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The Respiratory System > Respiratory Tract Infection > Flashcards

Respiratory Tract Infection Flashcards

1
Q

Give four upper respiratory tract infections

A
  1. Coryza
  2. Pharyngitis
  3. Sinusitis
  4. Epiglottits
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2
Q

What is the term for the common cold?

A

Coryza

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3
Q

Give four lower respiratory tract infections

A
  1. Acute bronchitis
  2. Acute exacerbation of of chronic bronchitis
  3. Pneumonia
  4. Influenza
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4
Q

Give three viruses that cause the common cold

A
  1. Adenovirus
  2. Rhinovirus
  3. Respiratory syncytial virus
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5
Q

How is infection from the common cold physically spread?

A
  • Droplets - small moisture particles
  • Formites - objects or materials that can carry infection (hospital blanket)
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6
Q

Complications of coryza may include what?

A
  • Sinusitis
  • Acute bronchitis
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7
Q

What does acute sinusitus entail?

A
  • Nasal discharge
  • Usually infection into the ethmopid sinuses which can spread to the eyes or brain
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8
Q

What is diptheria?

A

Usually caused by Corynebacterium diphtheriae

This bacterium can be stread via droplets or physical contact

Some strains can release toxin which can cause obstruction of the airways

The condition is vaccinated against in the UK

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9
Q

In which age demographic is acute epiglottitis most dangerous?

A

Young children

The key symptom is drooling - the child cannot swallow properly

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10
Q

What are the main clinical features of acute bronchitis?

A
  • Productive cough - mucous build-up in bronchi
  • Fever
  • Normal chest Xray
  • Normal chest exam
  • Transient wheeze
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11
Q

What are the three main symptoms of COPD?

A
  1. Chronic sputum production
  2. Bronchoconstriction
  3. Inflammation of airways
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12
Q

Give four clinical features of COPD

A
  1. Increased sputum production
  2. Increased sputum purulence (contains pus)
  3. More wheezy
  4. Breathless
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13
Q

What may be found on on a COPD physical examination?

A
  • Wheeze
  • Coarse crackles
  • Potential cyanosis
  • Ankle oedema
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14
Q

How can COPD be managed in primary care?

A
  • Antibiotics (doxycycline or amoxicillin)
  • Bronchodilator inhalers
  • Short course of steroids to reduce inflammation
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15
Q

In which two instances would a COPD patient be referred to hospital?

A
  • Evidence of respiratory failure
  • Acopia - unable to cope at home alone
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16
Q

How is management of COPD different in hospital versus primary care?

A
  • Arterial blood gases are taken
  • CXR
  • Oxygen is given in the instance of respiratory failure
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17
Q

Give 6 symptoms of pneumonia

A
  1. Malaise
  2. Anorexia
  3. Sweats
  4. Rigors - cold/shivering despite temperature rise
  5. Myalgia - muscle pain
  6. Arthralgia - joint pain
  7. Headache
  8. Confusion - determine with CURB65
  9. Cough
  10. Pleurisy
  11. Haemoptysis
  12. Dyspnoea
  13. Preceding URTI
  14. Abdominal pain
  15. Diarrhoea
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18
Q

What are some signs of pneumonia?

A
  • Fever
  • Rigors
  • Herpes labialis
  • Tachypnoea
  • Crackles
  • Rub
  • Cyanosis
  • Hypotension
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19
Q

How can pneumonia be investigated?

A
  • Blood culture
  • Serology (blood and sputum)
  • Arterial gases
  • Full blood count
  • Urea
  • Liver function
  • CXR
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20
Q

Describe the CURB65 severity score

A

Each of the criteria below account for one point

As the score increases, mortality increases

If COPD is also present, mortality is increased by 10%

  • C - new onset of confusion
  • U - urea > 7mmol/l
  • R - respiratory rate > 30/min
  • B - blood pressure systolic < 90 or diastolic <61
  • 65 - aged 65+

Score: 0 (0.6%), 1 (2.7%), 2 (6.8%), 3 (14.0%), 4 (27.8%), 5 (27.8%)

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21
Q

What is likely to cause death in a patient with pneumonia?

A

Bacteraemia and sepsis

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22
Q

What are severity markers for pneumonia besides the CURB65 score?

A

Temperature <35 or >40

Cyanosis PaO2 < 8kPa

WBC <4 or >30

Multi-lobar involvement

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23
Q

Whcih pathogens may be involved in pneumonia?

A
  • Streptococcus pneumonia
  • Haemophilus influenzae
  • Staph aureus
  • Legionella pneumophilia
  • Gram negative bacteria
  • Mycoplasma pneumonia
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24
Q

What are some complications of pneumonia?

A
  • Respiratory failure
  • Pleural effusion
  • Empyema
  • Death
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25
Q

If pneumonia is classified based on location of infection, what are the three categories?

A
  • Community acquired
  • Hospital acquired
  • Aspiration
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26
Q

What is the most common bacterial pneumonia?

A

Pneumococcal pneumonia

Caused by streptococcus pneumoniae

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27
Q

How is pneumococcal pneumonia treated?

A
  • Amoxicillin
  • Benzylpenicillin
  • Cephalosporin
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28
Q

What will a chest X-ray likely show for pneumococcal pneumonia?

A

Lobar consolidation

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29
Q

What is staphylococcal pneumonia?

A

Caused by staph aureus

Affects young, old, IV drug users or patients with an underlying condition most

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30
Q

How is staphylococcal pneumonia treated?

A

Flucloxacillin and potentiall rifampicin

If MRSA is present consider vancomycin

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31
Q

How will staphylococcal pneumonia present on a chest X-ray?

A

Bilateral cavitating bronchopneumonia

32
Q

Klebsiella pneumonia will likely affect which types of people?

A
  • Alcoholics
  • Elderly
  • Diabetics
33
Q

Which patients are vaccinated againstinfluenza and pneumococcal pneuonias?

A
  • Over 65
  • Chronic chest or cardio disease
  • Immunocompromised
  • Influenza vaccine is given to healthcare workers
34
Q

Pseudomonas pneumonia is caused by which pathogen?

A

Pseudomonas aeruginosa

(gram negative)

Commonly hospital acquired

35
Q

How is pseudomonas pneumonia treated?

A

Anti-pseudomonal penicillin, cerftazidime, meropenum, or ciprofloxacin + aminoglycoside

36
Q

How is klebsiella pneumonia treated?

A

Cefotaxime or Imipenem

37
Q

Mycoplasma pneumonia occurs in epidemics every _____ years and presents with ___-____ symptoms

A

Four

Flu-like

38
Q

How is mycoplasma pneumoniae treated?

A

Clarithromycin or Tetracycline or Fluroquinolone (e.g. ciprofloxacin or norfloxacin)

39
Q

How is Legionella pneumonia commonly caught?

A

Stagnant water reserves e.g. hotel water tanks

Causes flu-like symptoms are dry cough with dyspnonea

40
Q

What is chlamydophilia pneumonia?

A

The most common chlamydial infection

It is person to person spread

41
Q

How is chlamydophilia pneumonia treated?

A

Tetracycline or Clarithromycin

42
Q

What is chlamydiophilia psittaci?

A

A bacterial infection that causes psittacosis (commonly from infected birds)

43
Q

How is Chlamydophila psittaci treated?

A

Tetracycline or Clarithromycin

44
Q

What is the most common cause of viral pneumonia?

A

Influenza

Other viruses include:

Measles, CMV and varicella zoster

45
Q

How is viral pneumonia treated?

A

Ciprofloxacin and Co-Amoxiclav.

Prophylactically oseltamivir is given

46
Q

How can viral pneumonia be diagnosed?

A

PCR

Viral culture

47
Q

Pneumocystis pneumonia (caused by Pneumocystis jiroveci) commonly causes pneumonia in which type of patients?

A

Immunosuppressed

48
Q

What is the organism responsible for pneumocystis pneumonia?

A

Pneumocystis jiroveci

49
Q

How can pneumocystis pneumonia be diagnosed?

A
  • Visualisation in sputum
  • Bronchoalveolar lavage
  • Lung biopsy
50
Q

How is pneumocystis pneumonia treated?

A

High dose co-trimoxazole or pentamidine.

Steroids are beneficial if severe hypoxaemia. Prophylaxis often used.

51
Q

What is CVID?

A

Common variable immune deficiency

The most common cause of immunodeficiency characterised by a lack of immunoglobulins

52
Q

What is an intrapulmonary abscess?

A

It is a type of liquefactive necrosis

53
Q

Which symptoms will normally accompany an intrapulmonary abscess?

A
  • Weight loss
  • Productive cough
  • Lethargy
54
Q

What will often precede an intrapulmonary abscess?

A
  • Pneumonia, flu can preceed this
  • Aspirating pneumonia - vomiting or pharyngeal pouch use
  • Poor host immune response
55
Q

Which types of pathogens will cause intrapulmonary abscesses?

A
  • Streptococcus
  • Staphylococcus - especially post flu, leads to cavitating pneumonia and abscess formation
  • E.coli
  • Gram negatives
  • Aspergillus
56
Q

Septic emboli can cause conditions such as what?

A
  • Right sided endocarditis
  • Infected DVT
  • Septicaemia ( also known as sepsis,)
57
Q

What is empyema?

A

Pus in the pleural space

(associated with pneumonia)

58
Q

How do empyemas differ to abscesses on a CXR?

A

Empyema - banana shaped

Abscess - orange shaped

59
Q

If a pulmonary effusion is the initial cause of an empyema what is the stepwise progression to an empyema?

A
  1. Simple parapneumonic effusion
  2. Complicated parapneumonic effusion
  3. Empyema
60
Q

When a simple parapneumonic effusion becomes an empyema what changes happen?

A
  • Fluid thickens to puss
  • pH drops
  • Lactate dehydrogenase enzyme increases
  • Glucose levels decrease (lactate dehydrogenase breaks it down)
61
Q

In terms of oxygen requirement, which type of organisms are most likely to cause empyema?

A

Aerobic

62
Q

Which gram postitive bacteria are likely to cause empyema?

A

Strep milleri

Staph aureus (usually post op)

63
Q

Which gram negatives are likely to cause empyema?

A
  • E-coli
  • Pseudomonas
  • Haemophilus influenzae
  • Klebsiella
64
Q

If anaerobes cause empyema, this is usually under which circumstances?

A
  • Severe pneumonia
  • Poor dental hygiene
65
Q

How many an empyema be diagnosed?

A

CXR - looks D shaped, lateral can show fluid build up

Ultrasound

CT - can differentiate between abscess and empyema

66
Q

How is an empyema treated?

A

IV antibiotics

Amoxicillin and metronidazole

Oral antibiotics can be given to bacteria that are cultured

These are given for at least 14 days

67
Q

What is bronchiectasis?

A

Localised irreversible dilation of bronchial tree

Can easily collapse leading to airflow obstruction and clearance of secretions becomes difficult

68
Q

What can bronchiectasis commonly be condused with on a CT?

A

Abscesses

This is due to the extreme dilation

69
Q

What are some common symtoms of bronchiestasis?

A
  • Breathlessness
  • Increased sputum production
  • Chest pain
  • Lower respiratory tract infections
70
Q

What may cause bronchiectasis?

A
  • Rheumatoid arthritis
  • Immunodeficiency
  • Cystic fibrosis
  • Bronchial obstruction
  • Idiopathic
71
Q

How can bronchiectasis and chronic bronchial sepsis be differentiated?

A

Serological tests

72
Q

Which patients are suceptible to chronic bronchial sepsis?

A
  • Younger patients
  • Generally female
    • Age (>70 years)
  • Female gender
  • Smoking history* Older patients suffering from COPD
73
Q

How can bronchiectasis be treated?

A
  • Smoking cessation
  • Influenza vaccine
  • Pneumococcal vaccine
  • Reactive antibiotic (from sputum sample)
74
Q

In bronchiectasis, what is the treatment for a patient colonised with a persistant bacteria?

A
  • Prophylactic antibiotics
  • Nebulised gentamicin or colomycin - ensures local delivery
  • Alternating oral antibiotics
  • IV antibiotics
  • Anti-inflammatory treatment
  • Macrolide antibiotics (clarithromycin, azithromycin - effective against bacteria pseudomonas)
75
Q

what is the INITIAL management for patients with epiglottitis

A

Phone the on-call anesthetist

this is considered an emergency
key symptoms is drooling

The Respiratory System (19 decks)

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