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Respiratory > Respiratory tract infection > Flashcards

Respiratory tract infection Flashcards

1
Q

Give 4 conditions of the upper tact

A

Common cold - coryza
Sore throat - pharyngitis
Sinusitis
Epiglottitis

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2
Q

Give 4 conditions that can affect the lower respiratory tract

A

Acute bronchitis
Acute exacerbations of chronic bronchitis
Pneumonia
Influenza

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3
Q

What is the coryza

A

Common cold
Acute viral infection of the nasal passages
Spread by droplets and fomites
It is self-limiting

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4
Q

What is acute sinusitis?

A

Preceded by a common cold
Purulent nasal discharge
Usually self-limiting, some need antibiotics

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5
Q

What is acute bronchitis?

A

Cold ‘that goes to the chest’
Inflammation of mucus membrane of bronchial tubes
Preceeded by the common cold

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6
Q

What are clinical features of acute bronchitis?

A 
Productive cough
May have a fever (minority)
Normal chest examination
Normal CXR
May have a transient wheeze
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7
Q

What is the treatment for acute bronchitis?

A

Usually self-limiting

Antibiotics only given if the patient has underlying lung disease

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8
Q

What are the clinical features of acute exacerbation of chronic bronchitis?

A

Follows upper respiratory tract infection
Worsening of sputum production which is now purulent
More wheezy
Breathless

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9
Q

What would be seen on examination of a patient with an acute exacerbation of chronic bronchitis?

A 
Breathless
Wheeze
Coarse crackles
May be cyanosed
In advanced disease - ankle oedema
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10
Q

What management would a patient with an acute exacerbation of chronic bronchitis receive in primary care?

A

Antibiotic e.g. doxycycline or amoxicillin
Bronchodilator inhaler
In some cases, a short course of steroids

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11
Q

What additional management would a patient with an acute exacerbation of chronic bronchitis receive in hospital?

A

Measure arterial blood gases
CXR to check for additional diseases
Give oxygen if there is respiratory failure

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12
Q

What are the symptoms of pneumonia? (15)

A

Malaise, anorexia, sweats, rigors, arthralgia, headaches, confusion, cough, haemoptysis, dyspnoea, preceeding URT, abdominal pain and diarrhoea

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13
Q

What are the signs of pneumonia? (8)

A

Fever, rigors, herpes labialis, tachypnoea, crackles, rub, cyanosis and hypotension

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14
Q

What investigations would be carried out for pneumonia?

A

Blood culture, serology, arterial blood gases, full blood count, urea, liver function and CXR

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15
Q

What is the CURB 65 score for pneumonia?

A 
C - new onset of confusion
U - urea >7
R - respiratory rate >30/min
B - blood pressure systolic <61 
65 - age 65 or older 
Score 1 point for each of the above 
Mortality increases as CURB65 increases
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16
Q

What is the most common bacteria to cause pneumonia?

A

Streptococcus pneumoniae (pneumococcus)

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17
Q

What treatment would be given for community acquired pneumonia?

A 
Antibiotics - doxycycline or amoxicillin
Oxygen - SaO2 94-98%
Fluids
Bed rest
No smoking
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18
Q

What are 3 special cases of pneumonia?

A

Hospital acquired
Aspiration pneumonia
Legionella

19
Q

What can be done to prevent pneumonia?

A

Influenza and pneumococcal vaccinations

20
Q

Who is entitled to influenza and pneumococcal vaccinations?

A 
Over 65yo
Chronic chest or cardiac disease
Diabetes
Immunocompromised 
Health care workers (just influenza)
21
Q

What is the clinical presentation for influenza?

A 
Fever - high and abrupt onset
Malaise
Myalgia
Headache
Cough
Prostration (weak)
22
Q

What is the cause of classical ‘flu?

A

Influenza A virus and influenza B virus

23
Q

How is ‘flu transmitted?

A

Droplets or direct contact with respiratory secretions from an infected individual

24
Q

What is an epidemic?

A

A widespread occurrence of an infectious disease in a community at a particular time

25
Q

What is a pandemic?

A

A multi-continent epidemic

26
Q

What is the therapy for ‘flu?

A

Symptomatic therapy - bed rest, fluids, paracetamol

Antivirals - Oseltamivir and Zanamivir - given uncer NICE guidelines

27
Q

How do labs confirm influenza?

A

Direct detection of the virus using PCR
(virus from swabs of respiratory samples)
Or antibody detection

28
Q

What types of vaccine are used to prevent ‘flu and who receives them?

A

Killed vaccine given annually to adults at risk of complications, healthcare workers and children between 6months - 2yrs at risk of complications
Or live attenuated vaccine given to children aged 2-17yrs, administered intra-nasally

29
Q

What is mycoplasma pneumoniae a common cause of?

A

Community acquired pneumonia

30
Q

What is the clinical presentation of bronchiolitis?

A 
First or second year of life
Fever
Coryza
Cough 
Wheeze 
Severe cases - grunting, decreases PaO2 an intercostal/sternal indrawing
31
Q

What are 4 infections of the trachea and bronchi?

A

Acute epiglottitis
Acute exacerbations of COPD
Cystic fibrosis
Pertussis (whooping cough)

32
Q

What virus causes acute epiglottitis?

A

Haemophilus influenzae

33
Q

If there is an increase in sputum purulence what treatment would be given for an acute exacerbation of COPD?

A

1st line - amoxicillin 1g three times a day for 5 days

2nd line - doxycycline 200mg day 1 then 100mg daily for 4 days

34
Q

What is cystic fibrosis?

A

Inherited defect

Leads to abnormally viscid mucus which blocks tubular structures in many different organs, including the lungs

35
Q

What is the clinical presentation of pertussus?

A

Acute tracheobronchitis
Cold like symptoms for 2 weeks
Paroxysmal coughing
Residual cough for month or more

36
Q

Name 6 infections of the lungs

A 
Community acquired pneumonia
Nosocomial pnuemonia (aka hospital acquired)
Legionnaires disease
Pneumocysitis carinii pneumonia (PCP)
Fungal chest injection
Tuberculosis
37
Q

What percentage of community acquired pneumonia is accounted for by ‘atypical’ bacteria?

A

20%

38
Q

Amoxicillin does not cover the atypical bacteria. What antibiotic is given to cover the atypicals?

A

Clarithromythen

39
Q

What are 5 predisposing factors to nosocomial pneumonia?

A 
Intubation
Intensive Care Unit 
Antibiotics
Immunosuppression
Surgery
40
Q

Are the majority of nosocomial pneumonia caused be gram positive or negative bacteria?

A

Gram negative

41
Q

What is legionnaires disease?

A

Flu like illness
May progress to severe pneumonia, with mental confusion, acute renal failure and GI symptoms
Associated with travel and usually water

42
Q

What is a cause of pneumonia in patients with AIDS

A

Pneumocysitis carinii pneumonia (PCP)

43
Q

What causes TB?

A

Mycobacterium tuberculosis

44
Q

What are the causative organisms in community acquired pneumonia?

A 
Streptococcus pneumonia (70%)
Atypicals/viruses (20%)
Staphylococcus aureus (4%)
Other bacteria (1%)
Haemophilus influenzae (5%)

Respiratory (12 decks)

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