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MS-PA: Respiratory Diseases > Respiratory tract infections > Flashcards

Respiratory tract infections Flashcards

1
Q

What are the most common URTIs ?

A

-Rhinitis
– Pharyngitis
– Laryngitis and epiglottitis

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2
Q

What are the most common LRTIs ?

A

-Tracheitis
– Bronchitis
– Parenchymal infection - pneumonia

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3
Q

What are the risk factors for LRTIs ?

A
  • Age under 5 or over 65
  • More common in winter than in summer
  • Sick contacts
  • Travel and smoking
  • Immunosuppression
  • Iatrogenic: such as steroids and Biologic agents.
  • Stem cell transplant causing neurtopenia
  • HIV with CD4 <500
  • Anti-immunoglobuin antibodies
  • Organ transplan.
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4
Q

what is acute bronchitis ?

A

It is acute bronchial infection and >90% cases are viral origin.

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5
Q

What is the presentation of acute bronchitis ?

A

The patients typically Present in GP setting with cough +/- small volume purulent sputum, mild systemic symptoms, and the natural course can be up to 8 weeks.

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6
Q

what is the management of acute bronchitis ?

A

No indication for antibiotics unless
– systemically unwell (Low blood pressure, fevers, signs of sepsis)
– evidence of pneumonia
– chronic lung disease eg COPD, bronchiectasis, asthma

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7
Q

What is the definition of pneumonia ?

A

An acute infection of the pulmonary parenchyma resulting in lung consolidation.

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8
Q

What are the aetiologies of pneumonia ?

A

Strep pneumoniae (60% of bacterial pneumonia)
– Mycoplasma pneumoniae (Younger people)
– Haemophilus influenza
– Staphylococcus aureus (MSSA)
– Other: Chlamydia pneumoniae, Legionella pneumophila
– Respiratory viruses (Influenza, COVID in older people)

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9
Q

What is the mortality rate in pneumonia ?

A
  • Less than 1 to 5 % in out-patient setting.
  • Patients with community acquired pneumonia who are hospitalized will have 10% mortality.
  • In ICU cases the mortality approaches 40%.
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10
Q

What is Hospital-acquired pneumonia?

A

Hospital-acquired pneumonia (HAP) is pneumonia acquired after 48 hours of admission to hospital.

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11
Q

What is Ventilator-associated pneumonia?

A

Ventilator-associated pneumonia (VAP) is pneumonia occurring more than 48 hours after endotracheal intubation.

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12
Q

What are the aetiologies of HAP and VAP?

A

Aerobic gram negative bacilli: Pseudomonas aeruginosa,
Escherichia coli, Klebsiella pneumoniae,
– Resistant bacteria: MRSA
– Fungi – aspergillus or candida

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13
Q

What are the risk factors for pneumonia ?

A
  • Smoking
  • Alcohol
  • Malnutrition
  • ≥ 65 years
  • Immunosuppression
  • Altered level of consciousness (aspiration of food/vomit)
  • Chronic lung disease eg. COPD/Bronchiectasis
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14
Q

What is the Dx criteria of pneumonia ?

A

evidence of lung consolidation+ pleuritic chest pain or focal crepitations on auscultation+ opacification on chest xray or on CT thorax.

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15
Q

What are the signs of pneumonia ?

A
  • Tachypnoea
  • Tachycardia
  • Hypotension
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16
Q

What are the signs of consolidated lung ?

A

– Increased vocal fremitus on affected side
– Dull percussion over consolidated lung
– Bronchial breathing
– Crackles (crepitations)
– Increased vocal resonance
– Pleural rub

17
Q

what are the ddx of Pneumonia ?

A
  • Exacerbation of underlying lung disease
  • Lung cancer with post-obstructive pneumonia
  • Foreign body aspiration
  • Opportunistic infection- eg. Pneumocystis jirovecii pneumonia in
    HIV/AIDS
  • Mycobacterium tuberculosis
18
Q

What are the blood findings in pneumonia ?

A

Venous Bloods
– FBC: elevated WCC (or decreased in elderly / HIV / COVID)
– Renal profile (U&E):
* Determine baseline renal function/acute kidney injury in setting of
sepsis.
* Urea is a component of CURB-65 score
* Hyponatraemia in legionella pneumonia
– CRP (Non-specific marker of inflammation)
– LFTs: mycoplasma and legionella associated with hepatic transaminitis
– Blood cultures
* Arterial blood gas
– Degree of hypoxia
– Elevated lactate if septic

19
Q

What is CURB 65 score ?

A
  • Confusion (AMTS ≤ 8 or new disorientation)
  • Urea > 7 mmol/L
  • Resp rate ≥ 30/min
  • Systolic BP < 90 mmHg OR Diastolic BP ≤ 60 mmHg
  • Age ≥ 65 years
20
Q

What is the use of CURB 65 score in Community acquired pneumonia ?

A

CURB 65 score 0 to 1 = Low mortality suitable for home.
CURB 65 score 2= Intermediate mortality, consider hospital supervised Tx.
CURB 65 score 3 or more = High mortality Severe pneumonia ICU management.

21
Q

What is the management approach in pneumonia ?

A
  • Stabilise patient; assess and manage for sepsis
  • Oxygen therapy as appropriate
  • Anti-pyretics (Paracetamol / NSAIDS)
  • Antimicrobial therapy
  • Chest physiotherapy for clearance of secretions.
  • Nebulised saline and bronchodilators may assist secretion clearance in some patients.
22
Q

What is the antibiotic Tx in mild CAP?

A

Amoxicillin 500 mg – 1 gram TDS + Clarithromycin 500mg BD

23
Q

What is the antibiotic Tx in Hospitalised patient with moderate to severe CAP and or cardiovascular or respiratory illness?

A

1st line: Co-amoxiclav 1.2g IV TDS AND Clarithromycin 500 mg BD PO
OR
– 3rd generation Cephalosporin eg Cefuroxime 1.5 g tds iv AND
Clarithromycin 500 mg BD PO.
– 2nd line if penicillin-allergic: Levofloxacin 500 mg OD PO OR Moxifoxacin 400 mg OD PO.

24
Q

What is the Tx of Hospital-Acquired pneumonia ?

A

*Important to broaden gram-negative cover and in particular for
Pseudomonas +/- MRSA.
*1st line: Piperacillin/Tazobactam 4.5 g tds IV +/- Vancomycin 1g BD IV

25
Q

What are the factors to consider if the Pneumonia patient is not improving?

A
  • Failure to improve after 48 hours of antibiotic therapy
    should raised suspicion of:
    – Para-pneumonic pleural effusion or impending empyema (pus in
    the pleural space) that requires drainage
    – Resistant or atypical organism
    – Airway obstruction eg by tumour or foreign body. In such cases Repeat CXR, Sputum cultures, Bronchoscopy
26
Q

What are the respiratory complications of Pneumonia ?

A

-Para-pneumonic effusion and empyema
– Respiratory failure
– Acute Respiratory Distress Syndrome (ARDS)
– Lung abscess
– Pulmonary haemorrhage

27
Q

What are the systemic complications of pneumonia ?

A

-Sepsis and shock
– Renal failure
– Disseminated intravascular coagulation

28
Q

When to consider Tuberculosis as a differential of pneumonia ?

A

*High-risk profile such as from high-prevalence region or known exposure, homeless, IVDU and HIV/AIDS.
* Upper lobe pneumonia (especially
with cavitation).
* Longer course of illness
* Haemoptysis, weight loss

29
Q

When to suspect aspiration pneumonia ?

A
  • Suspect if recurrent lung infections and risk factors present
  • Microbiology: gram-negative and anaerobic mouth flora
  • Often lower lobes (right lower lobe commonest)
30
Q

What are the risk factors for aspiration pneumonia ?

A

*Reduced level of consciousness (eg alcoholics, epilepsy)
*Impaired swallow (eg post-stroke, dementia)

31
Q

When is pneumocystis jirovecii pneumonia classically seen ?

A

HIV AIDS with CD4
count <200 OR profound immunosuppression.

MS-PA: Respiratory Diseases (15 decks)

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