Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Respiratory > Respiratory infections > Flashcards

Respiratory infections Flashcards

1
Q

What is coryza? viral or bacterial? spread by? what organisms?

A

Common cold:mild fever/sore throat

  • viral infection nasal passages: adenovirus, rhinovirus, RSV
  • spread by droplets and formites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is acute sinusitis usually preceded by? what does it cause? viral or bacteral? treatment?

A
  • Preceded by a common cold
  • purulent nasal discharge
  • viral aetiology
  • self limiting: 10 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is diptheria? caused by? what is characteristic? other clinical features?

A
  • infection caused by bacterium Corynebacterium diphtheriae.
  • Signs and symptoms may vary from mild to severe
  • life threatening due to toxin production
  • characteristic ‘pseudomembrane’
  • sore throat/fever/barking cough/swollen neck due to lymph nodes
  • vaccination in UK
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Acute bronchitis:

  • preceded by?
  • clinical features?
  • treatment?
A
  • preceded by common cold
  • productive cough, minority have fever, may have transient wheeze
  • supportive tx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the clinical features (5) of an acute exacerbation of COPD? What clinical signs are seen?(5)

A

Usually preceded by upper respiratory tract infection

Increased sputum production

Increased sputum purulence

More wheezy

Breathless

OE:
Respiratory Distress
Wheeze
Coarse crackles
May be cyanosed
In advanced disease – ankle oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the management for an acute exacerbation of COPD? when to admit?

A
  • Antibiotic: 1st line amox. 500mg TDS for 5 days, 2nd line Doxy. 200mg OD for 1st day and then 100mg OD for further 4 days
  • Bronchodilator inhalers
  • Short course of steroids in some cases

Admit if:

  • evidence resp. failure
  • not coping at home
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the CURB65 severity score?

A 
C  	New onset of confusion
U  	Urea >7
R  	Respiratory rate >30/min
B  	Blood pressure Systolic <90  OR  Diastolic <61
65 	age 65 years or older

Score 1 for each

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the treatment for community acquired pneumonia?

A

CURB65:
0-2: amox. 1g TDS IV/PO 5days or doxy 200mg day 1 then 100mg OD (IV clarith. if NBM)

3-5 (severe): Co-amox IV 1.2mg TDS + doxy. 100mg PO BD

if in ICU:
Co-amoxiclav IV 1.2g tds + Clarithromycin IV 500mg bd

Severe - If penicillin allergic: IV Levofloxacin 500mg bd

Step down to Doxycycline 100mg bd for all
patients with severe CAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are 3 clinical complications of pneumonia?

A
  • respiratory failure
  • pleural effusion
  • empyema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the aetiology for:
Classical flu
Flu-like illnesses
Bacterial cause - is this a primary cause for flu?

A

Classical:

  • influenza A
  • influenza B

Flu-like:

  • parainfluenza
  • many others

Haemophilus influenza:
-not a primary cause of flue but may be a secondary invader

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the transmission of flu?

A

Droplets/resp. secretions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the four complications of flu?

A

Primary influenzal pneumonia:

  • seen most during pandemic years
  • can be disease of young adults
  • high mortality

Secondary bacterial pneumonia:
-more common in infants/elderly disabled/pre-existing disease/pregnant women

bronchitis

otitis media

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is influenza infection during pregnancy assoc. with? (4)

A
  • perinatal mortality
  • prematurity
  • smaller neonatal size
  • lower birth weight
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Flu treatment

A

supportive, paracetamol, fluid, bed rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How can you detect influenza virus?

A

PCR:
-nasopharyngeal swabs in virus transport medium

Antibody detection:

  • other hospitals
  • often retrospective
  • may need paired acute and convalescent bloods
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the main differences between the killed flu vaccine and the live attenuated vaccine:

  • what do they contain?
  • who recieves either vaccine?
  • administered?
A

Killed vaccine
currently contains 2 different influenza A viruses and one influenza B virus
given annually to adult patients at risk of complications
given to health care workers
Given to children aged 6 months to 2 years at risk of complications

Live attenuated vaccine
Also contains 3 viruses
More effective than killed vaccine in children aged 2-17
Offered this year to ALL children aged 2-5, and all primary school children
Administered intra-nasally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How effective is flu vaccine?

A

no more than 70% effective at preventing clinical disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Are antivirals ever used after a contact with flu?

A

-rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the usual bacterial organisms found for:

  • mild/moderate pneumonia
  • severe pneumonia

What is important to remember for pneumonia post flu?

A

Mild/moderate:

  • strep. pneumoniae
  • haemophilus influenzae
  • staph. aureus

Severe pneumonia:
as above but possible coliforms and atypicals such as:
m. catarrhalis, Mycoplasma pneumoniae, Legionella pneumophilia, Chlamydophila pneumoniae & Chlamydophila psittaci

Remember Staph aureus
pneumonia post influenza and the PVL producing strains of Staph aureus that can produce severe pneumonia in children and young adults especially

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What bacterial organisms can be seen in hospital acquired pneumonia?

A

-strep. pneumoniae,
Haemophilus influenzae
and coliforms.
Legionella can be hospital acquired.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What coliforms can cause pneumonia? what are the risk factors for this?

A 
Klebsiella
    Escherichia coli
    Enterobacter
    Proteus
    Pseudomonas aeruginosa
  • debilitated
  • chronically ill
  • alcoholism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What type of pneumonia is seen in those with immune defects and anatomical abnormalities (4)

A

Opportunistic pathogens

-Fungal pneumonia: Candida spp. causing candidiasis.
Aspergillus spp. causing aspergillosis.
Mucor spp. causing mucormycosis.
Cryptococcus neoformans causing cryptococcosis.
recurrent pneumonia
Pneumocystis jiroveci pneumonia (PJP), formerly known as Pneumocystis carinii pneumonia (PCP) - one of the most frequent and severe opportunistic infections in people with weakened immune systems.

Protozoa:
cryptosporidia, toxoplasma

Virus:
cytomegalovirus - CMV

Opportunistic bacteria (as well as virulent infection with common organism e.g. TB):
Mycobacterium avium intracellulare
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How can you diagnose community acquire pneumonia?

A

Sputum culture - purulence/viral PCR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which viruses can cause community acquire pneumonia?

A 
Flu A/B
Rhinovirus
RSV
Human metapneumovirus (hMPV)
Parainfluenza 1-4
Adenovirus
Coronaviru
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Describe the clinical features of legionella pneumonia
Flu like illness which may progress to a severe pneumonia, with mental confusion, acute renal failure and GI symptoms. Mortality 5-30%
26
How is legionella spread?
water droplets
27
What are the risk factors for legionella (2)?
- exposure of contaminated aerosolised water | - impaired immunity: >55yo, diabetes, smoking, malignancy, altered immunity
28
How is legionella pneumonia diagnosed?
-Legionella urinary antigen Detects serogroup 1 only -Culture Slow on selective media -Paired serology Rise in titres Now PCR available direct from Sputum
29
What is the antibiotic treatment for legionella pneumonia?
- clarythromycin, erythromycin | - quinolones (e.g. levofloxacin)
30
What is the treatment for severe vs non-severe aspiration pneumonia?
Severe: -IV amox + met + gent (if penicillin allergic change amox to co-trimoxazole) step down to: PO co-trim. + metronidazole (total IV/PO 7 days) Non-severe: -PO amox + metronidazole 5 days
31
What organisms can cause exac. of COPD?
Haemophilus influenzae & Moraxella catarrhalis (gram -ve coccus), Streptococcus pneumoniae (gram +ve diplococci), Gram-negatives & others
32
What is the treatment for COPD exac.?
Only treat if increase in sputum purulence or new CXR changes or pneumonia Empiric treatment as per NHST policy 1st line Amoxicillin 500 mg TDS (5 days) 2nd line Doxycycline 200mg D1 > 100 mg D2-5 Aim to cover in 1st instance H. influenzae, M. catarrhalis & S. pneumoniae
33
What is the diagnosis for pneumocystis pneumonia?
BAL > Sputum > Gargle Microscopy: Immunofluorescence PCR
34
What is the difference between pneumocystis pneumonia in a patient with HIV vs non-HIV
General: fever, dry cough, shortness of breath, and fatigue HIV: sub-acute, low grade fever > severe pneumonia Non-HIV: more acute, higher fever
35
What is the treatment for pneumocystis pneumonia?
co-trimoxazole
36
what is the difference of aspergillus pneumonia in immunocompromised vs immunocompetent patients?
Immunocompromised/suppressed patients Severe pneumonia and invasive disease. Immunocompetent patients: Localised pulmonary infection Aspergilloma (fungus ball) in pre-existing chest cavities
37
what is the diagnosis and treatment of aspergillus pneumonia?
Diagnosis BAL ideally: Fungal culture (PCR) Tissue: Histopathology Treatment - Amphotericin B - Voriconazole - Surgery
38
What type of organism is tuberculosis?
-acid alcohol fast bacilli with a thick waxy coat
39
TB clinical features respiratory (7)
``` LT cough Chest pain Sputum +/- haemoptysis Weakness or fatigue Weight loss Fever & chills Night sweats ```
40
What is the diagnosis of TB?
``` Microscopy of sputum/tissue Culture on selective media - slow PCR - fast (1-2hrs) but expensive (immune reaction) Ziehl-Neelson stain: dye red - cheap ```
41
What is formed when someone is exposed to TB? Do patients remain well or not?
Granuloma is formed - host walls off infection (type IV hypersensitivity) - 90% remain well - 50% clear TB spontaneously - 5% active TB - 5% reactivity of latent disease
42
What is heard on auscultation in TB infection?
-upper zone crackles
43
``` TB clinical features: Meningeal GI Spinal Pericardial Renal Joints Adrenal other? ```
Meningeal: - headache - drowsy - fits GI: - pain - bowel obstruction - perforation - peritonitis Spinal: - pain - deformity - paraplegia Pericardial: -tamponade Renal: -renal failure Septic arthritis: -cold monoarthritis of large joints (never inject steroids into a solitary arthritic joint) Adrenal: -hypoadrenalism Other: - lymphadenopathy - cold abscess (collections of pus without pain and acute inflamm.)
44
What is seen on histology for TB?
- Multinucleate giant cell granulomas - Caseating necrosis - Sometimes visible mycobacteria
45
What are they characteristics on x-ray for TB? (5)
``` Upper lobe predominance Cavity formation Tissue destruction Scarring and shrinkage Heals with calcification ```
46
What is the treatment for TB?
RIPE then drop the PE ``` Two months of Rifampicin Isoniazid Pyrazinamide Ethambutol ``` Then four months of Rifampicin Isoniazid
47
side effects rifampicin?
Colours urine and all bodily fluids orange Is a potent inducer of cytochrome enzymes Rapid breakdown of all steroid molecules including hormonal contraception. Similar breakdown of opiate analgesics and many other drugs
48
Side effects ethambutol?
Ethambutol can cause optic neuritis
49
What is the criteria for latent TB?
No evidence of active TB - Symptoms - X-ray - Culture Evidence of previous TB infection - History of TB prior to 1960 - Calcification on x-ray - Exposure to High Prevalence area
50
What are the two tests for previous TB exposure?
Interferon Gamma Release Assay ( Blood test ) Detects previous exposure to TB Mantoux ( tuberculin ) test. ( Skin test ) Detects previous exposure to TB and BCG
51
What are the differences between IGRA and mantoux test? Visit number sensitivity/specificity Does it require immunocompetence?
``` TST: 2 visits Operator dependent False negatives False positives Type 4 hypersensitivity reaction - has to be immunocompetent ``` ``` IGRA 1 visit Laboratory environment High sensitivity Ignores BCG ```
52
What is the treatment for latent TB?
Treat or leave it alone However if you want to give anti-TNF drugs (as this can cause reactivation) 6 months of isoniazid or 3 months rifampicin + isoniazid Caution: both drugs are associated with disturbance of liver function. This is more frequent in women.
53
What can cause reactivation TB?
-HIV (all TB cases offered HIV test, all HIV cases offered CXR) -steroids -immunosupressant drugs
54
Risk factors for pleural infection (6)
``` diabetes mellitus immunosuppression including corticosteroids gastro-oesophageal reflux alcohol misuse intravenous drug abuse ```
55
What are the three different types of pleural infection?
Simple parapneumonic effusion Complicated parapneumonic effusion Empyema- pus in the pleural space
56
What is a complicated parapneumonic effusion?
+ve G stain, pH <7.2, low glucose, septations, loculations
57
Treatment for pleural infection
``` Simple effusion = none of the above may be treated with antibiotics alone but may need drainage later on if things change Large effusion = chest drainage V small (<1cm) effusions may be left untapped ```
58
What are the four pathological complications of pneumonia?
- organisation (fibrous scarring) - Abscess - Bronchiectasis - Empyema (susupect if slow to resolve pneumonia)
59
What is bronchopneumonia?
Infection starting in airways and spreading to adjacent alveolar lung Most often seen in the context of pre-existing disease -COPD -Cadiac failure (elderly) -complication of viral infection (flu) -aspiration pneumonia
60
What does abscess cause and when is this usually seen?
Localised collection of pus Tumour-like Chronic malaise and fever Context - aspiration (vomiting/lowered conscious level/pharyngeal pouch)
61
What is bronchiectasis?
- Abnormal fixed dilatation of the bronchi - Usually due to fibrous scarring following infection (pneumonia, tuberculosis, cystic fibrosis) - Also seen with chronic obstruction (tumour) - Dilated airways accumulate purulent secretions - involved bronchi are dilated, inflamed and easily collapsable - airflow obstructions - impaired clearance of secretions
62
What are the primary and secondary tissue changes seen in TB?
Primary - Small focus (Ghon focus) in periphery of mid zone of lung - Large hilar nodes (granulomatous) Secondary -Fibrosing and cavitating -apical lesion (cancer an important differential diagnosis
63
What are the risk factors for developing chronic pulmonary infection?
Abnormal host response: - immunodeficiency: congenital/acquired - immunosuppression: drugs/malignancy Abnormal innate host defence: - damaged bronchial mucosa - abnormal cilia - abnormal secretions Repeated insult: - aspiration (NG feeding/poor swallow/pharyngeal pouch) - indwelling material (NG tube in wrong place/chest drain/foreign body)
64
What are 4 reasons for immunodeficiency?
Immunoglobulin deficiency: - IgA deficiency (common, increased risk of acute infections, rarely chronic infections) - Hypogammaglobulinaemia(rare, increased risk of acture and chronic infections) - CVID (commonest cause of immunodeficiency, recurrent infections) - Specific polysaccharide antibody deficiency Hypo-splenism immune paresis: -myeloma/lymphoma/metastic malig. HIV
65
what are 3 reasons for damaged bronchial mucosa?
- smoking - recent pneumonia/viral infection - malignancy
66
What are 2 reasons for abnormal cilia?
- kartenagers syndrome | - youngs syndrome
67
What are 2 reasons for abnormal secretions?
cystic fibrosis | channelopathies
68
What are 5 forms of chronic infection?
- intrapulmonary abscess - empyema - chronic bronchial sepsis - bronchiectasis - cystic fibrosis (and other rare conditions)
69
Intrapulmonary abscess - clinical features (6) - when does it occur?
Clinical features: - indolent presentation - wt loss - lethargy - tiredness - weakness - cough +/- sputum Usually occurs after a preceding illness of some sort: - pneumonic infection - post viral - foreign body REMEMBER: flu -> staph pneumonia -> cavitating pnuemonia -> abscess
70
what bacterial and fungal pathogens cause intrapulmonary abscess?
Bacteria: - streptococcus - staphylococcus (esp. post flu) - E-coli - Gram -ves Fungi: -aspergillus
71
What is a septic emboli?
``` Right sided endocarditis •Infected DVT •Septicaemia •Intravenous drug users Inject into groin / DVT/ Infection /PE + Abscesses ```
72
What pathogens cause empyema? Gram +ve Gram -ve
Gram +ve: - strep. milleri - staph. aureus (usually post op or nosocomial or immunocompromised) Gram -ve: - e-coli - pseudomonas - h. influenzae - klebsiella Anaerobes in 13% of cases (usually in severe pneumonia or poor dental hygeine)
73
``` How do: -CXR -USS -CT help with the diagnosis of empyema? ```
CXR: - persisting effusion, particularly if loculations visible - D sign - remember lateral (retrodiaphragmatic collections) USS: - PREFERRED Ix - simple/bedside/targetted sampling CT: -differentiating between empyema and abscess
74
What is the treatment for empyema?
IV antibiotics: Amox and met initially Oral: directed against cultured bacteria - AT LEAST 14 days
75
What is the presentation of bronchiectasis? (4)
- recurrent 'chest infections' - recurrent abiotic prescriptions - no/short lived response to abiotics - persistent sputum production
76
How is bronchiectasis diagnosed?
Clinically: - cough productive of sputum - chest pain - recurrent LRTI's Radiological: -high resolution CT
77
what is chronic bronchial sepsis?
- All hallmarks of bronchiectasis but no bronchiectasis on HRCT - confirmed positive sputum results - same work up as bronchiectasis
78
What demographic of patients get chronic bronchial sepsis?
- often younger patients, mainly women, often involved in childcare - others are older with COPD or airways disease
79
What are the treatment options for bronchiectasis?
* Stop smoking * Flu vaccine * Pneumococcal vaccine * Reactive antibiotics - get sputum culture and sensitivities from lab
80
What are the treatment options for bronchiectasis when it is colonised with persistent bacteria?
- prophylactic abiotics - neb. gentamicin/colomycin - pulsed IV abx - alternating oral abx Low dose macrolide antibiotics have been shown to reduce exacerbation rates in bronchiectasis –Clarithromycin 250 mg OD –Azithromycin 250mg Three Times a Week •Particularly effective in pseudomonas colonised individuals

Respiratory (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions