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3RD YEAR - Infectious Diseases > Respiratory Infections > Flashcards

Respiratory Infections Flashcards

1
Q

What is croup?

A

AKA laryngotracheobronchitis

This is a type of URTI usually caused by a virus, that causes a ‘barking’ cough, stridor and a hoarse voice. It usually only lasts 1 or 2 days

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2
Q

Name some signs of consolidation

A
  • Increased vocal resonance
  • Bronchial breathing
  • Crackles on auscultation
  • Dull on percussion
  • Reduced chest expansion on affected side
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3
Q

How can strep. pneumonia be classified?

A

GRAM POSITIVE DIPLOCOCCI

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4
Q

What are the main organisms causing typical community-acquired pneumonia?

A
  1. Strep. pneumonia
  2. H. influenzae
  3. Morazella catarhallis
  4. Klebsiella
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5
Q

What are the main organisms causing atypical community-acquired pneumonia?

A
  1. Mycoplasma (particularly in young)
  2. Chlamydia
  3. Legionella
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6
Q

What are the symptoms of typical pneumonia?

A

Pyrexia, tachycardia, pleuritic pain, severe SOB, painful cough with rusty sputum

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7
Q

What are the symptoms of atypical pneumonia?

A

Moderate fever, relative bradycardia, no pleurisy, variable consolidation, dry cough

(also may have diarrhoea, erythema multiform, myalgia etc)

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8
Q

What is nosocomial pneumonia and how is it caused?

A

Hospital-acquired pneumonia (48h after admission), caused by:

  • Oropharyngeal colonisation
  • Predispositions eg. antacids, antibiotics, biofilms
  • Ventilator associated e.g. pseudomonas aeruginosa, S.aureus
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9
Q

How can pneumonia be diagnosed clinically?

A
  1. Cough, fever and at least 1 other LRTI symptom
  2. New focal signs on chest exam (or radiographic features if CXR available)
  3. No other explanation for illness
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10
Q

How is the severity of CAP assessed using a specific tool?

A

CURB65
C - new onset confusion (AMTS score less than 8/10)
U - urea > 7mmol/l
R - respiratory rate > 29/min
B - diastolic blood pressure <60mmHg or SBP<90mmHG
Aged over 65

ALSO, hypoxaemia (<90%02), involvement of 2 or more lobes, and pre existing disease

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11
Q

How is CAP treated? (CURB65 3-5)

A

Amoxicillin (covers pneumococcus) and clarithromycin (covers atypical pathogens)

If staphylococcus is suspected, add flucloxacillin

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12
Q

How is severe CAP with sepsis treated ?

A

Pip/tazo - tazo is a beta lactamase inhibitor so allows a dual action

Under new guidelines:
Co-amoxiclav IV
Clarithromycin IV

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13
Q

How is HAP treated?

A

Pip/tazo

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14
Q

What are the symptoms of bronchitis?

A

Cough & other upper airway symptoms

NB - no consolidation on CXR

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15
Q

Is bronchitis usually viral or bacterial?

A

Viral - seldom needs hospital admission

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16
Q

What is the difference between bronchitis and bronchiectasis?

A

Bronchiectasis is a CHRONIC condition, due to repeated lung infections, causing irreversible WIDENING of the bronchi.
Bronchitis is inflammation of the bronchi, causing NARROWING.

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17
Q

Which diseases are associated with bronchiectasis?

A 
Cystic fibrosis
Youngs syndrome
Pneumonia
Immunodeficiency
Rheumatological diseases
IBD
Bronchial obstruction and infection - TB
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18
Q

What are the symptoms of a lung abscess?

A

Weight loss, fever, non-specific
Clubbing
Commonly presents after pneumonia

Looks like an egg-shaped mixture of pus and gas on CXR

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19
Q

How is a lung abscess treated?

A

DRAIN FIRST

Then 8 weeks or more broad-spectrum abx

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20
Q

What is an empyema?

A

Pus in the pleural space that needs draining

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21
Q

What causes TB?

A

Mycobacterium tuberculosis

22
Q

What percentage of people exposed and infected by TB will develop primary TB?

A

5%, the other 95% will have latent TB which will then reactivate

23
Q

What are the symptoms of TB?

A

EARLY - Weight loss, fatigue, night sweats
LATE - Cough, haemopytsis, breathlessness, chest pain
MUCH LATER - bronchiectasis, fibrosis

You can get extra pulmonary features but these are much more likely in the IMMUNOSUPPRESSED

24
Q

How is active TB investigated?

A

Chest X-ray (shows little, except miliary TB is dispersed)
Histology (caseating granuloma)
Microscopy and sputum culture (acid fast bacilli on ziehl-nielsen stain)
Contact tracing

25
Q

How is latent TB tested?

A

Interferon-gamma release assays - skin test

26
Q

Why does secondary TB occur in the immunosuppressed?

A

Normally the immune response keeps the mycobacteria inside the granuloma, but when it breaks down the bacteria is released and proliferates

27
Q

How is active TB treated?

A

4 antibiotics (RIPE):

  • Rifampicin (6 months)
  • Isoniazid (6 months)
  • Pyrazinamide (2 months)
  • Ethambutamol (2 months)

NB - after 2 weeks they won’t be contagious anymore

28
Q

What is the prophylactic treatment of TB?

A

BCG, attenuated strain of bacteria (following mantoux test)

29
Q

In which case is a patient likely to get military TB?

A

Immunosuppressed at time of infection - they are unable to control the bacteria so it disperses.

30
Q

How is CAP (CURB65 0-2) treated ?

A

Amoxicillin oral/IV

31
Q

What are the core symptoms of epiglottitis?

A 
Sore throat
Breathlessness, that is eased on sitting forward
Drooling
Stridor
Pain on swallowing 
Fever
32
Q

Epiglottitis is a medical emergency - what should be done?

A

A-E assessment; if acute airway obstruction call an anaesthetist to INTUBATE the patient for O2 delivery.
NB - dont put in airways, they won’t work, and dont give a mask to a child as it will frighten them

After this, do Xray and give broad spectrum abx

33
Q

What organism usually causes a sore throat

A

Strep A (pyogenes)

34
Q

What organism usually causes epiglottitis?

A

Haemaphilius Influenzae B (Hib)

35
Q

Which organism is most likely to cause empyema?

A

Klebsiella

36
Q

If you suspect an empyema in the lungs, what investigations should be performed?

A

Before draining the empyema you must do:

  • Ultrasound to look at site and amount of pus
  • FBC (esp clotting factors and platelets) prior to needle insertion

After draining, give IV antibiotics

37
Q

Which risk factors in a patient make them more likely to have pneumonia caused by klebsiella?

A

Diabetes
Alcohol excess
Immunocompromised

38
Q

If a pleural effusion contains transudate what does this mean?

A

Transudate = low protein = disturbances in pressure caused by organ failure

39
Q

If a pleural effusion contains exudate what does this mean?

A

Exudate = high protein = leaky capillaries from inflammation

40
Q

Below what pH pleural fluid is empyema suspected?

A

7.2

41
Q

What is aspiration pneumonia?

A

Bronchopneumonia that develops due to the entrance of foreign materials into the bronchial tree,[1] usually oral or gastric contents (including food, saliva, or nasal secretions)
It is often caused by an incompetent swallowing mechanism, such as occurs in some forms of neurological disease or injury including multiple sclerosis, CVA (stroke), Alzheimer’s disease or intoxication. An iatrogenic cause is during general anaesthesia for an operation and patients are therefore instructed to be nil per os (abbrev. as NPO), i.e. nothing by mouth, for at least four hours before surgery.

42
Q

If a patient with COPD is not responding to oxygen, what step should be taken?

A

Non-invasive ventilation

43
Q

What is the treatment for acute exacerbation of COPD?

A

1st line - Doxycycline for 5 days

2nd line - Trimethoprim for 5 days

44
Q

What are the CENTOR criteria

A

A patient is likely to have bacterial tonsillitis if they have 3/4 of:

  • Tonsillar exudate
  • Tender glands
  • Absence of cough
  • Fever >38C
45
Q

When should a sputum sample be taken from a patient with suspected TB?

A

Morning

46
Q

What is lobar pneumonia and what are the risk factors?

A

Unilateral pneumonia, limited by anatomical boundaries, that starts distally and spreads inwards
RF: males, middle age, healthy

47
Q

What is the most common pathogen in lobar pneumonia?

A

Strep. pneumonia

48
Q

What is bronchopneumonia and what are the risk factors?

A

Bilateral patchy pneumonia around the small airways, not limited by anatomical boundaries
RF: extremes of age

49
Q

What are the most common pathogens in bronchopneumonia?

A

Strep. pneumonia, H. influenza, Staph. aureus

50
Q

What are the stages of lobar infection by strep. pneumonia?

A
  1. Congestion - lung parenchyma is partially consolidated with fluid, vascular enlargement
  2. Red hepatization/consolidation - red blood cells, neutrophils and fibrin form an exudate that fills the alveolar space
  3. Grey hepatization - red cells leave, but others stay
  4. Resolution - exudate cleared by macrophages and cough
51
Q

What is consolidation?

A

When alveoli are filled with the products of disease (exudate), rather than air

52
Q

What are the complications of pneumonia?

A
  • Respiratory failure
  • Hypotension (due to dehydration and vasodilatation)
  • Atrial fibrillation (temporary)
  • Pleural effusion (fluid exudation into pleural space)
  • Empyema
  • Lung abscess
  • Sepsis

3RD YEAR - Infectious Diseases (16 decks)

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