Respiratory Tract Infections

Question 1

list infections of the upper respiratory tract

Answer 1

common cold (nose does not work properly in cold, viruses multiply) - coryza
sore throat - pharyngitis
sinusitis
epiglottis

Question 2

describe the test done to diagnose respiratory tract infections

Answer 2

viral throat swab via PCR

Question 3

describe strep throat

Answer 3

caused by virus (or streptococcus), does not require antibiotics

exudate (mass of cells and fluid seeped from blood vessels in inflammation)
pus
sore throat;
dysphagia (difficulty in swallowing)
dysphonia (difficulty in speaking)

Question 4

describe tonsilitis

Answer 4

swollen tonsils 
erythematous (redness due to accumulation of dilated blood vessels)
dysphagia 
dysphonia
recurrent - tonsillectomy

Question 5

describe quinsy

Answer 5

complication of tonsilitis, potentially life-threatening; 
can obstruct airway
peri-tonsillar abscess
sepsis
glomerulonephritis and rheumatic fever 
can be drained and IV antibiotics

Question 6

describe epiglottitis

Answer 6

critical emergency - complication of bacterial infection
obstruction of airway
treated with antibiotics

Question 7

describe common cold - coryza

Answer 7

acute viral infection (adenovirus, rhinovirus, respiratory syncytial virus) of nasal passages
accompanied by sore throat, mild fever
spreads via mild droplets and fomites
complications - sinusitis, acute bronchitis

Question 8

describe sinusitis and acute sinusitis

Answer 8

frontal headache
retro-orbital pain 
maxillary sinus pain 
tooth ache 
discharge 

acute sinusitis;
preceded by common cold 
purulent nasal discharge 
viral aetiology 
self-limited 
*may* need antibiotics
treated via nasal decongestant (oxymetazoline), nasal steroids, pseudo-ephedrine

Question 9

describe diphtheria

Answer 9

upper respiratory tract infection
life threatening - toxin production
pseudo-membrane
not seen in UK due to vaccination

Question 10

list infections of the lower respiratory tract

Answer 10

acute bronchitis 
acute exacerbation of COPD
pneumonia
influenza 
fungal infection

Question 11

describe acute bronchitis

Answer 11

cold which 'goes to the chest' (not life threatening)
receded by common cold 
clinical features;
productive cough 
fever (minority of cases)
normal chest examination 
normal chest x-ray
transient wheeze 

treatments;
no antibiotics, only paracetamol and ibuprofen, hydration and time
can lead to significant morbidity in patients with chronic lung disease

Question 12

describe infections in patients with COPD

Answer 12

may be preceded by upper-respiratory tract infection - increased sputum production and purulence, more wheezy, breathlessness

on examination - respiratory distress, wheeze, coarse crackles, may be cyanosed, in advanced disease - ankle oedema

management in primary care - antibiotics (doxycycline or amoxicillin), bronchodilator inhalers, short course of steroids

hospital care - respiratory failure, acopia
measurement of arterial blood gases, chest x-ray (identify other diseases), oxygen (if hypoxaemic)

Question 13

describe pneumonia

Answer 13

inflames air sacs of both lungs, air sacs may fill with fluid or pus
diagnosing - consolidation, new exudate on x-ray

symptoms;
malaise, anorexia, sweats, rigors, myalgia, arthralgia, headache, confusion, cough, pleurisy, haemoptysis, dyspnoea, preceding URTI, abdominal pain, diarrhoea

signs;
fever, rigors, herpes labialis (reactivation of herpes virus), tachypnoea, crackles, rub, cyanosis, hypotension

Question 14

describe the investigations and test for diagnosing pneumonia

Answer 14

blood culture 
serology
arterial gases
full blood count 
urea
liver function
chest x-ray
CURB 65 score (confusion, urea>7, respiratory rate >30, blood pressure systolic <90 or diastolic <61, age>65)
ask about pets - chlamydia psitacci 

temperature - <35 or >40 (lower temperature worse)
cyanosis PaO2 < 8 kPa
WBC <4 or >30 (lower count is worse)
muti-lobar involvement

Question 15

describe treatment for community acquired pneumonia

Answer 15

antibiotics - amoxicillin, doxycycline 
oxygen - sats 94-98%/88-92%
fluids
bed rest
no smoking

Question 16

describe mycoplasma pneumonia

Answer 16

peaks every 4 years
wide range of pathologies - pneumonia, hepatitis, immune thrombocytopenic purpura, autoimmune haemolytic anaemia, arthritis

bacterium has no cell wall and so is resistant to beta-lactam antibiotics (penicillins, cephalosporins)
causes protracted paroxysmal cough - cilial dysfunction, H2O2 production damages respiratory membranes (and erythrocytes)

Question 17

describe special cases of pneumonia

Answer 17

hospital acquired - requires extended gram -ve cover (amoxicillin and gentamicin)
aspiration pneumonia - need anaerobic cover (amoxicillin and metronidazole)
legionella - chest symptoms minimal, GI disturbance and confusion common, treated with levofloxacin
M. pneumoniae (MP) common in young people

Question 18

describe when IV antibiotics would be given

Answer 18

oral route no available
sensitivities - drug resistant organisms (pseudomonas) (can be identified via sputum)
deep seated infections - abscesses, bone, endocarditis, meningitis
first dose - rapid increase in plasma concentrations

Question 19

describe importance of examining sputum

Answer 19

identifies resistant organisms
TB or NTM suspected
high risk individuals
failure to improve standard therapies

Question 20

describe complications of pneumonia

Answer 20

respiratory failure
pleural effusion
empyema
death - due to sepsis, multiple organ failure

Question 21

describe prevention of pneumonia

Answer 21

influenza and pneumococcal vaccines;
over 65
chronic chest or cardiac disease 
diabetes
immunocompromised (e.g. splenectomy)

influenza vaccine - health care workers