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Med school ICP > Respiratory tract infections > Flashcards

Respiratory tract infections Flashcards

1
Q

Pneumonia risk factors

A 
Aspiration - gram negatives, anaerobes
Alcoholism - bacteraemic pneumococcal pneumonia
Diabetes - Klebsiella
Oral steroids/immunosuppression - Legionella
Smoking - strongest independent risk factor for invasive pneumonia
COPD - haemophilus/Moraxella
Nursing home residents
Age >65; <5
Chronic disease (asthma/COPD)
Malnutrition
Recent viral illness
Travel abroad
Occupational - brucellosis (abattoir), Q fever (sheep)
Air conditioning - legionella
Post-op
ITU
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2
Q

Bacterial causes

A

Strep pneumonia
H. influenza
Klebsiella
Pseudomonas

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3
Q

Viral causes

A

Influenza
Coxsackie
Adenovirus
RSV

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4
Q

Atypical causes

A

Mycoplasma
Legionella
Coxiella
Chlamydia

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5
Q

Protozoal causes

A

PCP

Toxoplasmosis

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6
Q

Fungal causes

A

Aspergillus
Histoplasmosis
Candida
Nocardia

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7
Q

Other causes

A

Aspiration
Lipoid
Bronchiectasis
CF

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8
Q

Strep pneumonia

A

Winter
2/3 of all bacteraemic pneumonia
Fever/pain

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9
Q

Legionella

A 
Autumn
52% travel related
Young smokers
Diarrhoea
↑ CK
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10
Q

Staph aureus

A

Coincident flu infection in 40% of admissions

50% of ITU

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11
Q

Mycoplasma

A

Young patients
Less multisystem
Epidemics every 4/5 years

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12
Q

Chlamydia pneumonia

A

Epidemics in community

Headaches

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13
Q

Investigations

A 
WCC
CRP
ABG
Sputum/blood cultures
Serology
CXR
Urinary antigens (pneumococcal, legionella)
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14
Q

CURB 65

A

Confusion - AMTS 7
Resps >30
BP <60d

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15
Q

Mortality by CURB 65 score

A

0: 0.7% - treat at home
1: 3.2% - treat at home
2: 13% - admission to hosp
3: 17% - admission to hosp
4: 41% - critical care referral
5: 57% - critical care referral

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16
Q

Management

A 
Tinz, nutrition, monitoring
Repeat CXR and CRP at 72h if no improvement
Antibiotics
No role for steroids
Follow up CXR 6 weeks
Vaccinate high risk individuals
17
Q

Antibiotics

A

Mild - oral amoxicillin (doxycycline)
Mod - oral amoxicillin + macrolide
Severe - IV tazocin/co-amoxiclav plus macrolide
7 days (longer for severe or staph aureus)

18
Q

Influenza-related pneumonia

A 
Primary viral:
• SoB, dry cough + 48h of fever
• Dry cough → haemoptysis
• Bilateral interstitial infiltrates
• Rapid deterioration with resp failure
• Up to 40% mortality, usually within 7 days
Secondary bacterial:
• 4x more common than viral
• Symptoms and signs in early convalescent period
• Lobar consolidation on CXR
• Mortality 7 - 24%
• Usual pathogens, ↑ S aureus

Med school ICP (15 decks)

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