Respiratory tract infections

Question 1

Name some examples of upper respiratory tract infections. (4)

Answer 1

Quinsy
Acute sinusitis
Acute epiglottitis
Croup

Question 2

What is quinsy?

How do you manage it?

Answer 2

Quinsy = peritonsillar abscess

Follows tonsillitis
Painful, often unilateral
Systemically unwell (temperature, low BP, feverish, sweating)
NEEDS ANTIBIOTICS + usually surgical drainage.

Question 3

What is acute sinusitis?

Answer 3

Facial pain which can mimic toothache or headache
Fever, malaise, postnasal drip
Painful on bending forward
Usually viral but can be bacterial, may require antibiotics

Question 4

What are 2 dangerous URTIs in children?

What symptom should you look out for?

Answer 4

1. Acute epiglottitis
2. Croup

What out for stridor

• > noisy laboured breathing
• > due to upper airway obstruction.

Question 5

Describe the cause of symptoms of acute epiglottitis.

Answer 5

• Rare since haemophilus influenzae vaccination
• Stridor
• Drooling, sitting upright
• Very unwell
• Do not examine the throat! straight to ED

Question 6

What is croup? and what is its symptoms?

Answer 6

Viral laryngotracheitis

Cough, stridor, hoarseness

Can be mild to (rarely) life-threatening

Other causes of stridor in children
: foreign body,
: allergic reaction.

Question 7

Name 4 lower respiratory tract infections - LRTI

Answer 7

• Acute bronchitis
• Pneumonia
• TB
• Covid

Question 8

What are the symptoms of acute bronchitis?

Answer 8

Cough, green sputum, fever

normal chest x-ray

usually viral but often get antibiotics

Question 9

What is pneumonia?
What is the treatment?
What are the symptoms?
Does it show on an x-ray?

Answer 9

Infection causing alveolar consolidation.

Can be life-threatening, NEEDS ANTIBIOTICS.

Cough, purulent/bloodstained sputum, fever, pleuritic chest pain (sharp chest pain worse on inspiration).

Abnormal chest x-ray (lobar vs bronchopneumonia)

Question 10

What are the 2 types of pneumonia? (where you get if from)

Answer 10

1. Community acquired
2. Hospital/institutional

Community acquired normally caused by streptococcus pneumonia, treated with amoxicillin.

Hospital/institutional e.g. nursing home pneumonia has lots of resistance to antibiotics. needs broader spectrum antibiotics and is more severe.

Question 11

Pneumonia can happen in immunocompetent and immunocompromised pts.
What can make someone immunocomporomised?

Answer 11

HIV, steroids, diabetes, chemo, bone marrow or other transplant.

Question 12

Name some causative organisms of pneumonia:

Answer 12

Pneumococcus (Strep. Pneumoniae)
Many other bacteria, viruses, ‘atypicals’, fungi…
inflammatory mimics

Question 13

Is TB a form of pneumonia?

Answer 13

Yes

Question 14

What bacteria causes TB?

Answer 14

Mycobacterium tuberculosis

Question 15

What are the symptoms of TB?

How long does it last?

Answer 15

Cough, fever, night sweats, weight loss, haemoptysis (coughing blood)

Lasts for weeks/months, not days.

Can reactivate many years after first infection - latency

Question 16

What are the risk factors?

Answer 16

• Travel/immigration from high-incidence areas (Africa, Asia (india, china, SE asia)
• Alcoholism or homelessness
• Institutional living
• Immunocompromised

Question 17

what can you look at to tell if someone has TB?

Answer 17

ZN sputum smear

Question 18

What is the treatment for TB and for how long?

Answer 18

3 or 4 drugs for 6 months

Question 19

Is TB contagious?

Answer 19

yes

Question 20

30-yr old woman returned from sub-Saharan Africa 4 weeks ago. Now has cough, fever, weight loss. Most likely diagnosis?

Answer 20

Tuberculosis
(recent travel indicated TB)

Not
\:pneumonia (possible)
\:bronchitis (possible)
\:lung cancer (possible)
\:PE (unlikely)

Question 21

What is covid pneumonitis?

What are the risk factors?

Answer 21

lung inflammation triggered by covid 19 infection (SARS-Cov-2 novel coronavirus)
major cause of death from covid

Risk factors:
\: age
\: obesity
\: ethnicity
\: immunosuppression

severe disease much less likely if vaccinated.

Question 22

What are the symptoms of covid pneumonitis?

How would you treat covid pneumonitis?

Answer 22

Worsening cough and breathlessness, usually 7-10 days after first covid symptoms.

low oxygen saturation.

Treated with:

• Oxygen, sometime via CPAP or invasive ventilation
• Steroids (dexamethosone)
• IL-6 inhibitors (tocilizumab, sarilumab)
• Covid antibodies (ronapreve)
• Antiviral drugs? (molnupiravir, ritonavir)