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Respiratory System > Respiratory Tract Infections > Flashcards

Respiratory Tract Infections Flashcards

1
Q

What are the two main subgroups of respiratory tract infection?

A

Upper and lower RTI

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2
Q

What are the causes of RTI?

A

Pathogens (primary, facultative, opportunistic)
Damage to mucociliary escalator
Pulmonary secretions

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3
Q

What are the common classifications of pneumonia and examples of them?

A

Anatomical (broncho, lobar, segmental pneumonia)
Circumstantial (aspiration, nosocomial, community acquired)
Microbiological (causative pathogen)

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4
Q

What characterises bronchopneumonia?

A 
Base of lungs
Some alveolar damage
Opportunistic pathogen
Doesn't normally involve pleura
Hypoxaemia via V/Q mismatch
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5
Q

What characterises lobar/segmental pneumonia?

A 
Whole lobe/segment involved
Hypoxaemia via shunt
Primary pathogen
Community acquired, young people
Can involve pleura = pleurisy
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6
Q

What are some complications of pneumonia?

A 
Bronchiectasis
Lung abscess
Fibrosis and scarring
Organising pneumonia (can be cryptogenic, may look like tumor)
Empyema/Pleurisy
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7
Q

What causes hypoxaemia in bronchopneumonia?

A

V/Q mismatch (alveoli hypoventilate but still work a bit)

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8
Q

What is the most common cause of hypoxaemia in lung diseases?

A

V/Q mismatch

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9
Q

What causes hypoxaemia in lobar pneumonia?

A

Shunt (total loss of alveolar ventilation)

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10
Q

What causes cor pulmonale?

A

RV hypertrophy caused by increase in pulm pressure, caused by vasoconstriction, caused by hypoxaemia

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11
Q

What type of pneumonia is most commonly associated with lung abscesses?

A

Aspiration pneumonia

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12
Q

What can be causes of recurrent respiratory tract infection?

A

Tumour/foreign body
Systemic damage (HIV)
Localised lung damage (bronchiectasis)
Generalised lung damage (COPD)

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13
Q

What are the main signs of pneumonia?

A 
Hypotension
Fever 
Tachycardia
Basal crackles
Dull on percussion
Increased vocal resonance
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14
Q

What are the main symptoms of pneumonia?

A

Nonspecific malaise, fever, weight loss
Dry or productive cough (not always)
May be wheezy
Coloured sputum

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15
Q

What are the main investigations for pneumonia?

A 
Blood test (CRP, serum, FBC)
CXR
Legionella test
HIV test
Blood culture
Throat swab
Sputum culture (not normally done in practice)
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16
Q

What is the process of pathogenesis in pneumonia?

A 
Infection 
Acute inflammation
Neutrophil involvement
Suppuration
Pus filling alveoli causing consolidation
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17
Q

What are the criteria for the CURB65 classification in pneumonia?

A 
C - confusion
U - blood urea >7
R - respiratory rate >30
B - diastolic blood pressure <60
65 - age over 65
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18
Q

What are the treatment options for pneumonia?

A

CURB 0-1 –> amoxycillin or clarythromycin/doxacycline
CURB 2-3 –> amoxycillin (or levofloxacin) + clarythromycin
CURB 3-5 –> co-amoxiclav (+levofloxacin) + clarythromycin

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19
Q

What treatment should be given in case of aspiration pneumonia?

A

Amoxycillin (or levoflacin) + metronidazole (against anaerobes)

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20
Q

Why should public health be involved in cases of legionella-associated pneumonia?

A

Because it may be due to contaminated water and other people may be affected

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21
Q

What complications can arise from pneumonia?

A

Acute kidney injury
lung abscess/empyema
sepsis
ARDS

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22
Q

What non-pharmacological treatment should also be considered in pneumonia?

A 
Oxygen
CPAP/ventilation/intubation
IV fluids (reverse acute kidney injury)
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23
Q

What are some of the potential differential diagnoses for pneumonia?

A

tuberculosis
lung cancer
pulmonary oedema
pulmonary embolism

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24
Q

What is a useful diagnostic tool for empyema?

A

Thoracentesis (fluid aspiration)
CT scan
Ultrasound scan

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25
Q

What organisms can cause empyema?

A

Strep pneumoniae
Staph aureus
Anaerobes

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26
Q

What can be signs/symptoms of empyema?

A

Pleuritic chest pain

Swinging fever

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27
Q

How to treat empyema?

A

Amoxycillin + metronidazole (anaerobes)
Drainage of fluid
Fibrinolytics to remove pyogenic membrane and allow fluid to drain away
Surgery if doesn’t improve

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28
Q

What confirms a diagnosis of empyema?

A 
pH <7.20
Putrid smell (anaerobic)
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29
Q

For which LRTIs should a sputum culture be taken?

A

Lung abscess

Bronchiectasis

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30
Q

What disease can be associated with bronchiectasis?

A

Cystic Fibrosis

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31
Q

What are some of the symptoms of bronchiectasis?

A

very productive chronic cough (lots of sputum)

Sometimes SoB, haemoptysis, wheeze, finger clubbing

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32
Q

What are some of the symptoms of a lung abscess?

A

non-specific fever, weight loss, malaise

33
Q

What investigations should be done for bronchiectasis?

A 
sputum culture
high resolution CT scan
genetic testing for CF
testing for hypogammaglobulinaemia
testing for allergic aspergillosis
34
Q

What is the main difference between pneumonia and bronchitis?

A

Bronchitis only affects the bronchi

Pneumonia affects the lung tissue itself

35
Q

What is the main difference between community acquired and hospital acquired pneumonia?

A

they are normally caused by different organisms

36
Q

Who is normally affected by bronchiolitis?

A

Infants

37
Q

What causes bronchiolitis?

A

Respiratory syncytial virus (RSV)

38
Q

What are common organisms to cause bronchitis in children?

A

Haemophilus influenza

Pneumococcus

39
Q

What normally precedes bronchitis in children?

A

Viral URTI (eg RSV, adenovirus)

40
Q

Can you hear crackles in bronchiolitis in infants?

A

Yes

41
Q

Can you hear crackles in bronchitis in children?

A

No

42
Q

What investigations should be done for bronchiolitis?

A

Snot sample

O2 saturation to check severity

43
Q

What is the best treatment for bronchitis and bronchiolitis in children?

A

None, observation

otherwise oxygenation, hydration, nutrition

44
Q

What treatment options should be given to children with LRTI/pneumonia which is moderate/severe?

A

Oral amoxycillin or clarythromicin

IV if child is vomiting

45
Q

When should a LRTI be referred as pneumonia in children?

A

When there is focal damage, high fever and crackles on auscultation

46
Q

Should a CXR be done in children with suspected pneumonia/LRTI?

A

No

47
Q

What is the most effective way of avoiding pertussis (whooping cough)?

A

vaccination

48
Q

What treatment should be given for tracheitis in children?

A

Co-amoxiclav

49
Q

Out of tracheitis, bronchitis, bronchiolitis, pneumonia, empyema in children, which ones should get antibiotics if needed and which ones?

A 
Tracheitis - augmentin
Bronchitis - none
Bronchiolitis - none
Pneumonia/LRTI - if needed, oral amoxycillin (if allergic, clarythromycin)
empyema - IV antibiotics
50
Q

What are some of the common URTIs in children?

A

Rhinitis (rhinovirus)
Otitis media
Pharyngitis/tonsillitis
Croup

51
Q

With what other URTI can croup be mistaken and why?

A

Epiglottitis

Inspiratory stridor in both (obstruction)

52
Q

What differentiates croup from epiglottitis?

A

Croup - barking cough, no drooling

Epiglottitis - drooling, no cough

53
Q

Is croup or epiglottitis a medical emergency, and what to do?

A

Epiglottitis

Immediate intubation and antibiotics

54
Q

What is the treatment for rhinovirus?

A

Nothing, it’s self limiting

55
Q

What is an important consideration for rhinovirus in children?

A

It may cause a secondary bacterial LRTI (bronchitis, bronchiolitis)

56
Q

What is the main symptom of otitis media in children, and what is the most effective treatment?

A

Pain

Analgesics

57
Q

What is the main course of action in URTI in children?

A 
No treatment (or analgesics)
Observe - normally self limiting
58
Q

What investigation should be done when tonsillitis/pharyngitis is suspected?

A

throat swab (bacterial vs viral)

59
Q

What treatment should be given for tonsillitis/pharyngitis?

A

Viral - nothing

Bacterial - 10 days penicillin (not amoxycillin!)

60
Q

What treatment can be given for croup?

A

Oral corticosteroids (dexamethasone)

61
Q

When should croup be treated?

A

If severe

62
Q

What are the possible outcomes of primary TB infection?

A
  • resolution
  • latency
  • progression
63
Q

What are the possible outcomes of latent TB, and where can it happen?

A
  • disease progression later in life

- can occur in any organ

64
Q

What are the possible causes for post primary tuberculosis?

A
  • reactivation of latent TB

- re-infection of TB from other source

65
Q

What is the name given to the first lesion in the lung caused by TB?

A

Ghon focus

66
Q

What is the Ghon complex and how does it form?

A 
ghon focus (lung lesion) + lymph node involvement
forms because macrophages bring parts of M tuberculosis to the nearest lymph node
67
Q

What is miliary TB?

A

it’s a presentation of progressive TB with many small granulomata in lungs

68
Q

What are the possible symptoms of tuberculosis?

A 
symptoms not always present
fatigue, malaise, weight loss
cough
haemoptysis
SoB
pleuritic chest pain
69
Q

What main tests are involved in TB diagnosis?

A 
3 sputum samples for 3 days
CXR
Bronchoscopy (+biopsy)
CT thorax
IGRA
Mantoux/Heaf test
70
Q

What are the three samples of sputum used for in TB diagnosis?

A

Sputum smear - ZN staining
Sputum culture
Sputum PCR

71
Q

In which case would IGRA be used for TB diagnosis, and give examples of IGRA tests

A

If sputum not collectable/can’t isolate organism
Interferon Gold
T-Spot

72
Q

What is the basis for IGRA tests?

A

Increased gamma interferon produced by Th cells if TB present

73
Q

Why can IGRA tests not always be reliable?

A

Because they can give false positives or false negatives

74
Q

What screening tests are used for TB?

A

Tuberculin skin tests: Mantoux test (single skin prick) or Heaf test (multiple pricks)

75
Q

What should be done if Heaf test on a child without BCG vaccine is positive?

A

CXR:
If CXR normal - prophylaxis treatment
If CXR abnormal - treat for TB

76
Q

What should be done if a sputum sample can’t be collected or an organism can’t be isolated in suspected case of TB?

A

CT scan thorax
Bronchoscopy (+biopsy)
If there is pleural effusion: pleural aspiration

77
Q

What is the treatment for TB and its duration?

A

4 drugs for 2 months (rifampicin, isoniazid, ethambutol, pyrazinamide)
2 drugs for 4 months (rifampicin, isoniazid)

78
Q

What are the common side effects of TB medication?

A

Rifampicin - orange body fluids, increased enzyme metabolism, hepatitis, oral contraceptive inactivated
Isoniazid - hepatitis, peripheral neuropathy
Ethambutol - optic neuropathy
Pyrazinamide - gout

Respiratory System (7 decks)

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