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RESPIRATORY > Respiratory Tract Infections > Flashcards

Respiratory Tract Infections Flashcards

1
Q

What viruses can be picked up on a viral throat swab?

A
  • Influenza A+B
  • RSV
  • Rhinovirus
  • Adenovirus
  • Enterovirus
  • Coronavirus
  • Parainfluenza
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2
Q

What symptoms are experienced by a patient with a streptococcal tonsillitis?

A 
Exudate
Pus
Pain
Dysphagia
Dysphonia
Swollen red tonsils
tender lymph nodes
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3
Q

Scoring high on what two types of criteria make a streptococcal sore throat more likely?

A 
FeverPAIN Score:
Fever (during last 24 hrs)
Pus on tonsils
Attended rapidly (<3 days of symptom onset)
Inflamed tonsils
No cough 
Or Centor Criteria:
Fever
Pus
Inflamed cervical lymph nodes
No cough
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4
Q

Quincy is a potential complication of tonsillitis. What is this?

A
  • Peri-tonsillar abscess

- Can be drained to treat

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5
Q

Epiglottitis is a critical emergency. TRUE/FALSE?

A

TRUE - bacterial infection can cause difficulty breathing

  • previously was mostly caused by HiB in children until vaccine was created
  • now mainly caused by strep pneumoniae/ strep pyogenes/ staph aureus
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6
Q

How is epiglottitis treated in an emergency?

A
  • Endotracheal tube

- IV antibiotics (ceftriaxone, vancomycin, clindamycin)

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7
Q

What viruses are known to cause the common cold (coryza)?

A

Adenovirus
Rhinovirus
Respiratory Syncytial Virus (RSV)

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8
Q

What are common complications of the cold?

A

Acute bronchitis

Sinusitis

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9
Q

How does sinusitis present?

A 
Frontal headache
Retro-orbital pain
Maxillary sinus pain
Tooth ache
Purulent Discharge
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10
Q

Most sinusitis is self-limiting. TRUE/FALSE?

A

TRUE

- resolves in around 10 days

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11
Q

What can be used to treat sinusitis symptoms whilst it is clearing?

A

Nasal decongestant

  • Oxymetazoline
  • Pseudoephedrine

Nasal Steroid sprays

  • beclometasone
  • fluticasone
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12
Q

How does Diptheria usually present in the throat?

A
  • white coloured pseudomembrane seen over back of the throat
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13
Q

Why is diptheria considered a life-threatening condition?

A

The toxin produced by the bacteria causes life-threatening effects

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14
Q

How long is the incubation period for flu and other common viruses?

A

Influenza and parainfluenza viruses: 1-4 days
Rhinoviruses: 1-5 days
RSV: 7 days

(=> up to 1 week)

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15
Q

How long is the incubation period for streptococcal tonsillitis?

A

Group A streptococci: 1-5 days

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16
Q

Which virus that can cause throat symptoms has a long incubation period?

A

Epstein-Barr virus: 4-6 weeks

causes glandular fever

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17
Q

What infectious conditions can affect the lower respiratory tract?

A 
Acute bronchitis
Acute exacerbation of COPD
Pneumonia
Influenza
Fungal Infection
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18
Q

What is acute bronchitis?

A 
- cold which "goes to the chest"
=> preceeded by cold
- Productive cough
- fever in some cases 
- Normal chest examination
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19
Q

What symptom of acute bronchitis can be the most debilitating for patients?

A

If they experience tracheitis (trachea inflammation) then this can be very painful when they cough

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20
Q

Patients with pre-existing lung disease (e.g. COPD) already experience a lot of symptoms that would be consistent with infection. What are these?

A
  • Chronic sputum production
  • Bronchoconstriction
  • Inflammation of the airways
  • Breathlessness
  • Chest pains
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21
Q

What symptoms and signs would prompt you to consider infection in a patient with pre-existing lung disease?

A
  • Increased sputum production +/- change in colour
  • More wheezy/ SOB

O/E

  • Respiratory Distress
  • Wheeze
  • Coarse crackles
  • Cyanosed
  • advanced disease – ankle oedema
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22
Q

How are acute exacerbations of COPD managed in the community?

A
  • Antibiotic. e.g. amoxicillin or doxycycline
  • Bronchodilator inhalers
  • Short course of steroids (sometimes)
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23
Q

When would you refer a COPD exacerbation to the hospital?

A

Evidence of respiratory failure

Not coping at home

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24
Q

How would a COPD exacerbation be treated in hospital?

A
  • IV antibiotics
  • Measure ABGs
  • CXR to look for other diseases
  • Give oxygen if hypoxaemic
  • Rest, initially, then mobilise
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25
Q

What are the main symptoms of pneumonia?

A 
CHEST:
Cough
Haemoptysis
SOB
Preceding URTI
GENERAL SYMP:
Malaise
Sweats/Rigors
Myalgia/Arthralgia
Abdominal pain
Diarrhoea
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26
Q

How do older people present with pneumonia?

A

confusion
diarrhoea
reduced mobility
rarely cough

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27
Q

What are the main signs of pneumonia?

A
  • Fever/Rigors
  • Herpes labialis
  • Tachypnoea
  • Crackles/Rub
  • Cyanosis
  • Hypotension
28
Q

What markers can be used to grade the severity of pneumonia?

A
  • Temperature <35 or >40
  • Cyanosis PaO2 < 8 kPa
  • WBC <4 or >30
  • Multi-lobar involvement
29
Q

GI disturbance is common in Legionella pneumonia. TRUE/FALSE?

A

TRUE

30
Q

How does Influenza typically present?

A 
Fever (high, abrupt onset)
Malaise
Myalgia
Headache
Cough (dry + painful, then productive + painless)
31
Q

Give an example of a “Flu-like” virus?

A

Parainfluenza

32
Q

Haemophilus influenzae is a strain of flu. TRUE/FALSE?

A
  • FALSE it is a bacterium (not a virus)
    => not a primary cause of ‘flu
    => may be a secondary invader
33
Q

How is flu transmitted?

A
  • droplets
    OR direct contact with respiratory secretions of someone with the infection

=> need aerosol protection (PPE)

34
Q

What are the potential complications of flu?

A
  • Primary influenzal pneumonia
  • Secondary bacterial pneumonia
  • Bronchitis
  • Otitis media
  • Influenza during pregnancy may cause perinatal mortality, prematurity and lower birth weight
35
Q

A secondary bacterial pneumonia which develops after the flu is most common in what vulnerable groups?

A
  • infants
  • elderly
  • pre-existing disease
  • pregnant women
36
Q

What treatment is usually given for the flu?

A

Symptomatic Tx:

  • bed rest
  • fluids
  • paracetamol
37
Q

When are antivirals used in the treatment of flu and what antivirals can be given?

A

Antivirals:

  • oseltamivir
  • Zanamivir

NICE states only to be given if:

  • early in disease when flu is still “circulating”
  • patient is at risk of complications
38
Q

When do flu epidemics usually occur? When do pandemics occur?

A

Epidemics
- each winter
- small changes in surface proteins of the virus
=> can reinfect patients already vaccinated

Pandemics

  • rare, unpredictable
  • influenza A only
39
Q

How does the lab confirm a case of influenza?

A

PCR of viral swab taken from patient

  • Nasopharyngeal swabs
  • Throat swabs
40
Q

How is flu “prevented”?

A

Killed vaccine:
- Contains 2 FluA viruses and 1/2 FluB viruses
- given annually to:
=> adult patients at risk
=> health care workers
=> children 6 months to 2 years at risk of complications

Live attenuated vaccine:

  • More effective than killed vaccine in children aged 2-17
  • Administered intra-nasally
41
Q

At what time of the year is parainfluenza virus most prevalent?

A

Summer

=> contrasts Influlenza which is prevalent in winter

42
Q

What organisms may cause an atypical pneumonia?

A

Mycoplasma (only common one in UK today)
Coxiella (from sheep/goats)
Chlamydophila (from pet birds - parrots, budgies)

43
Q

How are atypical pnuemonias such as Mycoplasma, coxiella and Chlamydophila treated?

A

Respond to tetracyclines/macrolides

i.e. clarithromycin

44
Q

How are atypical pneumoniae species confirmed by the lab?

A
  • serology (gold top vacutainer)
  • virus detection
    PCR on respiratory swabs / secretions
45
Q

How does bronchiolitis usually present?

A 
1st or 2nd year of life
Fever
Coryza
Cough
Wheeze
46
Q

If bronchiolitis is severe what symptoms may patients experience?

A
  • grunting
  • decreased PaO2
  • Intercostal / sternal indrawing
47
Q

What virus most commonly causes bronchiolitis?

A

Respiratory Syncytial Virus (RSV)

48
Q

How is RSV confirmed by the lab?

A

PCR

  • nasopharyngeal swab
  • throat swab
49
Q

How is Bronchiolitis caused by RSV treated?

A
  • supportive
50
Q

Bronchiolitis epidemics usually happen at what time of the year?

A

Winter

51
Q

Which other virus has been newly recognised to cause bronchiolitis similar to RSV in various patient groups?

A

Metapneumovirus

52
Q

What areas can be swabbed or tested to do a virus panel in Tayside?

A

nasopharyngeal swab
throat swab
bronchoalveolar lavage (BAL)
endotracheal aspirate etc

53
Q

What viruses are looked for on a virus panel in Tayside?

A 
Flu A/Flu B
parainfluenza 1-4, 
coronaviruses (4 species)
metapneumovirus
adenovirus
RSV
rhinovirus
enterovirus
Mycoplasma pneumoniae
54
Q

Chlamydia Trichomatis can cause infantile pneumonia if present in the mother before birth. TRUE/FALSE?

A

TRUE

- diagnosed by PCR on urine of mother or pernasal / throat swabs of child

55
Q

Describe the pathological appearance of pneumonia in the lung tissue

A
  • acute inflammatory response
  • Exudate = fibrin-rich fluid (found in the alveoli)
  • Neutrophil + Macrophage infiltration
  • Thickened alveolar walls
56
Q

What complications can pneumonia cause for the lung tissue?

A

Fibrous scarring
Abscess
Bronchiectasis
Empyema

57
Q

What is a lung abscess and what symptoms does it cause in the patient?

A
  • Localised collection of pus (Tumour-like)
  • usually due to patient aspirating
    Symptoms:
  • Chronic malaise and fever
58
Q

Describe the type of reaction TB causes in the lung

A
  • Type IV (delayed) hypersensitivity

- granulomas with necrosis

59
Q

Describe the pathology of Acute TB in the lung

A
  • inhaled organism phagocytosed
  • carried to hilar lymph nodes
    Immune activation causes granuloma to form (this can kill organism)
  • In a few cases, infection is overwhelming and spreads
60
Q

How long does the acute phase of TB last?

A

1st exposure and up to 5 years afterwards

61
Q

How does the lung tissue change in Primary vs Secondary TB?

A

Primary:

  • Small focus in periphery of mid zone
  • Large hilar nodes (granulomas)
  • granulomas have a centre of “caseous necrosis”

Secondary:
- cavitating apical lesion

62
Q

What stain is used to identify TB?

A

Acid fast stain

  • organism appears red
  • if patient has decreased immunity, more organisms appear on staining
63
Q

What is it called when TB spreads throughout the lung tissue?

A

Miliary disease

- haematogenous spread to lower lobe causes miliary white foci to appear

64
Q

Why does TB disease reactivate?

A

Decreased T-cell function due to:

  • age
  • coincident disease (HIV)
  • immunosuppression

Reinfection at high dose OR more virulent organism

65
Q

What organisms are more likely to infect an immunocompromised host?

A
  • Virulent TB infection
  • Opportunistic pathogen
    virus (cytomegalovirus - CMV)
    bacteria (Mycobacterium)
    fungi (aspergillus, candida, pneumocystis)
    protozoa (cryptosporidia, toxoplasma)

RESPIRATORY (9 decks)

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