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Clinical Pathology > Lower respiratory tract infections > Flashcards

Lower respiratory tract infections Flashcards

1
Q

define lower respiratory tract infection.

A

respiratory tract infections below the larynx

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2
Q

what are the common predisposing factors that lead to a Lower respiratory tract infection occurring.

A 
loss or suppression of cough reflex (pathogen is not removed).
Cillary defects
mucus disorders
pulmonary odema
immunodeficency
macrophage function inhibitiom
aspiration of food.
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3
Q

common bacterial organism which cause lower respiratory tract infections

A 
streptococcus pnemonia
haemophilus influenz
staphylococcus aureus
klebisella pneumona
Mcyoplaasma pneumonaie
Legionella pneumophila
Mycobacterium tuberculosis.
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4
Q

common viral organisms which cause lower respiratory tract infections

A

Influenza
Parainfluenza
Respiratory syncytial virus- RSV
Adenovirus

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5
Q

common fungal infections which cause lower respiratory infections

A

aspergillus, candida, pneumocytisis jiroveci.

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6
Q

define acute bronchitis

A

• Inflammation and oedema of trachea and the bronchi

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7
Q

clinical signs of acute bronchitis

A

cough (dry), dysponea, tachyponea, retrosternal pain

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8
Q

common pathogens which cause acute bronchitis and chronic bronchitis.

A

viral- common
rhinovirus, coranavirus, adenovirus and influenza
bacteria- rare
H. infleunza, M. pneumonia, B, pertussis.

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9
Q

diagnosis of acute bronchitis

A

vaccination history and previous exposure- to eliminate organisms
culture of respiratory secretions to isolate cause

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10
Q

treatment for acute bronchitis

A

supportotive
oxygen therapy-immuneocompromised
antibiotics is bacterial

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11
Q

define chronic bronchitis

A

cough productive of sputum on most days during atleast 3 months of 2 successive years (which cannot be attributed to alternative cause)

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12
Q

what factors contribute to developing chronic bronchitis

A 
sex- men
age- over 40
smoking
pollution
allergens- in particular.
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13
Q

In what age group is bronchioloitis common

A

children- narrow bronchioles

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14
Q

define bronchiolitis

A

• Inflammation and oedema of the bronchioles

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15
Q

clinical signs of bronchiolitis

A

acute onset wheeze, cough, nasal discharge, respiratory distress (grunting, retractions, and nasal flaring.

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16
Q

most common pathogen which causes bronchiolitis

A

RSV

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17
Q

diagnosis of bronchiolitis

A

chest X-ray
FBC
Microbiology
nasopharyngeal aspirate

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18
Q

Treatment for bronchiolitis

A

supportive- oxygen

antibiotic is bacterial

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19
Q

define pneumonia

A

• Infection of distal airway and alveoli- form inflammatory exudate

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20
Q

2 anatomical patterns of pneumonia

A

– Bronchopneumonia- patchy distributed around bronchioles and spread to alveoli.
– Lobar pneumonia-90% due to s. pneumniae, affects large part of the lung, line demarcation and consolidation.

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21
Q

4 ways in which pneumonia can be caused

A

community acquired-most common
hospital acquired
Ventilator acquired pneumonia
Aspiration pneumonia

22
Q

what defines hospital acquired pneumonia

A

• Pneumonia developing >48hrs after hospital admission

23
Q

what defines hospital ventilator pneumonia

A

• Subgroup of HAP
• Pneumonia developing >48hrs after ET intubation & ventilation
common when not breathing well

24
Q

what defines aspiration pneumonia

A

subgroup HAP or CAP.
• Pneumonia resulting for the abnormal entry of fluids e.g. food, drinks, stomach contents, etc. into the lower respiratory tract
• Common is patients unconscious

25
Q

how is CAP pneumonia transmitted

A

Person-to-person or from a person
from environment
from animals

26
Q

what organism cause CAP pneumonia

A 
Atypical
•	Mycoplasma pneumoniae
•	Legionella pneumophilia
•	Chlamydophila pneumoniae
•	Chlamydophila psittaci
•	Coxiella burnetii
Typical
•	Streptococcus pneumoniae
•	Haemophilus influenzae
•	Moraxella  catarrhalis
•	Staphylococcus aureus
•	Klebsiella pneumoniae
27
Q

clinical signs and symptoms of pneumonia

A 
•	Rapid onset
•	Fever/chills-rigors
•	Productive cough- blood or purulent.
•	Mucopurulent sputum
•	Pleurtitic pain- lung parenchyma is infected and inflamed, and on deep inspiration it rubs against the pleura
•	General malaise-fatigue and anxiety.
tachypnoea, tachycardia, hypotension
28
Q

what is found upon examination of a patient with pneumonia

A

dull to percuss (consolidation) and reduced air entry, bronchial breathing.

29
Q

main symptom of mycoplasma pneumonia

A

cough

30
Q

rare complications of mycoplasma pneumonia

A

guillian- barre, peripheral neuropathy

31
Q

mycoplasma pneumonia is common in which age group

A

children

32
Q

Chlamydophila pneumoniae is common in which age group

A

elderly

33
Q

what are outbreaks of legionella pneumophilla associated with

A

 Colonises water piping systems

 Outbreaks associated with showers, air conditioning units, humidifiers

34
Q

signs of legionella pneumophilla

A

 High fevers, rigors, cough: dry initially becoming productive, dyspnoea, vomiting, diarrhoea, confusion- low GCS.
 Bloods: deranged LFTs, SIADH (low sodium)

35
Q

what animal exposure is Chlamydophila psittaci associated with

A

birds

36
Q

signs of Chlamydophila psittaci

A

rash, hepatitis, haemolytic anaemia, reactive arthritis, spleenomegaly.

37
Q

what is the recover time from influenza

A

2-3 weeks

38
Q

symptoms of influenza

A

– Fever, headache, myalgia (pain in muscles) and sore throat

39
Q

primary viral pneumonia occurs most commonly in what types of people

A

people with pre-existing cardiac or lung problems (heart failure of COPD)

40
Q

What the of infections commonly occurs after a primary viral pneumonia

A

– Secondary bacterial pneumonia then may develop after initial period of improvement:- COMMON as viral infection damages the lung so it is an opportunity for bacteria to colonise.

41
Q

3 most common pathogens which cause secondary bacterial pneumonia

A

– S.pneumoniae, H.influenzae, S.aureus

42
Q

diagnosis of influenza

A

viral antigen detection in respiratory samples using PCR.

43
Q

treatment for influenza

A

no treatment

44
Q

non microbiological investigations for CAP

A

routine observations- BP/Pulse/Oximetry
Blood: FBC/U and E, CRP, LFT
Chest X-ray.

45
Q

Microbiological invesitagtions for inpatients for CAP

A

– Sputum gram stain and culture- see what the organism is.
– Blood culture- if serious as the pathogens has multiplied in the lung and then reached the blood supply.
– Pneumococcal urinary antigen
– Legionella urinary antigen
PCR for viral pathogen, mycoplasma pneumoniae, chlamydophilia

46
Q

what assessment is used to determine the disease severity of CAP

A 
CURB65
Confusion
Urea
Respiratory rate
Blood pressure
Age> 65 years
47
Q

which 2 vaccine prevent lower respiratory tract infections

A
  • Pneumococcal vaccination (S. pneumoniae)

* Influenza vaccination for vulnerable groups (annually)

48
Q

Management of CAP

A

A- airway- open and patent
B-breathing- reap rate, oxygen saturation
C-circulation- BP and heart rate, urinary catheter to measure output.
antibiotics given depends on CURB65 score.

49
Q

which groups of patients are given the pneumococcal vaccination

A

– Patients with chronic heart, lung and kidney disease

– Patients with splenectomy

50
Q

which groups of patients are given the influenza vaccine

A

– Over 65s

– Chronic disease, multiple co-morbidities e.g. diabetes.

Clinical Pathology (45 decks)

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