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Respiratory Pathology > Respiratory Tract Infection > Flashcards

Respiratory Tract Infection Flashcards

1
Q

Types of microorganism pathogenicity

A

Primary
Facultative
Opportunistic

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2
Q

What is primary pathogenicity?

A

If the microorganisms infect everybody

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3
Q

What is facultative pathogenicity?

A

Need a bit of help - predisposing conditions

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4
Q

What determines the capacity to resist infection?

A

Stage of host defence mechanisms

Age of patient

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5
Q

Is the upper respiratory tract sterile?

A

No

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6
Q

Is the lower respiratory tract sterile?

A

Yes

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7
Q

What does resistance to organisms decrease with?

A

Age

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8
Q

Examples of URTIs

A 
Coryza
Sore throat syndrome
Acute laryngotracheobronchitis
Laryngitis
Sinusitis
Acute epiglottitis
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9
Q

What is coryza?

A

Common cold

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10
Q

Another name for acute layrngotracheobornchitis

A

Croup

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11
Q

Who gets acute epiglottitis?

A

Young children

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12
Q

Causative organism of acute epiglottitis

A

Group A beta haemolytic streptococci

Haemophilus influenzae type b (Hib)

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13
Q

Examples of LRTIs

A

Bronchitis
Bronchiolitis
Pneumonia

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14
Q

Respiratory tract defence mechanisms

A 
Macrophage mucociliary escalator system
- alveolar macrophages
- mucociliary escalator
- cough reflex
- particle clearance from lungs
General immune system (humoral and cellular)
Respiratory tract secretions 
Upper resp tract acts as filter
- nose hair
- warms and humidifies air
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15
Q

Other exit routes for macrophages

A

Alveolar wall into lymphatic system

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16
Q

When can the mucosal ciliary escalator fail? What may this result in?

A

During viral infections

Viruses / foreign bodies retained in the lungs

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17
Q

What is a common reason to get bacterial lung infections?

A

Virus infections damage the epithelium and cause damage to the mucosal ciliary escalator

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18
Q

Aetiological classification of pneumonia

A 
Community acquired
Hospital acquired (nosocomial)
Pneumonia in the immunocompromised
Atypical
Aspiration 
Recurrent
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19
Q

What is atypical pneumonia?

A

Pneumonia caused by unusual infectious agents

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20
Q

Patterns of pneumonia

A 
Bronchopneumonia
Segmental 
Lobar
Hypostatic
Aspiration 
Obstruction
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21
Q

What is bronchopneumonia?

A

Acute inflammation of the walls of the bronchi with adjacent bits of lung infected

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22
Q

What is segmental pneumonia?

A

Segment of the lung

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23
Q

What is lobar pneumonia?

A

Affects a lobe of the lung

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24
Q

What is hypostatic pneumonia?

A

Patient lots of accumulation of secreted fluid - usually due to bronchitis producing mucus or cardiac failure

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25
Q

What does bronchopneumonia look like on CXR?

A

Bilateral basal patchy opacification - relating to the focal nature of consolidation

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26
Q

Complications of pneumonia

A 
Pleurisy 
Pleural effusion 
Empyema 
Mass lesion 
COP
Constrictive bronchiolitis
Lung abscess
Bronchiectasis
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27
Q

What is pleural effusion?

A

Fluid in pleural space

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28
Q

What is COP?

A

Cryptogenic organising pneumonia (BOOP)

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29
Q

What is bronchiectasis?

A

Pathological dilatation of the bronchi

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30
Q

Causes of bronchiectasis

A

Severe infective episode
Recurrent infections
Proximal bronchial obstruction
Lung parenchymal destruction

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31
Q

What % of bronchiectasis starts in childhood?

A

75%

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32
Q

Presentation of bronchiectasis

A

Cough
Abundant purulent foul sputum
Haemoptysis
Signs of chronic infection

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33
Q

Signs of bronchiectasis

A

Coarse crackles

Clubbing

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34
Q

Ix of bronchiectasis

A

CT

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35
Q

Treatment of bronchiectasis

A

Postural drainage
Antibiotics
Surgery

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36
Q

Causes of aspiration pneumonia

A 
Vomiting
Oesophageal lesion 
Obstetric anaesthesia
Neuromuscular disorders
Sedation
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37
Q

Possible causes of recurrent lung infection

A

Local bronchial obstruction (tumour/foreign body)
Local pulmonary damage (e.g. bronchiectasis)
Generalised lung disease (CF or COPD)
Non resp disease (immunocompromised / aspiration etc)

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38
Q

Types of organisms causing opportunistic infections

A

Low grade bacterial pathogens
CMV
Pneumocystitis jirovecci
Fungi and yeasts

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39
Q

Air flow in airways

A

Bulk flow

  • laminar (parallel)
  • turbulent (irregular)
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40
Q

What happens beyond the terminal bronchiole?

A

Diffusion

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41
Q

Normal PaO2

A

10.5 - 13.4 kPa

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42
Q

Normal PaCO2

A

4.8 - 6.0 kPa

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43
Q

Types of respiratory failure

A

Type 1

Type 2

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44
Q

Type I resp failure

A

PaO2 < 8kPa

Pa CO2 normal or low

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45
Q

Type II resp failure

A

PaCO2 > 6.5kPa

Pa02 usually low

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46
Q

What are the 4 abnormal states associated with hypoxaemia?

A

Ventilation / perfusion imbalance (V/Q)
Diffusion impairment
Alveolar hypoventilation
Shunt

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47
Q

Pulmonary vascular changes in hypoxia

A

Physiological pulmonary arteriolar vasoconstriction

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48
Q

Pathology of pneumonia causing hypoxaemia

A

Ventilation/perfusion abnormality (mismatch)
- some ventilation of abnormal alveoli, but not enough
Shunt
- severe bronchopneumonia
- no ventilation of abnormal alveoli
- blood passing from R to L shunt of heart without contacting ventilated alveoli

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49
Q

When do pathological shunts occur?

A

AV malformations
Congenital heart disease
Pulmonary disease

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50
Q

Pathology of COPD causing hypoxaemia

A

Ventilation perfusion abnormality - airway obstruction
Alveolar hypoventilation
- reduced resp drive
- entire lung volume not being ventilated well
- increased PaCO2
Diffusion impairment - loss of alveolar surface area
Shunt
- only during acute exacerbation
- area of lung tissue that is completely airless which has no ventilation to it because the lung is either obstructed or consolidated

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51
Q

The concentration of CO2 and H in where makes us breath in and out?

A

CSF

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52
Q

COPD patients effect on their respiratory drive

A

Patients who live in a chronic hypoxic situation despite the best efforts of the kidney means the respiratory centre loses the drive from the CO2 and the H ions
Patients with COPD rely on hypoxia to give them more of a resp drive (therefore have to manage how much oxygen you give them)

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53
Q

What is cor pulmonale?

A

Right sided heart failure due to pulmonary HTN

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54
Q

Pathology of cor pulmonale

A 
Pulmonary vasoconstriction 
Pulmonary arteriole muscle hypertrophy intimal fibrosis 
Loss of capillary bed 
Secondary polycythaemia 
Bronchopulmonary arterial anastomoses
Chronic
- hypertrophy of R ventricle
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55
Q

Examples of URTIs in children

A 
Rhinitis
Tonsillitis
Otitis media
Pharyngitis
Tacheitis / LTB
Laryngitis 
Epiglottitis
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56
Q

Viral infective agents causing URTIs in children

A 
Adenovirus 
Influenza A and B
Para flu I, III
RSV
Rhinovirus
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57
Q

What does RSV stand for?

A

Respiratory syncytial virus

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58
Q

Bacterial causes of URTIs in children

A 
H influenzae
M catarrhalis
Mycoplasma
S aureus 
Streptococci 
- B haemolytic 
- S pygoenes
- non haemolytic S pneumoniae
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59
Q

What is rhinitis?

A

Inflammation of mucous membrane inside nose

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60
Q

When does rhinitis occur?

A

Winter months

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61
Q

Is rhinitis self limiting?

A

Yes

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62
Q

What can rhinitis be a prodrome for?

A

Pneumonia
Bronchiolitis
Meningitis
Septicaemia

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63
Q

What is otitis media?

A

Ear infection

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64
Q

Presentation of otitis media

A

Bulging drum

Pain

65
Q

Is otitis media self limiting?

A

Yes

66
Q

Causes of otitis media

A

Primary viral infection
Secondary infection
- pneumococcus
- H flu

67
Q

What can otitis media lead to?

A

Spontaneous rupture of drum

68
Q

When should otitis media be treated?

A

Severe uni and bilateral > 6 months

Severe pain > 48 hours

69
Q

Treatment of otitis media

A

ANALGESIA

70
Q

Investigations of tonsillitis/pharyngitis

A

Throat swab

71
Q

Treatment of tonsillitis/pharyngitis

A

Nothing

10 days penicillin

72
Q

What must NOT be given in tonsillitis?

A

Amoxicillin

73
Q

Causative organism of Croup/LTB

A

Para influenza I

74
Q

Presentation of croup

A 
Coryza 
Stridor
Hoarse voice
Barking cough
Very well
75
Q

Treatment of croup

A

Oral dexamethasone

76
Q

Causative organism of epiglottis

A

H influenzae type B

77
Q

How common is epiglottitis?

A

Rare

78
Q

Presentation of epiglottitis

A

Stridor

Drooling

79
Q

Treatment of epiglottitis

A

Intubation

Antibiotics

80
Q

What % of URTIs in children are self limiting?

A

> 99%

81
Q

What are the lower resp tract infections in children?

A 
Pneumonia
Tracheitis
Bronchitis
Empyema 
Bronchiolitis
82
Q

Common infective agents of LRTI in children

A 
Strep pneumoniae
H influenzae
Moraxella catarrhalis 
Mycoplasma pneumoniae
Chlamydia pneumonia 
RSV
Para influenzae III
influenzae A and B
Adenovirus
83
Q

Presentation of tracheitis

A 
"Croup which doesn't get better"
Fever
Sick child
Off food
Lethargic
84
Q

Causative organisms of tracheitis

A

Staph

Strep

85
Q

Treatment of tracheitis

A

Augmentin

86
Q

How common is bronchitis?

A

Very very common

Mostly self limiting

87
Q

Presentation of bronchitis

A

Loose rattly cough with URTI
Post tussive vomit (glut = mucous stuff)
Chest free of wheeze / creps
Child very well

88
Q

Causative organisms of bronchitis

A

Haemophilus

Pneumococcus

89
Q

What is bronchitis an infection of?

A

Endobronchium

90
Q

Pathology of bacterial bronchitis

A 
Disturbed mucociliary clearance
1. minor airway malacia
2. RSV/adenovirus 
Lack of social inhibition 
Infection secondary (so no Ax)
91
Q

How long does bronchitis last for?

A

4 weeks

92
Q

What does bronchitis follow?

A

URTI

93
Q

Criteria for persistent bacterial bronchitis

A

Wet cough
More than one month
Remission with Ax

94
Q

What kind of diagnosis is bronchiolitis?

A

Clinical

95
Q

What is bronchiolitis?

A

LRTI of infants

96
Q

What % of infants get bronchiolitis?

A

30 - 40%

97
Q

Causative organisms of bronchiolitis

A

RSV
Others
- paraflu III
- HMPV

98
Q

What does RSV stand for?

A

Respiratory sinsitium virus

99
Q

Presentation of bronchiolitis

A

Nasal stuffiness
Tachypnoea
Poor feeding
Crackles +/- wheeze

100
Q

Does bronchiolitis have a predictive history?

A

YES

101
Q

Who gets bronchiolitis?

A

< 12 months old

102
Q

Is bronchiolitis recurrent?

A

NO

103
Q

What day after the start of cough does bronchiolitis start to stabilise?

A

Day 5 - 7

104
Q

How long does the whole illness of bronchiolitis last?

A

2 weeks

105
Q

Management of bronchiolitis

A

Maximal observation

Minimal intervention

106
Q

Investigations of bronchiolitis

A

NPA (cohorting)

Oxygen sats

107
Q

Treatment for bronchiolitis

A

NONE

Oxygen

108
Q

What does NPA stand for?

A

Naso pharyngeal aspirate

109
Q

What does O2 sats in bronchiolitis indicate?

A

Severity

110
Q

Presentation of a LRTI

A 
48 hours
> 38.5 degrees temp 
SOB
Cough 
Grunting 
Reduced or bronchial breathing sounds
111
Q

Wheeze indicates what is UNLIKELY?

A

A bacterial cause

112
Q

Does bronchiolitis cause fever?

A

NO

113
Q

Call the LRTI pneumonia if…..

A
  1. Signs are focal
  2. Creps (fine crackles)
  3. High fever
114
Q

How to confirm diagnosis of LRTI/Pneumonia

A

CXR

115
Q

Management of community acquired pneumonia in children

A

Nothing if symptoms are mild
Oral amoxycillin first line
Oral macrolide second line
IV if comiting

116
Q

Do you treat bronchiolitis with Ax?

A

NO

117
Q

Do you treat croup with Ax?

A

NO

118
Q

Do you treat acute LRTI with Ax?

A

Often not indicated

Amoxicillin first line if are treated

119
Q

Do you treat otitis media with Ax?

A

Not usually indicated
Consider amoxicillin if
- < 2 y/o
- bilateral infection

120
Q

Do you treat pharyngitis/tonsillitis with Ax?

A

Not indicated usually

Can consider penicillin

121
Q

What is the other name for pertussis?

A

Whooping cough

122
Q

What reduces the risk and severity of pertussis?

A

Vaccination

123
Q

Presentation of pertussis

A

Coughing fits
Vomiting
Colour change

124
Q

What is empyema a complication of?

A

Pneumonia

125
Q

What is empyema?

A

Extension of the infection into the pleural space

126
Q

Presentation of empyema

A

Chest pain

Very unwell

127
Q

Treatment of empyema

A

IV Antibiotics

Drainage

128
Q

Do children with empyema have a good prognosis?

A

Yes

129
Q

What organism commonly creates a cavitating pneumonia in the upper lobes, particularly in DM and alcoholics and may also be caused by aspiration?

A

Klebsiella pneumoniae

130
Q

Features of pneumoniae caused by legionella

A

Dry cough
Atypical chest signs
Hyponatraemia
Lymphopenia

131
Q

Causative organism of pneumonia following influenza

A

Staph aureus

132
Q

Who is pneumonia caused by pneumocystitis jiroveci seen in?

A

HIV patients

133
Q

Which organism accounts for 80% of pneumonia cases?

A

Strep pneumonia

134
Q

Features of strep pneumoniae

A

High fever
Rapid onset
Herpes labialis

135
Q

Is there a vaccine against step pneumoniae?

A

Yes - pneumococcus

136
Q

What type of pneumonia particularly occurs in patients with COPD?

A

Haemophilus influenzae

137
Q

Give an example of an atypical pneumonia

A

Mycoplasma pneumoniae

138
Q

Presentation of mycoplasma pneumoniae

A

Dry cough
Atypical chest signs / Xray findings
Autoimmune haemolytic anaemia
Erythema multiforme

139
Q

Presentation of PJP

A

Dry cough
Exercise induced desaturations
Absence of chest signs

140
Q

What is idiopathic interstitial pneumonia? Give an example

A

A group of non infective causes of pneumonia

Examples include cryptogenic organising pneumoniae

141
Q

What is cryptogenic organising pneumoniae?

A

A form of bronchiolitis which may develop as a complication of RA or amiodarone therapy

142
Q

Presentation of pneumonia

A 
Cough 
Sputum 
SOB
Chest pain; may be pleuritic 
Fever
Signs of SIRS
Reduced O2 sats
Reduced breath sounds / bronchial breathing
143
Q

What is the classical Xray finding of pneumonia?

A

Consolidation

144
Q

What is the risk stratification score called used for patients with community acquired pneumonia?

A

CURB-65

145
Q

What are the parts of CURB-65?

A 
C = confusion 
U = urea > 7
R = Resp rate > 30 
B = BP  < 90/<60
65 = Age > 65
146
Q

Management of patient with a CURB 65 score of 0

A

Should be managed in the community

147
Q

Management of a patient with a CURB 65 score of 1

A

Can be managed in community if sats > 92% and a CXR done

Hospital admission advised if on CXR - bilateral/multilobular shadowing

148
Q

Management of a patient with a CURB 65 score of 2

A

Management in hospital as this indicates a severe community acquired pneumonia

149
Q

What is ARDS caused by?

A

Increased permeability of alveolar capillaries leading to fluid accumulation in the alveoli i.e. non cardiogenic pulmonary oedema

150
Q

Mortality of ARDS

A

40%

151
Q

Causes of ARDS

A 
Infection; sepsis, pneumonia
Massive blood transfusion 
Trauma
Smoke inhalation 
Acute pancreatitis
Cardio pulmonary bypass
152
Q

Presentation of ARDS

A 
Acute onset and severe
SOB
Elevated RR
Bilateral lung crackles
Low O2 sats
153
Q

Key investigations for ARDS

A

CXR

Blood gas

154
Q

Management of ARDS

A

Oxygen
General organ support e.g. vasopressors as needed
Treat underlying cause

155
Q

What is the centor criteria involved with?

A

Sore throat
If 3 or more of the criteria is present, 40 - 60% chance the sore throat is caused by Group A beta haemolytic streptococcus

156
Q

Parts of the centor criteria

A

Presence of tonsillar exudate
Tender anterior cervical lymphadenopathy or lymphadenitis
History of fever
Absence of cough

157
Q

NICE guidelines on timeline of treatment and recovery of Community acquired pneumonia

A

Week 1 - fever should resolve
Week 4 - chest pain and sputum should have significantly reduced
Week 6 - cough and SOB should have significantly reduced
Month 3 - most symptoms should have resolved, except from tiredness
Month 6 - should be returned to normal

158
Q

Only indication for surgery in bronchiectasis

A

Localised disease on CT

159
Q

When should you consider granulomatosis with polyangiitis (wegeners)?

A

When a patient presents with ENT, resp and renal involvement

Respiratory Pathology (16 decks)

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