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Respiratory tract infections Flashcards

1
Q

What is the other name for a common cold?

A

Coryza

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2
Q

What is coryza?

A

An acute viral infection of nasal passages, often accompanied by a sore throat and a mild fever.

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3
Q

How is the common cold spread?

A

Spread by droplets and fomites (intermediate objects)

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4
Q

What are the typical infectious organisms associated with coryza?

A

Adenovirus
Rhinovirus
Respiratory Syncytial Virus

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5
Q

What is acute sinusitis?

A

short-term inflammation of nasal membranes and surrounding sinuses -> purulent nasal discharge.

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6
Q

Some symptoms of acute sinusitis?

A

Frontal headaches
maxillary sinus pain
toothache
discharge

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7
Q

Is acute sinusitis bacterial or viral aetiology?

A

viral but a bacterial infection can be acquired before the viral infection clears which prolongs duration

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8
Q

What is the proper name for the cold which ‘goes to chest’?

A

Acute bronchitis

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9
Q

What are the clinical features of acute bronchitis?

A

Productive cough - increased mucus production
Fever
Normal chest exam
Normal CXR
May have transient wheeze - inflamed bronchial wall

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10
Q

Treatment of acute bronchitis?

A

antibiotics NOT indicated
Usually self limiting
If person already has a chronic lung disease it can become serious

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11
Q

3 main features of COPD?

A

Chronic sputum production
Bronchoconstriction
Inflammation of airways

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12
Q

What are the clinical features of an acute exacerbation of COPD?

A

(Usually preceded by URTI)
Increased sputum production and purulence (more pus/green colour)
More wheezy
SOB

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13
Q

What would you find on examination of a COPD patient having an exacerbation?

A 
Respiratory distress
Wheeze
Coarse crackles
May be cyanosed
Ankle oedema (if advanced)
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14
Q

Which antibiotic would you give for an exacerbation of COPD?

A

Amoxicillin / Doxycycline

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15
Q

How would you manage a COPD exacerbation in primary care?

A

Antibiotic - amoxicillin / doxycycline
Bronchodilator inhaler
Potentially short course of steroids

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16
Q

What are the indications for antibiotics in an exacerbation of COPD? (antibiotic man)

A

Give if increased sputum purulence.

No antibiotics if no increased purulence UNLESS consolidation on CXR or signs of pneumonia

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17
Q

What is the treatment for COPD exacerbation in hospital?

A

Same as in primary but also check ABGs, CXR (for other diseases), and give O2 if in respiratory failure.

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18
Q

What would you find on a chest exam of a patient with pneumonia?

A 
Chest expansion reduced 
Percussion note dull
Breath sounds bronchial
Added sounds crackles
Vocal resonance increased
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19
Q

What investigations would you do if you suspect pneumonia?

A 
FBC
blood culture
serology
ABG
U&E
LFT
CXR
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20
Q

What is the UK definition of pneumonia?

A

Signs and symptoms of a lower respiratory tract infection, with a new infiltrate on a CXR.

21
Q

What is the score used to determine treatment of community acquired pneumonia?

A

CURB65

22
Q

What is the criteria for the Community Acquired Pneumonia score?

A 
C - confusion
U - urea > 7
R - resp rate > 30
B - BP: systolic <90 or diastolic <61
65 - age 65+
23
Q

How is a patient with a CURB score of 0-2 treated?

A

As an outpatient: Amoxicillin 1g IV/PO 5 days; Doxycycline if allergic to penicillin or Clarithromycin if NBM

24
Q

How is a patient with a CURB score of 3-5 treated?

A

Co-amoxiclav IV + Doxycycline PO
Levofloxacin IV if allergic to penicillin

ICU or NBM:
Co-amoxiclav IV + Clarithromycin IV (Levofloxacin)

25
Q

Apart from CURB65 what are severity markers for pneumonia?

A

Temperature <35 or >40
Cyanosis PaO2 <8
WBC <4 or >30
Multi-lobar involvement

26
Q

Which pathogen is the greatest cause of pneumonia?

A

Strep pneumoniae

27
Q

Other pneumonia pathogens?

A 
Strep pneumoniae
Haemophilus influenzae
Legionella sp
Staph aureus
Mycoplasma pneumoniae
Gram -ve enterobacteria 
Influenza A and B
28
Q

Which pneumonia pathogen has peaks every 4 years?

A

Mycoplasma pneumoniae

29
Q

Adult smokers with which infection are at an increased risk?

A

Chicken pox - varicella (chicken pox) pneumonia

30
Q

Patients who keep birds are likely to get…?

A

Pneumonia caused by Chlamydia psitacci

31
Q

What are some complications of pneumonia?

A

respiratory failure
pleural effusion
empyema
death

32
Q

What are the 3 other types of pneumonia (apart from CAP)?

A

Hospital acquired
Aspiration pneumonia
Legionella

33
Q

Which type of microbial cover does a patient need if they have aspiration pneumonia?

A

anaerobic cover

34
Q

Which type of microbial cover does a patient need if they have hospital acquired pneumonia?

A

extended gram negative cover

35
Q

How do you treat a patient with a severe hospital acquired pneumonia?

A

IV amoxicillin + metronidazole + gentamicin

If P. allergic:
Iv Co-trimoxazole + metronidazole +/- gentamicin

36
Q

How do you treat a patient with a non-severe hospital acquired pneumonia?

A

PO amoxicillin + metronidazole (5 days)

37
Q

If you took a sample of pneumonia caused by Strep pneumoniae, which type of haemolysis would you expect to see?

A

alpha (greening of colonies)

38
Q

Which test would come back positive for staph aureus pneumonia?

A

coagulase test +ve

39
Q

Which aerobic gram negative bacilli could cause hospital acquired pneumonia?

A

Legionella pneumophila

40
Q

How is M. pneumoniae spread? And who is at greatest risk?

A

Person to person transmission.

Children and young adults

41
Q

What causes Q-fever?

A

Coxiella burnetti

sheep and goats

42
Q

A patient who keeps a pet bird is likely to get pneumonia from?

A

Chalmydophila psittaci

43
Q

What is the therapy for CAP caused by Coxiella burnetti, C. psittaci, and M. pneumnoiae?

A

All respond to tetracycline and macrolides - e.g. clarithromycin and doxycycline

44
Q

Which respiratory infection presents in the 1st or 2nd years of life?

A

Bronchiolitis

45
Q

What are signs of a severe case of bronchiolitis?

A

Grunting, decreased PaO2, and intercostal/sternal in-drawing

46
Q

What is the most common cause of bronchiolitis?

A

RSV

47
Q

What is PCP and its cause?

A

Pneumocystic jirovecci pneumonia

One of the most frequent + severe opportunistic infections in the immunosuppressed

48
Q

What is the antibiotic of choice for PCP?

A

co-trimoxazole

49
Q

Give an example of a pneumonia caused by inhalation of fungal spores.

A

Aspergillus sp.

Resp (8 decks)

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