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103: Theme 4 - 304 - Respiratory > Respiratory Infections > Flashcards

Respiratory Infections Flashcards

1
Q

Classification of Pneumonia

A

Setting

  • Community acquired
  • Hospital acquired
  • Ventalotor related
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2
Q

Give an overview of the Common Cold

A
  • URTI
  • Rhinovirus is the cause of 30-50% of colds
  • Human Coronavirus cause about 10-15%
  • transmission through hand contact and droplets
  • IP is 2-3 days
  • symptoms last 3-10 days: up to 2 weeks in 25% of patients
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3
Q

sore throat, nasal congestion, sneezing, mucus discharge, cough, fever

What causes the symptoms of a cold?

A
  • Bradykinin: sore thought and nasal congestion due to vasodilation
  • Sneezing mediated by trigeminal sensory nerves, stimulated by histamine
  • Myeloperoxidase: cause of mucus discharge with increasing change of colour due to neutrophiles
  • Cough mediated by the vagus nerve: inflammation has to extend to the larynx to trigger this
  • Cytokines; a responsible for fevers
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4
Q

What is the difference between the flu and a cold?

A
  • flu appears quickly whilst the cold is gradual
  • affects system rather than just your nose and throat
  • flu makes you feel exhausted and awful
  • high fevers in the flu
  • lower-RTI features seen in the flu
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5
Q

What are the symptoms of uncomplicated influenza?

A
  • IP of 1-4 days
  • Abrupt onset of fever and cough
  • headache, cough, myalgia and malaise
  • sore throat, nasal discharge
  • Acutely debilitating
  • Fever 38-41 degrees
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6
Q

What are some risk factors/ groups for influenza?

A
  • immunosuppressed or those with chronic medical conditions
  • Pregnant or 2 weeks postpartum
  • Age < 27rs or >65yrs
  • B 40 (obese)
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7
Q

What are some complications of influenza?

A
  • primary viral pneumonia
  • secondary bacterial pneumonia: super-infection on top of the viral damage
  • CNS disease
  • Death
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8
Q

Describe how an influenza virus enters and leaves a cell?

A
  • flu haemagglutinin surface protein (H) binds sialic acids on the self cell surface glycoproteins and glycolipids in the respiratory tract
  • influenza virus can now enter the cell
  • Neuraminidase (N) on its cell surface allows the virus to escape by cleaving the sialic acid bonds
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9
Q

Explain reassortment in the influenza virus

A
  • has a segmented genome, into 8 parts so can reassort if two viruses infect the same cell
  • the Hemagglutinin (H) and the Neuraminidase (N) can re-assort themselves
  • there is an antigenic shift and drift
  • drift is a gradual change: more common in Influenza B
  • a shift is a quick drastic change in the viral genome: more common in Influenza A
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10
Q

What are the options for treatment and prevention of influenza?

A
  • active immunisation against H and N components
  • hand hygiene and droplet precaution
  • Tamiflu, Oseltamivir: a neuraminidase inhibitor
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11
Q

Explain what pneumonia including its cause and effects

A

Infection of the lung parenchyma ( functional tissue in the lungs, not connective tissue)

  • causes alveoli inflammation

symptoms:

  • Fever
  • breathlessness, hypoxia
  • increased respiratory rate
  • cough
  • sputum production
  • pleuritic chest pain

can lead to sepsis if there is an overwhelming bacterial infection

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12
Q

How can pneumonia be diagnosed?

A
  • infiltrates on a plain CXR
  • consolidation due to alveoli and bronchioles filled with inflammatory debris
  • heart borders and diaphragm obscured due to loss of solid-gas interface
  • air bronchograms: air in larger bronchi outlines by surrounding consolidation
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13
Q

Describe this CXR

A

Right Upper Left Consolidation

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14
Q

Describe this CXR

A

Right Lower Lobe Consolidation

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15
Q

What imaging technique is this and what is it showing?

A

CT scan

Pneumonia

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16
Q

What pathogens cause community-acquired pneumonia?

A

- Strep. pneumoniae

- Mycoplasma pneumoniae

- Legionella pneumophila

    • Haemophilus influenzae*
    • Staphylococcus areas*
17
Q

Give an overview of Strep. pneumoniae, including:

  • Gram stain
  • Risk factors
  • prevention/treatment
A
  • Gram-positive cocci

RFs

  • alcoholics, respiratory disease
  • smokers, hyposplenism
  • CHD, HIV
  • acquired in nasopharynx
  • prevent with vaccine
  • treat with penicillin
18
Q

Give an overview of Mycoplasma pneumoniae including:

  • Gram stain
  • Risk factors
  • diagnosis/treatment
A
  • the most common cause of ambulatory (atypical) pneumonia
  • Lacks cell wall can’t be gram stained
  • usually in young patients
  • extrapulmonary symptoms are common, i.e bruising elsewhere
  • diagnosis by PCR of throat swab
  • treatment: macrolides or tetracyclines which work on the ribosomes as there is no cel wall
19
Q

Give an overview of Legionella pneumophila, including:

  • Risk factors
  • prevention/treatment
A
  • can be sporadic or associated with contaminated water sources

RFs

  • smoking
  • chronic lung disease

Diagnosed: don’t grow on routine culture, use urinary legionella antigen

-Treatment: macrolides or quinolones

20
Q

What pathogens cause healthcare-associated pneumonia?

A
  • Escherichia coli
    • Klebsiella pneumoniae*
    • Pseudomonas aeruginosa*
    • Staphylococcus aureus*
    • Streptococcus spp.*

may be more resistant to antibiotics

21
Q

What are some social risk factors for tuberculosis?

A
  • Current EtOH misuse: more pulmonary diseases acquired
  • current or hx drug misuse: higher MDR rates
  • Homelessness: poorer tx completion rates
  • Imprisonment: poorer outcomes
22
Q

Describe the pathology and lab work of Tuberculosis

A
  • it’s an aerobic Acid Fast Bacillus
  • divides every 16-20 hrs (slow), cultured up to 56 days
  • lacks a phospholipid outer membrane: acid-fast stain, weakly positive Gram stain
  • Ziehl-Neelsen or auramine-rhodamine stain is used
23
Q

Describe how a person is infected with TB

A
  1. Inhalation of aerosol droplets that contain bacteria.
  2. The initial stages of infection involve the innate immune response: recruitment of inflammatory cells to the lung.
  3. Bacterial dissemination to the draining lymph node,
  4. this causes dendritic cell presentation of bacterial antigens which leads to T cell priming and triggers an expansion of antigen-specific T cells, which are recruited to the lung.
  5. The recruitment of T cells, B cells, activated macrophages and other leukocytes leads to the establishment of granulomas, which can contain Mycobacterium tuberculosis
24
Q

Explain the progression of TB from primary infection

A
25
Q

What are the two types of inflammation in the lungs and how do they present?

A

Macro inflammation:

  • redness, swelling, heat, pain and loss of function

Micro inflammation:

  • vasodilation, increased vascular permeability and inflammatory cell infiltration

103: Theme 4 - 304 - Respiratory (12 decks)

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