12. Respiratory Tract Infections Flashcards
(106 cards)
1
Q
What are the risk factors for someone who presents with a cough
A
History of smoking (pack years)
Occupational history
Medication history (ACE inhibitors, beta blockers, aspirin)
history of contact with someone who has TB
2
Q
Name some differentials diagnosis of an acute cough (less than 3 weeks)
A
Influenza COVID 19 Viral URTI pneumonia lung cancer pericarditis infective exacerbation of COPD bronchiectasis TB SBE (subacute bacterial endocarditis) PE
3
Q
when taking a history of someone with a new onset cough, what do you want to know about the cough
A
the onset and duration of the cough
wether it is productive/non productive
the timing of the cough ie is it worse at night or worse with the seasons
any associated symptoms
if there is sputum production the colour/amount of sputum
4
Q
In someone with a URTI what associated symptoms would you expect them to have which would help you to differentiate this
A
rhinorrea ( production of watery, mucus, nasal discharge)
odynphagia (painful swallowing)
myalgia (muscle discomfort
fever
5
Q
if someone has a productive cough then what differentials would you be thinking of
A
pneumonia bronchitis bronchiectasis pulmonary odema TB
6
Q
if someone has a non-productive dry cough then what differentials would you be thinking of
A
asthma
interstitial lung disease (one that causes scarring of the lung)
viral pneumonia
7
Q
What are the differentiating symptoms of COVID 19
A
fever
SOB
dry cough
anosmia
8
Q
what are the differentiating symptoms of influenza
A
general aches and pains, autumn and winter timing
9
Q
what are the differentiating symptoms of a viral URTI
A
sore throat, nasal congestion, cough and feeling generally unwell
10
Q
what are the differentiating factors of pneumonia
A
sputum is green yellow brown fever chest pain SOB unwell patient
11
Q
what are the differentiating factors of lung cancer
A
haemoptysis
weight loss
persistant cough
ex smoker
12
Q
what are the differentiating factors of pericarditis
A
chest pain that is relieved on sitting forwards, usually following a viral infection
13
Q
what are the differentiating factors of infective exacerbation of COPD
A
increased sputum production and SOB
background of COPD or smoking history
14
Q
what are the differentiating factors of bronchhiectasiss
A
chronic productive cough, breathlessness
15
Q
what are the differentiating factors of TB
A
swinging fever weight loss anorexia productive cough haemoptysis contact with TB case high risk person (country of birth, homeless, immunosuppression)
16
Q
what are the differentiating factors of PE
A
sudden onset of sharp pain felt when breathing in, breathlessness, haemoptysis
17
Q
When should you think: could this be sepsis?
A
for a person of any age with a possible infection, even if they do not have a high temperature
18
Q
What acute phase protein would be raised if someone has an infection and what blood marker
A
CRP & WCC
19
Q
what two bacterial antigens can you test from someones urine
A
pneumococcal & legionella antigen
20
Q
what is lactate a product of
A
anaerobic respiration and so would be increased in sepsis and shock
21
Q
How can you describe CAP simply
A
signs of lower respiratory tract infection (fever, cough, phlegm, crepitations or bronchial breathing) + CXR changes
22
Q
what are the red flags to ask about when someone presents with a cough
A
persistent fever, night sweats and weight loss
Dyspnoea ( CCF, asthma, COPD, interstitial lung disease)
hemoptysis
severe pleuritic pain
history of contact with someone with HIV or TB
23
Q
What is the CURB-65 score
A
this is used to assess the patients risk of mortality of CAP to help determine outpatient vs inpatient treatment
24
Q
what does CURB65 stand for
A
C- Confusion U- urea greater than 7 mmol/L R- RR more than 30 B- Blood pressure systolic less than 90 or diastolic less than 60 65- if the person is 65 or older
25
how does the CURB65 score relate to management
score of 0-1 then likely suitable for home treatment
score of 2 then consider hospital supervised treatment
score of 3 or more then manage in hospital as severe pneumonia
26
What is the NEWS2 score
```
this is 6 simple physiological parameters that form the basis of the scoring system
RR
O2
Systolic BP
pulse
level of consciousness/new confusion
temperature
```
27
how would you describe pneumonia simply
an infection of the lung tissue that causes inflammation of the lung tissue and sputum filling the airways and alveoli
28
what does pneumonia show up as on an x ray
consolidation
29
how does pneumonia usually present (symptoms)
SOB
cough productive of sputum
fever
haemoptysis (coughing up blood)
pleuritic chest pain (sharp chest pain that is worse on inspiration)
Delirium (acute confusion associated with the infection)
Sepsis
30
What signs indicate pneumonia and possible sepsis secondary to the pneumonia
Tachypnoea (raised RR)
tachycardia (rasied HR)
hypoxia (low O2)
hypotension (shock)
fever
confusion
bronchial breath sounds on inspiration and expiration (caused by consolidation of the lung tissue around the airway)
focal coarse crackles (air passing through sputum in the airways similar to using a straw to blow into a drink)
dullness to percussion due to lung tissue collapse or consolidation
31
in the CURB-65 what parameter do you not count if you are out of hospital
urea
32
What are the common bacterial causes of pneumonia
Streptococcus pneumonia (50%)
haemophilus influenza (20%)
Moraxella catarrhalis in immunocompromised patients or those with chronic pulmonary disease
Pseudomonas aeruginosa in patients with cystic fibrosis or bronchiectasis
Staphylococcus aureus in patients with CF
33
what is an atypical pneumonia and how is it treated
pneumonia caused by an organism that cannot be cultured in the normal way or detected using a gram stain
Don't respond to penicillins can be treated with macrolides (e.g. clarithomycin), fluoroquinolones (e.g. levofloxacin) or tetracyclines (e.g. doxycycline).
34
what kind of bacteria is streptococcus pneumoniae
gram positive coccus
35
what kind of bacteria is haemophilius influenza
gram negative bacillus
36
Name the 5 causes of atypical pneumonia
| hint the pneumonic is 'legions of psittacis MCQ
M- mycoplasma pneumoniae
C- Chlamydydophila pneumoniae
Q- Q fever (corella burrnetti)
Legionella
Chlamydia pscittaci
37
what is legionella pneumophilia caused by and what is the typical exam patient
infected water supply or air conditioning units
| typical exam patient has recently has a cheap hotel holiday and presents with hyponatraemia
38
what is mycoplasma pneumonia and what kind of patient does it cause neurological symptoms
milder pneumonia that causes a rash called erythema multiform which is characterised by varying sized 'target lesions' formed by pink rings with pale centres
can cause neurological symptoms in young patient
39
what is the common presentations of chlamoydophila pneumonia
school aged child with a mild to moderate chronic pneumonia and wheeze
40
what is the typical exam patient who presents with Q fever (coxiella burnetii)
linked to exposure to animals and their bodily fluids so MCQ patient is a farmer with a flu like illness
41
how is chlamydia psittaci usually contracted and what is the typical MCQ patient
contracted from contact with infected birds
| MCQ patient is from a parrot owner
42
what fungal pneumonia can occur in patients that are immunocomprised
```
pneumocystis jiroveci (PCP)
particularly important in patients with poorly controlled or new HIV with a low CD4 count
```
43
how does fungal penumonia usually present in an immunocompromised patient
dry cough, SOB on exertion and night sweats
44
what is the treatment for fungal pneumocystis jiroveci (PCP)
co-trimoxazole known by the brand name Septrin
45
what investigations would you want to do in someone that you suspect has pneumonia
```
chest X ray
FBC
U&Es
CRP
sputum culture
blood culture
legionella and pneumococcal urinary antigens
```
46
should always follow local area guidelines on antibiotic use however what is the broad treatment of the following
mild CAP
moderate to severe CAP
mild CAP: 5 day course of oral antibiotics (amoxicillin or macrolide)
moderate to severe CAP: 7-10 day course of dual antibiotics (amoxicillin and macrolide)
47
what are some common examples of macrocodes
azithromycin, clarithromycin, erythromycin, and roxithromycin
48
what are the main complications of pneumonia
```
sepsis
pleural effusion
empyema
lung abscess
death
• Venous thromboembolism
• Worsening of comorbidities
o AF, heart failure, kidney failure, worsening of respiratory failure (COPD)
```
49
true or false: the higher up the infection, the more likely it is to be viral
true
50
name some common URTI
```
primarily viral
common cold
sinusitis
pharyngitis
laryngitis
```
51
name some common LRTIs
```
viral and bacterial
acute bronchitis (COPD exacerbation)
exacerbation of bronchiectasis
pneumonia (lung abscess and empyema)
TB
influenza
```
52
Why does pneumonia show consolidation on the chest X ray
it is where there has been a mass infiltration of inflammatory cells and so the alveoli are filled with neutrophils
53
What are the main classifications of CAP
o G+ bacteria, mycoplasma, influenza
54
what are the main classifications of HAP
o Subtype is Ventilator-associated pneumonia (VAP)
| o G- bacteria, Staph. Aures
55
what are the main classifications of pneumonia in the immunosuprresed host
o Unusual organisms, fungi
56
what are the main classifications of aspiration pneumonia
o Chemical pneumonitis, mixed flora
57
Name some potential findings in someone with CAP
* Temperature
* Tachypnoea
* Dull percussion
* Bronchial breathing
* Focal crackles
* Mental confusion
58
Name some symptoms of someone presenting with new onset CAP
* Cough with purulent sputum (blood)
* Rigors and fever
* Dyspnoea
* Chest pain (pleuritic, sudden onset)
* Abdominal pain
* Confusion (elderly, multimorbid patient)
59
Again name the 2 main antigens that you test for in the urine
pneumococcus and legionella
60
Name some common oral antibiotics
amoxicillin (alternatively doxycycline or clarithromycin(
61
Name the common treatment for severe pneumonia in hospital
a broad-spectrum beta-lacamase stable antibiotics such as amoxiclav together with a macrolide
62
What are the main side effects of antibiotics
usual side effects (diarrhoea)
C difficile infection
future antimicrobial resistance
63
sputum in pneumococcal pneumonia is characteristically what colour
rust/red
64
why does someone with pneumonia get SOB
alveoli become filled with pus which impairs gas exchange
65
what common chest pain do pt with pneumonia get
commonly pleuritic in nature and worse when coughing
66
what are some other non-pulmonary signs of pneumonia
confusion, abdo pain, diarhhoea and vomitting
67
Myalgia (pain or tenderness of the muscles) and arthralgia (discomfort of the joints) are common, especially in which infections
legionella or mycoplasma
68
what is the major red flag conditions in someone with pneumonia
sepsis
69
what is sepsis
Sepsis is the body's extreme response to an infection. It is a life-threatening medical emergency. Sepsis happens when an infection you already have —in your skin, lungs, urinary tract, or somewhere else—triggers a chain reaction throughout your body
70
Diagnosisng pneumonia:
| what could the FBC show
```
WCC increases in acute infections
neutrophillia in bacterial infections
neutropenia in viral infections
lymphopenia indicates severe infections
Hb: anaemia can complicate pneumonia
high or low platelets can be indicative of inflammatory process
```
71
Diagnosisng pneumonia:
| what could U&E show
urea and creatinine could be raised in AKI which could be a sign of sepsis
72
Diagnosisng pneumonia:
| why would LFT be deranged q
can be a reflection of reduction in liver perfusion associated with sepsis
73
Diagnosisng pneumonia:
| what inflammatory marker would be raised
CRP c reative protein
it is an acute phase protein that is produced by the liver in response to infection of trauma
higher levels indicate infection whereas lower levels are seen in inflammatory conditions and malignancies
74
what measurement is used as a general marker of illness severity and is used in sepsis scoring system
lactate as it is a product of anaerobic respiration
75
what is the limitation of a CXR
cannot distinguish the different causes of pneumonia based on the CXR alone
76
in what situations would a CT scan be performed
in cases where. lung abscess or empyema are suspected
77
when should blood cultures be taken
any patient with a fever in hospital
78
PCR can detect which kind of pathogens
o Non-culturable pathogens (viruses, atypical bacterial causes of pneumonia and pneumocystis jivoreci) and slowly growing pathogens (M. tuberculosis) can be detected and identified from respiratory samples by PCR
79
what is the infective organism that causes TB
mycobacterium acid-fast bacillus AFB
80
what should patients presenting with pneumonia be offered a HIV test
this is a common presentation of HIV in an undiagnosed individual
81
why cant you use a penicillin to treat an atypical cause. of pneumonia
they don't process a cell wall on which penicillins or cephalosporins can act
82
typical causes of CAP are
streptococcus pneumonia
haemophilus influenza
klebsiella pneumoniae
staph. aures
83
IVDU and chronic lung pathology individuals are at risk from getting which causative agent of pneumonia ?
streptococcus pneumonia
haemophilus influenza
klebsiella pneumoniae
staph. aures
Staph. aures
84
Which causative agent of pneumonia is a commensal organism of the GI
elderly patient and people with co morbidities. or alcohol excess are at risk from
streptococcus pneumonia
haemophilus influenza
klebsiella pneumoniae
staph. aures
klebsiella pneumoniae
85
what are the most common viral causes of pneumonia
influenza A and B
| however coronaviruses should be considered
86
Pneumonia due to influenza is often complicated with a post viral superinfection with bacteria or in severe cases with fungi like aspergillus
---
87
in the UK what is the most common cause of fungal pneumonia
pneumocystis jivoreci
88
what is the most common complication of pneumonia that complicates around 50% of cases
pleural effusion
| note that sepsis can also complicate pneumonia
89
how does the causative agent differ in children
* Neonates are at risk of pneumonia caused by E.coli, group B streptococcus and listeria monocytogenes
* Between 1-6 months by chlamydia trachomatis, S.aureus and respiratory syncytial virus (RSV)
* From 6 months to 5 years the most common causes of pneumonia are RSV and para-influenzas virus
90
how do you define hospital acquired pneumonia
new onset of symptoms along with a compatable X-ray developing more than 48 hours after the patients admission to hospital
91
What is VAP
ventilator acquired pneumonia
92
What is the different between early and late onset HAP
o Early onset occurs within 4-5 days of admission and is usually caused by antibiotic-sensitive community organisms
o Late onset infection is more likely to be caused by antibiotic resistant hospital pathogens
93
what specimen samples can you take to look for infection
* Sputum
* Broncho-alveolar lavage: in ventilated patients, direct sampling of deep respiratory secretions is possible and produces good quality results
94
what are the risk factors for HAP
* ICU stay, mechanical ventilation
* Prolonged hospital or ICU stay
* Severe underlying illness, multi co-morbidities
* Underlying respiratory disease eg COPD, asthma
* Abdominal surgery, vomiting/aspiration
95
what is the sepsis 6
```
o Give high flow oxygen
o Take blood cultures
o Give IV antibiotics
o Give a fluid challenge
o Measure lactate
o Measure urine output
```
96
in a FBC;
| is neutrophillia common in bacteria or viral causes
bacterial
97
in a FBC;
| is neutropenia common in bacterial or viral causes
viral
98
in a. FBC
| what is lymphopenia suggestive of
severe infections
99
when dealing with HAP the common organisms that should be considered are
Staphylococci (including MRSA)
enterococci
Gram negative bacili (such as E-coli or pseudomonas
100
NICE. guidelines recommend which antibiotics as first line for severe HAP and which antibiotics for non-severe HAP
tazocin
co-amoxiclav
101
which lobe is aspiration pneumonia most common in and why
the right lobe as the right main bronchus is straighter from the trachea compared to the left
102
Answer with effusion, consolidation or both;
which produce opacification of the lung field
both
103
Answer with effusion, consolidation or both;
the margins of opacification are not as clear
consolidation
104
Answer with effusion, consolidation or both;
the margins of opacification are quite clear
effusion
105
Answer with effusion, consolidation or both;
the opacification is dense are there are non markings visible in the lung field
effusion
106
Answer with effusion, consolidation or both;
you can see air bronchograms, so the opacification is not dense
consolidation
