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MD3001 Cardiology > Respiratory Tract Infections 1 > Flashcards

Respiratory Tract Infections 1 Flashcards

1
Q

What are the sources of respiratory infections?

A
  • humans: family social contact
  • environment: air conditioning systems
  • animals: psitaccosis
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2
Q

What aspect of anatomy makes children under 7 more susceptible to infection?

A
  • shorter flatter eustachian tube (more likely to be blocked)
  • can spread infection to middle ear (through build up of fluid)
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3
Q

What are the common symptoms of an upper respiratory tract infection?

A
  • nasal congestion
  • chest congestion
  • sinus pressure
  • cough
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4
Q

What are the common pathophysiologies of an upper respiratory tract infection?

A
  • swollen mucosa
  • vascular enlargement
  • arrested cilia
  • clogged osta
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5
Q

Ottitis media infection

A
  • can rupture and release pus and damage hearing
  • acute and chronic infection can rupture into the mastoid sinuses (causing sinusitis)
  • infection can ascend the eustachian tube
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6
Q

Sinusitis

A

sinuses must drain so inflammation due to allergy/infection can block drainage and cause a secondary infection

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7
Q

What are the respiratory innate defenses?

A
  • nasal mucus
  • ciliated cells
  • mucociliary clearance elevator
  • alveolar macrophages
  • polymorphonuclear leucocytes
  • complement
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8
Q

Describe the mucociliary clearance elevator defence mechanism and what disruption of this causes

A
  • particles trapped in mucus covering respiratory tract
  • ciliary action drags mucus upwards
  • material is expelled
  • disruption results in chronic infections (like CF, bronchiectasis)
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9
Q

What are the respiratory tract host defences?

A
  • saliva
  • mucus
  • cilia
  • nasal secretions
  • antimicrobial peptides
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10
Q

How can the common cold be transmitted and what are its causative agents?

A

transmission:

  • aerosol
  • virus contaminated hands

causative agents:

  • rhinoviruses
  • coronaviruses
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11
Q

What are the clinical features of the common cold?

A
  • tiredness
  • slight pyrexia
  • malaise
  • sore nose and pharynx
  • sneezing
  • profuse, watery nasal discharge becoming mucopurulent
  • generally mild
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12
Q

What are the causative agents of acute pharyngitis and tonsilitis?

A

Virus:

  • Epstein-Barr virus (EBV)
  • cytomegalovirus (CMV)

Bacteria:
- streptococcus pyogenes

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13
Q

How is cytomegalovirus transmitted and what is the severity of it?

A

Transmission:

  • body secretions
  • organ transplants
  • can reactivate and cause disease if cell-mediated immunity is compromised

Severity:
- mild/asymptomatic in healthy adults

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14
Q

How would you go about diagnosing a secondary CMV infection and CMV pneumonitis?

A
  • secondary infection: look at IgM levels in blood

- CMV pneumonitis: look for CMV antigen in bronchoalveolar lavage (BAL)

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15
Q

What is the treatment for cytomegalovirus infections?

A
  • ganciclovir
  • foscarnet
  • cidofvir
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16
Q

What virus causes glandular fever and how is it transmitted?

A
  • Epstein-Barr virus
  • saliva
  • aerosol
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17
Q

Describe the progression of glandular fever

A
  • occurs in 2 peaks: 1-6 yo, 14-20 yo
  • incubation: 4-8 weeks
  • illness: 4-14 days
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18
Q

What are the clinical features of glandular fever?

A
  • fever
  • headache
  • malaise
  • sore throat
  • anorexia
  • palatal petechiae
  • cervical lymphadenopathy
  • splenomegaly
  • mild hepatitis
  • swollen tonsils and uvula
  • white exudate
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19
Q

How would you diagnose glandular fever?

A
  • detection of heterophile IgM antibodies specific for EBV through:
  • monospot test
  • Paul-Bunnell test
  • if negative consider HIV
20
Q

What is the treatment for glandular fever?

A
  • NOT antibiotics

- contact sports and heavy lifting should be avoided during first month of illness and until splenomegaly has resolved

21
Q

What are the complications of glandular fever?

A
  • Burkitt’s lymphoma
  • nasopharyngeal carcinoma
  • Guillain-Barre syndrome
22
Q

How can tonsilitis be transmitted and who is mainly affected?

A

transmission:

  • air-droplets
  • contact
  • affects mainly children
23
Q

What is the treatment for tonsilitis?

A

penicillin

24
Q

What are the clinical features of tonsilitis?

A
  • fever
  • sore throat
  • enlargement of tonsils
  • tonsillar lymphadenopathy
25
Q

What are the features of streptococcus pyogenes?

A
  • group A streptococcus
  • gram positive cocci in chains
  • cultured on blood agar
26
Q

What are the complications of streptococcus pyogenes?

A
  • scarlet fever (caused by erythrogenic toxin produced by S. pyogenes)
  • peritonsillar abscess (quinsy)
  • sinusitis/otitis media
  • rheumatic heart disease
  • glomerulonephritis
27
Q

Who is usually affected by diptheria and what is the incubation period?

A
  • mainly children affected (but can affect adults in countries where vaccination is poor)
  • 2-7 day incubation
28
Q

What are the clinical features of diptheria?

A
  • sore throat
  • fever
  • formation of pseudomembrane
  • lymphadenopathy
  • oedema of anterior of cervical tissue (bull-neck)
29
Q

How would you diagnose diptheria?

A

made on clinical grounds as therapy is usually urgently required

30
Q

What is the treatment of diptheria?

A
  • prompt anti-toxin therapy administered intra-muscularly
  • concurrent antibiotics (penicillin or erythromycin)
  • strict isolation
31
Q

How would you prevent diptheria infections?

A
  • childhood immunisation with toxoid vaccine

- booster doses given if travelling to endemic areas

32
Q

What is the cause of diptheria and its features?

A
  • corynebacterium diptheriae
  • only toxin-producing strains cause disease
  • transmitted through air-borne droplets
  • colonises pharynx, larynx and nose

subunit toxin:

  • subunit A (active): responsible for clinical toxicity
  • subunit B (binding): transports toxin to receptors to myocardial and peripheral nerve cells
33
Q

What are the clinical features of parotitis?

A
  • fever
  • malaise
  • headache
  • anorexia
  • trismus (lock jaw)
  • severe pain and swelling of parotid gland
34
Q

What causes parotitis and the features of it?

A
  • caused by mumps virus
  • transmission by droplets and fomites
  • diagnosis based on clinical features:
  • IgM serology can be performed in doubtful cases from saliva/CSF/urine
35
Q

What is the treatment of parotitis?

A
  • mouth care
  • nutritional
  • analgesia
36
Q

What is the prevention and complications of parotitis?

A

prevention:

  • active immunisation
  • MMR vaccine

complications:

  • CNS involvement
  • epididymo-orchitis
37
Q

What is the cause and clinical features of acute epiglottitis?

A
  • haemophilus influenzae
  • high fever
  • massive oedema in epiglottis
  • severe airflow obstruction resulting in breathing difficulties
  • bacteraemia
38
Q

What are the features of haemophilus influenzae?

A
  • gram negative bacillus

- present in nasopharynx of 75% healthy people

39
Q

Describe the diagnosis and treatment of acute epiglottitis

A

diagnosis:

  • do not examine throat/take throat swabs as will precipitate complete obstruction of airway
  • blood cultures to isolate H. influenzae

treatment:

  • life threatening emergency
  • urgent endotracheal intubation
  • IV antibiotics (ceftriaxone/chlorphenicol)
40
Q

Describe how laryngitis and tracheitis can occur and how it can present in adults and children

A
  • can spread from URT
  • parainfluenza virus
  • respiratory syncytial virus
  • influenza virus
  • adenovirus
  • adults: hoarseness, retrosternal pain
  • children: dry cough, inspiratory stridor (croup)
41
Q

What are the clinical features of whooping cough?

A

Catarrhal stage (1 week):

  • highly contagious
  • malaise
  • mucoid rhinorrhoea
  • conjunctivitis

Paroxysmal stage (1-4 weeka):

  • paroxysms of coughing with inspiratory whoop
  • lumen of respiratory tract compromised by mucus secretion and mucosal oedema
42
Q

What is the diagnosis and treatment of whooping cough?

A

diagnosis:

  • characteristic whoop
  • bacterial isolation from nasopharyngeal swabs
  • NAAT

treatment:

  • catarrhal stage: erythromycin
  • paroxysmal: antibiotics no effect
  • isolation
  • supportive care
43
Q

What causes whooping cough and its features?

A
  • bordetella pertussis
  • gram negative aerobic coccobacillus
  • attaches to and replicates in the ciliated respiratory epithelium
  • specific attachment due to surface components
44
Q

What are the toxic factors of bordetella pertussis?

A
  • pertussis toxin
  • adenylate cyclase toxin
  • tracheal cytotoxin
  • endotoxin
45
Q

What causes acute bronchitis?

A

usually due to infection:

  • rhinovirus
  • coronavirus
  • adenovirus
  • mycoplasma pneumoniae

secondary infections:

  • streptococcus pneumoniae
  • haemophilus influenzae
46
Q

What is chronic bronchitis?

A

anatomical disturbance of the respiratory system

  • immune deficit: SCID
  • ciliary deficit: Kartegener syndrome; smoking
  • excessively thick mucus: CF

MD3001 Cardiology (56 decks)

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