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Y3 > Respiratory Tract infections > Flashcards

Respiratory Tract infections Flashcards

1
Q

what are the approaches to respiratory tract infections

A 
anatomical 
- upper vs lower respiratory tract infections
microbiological 
- virus, bacteria, fungus, parasite
- atypical vs typical pneumonia
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2
Q

what is the healthy ‘normal’ state of the lungs

A 
URT - is not sterile, some microorganisms are present in healthy individuals (normal flora)
LRT- tract is normally sterile 
defence mechanisms include: 
- cilia
- mucous production 
-cough 
- cough and swallow mechanisms 
- immunoglobulins - IgA
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3
Q

problems with lung defence mechanisms

A
  • ciliopathy - Kartageners
  • mucus pathology - CF
  • immunodeficiency states
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4
Q

history taking

A

symptoms: cough, nature of sputum, haemoptysis, pleuritic pain, fever, night sweats, coryxam symptoms (nasal discharge/facial pain, muscle aches and pains, lethargy)
history of travel
employment - animal exposure, weather, air conditoning, student, occupational exposures
birds? - pets
underlying predisposing illness
unwell contacts

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5
Q

URTI - facts

A 
common 
short lived and rarely serious 
usually viral aetiology 
only require antibiotics if:
- bacterial aetilogy known or suspected
- systemically unwell
- features high risk complications
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6
Q

URTI - features

A

coryzal features
- nasal discharge, sneezing and cough
pharyngeal involvement - sore throat
laryngeal involvement - hoarse/lost voice
can be complicated by - tracheitis/bronchitis = wheeze
nasal congestions, facial pain/pressure should raise the possibility of sinusitis - if persisits consider Ab

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7
Q

URTI - causative organisms

A

location and common pathogens
nasopharynx - rhinovirus, coronavirus, S. aureus
oropharynx - Group A strep, corynebacterium, diptheriaw, EBV, adenovirus
Epiglottis - Haemophilis influenzae
Larynx , trachea - parainfluenza, S aureus

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8
Q

What bacteria causes epiglottitis

A

Haemophilus influenza type B - nearly completely disappeared due to vaccine

  • acute onset of fever
  • sore throat
  • must avoid manipulation of the throat - call for help ENT
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9
Q

What bacteria causes sinusitis

A

Inflammation of the lining of the sinuses
S. Aureus
H. Influenzae
Anaerobes

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10
Q

What bacteria causes pharyngitis - sore throats

A 
Streptococcus pyogenes - group A strep most common bacterial cause causing 30%
Characterised by:
- inflammation 
- exudate 
- fever 
- tender cervical lymph nodes 
Complications 
- scarlet fever -red rash all over the body 
- rheumatic fever 
- post strep glomerulonephritis
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11
Q

Whooping cough

A 
Bordetella pertussis bacteria 
Contagious - notifiable 
Symptoms: 
- mild cold like 
- develop into coughing fits - BARKING cough can persist from weeks to months 
Transmission person to person coughs etc 
Young children most at risk
Vaccination programme
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12
Q

Important viruses in respiratory tract infection

A

Influenza/parainfluenza
RSV
Novel Coronavirus

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13
Q

Influenza facts

A 
3 types A, B, C
Type A and B most disease burden
Influenza virus is antigenically unstable 
Drift and shift 
Seasonal epidemics and pandemics
Vaccinations - risk groups offered, components aim to cover circling strain 
Diagnosis - throat swab - 
Suspect flu clinically - isolate
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14
Q

What does RSV stand for and how is it transmitted

A

Respiratory syncytial virus - droplets and secretions
Symptoms mild - children <6months severe - bronchiolitis and pneumonia
60% of children are infected prior to 1yo
Disease in childhood does not given life long protections

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15
Q

What are novel coronaviruses

A

Cause infection of differing severity in humans and animals
SARS - severe acute respiratory syndrome
- identified 2002
MERS-CoV - Middle East respiratory syndrome coronavirus
2012 identified

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16
Q

Types of lower resp tract infections

A

Pneumonia - infection of lung tissues
Acute bronchitis/bronchiolotis - inflammation of bronchi
Difference pneumonia shows radiological changes on CXR

17
Q

Types of pneumonia

A

Acute and chronic
Acute: community and hospital acquired
Community - typical and atypical
Chronic: pulmonary TB and fungal pneumonia

18
Q

Predisposing conditions to pneumonia

Condition and the organism

A

Alcoholic - s. Pneumoniae, h. Influenzae, k. Pneumoniae
COPD- h. Influenzae, s. Pneumoniae
Cystic fibrosis - pseudomonas, staphylococci
Post influenza - staphylococci, H. Influenzae
Mechanical ventilation- klebsiella, MRSA, P. Aeruginosa, enterobacter

19
Q

When are community acquired pneumonias most common

A

Winter

20
Q

What are the causes of community acquired pneumonia

A

Variety typical and atypical

21
Q

Signs and symptoms of community acquired pneumonia

A

Typical -fever, chest pain, purulent sputum

Atypical - dyspnoea, cough, minimal sputum production, more systemic upset

22
Q

Chest radiograph signs in community acquired pneumonia

A

Can be lobar, multilobar, segmental - one or more lung lobes affected
Bronchopneumonia- diffuse/patchy, bilateral, assymetric, usually affects both lower lobes

23
Q

Most common cause of community acquired pneumonia

A

Stereptococcus pneumoniae - aka pneumococcus
It is a normal inhabitant of URT
Associated with - resp tract infection, otitis media, sinusitis

24
Q

How to prevent pneumococcal pneumonia

A 
Polyvalent pneumococcal vaccine 
Offered to only those at risk 
-elderly 
- splenectomised patients 
- alcoholics
- COPD
25
Q

COPD exacerbation

A

Not always due to infection - characterised by colour of the sputum, increased production, fever

H. Influenzae
Streptococcus pneumoniae
Moraxella catarrhalis

26
Q

Types atypical pneumonia bacteria

A 
Legionella pneumophila 
Mycoplasma pneumoniae 
Chlamydia psittaci 
Chlamydia pneumoniae 
Coxiella burnetti
27
Q

Facts about legionella pneumophilia

A

Gram neg rod
Responsible for large outbreaks
Associated with environmental water sources
- taps in hospitals
- water systems - air conditioning
Symptoms - mild fluid like to sever pneumonia
Lab diagnosis - urine legionella antigen test

28
Q

Facts about chlamydia psittaci

A

Obligate intracellular bacteria
Usually causes infection in birds - parrots and budgies
Transmission to humans is by inhalation of dried bird faeces
Symptoms - flu like illness, pneumonia
Prevention - treat infected birds

29
Q

Mycoplasma pneumoniae facts

A

Small gram neg organism
Transmission- resp droplets
Infection most common in children5-14 and adults 30-39
Epidemics occur every 4 years
Range of symptoms from ill resp illness to pneumonia
Difficult to diagnose and grow

30
Q

How is hospital acquired pneumonia defined

A

Presenting 2 or more days after hospital admission
Patient from nursing home or long term residential care facility/having haemodialysis and has spent less than 2 days in hospital in the last 90 days a
- health care associated pneumonia

31
Q

Risk factors of hospital acquired pneumonia

A

Endotrachial intubatiin
Ventitlation - VAP
Immunocompromised
Post surgery

32
Q

Common organisms of hospital acquired pneumonia

A 
Gram. E.g. 
E. coli
Klebsiella
Serratia 
Pseudomonas 
MRSA
S pneumoniae
33
Q

How do antimicirobial therapies differ in hospital acquired pneumonia

A

Differs between late onset after 5 days and early onset before 5 days

34
Q

Why does the patient not improve

A

Wrong bug
Wrong drug
Complications

35
Q

Diagnosing approach to pneumonia

A

History and exam
Blood culture (if considering IV antibiotics take a BC)
Sputum cultures and throats swab of appropriate
Send urine
CXR
Routine blood - inc LFTs - atypical pneumonias and systemic viral infections can affect them
Pleural aspiration if evidence required

36
Q

How to assess the severity of community acquired pneumonia

A 
CURB 65
Confusion of new onset 
U rea greater than 7mmol/l
Resp rate greater than 30
Blood pressure less than 90mmHg systolic or less than 60 diastolic 
Age 65+
37
Q

Treatment approach to pneumonia

A

Start smart then focus
Broad empirical antibiotics based on most likely infection presentation - all trusts have guidelines
Narrow spectrum when further microbiological clinical evidence emerges

38
Q

When prescribing initially 4 things that are considered

A

Reason
Route
Dose
Duration

39
Q

After 48hours of antibiotic treatment what is considered

A

Whether to continue
Cancer
Or
Concert to oral

Y3 (22 decks)

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