Respiratory Track Infection

Question 1

Name 4 conditions which affect the upper respiratory system?

Answer 1

Coryza - common cold
Sinusitis
Epiglottitis
Sore throat - pharyngitis

Question 2

Name 4 lower respiratory tract infections?

Answer 2

Pneumonia
Acute exacerbation of COPD
Acute bronchitis
Influenza

Question 3

What is Coryza and what are the symptoms?

Answer 3

Its an acute (highly infectious) viral infection of the nasal passages. Spread by droplets. Usually caused by adenovirus or rhinovirus

• sore throat
• sometimes mild fever
• tiredness

Question 4

What are some complications of Coryza?

Answer 4

Sinusitis

Acute bronchitis

Question 5

What is acute sinusitis and what are the symptoms?

Answer 5

Infection of the nasal sinuses usually bacterial. It is usually preceded by a common cold.

• nasal dischage
• frontal headache

Usually self limited and resolves in 10 days

Question 6

In what area could sinusitis be very worrying?

Answer 6

In the ethmoid sinuses, go to the brain and eye

Question 7

What is quinsy?

Answer 7

Quinsy, also known as a peritonsillar abscess, is a rare and potentially serious complication of tonsillitis. The abscess (a collection of pus) forms between one of your tonsils and the wall of your throat. This can happen when a bacterial infection spreads from an infected tonsil to the surrounding area.

Question 8

What is diphtheria?

Answer 8

Diphtheria is a potentially fatal contagious bacterial infection that mainly affects the nose and throat, and sometimes the skin. Dont see it in the UK due to vaccination

Question 9

What is acute epiglottis and what is it caused by?

Answer 9

Acute inflammation of the epiglottis, causes swelling and can interfere with breathing. Life threatening in children. (Usually caused by H.Influenza type b (His)

Need to call anaesthetist and intubate

Question 10

What is acute bronchitis and what are its symptoms?

Answer 10

A cold that goes to the chest. Infection of the bronchi causing them to become inflamed. Usually due to strep.pneumonia /H.influenza or people with COPD.

• productive cough
• mild fever
• usually normal CXR and Chest examination
• transient wheeze

Question 11

What is the treatment for acute bronchitis?

Answer 11

Usually self limiting and will resolve in a few weeks

No antibiotics unless there is an underlying chronic lung disease

Question 12

What is an acute exacerbation of COPD?

Answer 12

Chronic cough production, bronchoconstriction, inflammation of the airways.

• In acute exacerbation
• increased sputum production and darker colour
• more wheezy and breathless
• usually preceded by a URTI

Question 13

What would a sputum that is clear and green indicate?

Answer 13

Clear = okay 
Green = bacterial

Question 14

On examination what would you find in an acute exacerbation of COPD?

Answer 14

Respiratory distress
Wheeze
Coarse crackles - due to infection or secretion retention due to COPD
Cyanosed (Maybe)

Question 15

How would you treat acute exacerbation of COPD in primary care?

Answer 15

Antibiotics - amoxicillin (or doxycycline)
Bronchodilator inhalers
Steroids in some cases
Hospilitisation if - evidence of resp failure/not coping at home

Question 16

How would you treat/investigate acute exacerbation of COPD in hospital?

Answer 16

Everything as you would in primary care 
AS WELL AS
ABG's
CXR - to look for other diseases 
O2 if you have resp failure

Question 17

What is pneumonia?

Answer 17

Inflammation of the substance of the lungs. Usually caused by bacteria and viruses. Can get CAP, HAP etc

Pneumonia is defined in the UK as signs and symptoms of a lower respiratory tract infection, with a new infiltrate on a CXR

Question 18

What are the symptoms of pneumonia?

Answer 18

Fever
Rigors
Malaise - general unwellness
Anorexia
Dyspnea - difficult or laboured breathing.
Cough - purulent sputum 
Haemotpysis 
Pleuritic pain (pleurisy)

Question 19

How would these change in pneumonia?

Chest expansion, Percussion note, breath sounds, added sounds, vocal resonance?

Answer 19

Chest expansion - reduced 
Percussion ote - dull
Breath sounds - bronchial 
Added sounds - crackles 
Vocal resonance - increased

Question 20

What investigations would you do for pneumonia?

Answer 20

CXR
Blood culture 
Serology
ABG
Full blood count 
CURB

Question 21

What is CURB 65 and describe it

Answer 21

It is a severity score for CAP
C - new onset of confusion 
U - urea > 7 
R - respiratory rate > 30/min 
B - blood pressure systolic < 90 or diastolic < 61
65 - age 65 or older 

1 point for each

Question 22

Can CURB 65 be used in patients with COPD?

Answer 22

Yes but the mortality rate increases by 10% for each score

Question 23

What are some other severity markers for pneumonia?

Answer 23

Temp <35 or >40
Cyanosis PaO2 < 8 kPa
WBC <4 or >30
Multi-lobar involvement

Question 24

What is the treatment for CAP?

Answer 24

Mild/mod (7days) - PO amoxycillin
Severe (10days) - IV co-amoxiclav + IV clarithromycin/ PO doxycycline

Fluids
Best rest
O2

Question 25

What are some complications of pneumonia?

Answer 25

Resp failure
Pleural effusion
Empyema
Death

Question 26

What are some other cases of pneumonia and how do you treat them?

Answer 26

Hospital acquired - need extended gram negative cover
Aspiration pneumoina - need anaerobic cover
Legionella - confusion common, Gi disturbance etc

Question 27

How do you prevent pneumonia?

Answer 27

Influenza and pneumococcal vaccines

Question 28

What is unique about mycoplasma pneumonia?

Answer 28

It is resistant to penicillin as it doesn’t have a cell wall.