Respiratory Tract Infections

Question 1

Describe the right lung?

Answer 1

3 lobes - U, M, L and steeper bronchi

Question 2

Describe the left lung?

Answer 2

2 lobes - U, L and flatter bronci

Question 3

Name 3 parts of the upper respiratory tract?

Answer 3

Pharynx
Larynx
Trachea

Question 4

Name 2 parts of the lower respiratory tract?

Answer 4

Bronchi

Alveoli

Question 5

Generally, what are upper respiratory tract infections?

Answer 5

Viral and minor

Question 6

Name 2 upper respiratory tract infections?

Answer 6

Quinsy

Acute Sinusitis

Question 7

What is quinsy?

Answer 7

Peritonsillar abscess - bacterial cause
Follows tonsillitis
Unilateral sore throat, painful to swallow
Systemic upset
Abscess needs draining

Question 8

What is acute sinisitis?

Answer 8

Often viral (can be bacterial)
Facial pain, headache, toothache, fever, malaise, nasal drip,
Can be complicated by a brain abscess

Question 9

Name 3 life threatening upper respiratory tract infections in children? (because airway is already narrower)

Answer 9

Acute epiglottitis - H. influenzae type B - admit to hosp!
Croup - viral. Acute obstructive laryngo tracheo bronchitis
Stridor - wheeze on inhalation

Question 10

Name 2 major lower respiratory tract infections?

Answer 10

Bronchitis

Pneumonia

Question 11

What is bronchitis?

Answer 11

Very common - not a problem unless elderly, immunocompromised or COPD
Treatment only needed if underlying disease - H.influenzae or S. pneumoniae (amoxicillin, clarithromycin, doxycyclin)

Question 12

What is pneumonia?

Answer 12

WBC in alveoli and fill with organisms and inflammatory exudate, causing lung consolidation
Impaired gas exchange and risk of bacteremia
Rapidly fatal if left untreated

Question 13

How does pneumonia present?

Answer 13

Cough +

breathless/ tachypnoea/ pleuritic plain/ systemically unwell (fever, sweating)

Question 14

What causes pneumonia?

Answer 14

Often bacterial
Organism identified from sputum, blood, AB titres, bronchoalveolar lavage
Best clue is where the infection occurs

Question 15

When should treatment be started?

Answer 15

ASAP - before organism known as dont have time to wait

Question 16

What are the types of pneumonia?

Answer 16

Hospital acquired (HAP)
Community acquired (CAP)
Asipration pneumonia (AP)
Immunocompromised host (IHP)

Question 17

What gram stain is CAP?

Answer 17

gram +ve

Question 18

How do we treat CAP?

Answer 18

combination of amoxycillin and clarithromycin

Question 19

What organisms cause gram +ve CAP?

Answer 19

S. pneumoniae - peniciilin sensitive
H. influenzae - penicillin sensitive
Legionella sp - erythromycin sensitive

Question 20

What antibiotics are used in CAP?

Answer 20

PENICILLIN (best for S. pneumoniae
benzylpenicillin
amoxycillin (broader spectrum)

MACROLIDES (best for atypical organisms)
erythromycin
clarithromycin

Question 21

When is pneumonia dangerous?

Answer 21

RR > 30/min

cyanosis / confusion - hypotension

Question 22

What gram stain is HAP?

Answer 22

Gram -ve

Question 23

What organisms cause gram -ve HAP?

Answer 23

Bacilli
S. aureus
S. pneumoniae

Question 24

What antibiotics are used in HAP?

Answer 24

Anti - pseudomonas - Beta lactams - ceftazidime

Aminoglycosides - gentamycin

Question 25

What organisms cause AP?

Answer 25

90% anaerobes and 10% aerobes - bacterial flora of mouth

Question 26

What are the predisposing conditions for AP?

Answer 26

Impaired consciousness - alcohol, seizures
Dysphagia
Nasogastric tubes
Perio disease

Question 27

What antibiotics are used in AP?

Answer 27

Benzylpenicillin, flucloxacillin or co-amoxiclav

Question 28

What should happen after treatment?

Answer 28

fever settles in few days
x rays return to normal 4 - 6 weeks
If not = wrong antibiotic