respiratory tract infections Flashcards
is stridor upper or lower respiratory tract infection ?
upper
expiratory wheeze or crackles - what type or RT
lower
what is the first sign of HIV
thrush - fungal infection in throw that can cause oesophagitis
Case 1 - Jarad , 49 , asthmatic - 10 day history of nasal congestion, green nasal discharge , headache which is frontal and constant and worse when he leans forward - what are your first thoughts
green - bacterial
sinuses - headache when you press over them which makes them worse - worse on leaning forward as you put pressure on that area
thinking could be rhino sinusitis
is normal viral sinusitis ( rhino sinusitis) self resolving
bacterial sinusitis is bi phasic illness meaning often they had viral leaving tissues more vulnerable to infection and bacterial will get in there causing a secondary infection - do these last more or less than 10 days
yes - viral less than 10 days
bacterial more than 10 days
sinusitis is where the sinuses become swollen and are usually caused by an infection - causing pain in face and nose- what bacteria most often cause this
streptococcus pneumonias
haemohilus influenza
mortadella catarrali ( pathogens that live there)
what are the red flags if someone with asthma comes in with headache and pain
severe or persistent neck stiffness ( meningitis ) periorbital oedema ( cellulitis - visual change)
ophthalmoplegia - paralysis or weakens of the eye muscles
cranial nerve palsy
altered mental state and neck stiffness
Complications Periorbital- orbital cellulitis Subperiosteal abscess Osteomyelitis of sinus Meningitis Intracranial abscess Septic cavernous sinus thrombosis
what supportive therapy can you have for viral rhinosinustiis
analgesics
intranasal steroids for over 10 days
decongestants
can you give antibiotics to treat bacterial rhinosinustiis
5-7 days if not resolving
case 2 lady 26 with 5 day history of dry cough, sore throat , tiredness ( malaise) and runny nose ( rhinorrhea(free discharge of a thin nasal mucus fluid))
how can it be transmitted
most common upper respiratory tract infection that is the common cold
Direct transmission - hand contact up to 2 hours on skin
Sneezing or coughing - tissues don’t support virus transmission
Large droplets from close contact or 8 hours on external surfaces
effective treatments for the common cold
supportive
nasal decongestants
analgesics
complications of common cold ( rhinovirus, coronavirus , infleuzna )
Acute rhinosinusitis
Lower RT infection
Asthma exacerbation
Acute otitis media
Case 3 - 31year old with 2w history of sore throat and difficulty swallowing what is most likely diagnosis
acute pharyngitis - tonsillitis
examination reveal swollen tonsils and lymph glands
nasal congestion and cough with a viral tonsillitis
in a bacterial tonsillitis what do you see on the tonsils
exudate/puss
pharyngeal oedema and tender anterior cervical lymphadenopathy
normally by Group A strep
what is the difference between tonsillitis and strep throat
tonsillitis is viral or bacterial and strep throat caused by specific type of bacteria - Group A strep
splenomegaly
enlarged spleen - caused by underlying illness such as liver diseases, cancers , inflammatory disease and infection
if not viral tonsillitis what do you need to give the patient to treat them
penicillin
feverapain score measures certain aspects of the illness and depending on this determines what treatment you get
for strep pharyngitis
centor score (ever >38.5°C, swollen, tender anterior cervical lymph nodes, tonsillar exudate and absence of cough) are an algorithm to assess the probability of group A β haemolytic Streptococcus (GABHS) as the origin of sore throat, developed for adults.)
Case4 -LRT , 2 year old boy with 2 day history of sniffly cold and runny nose, presenting with fever and cough and wheezing and increased respiratory rate with poor feeding.
most likely bronchiolitis
caused by viral infection (respiratory syncytial virus)
90% roscoe within 3 weeks
what are these risk factors for prematurity below 36weeks low brith weight under 12 weeks chronic lung disease congenital heart defects immunodeficiency
severe disease
treatment for bronchiolitis is
nothing normally as should self resole
discharge when
clinically stable
taking oral fluids
Sp02 start are above 92%
what should you not use when treating bronchiolitis
antibiotics hypertonic slaine adrenaline - nebuliser salbutamol ipratropium bromide - COPD montelukast - good efficacy is asthma inahled or systemic corticosteroids
in broniectasis why is hypertonic saline good ?
airway clearance by increasing hydration or the airway surface layer and mucus making it easier to cough and breast up the phlegm
In Respiratory failure - lungs cease capacity to exchange oxygen for CO2 - if you get to much C02 blood turns to acid - non invasive ventilation - push air in and out of lungs to make lungs exchange co2 for oxygen so makes blood less acidic
what are two primary methods for this
CPAP ( continuous pressure - opens up respiratory failure good in type 1 respiratory failure) and then BiPAP( bi level - two levels of ventilation of air being forced into lungs at two different pressures - opens up then more again going to help exchange - type 2 respiratory failure)
what the difference between type 1 and type 2 respiratory failure
type 1 involves low oxygen and normal or low carbon dioxide levels. Type 2 involves low oxygen with high carbon dioxide levels
Case 5 - LRT - 67yr with 4 day history with worsening cough and green sputum , lower right sided chest pain with breathing in and fatigue and confusion
most likely?
pneumonia
what are the Sx of pneumonia
headaches loss of appetite high fever and chills clammy and blue skin low blood pressure cough with sputum SOB pleuritic chest pain hemoptysis muscle fatigue high heart rate vomiting high temp and repsriaotry rate
how can you score pneumonia
CURB65 confusion urea above 7.0mmol respiratory rate blood pressure below 90 systolic or below 60 diastolic above 65 years old if you have a crib score below 1 - ambulatory 1-2 is asdmit above 3 - ITU 40% risk of death
GCS
glasgow coma scale
used to measure a person level of consciousness after a brain injury
eyes verbal and motor responses assessed
cause of CAP
no cause normally found
typical - viewed as stain , atypical cannot be viewed
strep penuomoa haemophilus influenza mortadella catarrhlais staph aureus group a strep rhinovirus chlamydia pneumonia
HAP pneumonia occur over 48 hours after admission
what pathogens can accuse this
S-aureus
pesodomonus aeruginosa
e-coli
VAP - mechanical ventilation infections - in ICU
CAP - penicillin or macrocodes like clarithromycin
HAP - penicillin
what are the complications
pleural effusion empyema( pus in the pleura) repsriaotry failure acute RDS caveating disease access
what is the curb 65 score
The CURB-65 calculator can be used in the emergency department setting to risk stratify a patient’s community acquired pneumonia. The CURB-65 Score includes points for confusion and blood urea nitrogen, which in the acutely ill elderly patient, could be due to a variety of factors.
what is antibiotic stewardship
Antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients. Improving antibiotic prescribing and use is critical to effectively treat infections, protect patients from harms caused by unnecessary antibiotic use, and combat antibiotic resistance.
what is the R number
R is the number of people that one infected person will pass on a virus to, on average
If the R value is higher than one, then the number of cases increases.
But if the R number is lower the disease will eventually stop spreading, because not enough new people are being infected to sustain the outbreak.
An R value between 0.7 and 1.1 means that, on average, every 10 people infected will infect between 7 and 11 other people.
