cultures are the most accurate way to definitively diagnose these infections but can take 1-2 days

38
Q

How to tx strep pyogenes?

A

penicillin

or erythromycin (of penicillin allergy)

39
Q

How to tx viral pharyngitis?

A

supportive care

acetaminophen and warm saline garlgles are suggested

40
Q

Strep pyogenes structure [5]

A

Gram +

Cocci

Catalase -

Beta hemolytic

bacitracin sensitive

41
Q

What else can strep pyogenes cause? [3]

A
  • rheumatic heart disease
  • glomerulonephritis
  • scarlett fever
42
Q

Why does strep pyogenes cause scarlet fever? [3]

A

by secreting ssa, speA, and speC exotoxins.

These toxins are superantigens

strawberry tongue

43
Q

How does strep pyogenes get rid of oxygen radicals since it is catalase -?

A

By using peroxidase

O2 + H2O2 –> +NADH2 –>2H2O +NAD

44
Q

What other bacteria can cause pharyngitis?

A

corynebacterium diphtheriae (diptheria)

45
Q

What symptom is unique to pharyngitis caused by diptheria? [1]

A

thick grey membrane covering back of throat

46
Q

How is diptheria spread?

A

by inhilation or thorugh contaminated objects and surfaces. Individuals can to asymptomatic carriers

47
Q

Diptheria structure [4]

A

Gram +

Bacilli

non-spore forming

non-motile

48
Q

Diptheria virulence factor

A

A-B exotoxin

A = active
B= binding

the B part of toxin binds to cell membrane and inserts A part into the cell

49
Q

How is diptheria prevented?

A

via DTaP vaccine

50
Q

Viral croup (laryngotracheobronchitis sx? [4]

A

“bark-like” cough
fever of 38-39C (100.4 - 102.2F)
restlessness
SOB

51
Q

Viral croup disease course-adult?

A

begins with a mild URI with general cold-like symptoms and cough that lasts 2-3 days

that is followed by a harsh, bark-like cough. Respiratory stridor (noisy breathing) usually occurs at night and can wake patient

52
Q

Viral croup disease course - child?

A

have primarily inspiratory stridor at rest with nasal flaring and suprasternal and intercostal retractions.

Lethargy or agitation may be a result of hypoxemia.

Other warning signs are tachypnea (abnormally rapid breathing) out of proportion to presence of fever, lethargy, pallor, and hyptonia (decreased muscles tone).

Cyanosis is a late and ominous sign. Croup symptoms usually peak over 3-5 days and resolve within 4-7 days

53
Q

How is croup spread?

A

person-to-person

54
Q

Children are the most susceptible group to viral croup? which sex is more vulnerable and what age range?

A

boys

6 months to 3 years

55
Q

What are the complications from croup? [5]

A
  • crusty exudates resulting from obstruction of the airways
  • segmental atelectasis
  • pneumothorax
  • obstructive mediastinal emphysema
  • bronchopenumonia
56
Q

What are the most common causative agents of croup?
When are they active?
[3]

A

Parainfluenza virus (any time of year)

Influenza virus (more in winter/early spring)

Respiratory syncytial virus (more in winter/early spring)

57
Q

typical Croup tx?

A

typically self-limiting so sx therapy

58
Q

moderate to severe cases of croup tx? [2]

A

corticosteroids and nebulized epinephrine

oxygenation with ventilation support in the case of severe respiratory distress

59
Q

Respiratory syncytial virus structure RSV [5]

A

SS- (class V) RNA virus, Non-segmented linear

enveloped

helical nucleocapsid

paramyxoviridae

pneumovirus

60
Q

What is respiratory syncytial virus (RSV) the most common cause of?

A

pneumonia in young children

61
Q

What is distinct about respiratory syncytial virus (RSV) histologically?

A

multinucleated cell that can result from multiple cell fusions of uninuclear cells

62
Q

who gets Epiglottitis?

A

children

63
Q

What causes epiglottitis? [2]

A

beta hemolytic strep - group A is most frequent but also group B and C.

Haemophilus influenzae tybe b (Hib)

64
Q

Epiglottitis tx? [2]

A

***if respiratory distress is present, 1st priority is to secure the airway

broad spectrum second and third generation cephalosporins in combination with penicillinase-resistant penicillin is typical empiric therapy.

65
Q

How do you differentiate epiplottitis and croup? [2]

A

Onset: sudden for epiglottitis, gradual for croup

Drooling: present in epiglottitis, absent in croup

CRRAB 2 (12 decks)

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