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Year 2 clinical pathology > Week 5 Upper and lower Respiratory Tract Infection > Flashcards

Week 5 Upper and lower Respiratory Tract Infection Flashcards

1
Q

What are the different normal flora in the URTI?

A

Streptococcus viridans, commensal Neisseria spp., diphtheroids, anaerobes.

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2
Q

Give examples of infections that cause transient colonisation post antibiotics?

A

Coliforms, Pseudomonas, Candida

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3
Q

What respiratory pathogens are usually asymptomatic but can become symptomatic due to another infection?

A

Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pyogenes
Sit in your throat

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4
Q

How are Upper respiratory tract infections transmitted?

A

Coughs and sneezes spread diseases”

DROPLET spread. Hand washing and decontamination very important

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5
Q

What group of people are most likely to get URTI?

A

Most often v. young children/teenagers
Winter/viral. Bacterial and viral common in children.
Also immunocompromised people

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6
Q

What is the strategy used when GP are prescribing antibiotics? For kids and adults over the age of 3

A

Address concerns – have 1 of 3 strategies
No prescribing
Delayed prescribing
Prescribe if risk of complications

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7
Q

What is the main disease that caues a cold?

A

Rhinovirus

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8
Q

What are less common causes of the cold?

A 
Coronoviruses
RSV,
Parainfluenza viruses
Enteroviruses
Adenovirus
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9
Q

What is symptoms of cold?

A

Nasal discharge, sneezing and sore throat

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10
Q

What is Coryza?

A

The common cold

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11
Q

What are the symptoms of Rhino-sinusitis?

A

Facial pain, nasal blockage, reduction smell

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12
Q

What is the aetiology of Rhino-sinusitis?

A

Post viral inflammation

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13
Q

What are the causes of Rhino-sinusitis?

A 
Streptococcus pneumoniae, 
Haemophilus influenzae, 
Streptococcus milleri group,
 anaerobes, 
fungal
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14
Q

What are the complications of Rhino-sinusitis?

A

chronic sinusitis,
Osteomyelitis,
meningitis,
cerebral abscess

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15
Q

What are less common causes of Rhino-sinusitis?

A

Allergic and non-infective causes

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16
Q

What are the investigations for Rhino-sinusitis?

A

Imaging

Sinus washouts

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17
Q

When using imaging for a patient with Rhino-Sinusitis what are you investigating?

A

Imaging for severe or suspected complications – Sinus X-ray, CT or MRI scans. See air fluid levels.

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18
Q

What is Sinus washouts ?

A

Diagnostic and therapeutic after referral to ENT.

Relieve some of the symptoms and so be able to get some sample to give to microbiologists

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19
Q

What are the treatment for Rhino-Sinusitis?

A

Treatment - if viral, no antibiotics. Many patients improve without antibiotics anyway.

Otherwise cover suspected/proven bacterial pathogens e.g. amoxicillin if severe disease

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20
Q

What is a uncommon cause of Rhino-Sinusitis?

A

Dental problem

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21
Q

What is the difference between pharyngitis and tonsillitis?

A

Pharyngitis and tonsillitis are infections in the throat that cause inflammation.
If the tonsils are primarily affected, it is called tonsillitis.
If the throat is primarily affected, it is called pharyngitis.

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22
Q

What are the viral causes of pharyngitis/tonsillitis?

A

Viral (RSV, Influenza, Adeno, Epstein barr virus, HSV1)

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23
Q

What is the main bacterial causes of pharyngitis/tonsillitis?

A

Streptococcus pyogenes,

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24
Q

What are the rarer bacterial causes of pharyngitis/tonsillitis?

A

Neisseria gonorrhoeae
Corynebacterium diphtheria
Mycoplasma pneumoniae
Chlamydophila pneumoniae

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25
Q

What investigation is done when a person is suspected of pharyngitis/tonsillitis?

A

Throat swabs and proper history

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26
Q

What are the signs and symptoms of pharyngitis/tonsillitis?

A

Sore throat , dysphagia, fever, headache, red tonsillar/uvular area +/- exudate. Lymphadenopathy

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27
Q

What does Group A Streptococcal Infection cause and in what group of people?

A

Pharyngitis/Tonsillitis in children

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28
Q

What complications can be caused when a child is infected with Group A Streptococcal Infection?

A

acute glomerulonephritis
rheumatic fever
scarlet fever

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29
Q

How do you prevent a child infected with Group A Streptococcal Infection getting scarlet fever?

A

Aim to prevent this rheumatic fever by giving penicilli

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30
Q

What other conditions do you try and prevent from occuring in a patient with Group A Streptococcal Infection?

A

Prevent suppurative complications too –> e.g. otitis media and quinsy (peritonsillar abscess))

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31
Q

What causes glandular fever?

A

Epstein-Barr virus (EBV

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32
Q

Who is at most risk of glandular fever?

A

Teenagers and older. Often asymptomatic.

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33
Q

What are the symptoms of glandular fever?

A

Sore throat, fever, cervical lymphadenopathy

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34
Q

What are the complications of glandular fever?

A

splenic rupture

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35
Q

What should you avoid when a person has glandular fever?

A

Avoid ampicillin (mac-pap rash, not a true allergy)

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36
Q

Why should you not do contact sport for some weeks when you have glandular fever?

A

Cause your spleen to rupture

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37
Q

How do you test for glandular fever?

A

Serology – IgM/IgG, Paul Bunnell Test/PCR

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38
Q

What is Diptheria?

A

An acute and highly contagious bacterial disease causing inflammation of the mucous membranes in the throat

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39
Q

What causes diptheria?

A

Corynebacterium diphtheriae

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40
Q

What are the symptoms of diptheria?

A

Malaise, fatigue, fever +/- sore throat

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41
Q

What is the treatment of Diptheria?

A

Treatment is Erythromycin/ penicillin/antitoxin

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42
Q

What is the prevention steps for Diptheria?

A

Prevention is Immunisation
travel history

Notifiable disease

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43
Q

What caues Thrush?

A

Candida, usually after antibiotics or steroids

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44
Q

What happens in Epiglottitis?

A

MEDICAL EMERGENCY

Cellulitis of epiglottis (“cherry red”) – airway obstruction

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45
Q

What are symptoms of Epiglottitis?

A

Fever, irritable, difficulty speaking (“hot potato”) and swallowing.
Leans forward, drools.
Stridor, hoarse.

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46
Q

How can you investigate a epiglottitis?

A

Lateral neck X-ray – enlarged epiglottis

Must send blood cultures

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47
Q

When a person has epiglottitis why do you send blood cultures and not a mouth swab?

A

You do not swab or examine epiglottis unless already intubated, or can intubate immediately (theatre).

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48
Q

What is the treatment of epiglottitis ?

A

maintain airway, cefotaxime

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49
Q

What used to be a common cause of epiglottitis?

A

H. influenzae type B prior to immunization

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50
Q

What is laryngitis?

A

Inflammation of the larynx

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51
Q

What is the symptoms of acute laryngitis?

A

Hoarse/husky voice, globus pharyngeus (lump in throat), fever, myalgia, dysphagia

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52
Q

Cause of acute laryngitis?

A

Usually viral and self-limiting, occasionally it is bacterial

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53
Q

Is antibiotics given to a person with acute laryngitis?

A

No unless if the patient has a severe disease

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54
Q

What are non infection causes of acute laryngitis?

A

voice abuse, malignancy

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55
Q

What is Croup/Acute laryngotracheobronchitis?

A

Inflammation of larynx and trachea after infection of upper airways

Common in children

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56
Q

What is the cause of Croup/Acute laryngotracheobronchitis?

A

Viral esp. parainfluenza type 2 therefore NO antibiotics also Respiratory Syncytial Virus

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57
Q

What is the treatment for Croup/Acute laryngotracheobronchitis?

A

Symptomatic treatment only

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58
Q

What is the cause of Whooping cough?

A

Bordetella pertussis - Gram negative coccobacillus

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59
Q

Does whooping cough just happen in children?

A

No happens in adults as well as the immunization can wear off.

Very contagious

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60
Q

How do you test fr whooping cough?

A

Pernasal swab and PCR

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61
Q

How long is the incubation period for whooping cough?

A

1-3 wks

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62
Q

What are the initial symptoms of whooping cough?

A

Initially catarrhal phase – runny nose, fever, malaise

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63
Q

What is catarrhal?

A

is a disorder of inflammation of the mucous membranes in one of the airways or cavities of the body

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64
Q

What is the symptoms of whooping cough after few weeks?

A

Dry non productive cough. This becomes whooping/paroxysms. (short bursts on exhalation, then inspiratory gasp which is the whoop.

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65
Q

What is the treatment of whooping cough?

A

Supportive and erythromycin

May be prolonged convalescence - weeks

66
Q

What is the complications of whooping cough?

A

otitis media,
pneumonia Often secondary infection or aspiration
Convulsions.
Subconjunctival haemorrhages

67
Q

How is whooping cough prevented?

A

Immunisation very important. Erythromycin to household contacts/Notifiable disease

68
Q

What is Otitis externa?

A

Infection of the external auditory canal

69
Q

What is the symtpoms of Otitis externa?

A

Pain, itch, swelling and erythema, otorrhoea

70
Q

What are the 3 different types of Otitis externa?

A

Acute OE, chronic OE and malignant OE.

71
Q

What are the caues of acute Otitis externa?

A

S. aureus and Pseudomonas spp.(esp. after swimming)

72
Q

How do you test for acute OE?

A

Swab ear canal and give to microbiology

73
Q

What is the treatment for acute OE?

A

Toilet with saline and/or alcohol and acetic acid. Wick insertion. Topical drops

74
Q

What is the cause of Otitis externa - chronic?

A

Irritation from drainage from perforated tympanic membrane.

75
Q

What is the symptoms and treatment of chronic OE?

A

Itchy

Treat underlying cause

76
Q

Why should aminoglycosides be avoided by a person with chronic OE?

A

Avoid aminoglycosides if perforation. Resistance may form and sensitisation occurs with prolonged courses

77
Q

What happens in Otitis externa - malignant?

A

Severe, necrotizing. Spreads from local area more deeply. May invade bone, cartilage and blood vessels.

78
Q

When is Otitis externa - malignant life threatening?

A

Spread to temporal bone, base of skull, meninges and brain.

79
Q

What is the cause of malignant OE?

A

Often Caused by Pseudomonas aeruginosa

80
Q

What is the symptoms of malignant OE?

A

pain, drainage of pus from canal

81
Q

Who is likely to have malignant OE?

A

Elderly, diabetics, immunosuppressed

82
Q

What is the treatment for malignant OE?

A

Treat 4-6 weeks altogether e.g. with iv ceftazidime then ciprofloxacin

83
Q

What is Otitis media (OM)?

A

Middle ear inflammation. Fluid present in the middle ear.

V. common in children

84
Q

What is the symptoms of OM?

A

Fever, pain, impaired hearing. Red bulging tympanic membrane

85
Q

What is the cause of OM?

A

VIRAL. H influenzae, S. pneumoniae, M. catarrhalis

86
Q

What test do you do for OM?

A

Swab any pus discharging

87
Q

What is the treatment of Otitis media?

A

Treatment, if not unwell WATCH and treat symptomatically (decongestant etc) and review early. If unwell give amoxicillin.

88
Q

What is Mastoiditis?

A

Inflammation of the mastoid air cells after middle ear infection. Pus collects in cells and may proceed to necrosis of bone

89
Q

It mastoiditis common?

A

Much lower incidence after introduction of antibiotics.

90
Q

What are the signs of Mastoiditis?

A

Signs as Acute Otitis Media, but pain/swelling over mastoid too

91
Q

What sample do you need to confirm the infection of mastoiditis?

A

Need bacteriology samples

Imaging – CT helps to assess extent

92
Q

What is the treatment of Mastoiditis?

A

Similar treatment to acute OM unless Gram negatives are suspected and then need broader spectrum cover as per organism isolated

1st line treatment is co-amoxiclav (amoxicillin-clavulanate)

93
Q

What are Ludwig’s angina, Lemierre’s Syndrome?

A

Deep fascial space infections of head and neck

94
Q

What are gingivitis/peridontal infection?

A

Infection of the gums

95
Q

What are the different ways of diagnosing a infection? 6 answers

A 
Send pus/throat swab/blood cultures
Gram stain 
Culture 
Sensitivity testing
Reference laboratory work (typing, toxin detection)
Serology and antibody detection
96
Q

When is Erythromycin mainly used?

A

If pencillin allergic and Whooping cough/diphtheria

97
Q

What is classed as lower respiratory tract?

A

Below the larynx

98
Q

Give examples of LRTI and what part of the LRT they affect?

A

Tracheitis –> affecting the trachea

Bronchitis affecting the bronchus and bronchioles

Pneumonia –> lung

Abscesses –> lung

99
Q

What are the different types of Bronchitis?

A

Acute

Chronic but can have acute exacerbations

100
Q

What are the different types of Pneumonia?

A

Community acquired

Hospital acquired

Ventilator acquired

Aspiration

101
Q

What are the Predisposing factors to LRTI?

A

Loss or suppression of cough reflex / swallow
e.g. stroke, coma, ventilation

Ciliary defects e.g. PCD  similar to CF

Mucus disorders e.g. CF

Pulmonary oedema – fluid flooding alveoli ( warm and moist harbour organisms)

Immunodeficiency: congenital or acquired (Multiple examples!)

Macrophage function inhibition e.g. smoking

102
Q

What viruses cause LRTI’s?

A
  • Influenza
  • Parainfluenza
  • Respiratory syncytial virus
  • Adenovirus
103
Q

When do fungus cause LRTI?

A

When the person is immunosuppressed most of the time

104
Q

Examples of fungi that cause LRTI?

A

Aspergillus sp.

  • Candida sp.
  • Pneumocystitis jiroveci
105
Q

Examples of baceteria that cause LRTI?

A

Streptococcus pneumoniae

  • Haemophilus influenzae
  • Staphylococcus aureus
  • Klebsiella pneumonia
  • Mycoplasma pneumoniae
  • Chlamydophila pneumoniae
  • Legionella pneumophila
  • Mycobacterium tuberculosis
106
Q

What happens to the bronchi in Acute bronchitis?

A

Inflammation & oedema of trachea and bronchi

107
Q

What are the symptoms of acute bronchitis?

A

Cough (typically dry), dyspnoea & tachypnoea

Cough may be associated with retrosternal pain

108
Q

What is the Epidemiology of acute bronchitis?

A

Most frequent in winter, in children

109
Q

What are the Causative viruses for acute bronchitis?

A

Viruses are the usual cause (rhinovirus, coronavirus, adenovirus, influenza)

110
Q

What are bacterial causes of acute bronchitis?

A

Bacterial causes less common (H.influenzae, M.pneumoniae, B.pertussis)

111
Q

Is it more common for a bacteria or a virus to cause acute bronchitis?

A

Virus more common than bacteria

112
Q

How is diagnosis of acute bronchitis made?

A

Usually there is no diagnostic test for mild presentation.

Might look at vaccination & previous exposure history e.g. influenza, B. pertussis to exclude some organisms

113
Q

When is culture of respiratory secretion done in case of acute bronchitis?

A

If looking for a specific cause e.g B pertussis and the person is very unwell but not routine

114
Q

What is the treatment for acute bronchitis?

A

Supportive treatment for healthy patients

Those with severe disease or co-morbidities may require oxygen therapy or respiratory support

Antibiotics only if bacterial cause is suspected or found

115
Q

What is the definition of chronic bronchitis?

A

Cough productive of sputum on most days during at least 3 months of 2 successive years (which cannot be attributed to an alternative cause)

116
Q

Chronic bronchitis is common in what type of people and what is assoicated with it?

A

Most common in men and >40yrs

Associated with smoking, pollution, allergens

117
Q

What is the main difference apart from duration of symptoms between acute and Chronic bronchitis?

A

In Chronic the inflammation and oedema of airways is mediated by exogenous irritants rather than infective agents seen in acute bronchitis.

118
Q

Is chronic bronchitis caused by different infective agents to acute bronchitis?

A

Patients have chronic exacerbations mediated by same infective pathogens as acute bronchitis

119
Q

What is the presentation of bronchiolitis?

A

Inflammation and oedema of bronchioles

120
Q

What is the symptoms of bronchiolitis?

A

: Acute onset wheeze, cough, nasal discharge, respiratory distress (grunting, retractions, nasal flaring)

121
Q

What is the epidemiology of bronhciolitis?

A

Peaks in winter and early spring, in infants 2-10 months.

Primarily paediatrics

122
Q

What is the main cause of Bronchiolitis?

A

Most commonly caused by Respiratory syncytial virus (RSV)–> 75% of cases

123
Q

What percentage of children by age of 2 have been infected by RSV?

124
Q

What are less common causes of bronchiolitis?

A

Also caused by parainfluenza, adenovirus, influenza

125
Q

What is the diagnosis of bronchiolitis?

A

Chest x-ray

Full blood count

Microbiological diagnosis: usually nasopharyngeal aspirate of respiratory secretions sent for viral PCR

126
Q

What is the treatment for bronchiolitis?

A

Supportive: oxygen, feeding assistance ( due to problems of eating due to irritants)

No clear evidence to support steroids, bronchodilators, ribavirin

Antibiotics only if complicated by bacterial infection

127
Q

What is pneumonia?

A

Infection affecting the most distal airways and alveoli

Formation of inflammatory exudate

128
Q

What are the two anatomical patterns of pneumonia? Give a description for both

A

Bronchopneumonia
Characteristic patchy distribution centred on inflamed bronchioles & bronchi then subsequent spread to surrounding alveoli

Lobar pneumonia
Affects a large part, or the entirety of a lobe
90% due to S.pneumoniae
Solid consolidation
Demarcated by the lob of the lug
129
Q

Which type of pneumonia is the most common?

A

Community acquired pneumonia

130
Q

When do you get hospital acquired pneumonia?

A

Pneumonia developing >48hrs after hospital admission

131
Q

What are the causative orgaisms of hospital acquired pneuomina?

A

Different causative organisms to CAP, especially if >5days after admission: enterobacteriaceae & Pseudomonas sp.

132
Q

What sub group is Ventilator acquired pneumonia (VAP) in?

A

Subgroup of HAP

133
Q

What is the cause of Ventilator acquired pneumonia?

A

Pneumonia developing >48hrs after ET intubation & ventilation

Et > preaching there natural defence and causing impairment of swallowing and coughing > increase risk of infection

134
Q

What is the cause of Aspiration pneumonia?

A

Pneumonia resulting for the abnormal entry of fluids e.g. food, drinks, stomach contents, etc. into the lower respiratory tract

Patient usually has impaired swallow mechanism

135
Q

When is CAP mostly seen and by what group of the population?

A

Peak age 50-70 years

Peak onset midwinter to early spring

136
Q

What are the different acquisition of CAP? GIve example of organims

A

Person-to-person or from a person’s existing commensals (S.pneumoniae, H.influenzae)

From the environment (L. pneumophilia)

From animals (C.psittaci)

137
Q

Bacterial cause of CAP can be divided into what two groups?

A

Typical and Atypical bacteria cause

138
Q

What is meant by Atypical pneumonia?

A

Traditionally described cases which failed to respond to penicillin or sulpha drugs and no organism could be identified

Now recognised as atypical organisms due to different clinical presentation and treatment is slightly different

139
Q

Name 5 typical organisms of CAP?

A 
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella  catarrhalis
Staphylococcus aureus
Klebsiella pneumoniae
140
Q

Name 5 atypical organisms of CAP?

A 
Mycoplasma pneumoniae
Legionella pneumophilia
Chlamydophila pneumoniae
Chlamydophila psittaci
Coxiella burnetii
141
Q

What are the symptoms of bacterial CAP?

A 
Usually rapid onset
Fever / chills
Productive cough 
Mucopurulent sputum
Pleuritic chest pain
General malaise: fatigue, anorexia
142
Q

What are the signs of bacterial CAP?

A

Tachypnoea
Tachycardia
Hypotension

Examination findings consistent with consolidation: 
Dull to percuss
Reduced air entry, bronchial breathing
Can hear crakles 
Alveoli trying to work against the fluid
143
Q

Atypical Mycoplasma pneumonia is commonest at what time of year and by who?

A

Autumn epidemics every 4-8 years

Commonest in children & young adults

144
Q

What is the diagnosis of Mycoplasma pneumonia, common symptoms and possible complications?

A

Diagnosis: serology (difficult to culture)

Main symptom is cough

Rare complications: pericarditis, arthritis, Guillain-Barre, peripheral neuropathy

145
Q

Outbreak of Legionella pneumophilia is assoicated with what?

A

Colonises water piping systems

Outbreaks associated with showers, air conditioning units, humidifiers

146
Q

What are the symptoms of Legionella pneumophilia, how is it diagnosed?

A

High fevers, rigors, cough: dry initially becoming productive, dyspnoea, vomiting, diarrhoea, confusion

Bloods: deranged LFTs, SIADH (low sodium

147
Q

What percentage of people who have CAP in adults are affected by Chlamydophila pneumoniae?

A

3-10% of CAP cases in adults

Highest incidence in elderly

148
Q

What are the symptoms of Chlamydophila pneumoniae

and do they vary by age?

A

Causes mild pneumonia or bronchitis in adolescents & young adults

Incidence highest in the elderly – may experience more severe disease

149
Q

What is Chlamydophila psittaci

assoicated with?

A

Associated with exposure to birds

150
Q

What 3 factors would make you consider pneumonia caused by Chlamydophila psittaci?

A

Consider in those with pneumonia, splenomegaly & history of bird exposure

151
Q

What is Splenomegaly?

A

Abnormally enlarged spleen

152
Q

What are the symptoms would a person infected with Chlamydophila psittaci
may show?

A

Rash
hepatitis
Haemolytic anaemia
Reactive arthritis

153
Q

Is influenza a complicated disease? What are the symptoms and recovery time?

A

IT is a uncomplicated disease.

Fever, headache, myalgia, dry cough, sore throat

Convalescence takes 2-3 weeks

154
Q

What type of patients does primary viral pneumonia commonly occur in? What are the symptoms associated?

A

Occurs more commonly in patients with pre-existing cardiac & lung disorders

Cough, breathlessness, cyanosis

155
Q

How would priamry viral pneumonia develop into secondary bacterial pneumonia?

A

It could develop after initial preiod of imporvement but follows infection caused by:

S.pneumoniae, H.influenzae, S.aureus

156
Q

How do you diagnose viral pneumonia?

A

Viral antigen detection in respiratory samples using PCR

157
Q

What are the 3 non- microbiological investigations for CAP?

A

Routine observations: BP / pulse / oximetry
Bloods: including FBC / U&E / CRP / LFTs
Chest X-ray

158
Q

What are 5 microbiological investiations recommended by BTS for all moderate- severe cases of CAP?

A 
Sputum Gram stain & culture
Blood culture
Pneumococcal urinary antigen
Legionella urinary antigen
PCR or serology for:
Viral pathogens
Mycoplasma pneumoniae
Chlamydophila so
159
Q

Why should we bother establishing a diagnosis?

A

Optimise antibiotic selection
Limit the use of broad spectrum agents
Identify organisms of epidemiological significance
Identify antibiotic resistance and monitor trends
Identify new or emerging pathogens

160
Q

What is CURB test based on and what does it tell you?

A

Confusion
Urea >7mmol/l
REspiratory rate >30
Blood pressure

You get 1 point on each point–> tell you how severe the CAP is and where should treatment happen

161
Q

What are the prevention methods of LRTIs?

A

Pneumococcal vaccination (S. pneumoniae)

Patients with chronic heart, lung and kidney disease
Patients with splenectomy
May repeat after 5 years in certain populations

Influenza vaccination for vulnerable groups (annually)

Over 65s
Chronic disease, multiple co-morbidities

Year 2 clinical pathology (21 decks)

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