Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Roomies Collab Deck 1: Infectious Disease and CV > Respiratory System Infections > Flashcards

Respiratory System Infections Flashcards

1
Q

What organism causes epiglottitis?

A

Haemophilus influenzae

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

What is the treatment of choice for epiglottitis?

A

FIRST LINE:
- cefotaxime or ceftriaxone

SECOND LINE: (if history of immediate hypersensitivity to penicillin or cephalosporins)
- chloramphenicol

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

What causes bronchiectasis?

A

Persistent or progressive condition caused by chronic inflammation leading to damage of the airways of the lower respiratory tract; characterized by thick-walled, dilated bronchi

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

What are the classic signs and symptoms of bronchiectasis?

A
  • intermittent expectoration
  • chronic cough
  • persistent daily production of sputum
  • bacterial colonisation
  • recurrent infections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What characterizes an acute exacerbation of bronchiectasis? (3)

A
  1. Sustained deterioration of the patient’s signs and symptoms from their baseline;
  2. worsening local symptoms with or without increased wheeze, breathlessness, or hemoptysis;
  3. may be accompanied by fever or pleurisy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the treatment of an acute exacerbation of bronchiectasis?

A
  1. Obtain sputum sample and send for culture and susceptibility testing
  2. Give antibacterial therapy to all patients with an acute exacerbation
  3. Refer patients to hospital if they have signs or symptoms suggestive of a more serious illness such as cardiorespiratory failure or sepsis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is antibacterial therapy chosen for acute exacerbations of bronchiectasis?

A

Treatment should be guided by the most recent sputum culture and susceptibility results when available

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

What is the treatment of choice for mild to moderate acute exacerbations of bronchiectasis (pending culture and sensitivity)?

A

ORAL administration in mild-moderate cases: 7-14 days

FIRST LINE ORAL:
- amoxicillin, clarithromycin, or doxycycline

SECOND LINE ORAL: (if high risk of treatment failure or complications)
- co-amoxiclav or Levofloxacin

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

What is the treatment of choice for severe acute exacerbations of bronchiectasis (pending culture and sensitivity)?

A

IV abx administration should be used in cases of severe acute exacerbations of bronchiectasis

FIRST LINE: 7-14 days
- IV co-amoxiclav, piperacillin with tazobactam, or Levofloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What factors increase the risk of treatment failure in the management of a patient with an acute exacerbation of bronchiectasis? (2)

A
  1. Repeated courses of antibacterials
  2. Previous culture with resistant or atypical bacteria

**these factors indicate the use of stronger abx coverage eg co-amoxiclav or Levofloxacin

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

When should abx prophylaxis be considered in a patient with bronchiectasis?

A

When patient has repeated acute exacerbations, a trial of abx prophylaxis may be given on specialist advice ONLY

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

How is an acute exacerbation of COPD defined?

A

An acute exacerbation of chronic obstructive pulmonary disease (COPD) is a sustained worsening of symptoms from the patient’s usual stable state, that is beyond the usual day to day variations.

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

What causes acute exacerbations of COPD?

A

Many exacerbations are not caused by bacterial infections, but instead can be triggered by other factors such as smoking or viral infections.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What factors should be taken into consideration when choosing whether or not to use antibacterial therapy in the treatment of acute exacerbation of COPD? (5)

A
  1. The severity of symptom
  2. Sputum color changes and increases in volume and thickness
  3. The need for hospital admission
  4. Previous exacerbations and hospital admission history
  5. Risk of developing complications

**refer patients to hospital if they have signs or symptoms suggestive of a more serious illness such as cardiorespiratory failure or sepsis

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

What is the recommended total duration of treatment for acute exacerbations of bronchiectasis?

A

7-14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the recommended total duration of treatment for acute exacerbations of COPD?

A

5 days

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

How is antibacterial treatment chosen for acute exacerbations of COPD?

A

Treatment should be guided by most recent sputum culture and susceptibility when available

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

What is the initial antibacterial treatment of choice for acute exacerbations of COPD?

A

ALL ORAL, 5 DAYS

FIRST LINE:
- amoxicillin, clarithromycin, or doxycycline

FIRST LINE if high risk of treatment failure or complications
- co-amoxiclav or Levofloxacin

SECOND LINE: (if no improvement after at least 2 to 3 days)

  • use a first line antibacterial from a different class to the abx used previously
  • co-amoxiclav, Levofloxacin, or co-trimoxazole (only when sensitivities are available and there is good reason to use co-trimoxazole over a single abx)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the treatment of choice in a patient with an acute exacerbation of COPD who are severely unwell or unable to take oral treatment?

A

ALL IV, 5 DAYS

FIRST LINE:
- amoxicillin, co-amoxiclav, clarithromycin, co-trimoxazole, or piperacillin with tazobactam

SECOND LINE:
- choice should be made in consultation with a local microbiologist

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

What is the most common cause of acute cough?

A

Viral URTIs

But can have other causes such as acute bronchitis or pneumonia, OR non-infective causes such as interstitial lung disease or GERD

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

What is the treatment of acute cough?

A

Patients should be advised that an acute cough is usually self-limiting (often resolves within 3-4 weeks) and to manage their symptoms using self-care treatments. These include honey and over-the-counter cough medicines containing expectorants or cough suppressants, however there is limited evidence to support the use of such products.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is an expectorant?

A

An agent that helps loosen mucus so it can be coughed up; usually achieved by increasing the water content of the mucus, thereby thinning it out and making coughs more productive

23
Q

When are antibacterials indicated in the management of patients with acute cough?

A

If they are systemically very unwell; do not routinely offer an antibacterial to treat an acute cough associated with an upper respiratory tract infection or acute bronchitis in patients who are not systemically very unwell or at higher risk of complications

24
Q

Which patients are considered to be at higher risk of complications if they present with acute cough? (3)

A
  1. Patients with pre-existing co-morbidity
  2. Young children who were born prematurely
  3. Patients over 65 yo who:
    • have been hospitalized in the previous year
    • have DM (types 1 or 2), or
    • are currently taking oral corticosteroids

**these patients should be considered for immediate or back-up antibacterial treatment when presenting with acute cough based on face-to-face clinical examination

25
Q

What is meant by back-up treatment for management of acute cough in high-risk patients?

A

patients are advised to start treatment if symptoms worsen rapidly or significantly at any time

26
Q

What is the antibacterial treatment of choice for acute cough?

A

ALL ORAL, 5 DAYS

FIRST LINE:

  • doxycycline
  • amoxicillin, clarithromycin, or erythromycin

DURING PREGNANCY:
- amoxicillin or erythromycin

27
Q

Is erythromycin safe to prescribe in pregnancy?

A

Yes, however “use only if potential benefits outweigh risks”

28
Q

Is erythromycin safe to prescribe in infancy?

A

Overall two- to three-fold increase in the risk of infantile hypertrophic pyloric stenosis after exposure to erythromycin during INFANCY, in general, and found the risk to be highest in the first 14 days after birth. Healthcare professionals are advised to assess the benefit-risk balance of erythromycin therapy in infants. Parents and carers should be advised to seek medical attention if vomiting or irritability with feeding occurs in infants during treatment.

29
Q

How is pneumonia defined?

A

An acute infection of the lung parenchyma that presents with symptoms such as cough, chest pain, dyspnea, and fever

30
Q

Is nursing-home acquired pneumonia considered community-acquired or hospital-acquired?

A

Community-acquired

31
Q

When should antibacterial treatment be started?

A

Within 4 hours of establishing a diagnosis OR within 1 hour if the patient has suspected sepsis and meets any of the high risk criteria

32
Q

Which organisms are associated with community-acquired pneumonia in otherwise healthy individuals? (3)

A
  1. Strep pneumo
  2. Haemophilus influenzae (if not vaccinated)
  3. Atypicals (mycoplasma, legionella, chlamydophila pneumoniae)
33
Q

Which organisms are associated with community-acquired pneumonia in immunocompromised individuals? (3)

A

The usual suspects: Strep, Hib, and atypical PLUS

  1. Staph aureus
  2. Coliforms
  3. TB

*immunocompromised in this case could include malnourished individuals, alcoholics, diabetics, patients on long term steroids

34
Q

Which organisms are associated with community-acquired pneumonia in severely immunosuppressed individuals? (6)

A

The usual suspects: Strep, Hib, and atypical PLUS

  1. Pneumocystis carinii
  2. Cryptococcus
  3. CMV
  4. Varicella zoster virus
  5. Influenza
  6. Fungal infection

**severely immunosuppressed individuals include those with HIV and CD4<200 and transplant recipients

35
Q

Which organisms are considered “atypical” causes of pneumonia? (3)

A
  1. Mycoplasma
  2. Legionella
  3. Chlamydophila pneumoniae
36
Q

What is the CURB-65 score (CRB-65)?

A

The CURB-65 score is used to determine severity and guide treatment of CAP

C- confusion 
(U- urea >7 mmol/L)
R- resp rate >/= 30 
B- SBP=90 or DBP=60 mmHg
65- age over 65

Each worth 1 point; score used to determine management of pneumonia

0-1: 1.5% risk of 30-day mortality = low risk, consider home treatment
2: 9.2% risk of 30-day mortality = probably admission OR close outpatient management
3-5: 22% risk of 30-day mortality = admit, manage as severe

37
Q

What is the treatment of choice for low severity community-acquired pneumonia?

A

ORAL FIRST LINE:
- amoxicillin

SECOND LINE: if penicillin allergy or amoxicillin unsuitable eg atypical pathogen suspected
- clarithromycin, doxycycline or erythromycin (in pregnancy)

38
Q

Which antibiotic is first line for targeting strep pneumo CAP?

A

Amoxicillin

39
Q

Which abx target atypical pathogens causing CAP? (2)

A

Macrolides eg clarithromycin (or erythromycin if pregnant)

AND

Tetracyclines eg doxycycline

40
Q

Which macrolide antibiotic is preferred in pregnancy?

A

Erythromycin

41
Q

What is the treatment of choice for CAP of moderate severity?

A

FIRST LINE:

  • oral amoxicillin OR
  • oral clarithromycin (or erythromycin in pregnancy) if atypicals are suspected

SECOND LINE: if penicillin allergy

  • oral clarithromycin
  • oral doxycycline
42
Q

What is the treatment of choice for CAP that is severe?

A

FIRST LINE: oral OR IV (depending on severity)
- co-amoxiclav WITH clarithromycin (or oral erythromycin in pregnancy)

SECOND LINE: in penicillin allergy
- Levofloxacin

43
Q

What organisms commonly cause hospital-acquired pneumonia? (4)

A
  1. Staph aureus (including MRSA)
  2. Anaerobes
  3. Coliforms
  4. Pseudomonas
44
Q

What are coliform bacteria?

A

Gram (-), rod shaped, non-spore forming bacteria which can ferment lactose; found in the feces of all warm-blooded animals including humans; don’t usually cause illness but can cause severe infections in some cases including HAP

Coliforms include enterobacter, klebsiella, citrobacter, E.coli, as well as others

45
Q

Name 4 common coliform bacteria

A

Coliforms include enterobacter, klebsiella, citrobacter, E.coli, as well as others

46
Q

How is hospital-acquired pneumonia defined?

A

Pneumonia that develops 48 hours or more after hospital admission

47
Q

Should samples be taken for microbiological testing?

A

Yes eg sputum, nasopharyngeal swab, or tracheal aspirate

48
Q

When should patients with respiratory infections be reassessed? (2)

A
  1. If symptoms do not improve or worsen rapidly or significantly
  2. When microbiological results are available in order to change treatment if necessary, using a narrower-spectrum abx if appropriate
49
Q

What factors contribute to higher risk of resistance in patients with HAP? (5)

A
  1. Signs or symptoms starting more than 5 days after hospital admission
  2. Relevant comorbidity
  3. Recent use of broad-spectrum abx
  4. Colonisation with multi drug-resistant bacteria
  5. Recent contact with a health or social care setting before current admission

*treatment should be based on specialist microbiological advice and resistance data in these cases

50
Q

What factors are used to determine treatment in cases of HAP? (2)

A
  1. Severity
  2. Risk of resistance
    • two categories of treatment for HAP:
      1. Non-severe signs or symptoms and not at higher risk of resistance
      2. Severe signs or symptoms or at higher risk of resistance
51
Q

What is the recommended treatment for HAP with severe signs or symptoms or at higher risk of resistance?

A

FIRST LINE: Intravenous

  • piperacillin with tazobactam
  • ceftazidime
  • ceftazidime with avibactam
  • ceftriaxone
  • cefuroxime
  • Levofloxacin (unlicensed)
  • meropenem

AND if MRSA is suspected or confirmed, ADD:

  • vancomycin
  • teicoplanin
  • linezolid (under specialist advice only if vancomycin cannot be used)
52
Q

What is the treatment of choice for HAP with non-severe signs or symptoms and not at higher risk of resistance?

A

ALL ORAL

FIRST LINE:
- co-amoxicillin

SECOND LINE: in cases of penicillin allergy or if co-amoxicillin unsuitable

  • doxycycline
  • cefalexin (caution if penicillin allergy)
  • co-trimoxazole (unlicensed)
  • Levofloxacin (unlicensed)
53
Q

As a general rule, when should oral abx be used over IV abx in treatment of respiratory system infections?

A

Generally speaking, oral abx are preferred and should be used for mild to moderate infections whereas IV abx are reserved for cases that are severe or life-threatening, when patents are unable to take oral treatment, or when there is a high risk of resistance

Roomies Collab Deck 1: Infectious Disease and CV (84 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions