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SA respiratory > S9) Lower Respiratory Tract Infections and Pneumonia ❌❌❌❌ > Flashcards

S9) Lower Respiratory Tract Infections and Pneumonia ❌❌❌❌ Flashcards

1
Q

Identify 4 common microbial flora of the upper respiratory tract

A
  • Viridans streptococci
  • Neisseria sp
  • Anaerobes
  • Candida sp
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2
Q

Identify 5 less common microbial flora of the upper respiratory tract

A
  • Streptococcus pneumoniae
  • Streptococcus pyogenes
  • Haemophillus influenzae
  • Other: Pseudomonas, Escherichia coli
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3
Q

Identify three defences of the respiratory tract

A
  • Muco-ciliary clearance mechanisms (nasal hairs, ciliated columnar epithelium)
  • Cough & the sneezing reflex
  • Mucosal immune system (lymphoid follicles, alveolar macrophages, IgA, IgG)
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4
Q

Identify 5 ways in which the respiratory defences can be compromised

A
  • Poor swallowing (muscle weakness, alcohol)
  • Abnormal ciliary function (smoking, viral infection)
  • Abnormal mucus (cystic fibrosis)
  • Dilated airways (bronchiectasis)
  • Defects in host immunity (HIV, Immunosuppression)
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5
Q

Identify 5 common upper respiratory tract infections

A
  • Rhinitis
  • Pharyngitis
  • Laryngitis
  • Sinusitis
  • Otitis media
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6
Q

Respiratory tract infections are most commonly caused by viruses.

Identify 5 of these

A
  • Rhinovirus
  • Coronavirus
  • Influenza
  • Respiratory syncytial virus (RSV)
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7
Q

When are bacteria common causes for respiratory tract infections?

A

Bacterial super-infection common with sinusitis and otitis media – can lead to mastoiditis, meningitis, brain abscess

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8
Q

Identify 5 common lower respiratory tract infections

A
  • Bronchitis
  • Pneumonia
  • Empyema
  • Lung abscess
  • Bronchiectasis
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9
Q

What is acute bronchitis?

A

Acute bronchitis is the short-term inflammation of medium-sized airways

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10
Q

Identify 5 typical presentations of acute bronchitis

A
  • Cough
  • Fever
  • Increased sputum production
  • Increased shortness of breath
  • Normal CXR
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11
Q

Identify 2 causative organisms of acute bronchitis

A
  • S. pneumoniae
  • H. influenzae
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12
Q

How is acute bronchitis treated?

A
  • Bronchodilation
  • Physiotherapy
  • ± Antibiotics
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13
Q

What is pneumonia?

A

Pneumonia is a condition resulting from the inflammation of the lung parenchyma (alveoli) and the accumulation of fluid in the air spaces

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14
Q

Identify and describe the four different ways of classifying pneumonia?

A
  • By clinical setting (community acquired, hospital acquired)
  • By presentation (acute and chronic)
  • By organism (bacterial, viral, fungal)
  • By lung pathology (lobar, interstitial or bronchopneumonia)
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15
Q

Describe the pathology of pneumonia

A
  • Acute inflammatory response
  • Fibrinous exudate
  • Neutrophil infiltration
  • Macrophage infiltration
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16
Q

Identify the 5 main causative organisms for Community Acquired Pneumonia (CAP)

A
  • Streptococcus pneumoniae (most common)
  • Haemophilus influenzae (common)
  • Moraxella catarrhalis
  • Staphylococcus aureus
  • Klebsiella pneumoniae
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17
Q

Identify 5 symptoms of pneumonia (besides being explictly unwell)

A
  • Fever
  • Cough (± sputum)
  • Pleuritic chest pain
  • Shortness of breath
  • Nausea & vomiting
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18
Q

Identify 6 signs of pneumonia seen on examination

A
  • Pyrexia
  • Tachycardia
  • Tachypnoea
  • Cyanosis
  • Dullness to percussion (tactile vocal fremitus)
  • Crackles
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19
Q

Identify 5 investigations commonly requested for pneumonia

A
  • Full Blood Count
  • Urea & Electrolytes
  • C Reactive Protein
  • Arterial Blood Gases
  • Chest X Ray (abnormal)
20
Q

Which microbiological samples and investigations are requested for pneumonia?

A
  • Sputum / induced sputum
  • Blood culture
  • Broncho alveolar lavage fluid (BAL)
  • Nose & Throat swabs
21
Q

The CURB-65 score is used to determine the severity of pneumonia.

Which 5 measurements are involved?

A
  • Confusion
  • Urea > 7 mmol/l
  • RR > 30
  • BP <90/60
  • Age > 65 years

Score 2-5 = manage as severe

22
Q

Which 4 considerations are made when determining whether or not a patient needs antibiotic treatment for pneumonia?

A
  • Community vs hospital acquired?
  • Severity of illness?
  • Personal risk factors
  • Ventilator associated?
23
Q

Community acquired pneumonia is treated with empiric therapy.

Outline this treament for mild-moderate and moderate-severe pneumonia

A
  • Mild-moderate: amoxicillin or doxycycline/erythromycin/clarithromycin
  • Moderate-severe: co-amoxiclav and clarithromycin/doxycycline
24
Q

Describe the outcome of acute bacterial pneumonia in terms of resolution and complications

A
  • Resolution – organisation (fibrous scarring)
  • Complications – lung abscess, bronchiectasis, empyema
25
Q

Identify 5 possible reasons for the failure of antibiotic treatment for pneumonia

A
  • Empyema / abscess
  • Proximal obstruction (tumour)
  • Resistant organism (incl. Tb)
  • Not receiving / absorbing antibiotics
  • Immunosuppression
26
Q

Identify 4 atypical organisms which do not respond to penicillins (cell-wall active antibiotics)

A

Organisms without a cell wall:

  • Mycoplasma
  • Legionella
  • Chlamydia
  • Coxiella
27
Q

Which antibiotics can be used for pneumonia caused by atypical organisms?

A

Agents that work on protein synthesis:

  • Macrolides (clarithromycin / erythromycin)
  • Tetracyclines (doxycyline)
28
Q

Identify 2 extra-pulmonary features of pneumonia caused by atypical organisms

A
  • Hepatitis
  • Hyponatraemia
29
Q

Viral pneumonia accounts for 10% of pneumonia cases.

Identify 3 effects of viral pneumonia (and arising immune cells)

A
  • Damage to cells lining the airways / alveoli
  • Fluid filled air spaces interferes with gas exchange
  • Severe viral pneumonia necrosis / haemorrhage into the lung parenchyma
30
Q

How does viral pneumonia present on a chest X-ray?

A

Abnormal – patchy or diffused ground glass opacity

31
Q

Identify 4 causes of viral pneumonia

A
  • Influenza
  • Parainfluenza
  • Respiratory Syncytial virus (RSV)
  • Adenovirus
32
Q

When does hospital acquired pneumonia commonly occur?

A
  • > 48 hours in hospital
  • Often previous antibiotics
  • ± Ventilator
33
Q

Identify 5 causative organisms of hospital acquired pneumonia

A
  • Staphylococcus aureus
  • Enterobacteriaciae
  • Pseudomonas spp
  • Haemophilus influenzae
  • Fungi (Candida sp.)
34
Q

Outline the treatment of hospital acquired pneumonia

A
  • First line: Co-amoxiclav
  • Second line/ITU: Pipperacilin / Tazobactam / Meropenem
35
Q

When is aspiration pneumonia commonly seen?

A

Aspiration of exogenous material or endogenous secretions into the respiratory tract

36
Q

Which patient groups commonly present with aspiration pneumonia?

A
  • Neurological dysphagia (strokes)
  • Epilepsy
  • Alcoholics
  • Drowning
37
Q

Which causative organisms are at play in aspiration pneumonia?

A

Mixed infection – viridans streptococci & anaerobes

38
Q

How is aspiration pneumonia treated?

A

Co-amoxiclav

39
Q

Identify 4 immunosuppresion patient groups who are vulnerable to pneumonia and other lower respiratory tract infections

A
  • HIV (PCP, TB, atypical mycobacteria)
  • Neutropenia (fungi e.g. Aspergillus spp)
  • Bone marrow transplant (CMV)
  • Splenectomy (encapsulated organisms)
40
Q

Identify and describe three ways in which pneumonia can be prevented

A
  • Vaccination – flu vaccine and pneumococcal vaccine (high risk patients)
  • Chemoprophylaxis – oral penicillin / erythromycin (high risk patients)
  • Stop smoking
41
Q

what is a course of a typical infection indside and outside the lungs?

A

INSIDE:

  1. alveoli macrophages fail to stop pathogen
  2. cytokines recruit more macrophages
  3. inflammation → increased permeability
  4. more WBC + proteins

OUTSIDE:

  1. inflammatory mediators into systemic circulation
  2. physiological response → activates bone marrow, more CO, raised body temp
  3. dysregulation → signs of tissue or organ injury
42
Q

chalmydia pneumonia virulence factor

A

ciliostatic factor

43
Q

mycoplasma pneumonia virulence factor

A

shear of cilia

44
Q

influenza virulence factor

A

slows mucus velocity

45
Q

pneumococcus virulence factor

A

inhibits phagocytosis

46
Q

what are some drugs that can increase risk of pneumonia

A
  1. antacids (PPI/H2 antagonist)
  2. antipsychotics
  3. ACE inhibitors
  4. glucocorticosteroids

SA respiratory (23 decks)

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