LRTI Flashcards

1
Q

Croup- aetiology

A
  • usually in children

- COVID-19, parainfluenza virus, influenza virus, RSV, mycoplasma pneumoniae

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2
Q

Croup- symptoms

A
  • seal’s bark, hoarseness
  • precedent URTI (fever, laryngitis, tachypnea and wheezing, inspiratory stridor, hypoxemia)
  • steeple sign on XR
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3
Q

Croup- diagnosis

A
  • clinical

- viral antigen detection, PCR for NPA

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4
Q

Croup- treatment

A

oxygen therapy
ventilatory support
nebulised bronchodilator

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5
Q

Pertussis- Treatment

A
  • macrolides

- supportive

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6
Q

Community acquired pneumonia- treatment

A
  • beta lactam + macrolide/tetracycline

- supportive

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7
Q

Atypical pneumonia syndrome

A
  • walking pneumonia
  • No significant pathogen in routine culture
  • not responding to beta lactam
  • long course of illness
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8
Q

Atypical pneumonia syndrome- aetiology

A
  • mycoplasma pnuemoniae (special culture)
  • chlamydia trachomatis (cell culture)
  • chlamydophila pneumoniae (cell culture)
  • chlamydophila psittaci - parrot fever, psittacosis (cell culture)
  • legionella pneumophila (special culture, antigen)
  • respiratory viruses (cell culture, antigen)

PCR/nucleic acid amplification

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9
Q

Legionnaire/ legionellosis

A
  • urine antigen detection, in fresh water
  • charcoal based medium
  • treatment: macrolides, fluoroquinolones
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10
Q

nosocomial pneumonia- predisposinng factors

A
  • advanced age, underlying diseases
  • gastric acid suppression
  • intubations and use of respiratory equipment
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11
Q

Nosocomial pneumonia- aetiology

A
  • MRSA, non-fermenters: pseudomonas, acinetobacter baumanii, legionella penumophila, gram negs
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12
Q

Aspiration pneumonia

A
  • elderly, drunk, unconscious, iV drug addicts
  • loss of gag and swallowing reflex, loss of consciousness
  • obstruction, chemical pneumonitis, bacterial pneumonia
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13
Q

Complications- lung abscess

A
  • necrotising lung parenchyma, with pus containing cavitations (air fluid level)
  • bronchiectasis, bronchial obstruction, aspiration pneumonia, septic emboli
    Secondary to aspiration: mixed oral flora, anaerobes
    Secondary to bacteremia: monobacteria e.g. S. aureus, K. pneumoniae, P. aeroginosa
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14
Q

Complications- empyema thoracis

A
  • predisposing factors: pneumonia, surgery, perforated oesophagus, mediastinitis
  • Secondary to pneumonia: the one causing pneumonia
  • Secondary to surgery or eosophagus: anaerobes, aerobic gram neg
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15
Q

TB- diagnosis

A

clinical, radiological, acid fast stain
culture: faster culture system and earlier sensitivity result from BACTEC
tuberculin skin test
PCR

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16
Q

Pneumocystosis- presentation

A

pneumocystis jirovecii
- commonly present as pneumonia
(pulmonary Pneumocystosis, extrapulmonary not common)

17
Q

Pneumocystosis- epidemiology

A
  • immunocompromised people (AIDS-defining illness, malnourished premature and overcrowded children)
  • transplant recipient, high dose corticosteroid
  • chronic lung disease
18
Q

Pneumocystosis- diagnosis

A

Signs: diffuse bilateral infiltrate on CXR
hypoxemia

Definitive:
Sputum- induced sputum by nebulised hypertonic saline, expectorated not accepted
Bronchoalveolar lavage, transbonchial or open lung biopsy
Stain: methenamine silver stain, Giemsa stain and immunofluorescent stain

19
Q

Pneumocystosis- treatment

A

high dose cotrimoxazole

20
Q

Influenza symptoms

A
  • systemic more prominent than respiratory
    system: fever, headache, myalgia, malaise, arthralgia
    respiratory: dry cough, sore throat, rhinorrhea
21
Q

Influenza- complications

A
  • pneumonia

- myositis, encephalitis, Reye syndrome (with NSAID and aspirin)

22
Q

Influenza- diagnosis

A
  • clinical/hx
  • RT-PCR
  • antigen detection: immunofluorescent study, immunochromatographic assay, ELISA
23
Q

Influenza- treatment

A
  • supportive: analgesics, antipyretics (do not use aspirin and NSAID)
  • antivirals: adamantanes, neuraminidase inhibitors (oseltamivir, zanamivir, baloxivir)
24
Q

Influenza- prevention

A

chemoprophylaxis: oseltamivir
vaccine: inactivated (not used, IM/ID), live attenuated (inhalation), recombinant hemagglutinin (not used)
composition: seasonal- trivalent or quadrivalent, pandemic- monovalent