Respiratory Tract Infections

Question 1

What is the name for the common cold?

Answer 1

Coryza

Question 2

What is coryza?

Answer 2

Acute viral infection of the nasal passages. Spread by droplets and fomites/

Question 3

What are the symptoms of coryza?

Answer 3

Rhinorrea
Mild fever
sore throat

Question 4

What are the complications of coryza?

Answer 4

Sinusitis

Acute bronchitis

Question 5

What is acute sinusitis?

Answer 5

Preceded by the common cold.

Purulent masal discharge

Question 6

What is diptheria?

Answer 6

A life threatening upper respiratory tract illness caused by Corynebacterium diphtheriae, a facultative anaerobic, Gram-positive bacterium

Question 7

Why is diptheria so life threatening?

Answer 7

Toxin production

Question 8

What are the characteristics of diptheria?

Answer 8

Pseudomembrane of the tonsils

Swollen ‘bull’ neck

Question 9

What is acute epiglottitis?

Answer 9

Inflammation of the epigottis usually in children

Question 10

What causes epiglottis?

Answer 10

Haemophilus influenzae

Question 11

What are the complications of acute epiglottitis?

Answer 11

Respiratory obstuction

Death

Question 12

How do you diagnose acute epiglottitis?

Answer 12

Upper respiratory tract
Small gram negatic bacillus on microscopy
Choclate agar- small translucent colonies on cultue
X and V test- H.influenza requires both to grow

Question 13

What is the treatment for acute epiglottitis?

Answer 13

ITU and ceftriaxone

Question 14

What is acute bronchitis?

Answer 14

The cold which goes to the chest

Preceded by coryza

Question 15

What are the clinical features of acute bronchitis?

Answer 15

Productive cough
Fever
Normal chest examination and normal CXT
Transcient wheeze

Question 16

What is the treatment for acute bronchitis?

Answer 16

Self limiting

unless underlying chronic lung disease

Question 17

What is an acute exacerbation of COPD?

Answer 17

Worsening COPD symptoms due to a viral or bacterial infection

Question 18

What are the clinical features of an exacerbation of COPD?

Answer 18

Preceded by upper resp tract infection- viral
Worsening sputum production- purulent now
More wheezy
Increased breathless ness

Question 19

What may be found on examination in a patient with an acute exacerbation of COPD?

Answer 19

Coarse crackles
Cyanosis
Ankle oedema in advanced disease

Question 20

What usually cause an exacerbation of COPD?

Answer 20

Viral 30 percnet

Bacterial- 50 percent

Question 21

What bacteria most commonly cause exacerbations of COPD?

Answer 21

Normal upper resp flora:
H.influenzae
Strep. pneumoniae
Moraxella catarrhalis

Question 22

What is the treatment for acute exacerbations of COPD?

Answer 22

Give antibiotics if increased purulence. Antibiotics not needed if no increased sputum unles CXR shows consilidation/pneumonia. Treat same way as mild CAP pneumonia.
Consider bronchodilator inhalers
Steroids in some cases

Question 23

When would you admit a patient with a COPD exacerbation to hospital?

Answer 23

Evidence of resp failure

Not coping at home

Question 24

How would you manage a patient with COPD exacerbation in hospital?

Answer 24

ABG
CXR
Oxygen if there is resp failure

Question 25

What is cystic fibrosis?

Answer 25

Inheritied defect which leads to abnormally viscid mucus which blocks tubular structures in many different organs including the lungs thus chronic resp infection a problem

Question 26

What bacteria tend to cause infections in CF?

Answer 26

Staph aureus and H.influenzae Pseudomonas aeruginosa Burkholderia cepacia

Question 27

What is pertussis?

Answer 27

Whooping cough | Acute tracheobronchitis

Question 28

What causes whooping cough?

Answer 28

Bordella pertussis

Question 29

What are the clinical features of whooping cough?

Answer 29

Cold like symptoms for two weeks Paroxysmal coughing for two weeks (violent) vomiting common residual cough for a month or so

Question 30

How do you diagnose pertusis?

Answer 30

Pernasal swab Serology Clinical

Question 31

What is the treatment for whooping cough?

Answer 31

Most effective in first ten days | Vaccine

Question 32

How are influenza cases described?

Answer 32

Seasonal- every year- small number of cases Pandemic- not very often- large number of cases, rapid spread, minimal immunity Bird flu- migration of avian flu to poultry workers- high mortality- little man to man transmission

Question 33

What are the clinical features of flu?

Answer 33

``` Incubation 1-4 days Abrupt onset Fever, chills, headache, sore throat, myalgia, malaise, anorexia, dry cough, prostration Clear nasal discharge 3-5 days in bed 5-6 days recovery ```

Question 34

What can be the causes of flu?

Answer 34

``` Classical: Influenza A- world wide pandemics- develops new antigens Influenza B-local outbreaks Flu- like illneses: Parainfluenza Bacterial: H.influenzae Secondary invader ```

Question 35

What are the complications of flu?

Answer 35

Primary influenzal pneumonia- high mortality- bloody sputum Secondary bacterial pneumonia- new fever on day 7 Myosistis Encephalitis Depression

Question 36

What are the treatments for flu?

Answer 36

Bed rest, fluids, paracetamol | Anti-viral drugs

Question 37

What anti viral drugs are used to treat flu?

Answer 37

Neuramindase inhibitors: Zanamavir Oseltamivir (tamiflu) oral- many benefits reduce symptom time, reduce antibiotic use

Question 38

What is H5N1?

Answer 38

Pathigenic avian flue | Influenza A

Question 39

How woulf you confirm a flu diagnosis?

Answer 39

``` PCR- detect virus Nasopharyngeal swabs Throat swabs Antigen detection Virus culture Immunofluorescense ```

Question 40

How is flu prevented?

Answer 40

Vacinnation- killed | Intra nasal live vaccine in children

Question 41

What flu prophylaxis is indicated?

Answer 41

NICE indicate antiviral prophylaxis after exposure- rarely used During 'containment phase of first wave of pandemic

Question 42

What is bronchiolitis?

Answer 42

Inflammation of the bronchioloes in the 1st and 2nd year of life

Question 43

What are the clinical features of bronciolitis?

Answer 43

``` Fever Coryza Cough Wheeze Severe case- gruntin, decrease PaO2, intercostal, sternal indrawing ```

Question 44

What are the complications of bronciolitis?

Answer 44

Resp and cardiac failure

Question 45

What causes bronchiolitis?

Answer 45

Respiratory Syncytial virus

Question 46

How do you confirm bronchiolotis?

Answer 46

PCR by throat or pernasal swabs

Question 47

What therapy is used to treat bronchiolitis?

Answer 47

Supportive | Nebulised ribavirin no longer used

Question 48

How are outbreaks of bronchiolitis controled?

Answer 48

No vaccine In hospital- cohort nusing Passive immunity with monoclonal antibodies not effective

Question 49

What other virus is common in children with acute resp tract infection such as bronciolitis?

Answer 49

Metapneumovirus

Question 50

What can chlamydia trachomatis cause?

Answer 50

STI which can cause infantile pneumonia | diagnosed with PCR

Question 51

What can chlamydophila pneumoniae cause?

Answer 51

Mild resp infections | person to person spread