Respiratory: - Lecture 9 - Respiratory tract infection Flashcards
What is Coryza?
General cold like symptoms
What is Pharyngitis?
Sore Throat
What is Sinusitis?
Also known as rhinosinusitis - It is inflammation of the paranasal sinuses
What is Epiglottitis?
Epiglottitis is an inflammation of the epiglottis — the flap at the base of the tongue that keeps food from going into the trachea (windpipe)
What range of conditions that affect the upper respiratory tract caused by infections? ?
Coryza Pharyngitis Sinusitis Epiglottitis
What are the range of conditions that affect the lower respiratory tract caused by infections?
Acute Bronchitis Acute Exacerbation of chronic bronchitis Pneumonia Influenza
What causes Coryza?
Acute viral infection of the nasal passage
What are the symptom of a common cold?
Sore throat Mild fever
How is the common cold spread?
Droplets and fomites (substance capable of carrying infection)
What are common complications of the common cold?
Sinusitis Acute Bronchitis
What viruses generally cause the common cold?
Adenovirus Rhinovirus Respiratory Syncytial virus (In children)
What virus causes Bronchiolitis?
Respiratory Syncytial Virus
What is Acute sinusitis usually preceeded by?
A common cold
What is the treatment of Acute Sinusitis?
Purulent Nasal Discharge - May include blood Sinus pain
When do patients get antibiotics for Acute Sinusitis?
After 10 days of purulent nasal discharge. - Fear of secondary infection
What antibiotic is used to treat secondary infections in the nasal cavity/upper respiratory tract?
Doxycycline Clarithromycin - Due to good penetration.
What is a tonsillar abscess called?
Quinsy
What is treatment of Quinsy?
Incision
What is Diphtheria?
Bacteria infection. Characterised by a Pseudo-Membrane formation - preventing the person from breathing. Can cause sepsis and septic shock.
What is Acute Epiglottis?
Enlargement of the Pharynx Causes Stridor Commonly known as Croup
What is Acute Bronchitis?
“The cold which goes to the chest”
Symptoms of acute bronchitis?
Productive cough Fever – minority of cases Normal chest examination Normal chest X-ray May have a transient wheeze
What causes Crepitus in the lung?
Consolidation
What is acute bronchitis?
Infection of the bronchi. Can get tracheitis
What is infection of the parenchyma?
Pneumonia
How is acute bronchitis treated?
No Antibiotics. Fluids Paracetamol
Patients with co-morbidities and acute bronchitis how are they treated?
Generally with antibiotics - Fear of secondary infections.
How long does it take for Rhinovirus to manifest symptoms?
1-5 days
How long does it take for Streptococci A to manifest symptoms?
4-5 days
What is the commonest cause of tonsillitis fasciitus?
Group A Streptococci
How long does it take for Parainfluenza virus to manifest symptoms?
1-4 days
How long does it take for RSV virus to manifest symptoms?
A week
How long does it take for Whooping cough virus to manifest symptoms?
A week to three weeks
How long does it take for Diphtheria virus to manifest symptoms?
1-10 days
How long does it take for Epstein Barr virus to manifest symptoms?
4 - 6 weeks.
What do you see in bronchoscope in the airways of a COPD patient?
“Pits” in the airway
What happens to the cilia cells in COPD?
Stop wafting
What are the symptoms of an exacerbation of COPD?
Increased sputum volume increased sputum purulence Fevers Sweats More Wheeze More Breathless Cyanosed Oedema of the ankles Heart failure
What is an indication of bacteria infection?
Green sputum
What antibiotics are given should the sputum turn green?
Doxycycline Amoxicillin
What other treatments other than antibiotics may a patient require in a secondary infection and exacerbation of COPD?
Acute course of steroids Bronchodilators Antibiotics
How do you treat Acute exacerbation of chronic bronchitis?
Antibiotic. e.g. doxycycline or amoxicillin Bronchodilator inhalers Short course of steroids in some cases
What do you find on examination of Acute exacerbation of chronic bronchitis?
Breathless Wheeze Coarse crackles May be cyanosed In advanced disease – ankle oedema
What tests do you do for Acute exacerbation of chronic bronchitis
Measure arterial blood gases CXR to look for other diseases Give oxygen if has respiratory failure
What is depicted in this picture?
Right Upper Lobe Pnemonia
What are the symptoms of Pneumonia?
§Malaise
§Anorexia
§Sweats
§Rigors
§Myalgia
§Arthralgia
§Headache
§Confusion
§Cough
§Pleurisy
§Haemoptysis
§Dyspnoea
§Preceding URTI
§Abdominal pain
§Diarrhoea
What is the survival rate of Pneumonia?
5-10% from Pneumococcal
30% if Bacteraemic (bacteria in the blood stream)
Describe the appearance of lung consolodation from Pneumonia?
Red Hepatisatisation
What is shown in this picture?
Lobar Pneumonia lung Biopsy
- Filled with inflammatory cells. This should just be air
What does Malaise mean?
Tired
What does Anorexia mean?
Not eating
What is Rigors?
Uncontrolable shaking
What is Myalgia?
Muscle pains
What is Artharalgia?
Joint ache
How is Pneumonia investigated ?
- Blood culture
- Serology
- Full blood count
- Arterial gases
- Liver funciton
- Chest X ray
- Urea
What are the pathogens in Pneumonia?
- Strep pneumoniae (pneumococcus)
- H. influenzae
- Mycoplasma pneumoniae
- Influenza
- Chicken pox – in adult smokers
- Legionella
- Coxiella burnetti
- Chlamydia psittaci
What is the CURB 65 severity score for pneumonia?
System used to detect how severe the pneumoia is - Each level gains another point
- 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
*
What is Pleurisy?
Inflammation of the pleura
What are red flags for pneumonia?
- Temperature < 35 or > 40
- Cyanosis PaO2 < 8 kPa
- WBC < 4 or > 30
- Multi-lobar involvement
How is Pneumonia treated?
Antibiotics
- *Amoicillin *
- *Doxycycline *
Oxygen
Fluids
Bed rest
No smoking
What are the complications of Pneumonia?
- Respiratory Failure
- Pleural Effusion
- Empyema (collection of pus)
- Death
What are the types of Pnemonia ?
Hospital Acquire Pneumona - needed extend gram negative cover
Aspiration Pneumona - Need anaerobic cover
Legionella - Chest symptoms may be absent, GI disturbance is common
What is Pandemic flu ?
Large number of cases with rapid spread in a population with minimal immunity
What is seasonal flu?
Small numbers of cases amoungst a population with background immunity
What are the clinical features of flu?
- Incubation 1-4 days
- Abrupt onset fever, chills, headache, sore throat, myalgia, malaise, anorexia, dry cough
- Clear nasal discharge
- Signs of complications
- In bed for 3-4 days. Then 5-6 days recovery
- Back to work within two weeks
What are complications of influenza?
- Primary Viral Pneumonia
- Secondary Bacterial Pneumonia
- Myositis skeletal/cardiac (Inflammation of muscle)
- Encephalitis
- Depression
What Anti-viral drugs can be used for influenza?
Zanamavir
Oseltamivir
What are the benefits of oseltamivir?
- Reduced duration of symtpoms by one day
- Reduced use of antibiotics
- No data on Mortality