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Respiratory infections Flashcards

1
Q

What are the complications of coryza?

A

sinusitis and acute bronchitis

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2
Q

What symptoms does sinusitis cause?

A
  • frontal headache
  • retro-orbital pain
  • maxillary sinus pain
  • toothache
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3
Q

What is the treatment for acute sinusitis?

A
  • decongestant
  • nasal steroids
  • pseudoephedrine
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4
Q

For what group of people is epiglottitis life threatening?

A

infants due to obstruction

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5
Q

What is quincy?

A

a complication of tonsillitis that is a tonsillar abscess that can be drained

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6
Q

What are the symptoms of strep throat?

A
  • yellow exudates
  • pus
  • sore throat
  • dysphagia (can’t swallow)
  • dysphonia
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7
Q

What are the features of acute bronchitis?

A
  • productive cough
  • fever occasionally
  • normal CXR and examination
  • may have transient wheeze
  • no treatment
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8
Q

What are the features of an acute exacerbation of COPD?

A
  • increased sputum
  • more wheeze
  • more breathless
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9
Q

What is the treatment for an acute exacerbation of COPD?

A
  • amoxicillin or doxycycline will be prescribed
  • bronchodilator inhalers and a short course of steroids
  • do ABGs and CXR
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10
Q

What are the symptoms of pneumonia?

A
  • cough
  • tiredness
  • sweats and rigors
  • confusion, diarrhoea and abdominal pain in older people
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11
Q

What will be seen in pneumonia on examination?

A
  • fever
  • tachypnoea
  • crackles and rub
  • cyanosis
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12
Q

What tests would be done for pneumonia patients?

A
  • blood culture
  • serology
  • arterial gases
  • full blood count
  • urea
  • liver function
  • CXR
  • CURB 65
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13
Q

What is the CURB 65 score?

A 
C is new onset confusion
U is urea over 7
R is respiratory rate over 30 
B is blood pressure of less than 90 systolic or 61 diastolic 
65 or older
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14
Q

What is the increase in mortality for pneumonia in COPD patients?

A

10% increase

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15
Q

What are the symptoms of legionella pneumonia?

A

GI disturbance and confusion rather than chest disturbance

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16
Q

What are the symptoms and the special feature of mycoplasma pneumonia?

A

causes paroxysmal cough and the bacteria has no cell wall

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17
Q

What is the presentation of flu?

A
  • fever
  • malaise
  • myalgia
  • headache
  • cough
  • prostration
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18
Q

What are the viruses that cause flu?

A

influenza A and B, parainfluenza, haemophilus influenza (bacteria)

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19
Q

What virus can have antigenic shift?

A

influenza A

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20
Q

How is a virus detected?

A

PCR using a nasopharyngeal swab

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21
Q

What are the symptoms of bronchiolitis?

A

fever, coryza, cough and wheeze

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22
Q

What are the more severe symptoms of bronchiolitis?

A

grunting, lowered Pa O2 and intercostal drawing

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23
Q

What are the complications of bronchiolitis?

A

respiratory or cardiac failure

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24
Q

What is done in hospitals when there is an epidemic of bronchiolitis?

A

cohort nursing

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25
Q

What is metapneumovirus and how is it treated?

A

newly discovered virus that is confirmed with PCR, nasopharyngeal/ throat swab or by bronchoalveolar lavage

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26
Q

What are the three ways that pneumonia can be classed by?

A

clinical setting, organism or morphology

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27
Q

What is lobar pneumonia and what bacteria causes it?

A

it is a confluent consolidation involving a complete lung lobe mostly due to streptococcus pneumoniae

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28
Q

What is the pathology of pneumonia?

A
  • exudation of fibrin-rich clot
  • neutrophil infiltration
  • macrophage infiltration
  • resolution
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29
Q

What are the complications of pneumonia?

A

organisation and fibrous scarring, abscess, bronchiectasis or empyema

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30
Q

What is bronchopneumonia?

A

infection in airways spreading to adjacent alveolar lung (pre-existing disease)

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31
Q

What is a lung abscess?

A

localised collection of pus which is tumour-like

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32
Q

What are the symptoms of a lung abscess?

A

chronic malaise and fever

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33
Q

What is bronchiectasis?

A

abnormal fixed dilation of the bronchi so dilated airways accumulate purulent secretions

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34
Q

What are the two examples of chronic suppuration?

A

abscess and bronchiectasis

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35
Q

What type of infection is TB?

A

mycobacteria

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36
Q

What is the pathology of TB?

A

delayed hypersensitivity….tissue damage due to self T cells causing tissue necrosis, scarring and granulomatous inflammation

37
Q

What is primary TB?

A

the first exposure and up to 5 years afterwards

38
Q

What is the initial response to TB entering the body?

A

organism is inhaled and phagocytosed, this guest the hilarity lymph nodes so there is immune activation leading to granulomatous response in nodes

39
Q

What is secondary TB?

A

reinfection or reactivation, disease will remain in apices but can spread by airways or bloodstream

40
Q

How is secondary TB seen?

A

fibrosing and cavitating apical lesions

41
Q

Why is there reactivation of TB?

A

high dose, more virulent organism or decreased T cell function (due to age, HIV or immunosuppressive therapy like steroids or chemotherapy)

42
Q

How many weeks does it take the body to recognise TB?

43
Q

What is the main age group that gets TB?

A

25-34 and occasionally 75-84

44
Q

What class of person usually gets TB?

A

immigrants, socially deprived, suppressed immune systems

45
Q

What are the symptoms of TB?

A
  • night sweats
  • fever
  • malaise
  • anorexia
  • weight loss
46
Q

What is seen win examination with pulmonary TB?

A
  • cough
  • haemoptysis
  • crepitations
  • bronchial breathing
47
Q

What is seen on a TB X-ray?

A

patchy nodular shadowing mainly in the upper lobes with dry cavitation and enlarged mediastinal nodes

48
Q

What are the types of TB from worst to best?

A
  • miliary
  • meningeal
  • widespread pulmonary
  • localised pulmonary
  • localised extra pulmonary
  • lymph node
  • healthy but contact with latent
49
Q

How do you make the diagnosis of TB?

A
  • history and examination
  • simple blood tests
  • radiology and imaging
  • microbiology and histology (sputum to find M. tuberculosis or M. Bovis which takes 6 weeks, gastric washings, bronchoalveolar lavage, biopsies)
  • microscopy (ziehl-nielson)
  • culture and look for caseous necrosis and acid-fast bacilli-positive organisms
50
Q

What is the treatment for active TB?

A

Active TB:
4 drugs for two months (Rifampicin, Isoniazid, Pyrazinamide and Ethambutol), then 2 drugs for 4 months (Rifampicin and Isoniazid)

51
Q

What is the treatment for latent TB?

A

Latent TB:
2 drug for 3 months (Rifampicin and Isoniazid)
or 1 drug for 6 months (Isoniazid)

52
Q

What are the common gram positive upper respiratory tract colonisers?

A
  • strep pneumoniae
  • strep pyogenes
  • staph aureus
53
Q

What are the common gram negative upper respiratory tract colonisers?

A
  • haemophilus influenza

- mortadella catarrhalis

54
Q

What are the defences in the upper respiratory tract against infection?

A
  • hairs
  • ciliated epithelia
  • IgA in the nasopharynx and saliva
  • cough in the oropharynx
55
Q

What is acute bronchitis?

A

infection and inflammation of the bronchi with productive cough and sometimes wheeze and/or fever

56
Q

What is the microbiology of acute bronchitis?

A

90% viral so antibiotics are not given

57
Q

What is seen in the CXR and chest examination of acute bronchitis?

58
Q

What microorganisms are the cause of COPD?

A
  • haemophilus influenzae
  • mortadella catarrhalis
  • strep pneumoniae
  • gram negatives and others
59
Q

What are the typical and atypical infections of the lower respiratory tract?

A

strep pneumonia is typical

atypical is mycoplasma, legionella, chlamydia, viruses etc

60
Q

What is the most common organism for community acquired pneumonia?

A

streptococcus penumoniae

61
Q

What are the microbiological features of strep pneumonia?

A
  • capsule which is the key virulence factor
  • alpha haemolysis is green/brown
  • gram positive
62
Q

What is the type of person that is affected by legionella?

A

older person
ex-smoker
warmish country

63
Q

How is legionella detected?

A

not by culture but by urine analysis

64
Q

What is the main treatment for legionella?

A

quinolone but there is a big risk of C.diff here

65
Q

What are the symptoms of walking pneumonia?

A

rash with dark outer ring with pale ring then dark middle spot

66
Q

Why can’t amoxicillin be given to walking pneumonia patients?

A

no cell wall

67
Q

Who tends to get staph pneumonia?

A

intravenous drug users

68
Q

How long are you in hospital before it becomes hospital acquired pneumonia?

A

three days

69
Q

What is the microorganism that causes whooping cough?

A

bordetella pertussis which is a gram negative coccobacillus

70
Q

How is whooping cough diagnosed?

A

bacterial culture or PCR

71
Q

How do you diagnose a common respiratory tract infection?

A

gram, culture, serology or PCR

72
Q

What are the factors affecting which antibiotic is used?

A
  • antibiotic spectra
  • severity of infection
  • unusual pathogen clues
73
Q

What are the risk factors for chronic pulmonary infection?

A
  • abnormal host response so immunodeficiency and immunosuppression
  • abnormal innate host defence (damaged bronchial mucosa, abnormal cilia or abnormal secretions)
  • repeated insult (recurrent aspiration or indwelling material)
74
Q

What is the mortality from abscess?

75
Q

What is the mortality from empyema?

76
Q

What is the presentation of pulmonary abscess?

A
  • lethargy
  • tiredness
  • weakness
  • cough
  • usually preceding injury so staph pneumonia, flu , cavitating pneumonia
77
Q

What are the pathogens involved with pulmonary abscess?

A

strep, staph, e-coli or gram negatives for bacteria or aspergillum for fungi

78
Q

What is septic emboli?

A

when an infection moves in the body and lodges in the lungs

79
Q

What is empyema?

A

pus in the pleural space usually associated with pneumonia

80
Q

Out of the three types of effusion, which ones need a chest drain?

A
  • complicated parapneumonic effusion and empyema need a chest drain
  • simple parapneumonic effusion doesn’t need a chest drain
81
Q

How do you diagnose empyema?

A
  • clincial suspicion
  • CXR (D sign)
  • USS (best way)
  • CT
82
Q

What is the treatment for empyema?

A

broad spectrum IV antibiotics so amoxicillin and metronidazole or directed oral antibiotics by culture

83
Q

What is bronchiectasis?

A

localised and irreversible widening of the airways that are easily inflamed and collapsible, there is airflow obstruction and impaired clearance of secretions

84
Q

What is the presentation of bronchiectasis?

A

recurrent chest infections or multiple prescriptions of antibiotics with no or short lived response

85
Q

What is the catch with CT and bronchiectasis?

A

just because it’s on the CT doesn’t mean there is disease and just because it’s not on the CT doesn’t mean there is no disease

86
Q

What is seen on the CT with bronchiectasis?

A

airway will be bigger than the accompanying pulmonary artery
signet ring appearance

87
Q

What is the treatment for chronic bronchial sepsis?

A
  • stop smoking
  • flu and pneumococcal vaccine
  • antibiotics
88
Q

How is chronic bronchial sepsis seen?

A

all the hallmarks of bronchiectasis and confirmed positive sputum results

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