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Medicine Y3 TCD 1-12 > 12. Respiratory Tract Infections > Flashcards

12. Respiratory Tract Infections Flashcards

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

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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
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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

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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

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5
Q

if someone has a productive cough then what differentials would you be thinking of

A 
pneumonia 
bronchitis 
bronchiectasis 
pulmonary odema 
TB
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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

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7
Q

What are the differentiating symptoms of COVID 19

A

fever
SOB
dry cough
anosmia

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8
Q

what are the differentiating symptoms of influenza

A

general aches and pains, autumn and winter timing

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9
Q

what are the differentiating symptoms of a viral URTI

A

sore throat, nasal congestion, cough and feeling generally unwell

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10
Q

what are the differentiating factors of pneumonia

A 
sputum is green yellow brown 
fever 
chest pain 
SOB 
unwell patient
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11
Q

what are the differentiating factors of lung cancer

A

haemoptysis
weight loss
persistant cough
ex smoker

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12
Q

what are the differentiating factors of pericarditis

A

chest pain that is relieved on sitting forwards, usually following a viral infection

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13
Q

what are the differentiating factors of infective exacerbation of COPD

A

increased sputum production and SOB

background of COPD or smoking history

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14
Q

what are the differentiating factors of bronchhiectasiss

A

chronic productive cough, breathlessness

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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)
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16
Q

what are the differentiating factors of PE

A

sudden onset of sharp pain felt when breathing in, breathlessness, haemoptysis

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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

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18
Q

What acute phase protein would be raised if someone has an infection and what blood marker

A

CRP & WCC

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19
Q

what two bacterial antigens can you test from someones urine

A

pneumococcal & legionella antigen

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20
Q

what is lactate a product of

A

anaerobic respiration and so would be increased in sepsis and shock

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21
Q

How can you describe CAP simply

A

signs of lower respiratory tract infection (fever, cough, phlegm, crepitations or bronchial breathing) + CXR changes

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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

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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

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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
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25
Q

how does the CURB65 score relate to management

A

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

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26
Q

What is the NEWS2 score

A 
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
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27
Q

how would you describe pneumonia simply

A

an infection of the lung tissue that causes inflammation of the lung tissue and sputum filling the airways and alveoli

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28
Q

what does pneumonia show up as on an x ray

A

consolidation

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29
Q

how does pneumonia usually present (symptoms)

A

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

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30
Q

What signs indicate pneumonia and possible sepsis secondary to the pneumonia

A

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

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31
Q

in the CURB-65 what parameter do you not count if you are out of hospital

A

urea

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32
Q

What are the common bacterial causes of pneumonia

A

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

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33
Q

what is an atypical pneumonia and how is it treated

A

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).

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34
Q

what kind of bacteria is streptococcus pneumoniae

A

gram positive coccus

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35
Q

what kind of bacteria is haemophilius influenza

A

gram negative bacillus

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36
Q

Name the 5 causes of atypical pneumonia

hint the pneumonic is ‘legions of psittacis MCQ

A

M- mycoplasma pneumoniae
C- Chlamydydophila pneumoniae
Q- Q fever (corella burrnetti)

Legionella
Chlamydia pscittaci

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37
Q

what is legionella pneumophilia caused by and what is the typical exam patient

A

infected water supply or air conditioning units

typical exam patient has recently has a cheap hotel holiday and presents with hyponatraemia

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38
Q

what is mycoplasma pneumonia and what kind of patient does it cause neurological symptoms

A

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

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39
Q

what is the common presentations of chlamoydophila pneumonia

A

school aged child with a mild to moderate chronic pneumonia and wheeze

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40
Q

what is the typical exam patient who presents with Q fever (coxiella burnetii)

A

linked to exposure to animals and their bodily fluids so MCQ patient is a farmer with a flu like illness

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41
Q

how is chlamydia psittaci usually contracted and what is the typical MCQ patient

A

contracted from contact with infected birds

MCQ patient is from a parrot owner

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42
Q

what fungal pneumonia can occur in patients that are immunocomprised

A 
pneumocystis jiroveci (PCP) 
particularly important in patients with poorly controlled or new HIV with a low CD4 count
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43
Q

how does fungal penumonia usually present in an immunocompromised patient

A

dry cough, SOB on exertion and night sweats

44
Q

what is the treatment for fungal pneumocystis jiroveci (PCP)

A

co-trimoxazole known by the brand name Septrin

45
Q

what investigations would you want to do in someone that you suspect has pneumonia

A 
chest X ray 
FBC 
U&Es
CRP
sputum culture 
blood culture 
legionella and pneumococcal urinary antigens
46
Q

should always follow local area guidelines on antibiotic use however what is the broad treatment of the following
mild CAP
moderate to severe CAP

A

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
Q

what are some common examples of macrocodes

A

azithromycin, clarithromycin, erythromycin, and roxithromycin

48
Q

what are the main complications of pneumonia

A 
sepsis 
pleural effusion 
empyema 
lung abscess 
death
•	Venous thromboembolism 
•	Worsening of comorbidities 
o	AF, heart failure, kidney failure, worsening of respiratory failure (COPD)
49
Q

true or false: the higher up the infection, the more likely it is to be viral

A

true

50
Q

name some common URTI

A 
primarily viral 
common cold
sinusitis 
pharyngitis 
laryngitis
51
Q

name some common LRTIs

A 
viral and bacterial 
acute bronchitis (COPD exacerbation) 
exacerbation of bronchiectasis 
pneumonia (lung abscess and empyema) 
TB
influenza
52
Q

Why does pneumonia show consolidation on the chest X ray

A

it is where there has been a mass infiltration of inflammatory cells and so the alveoli are filled with neutrophils

53
Q

What are the main classifications of CAP

A

o G+ bacteria, mycoplasma, influenza

54
Q

what are the main classifications of HAP

A

o Subtype is Ventilator-associated pneumonia (VAP)

o G- bacteria, Staph. Aures

55
Q

what are the main classifications of pneumonia in the immunosuprresed host

A

o Unusual organisms, fungi

56
Q

what are the main classifications of aspiration pneumonia

A

o Chemical pneumonitis, mixed flora

57
Q

Name some potential findings in someone with CAP

A
  • Temperature
  • Tachypnoea
  • Dull percussion
  • Bronchial breathing
  • Focal crackles
  • Mental confusion
58
Q

Name some symptoms of someone presenting with new onset CAP

A
  • Cough with purulent sputum (blood)
  • Rigors and fever
  • Dyspnoea
  • Chest pain (pleuritic, sudden onset)
  • Abdominal pain
  • Confusion (elderly, multimorbid patient)
59
Q

Again name the 2 main antigens that you test for in the urine

A

pneumococcus and legionella

60
Q

Name some common oral antibiotics

A

amoxicillin (alternatively doxycycline or clarithromycin(

61
Q

Name the common treatment for severe pneumonia in hospital

A

a broad-spectrum beta-lacamase stable antibiotics such as amoxiclav together with a macrolide

62
Q

What are the main side effects of antibiotics

A

usual side effects (diarrhoea)
C difficile infection
future antimicrobial resistance

63
Q

sputum in pneumococcal pneumonia is characteristically what colour

A

rust/red

64
Q

why does someone with pneumonia get SOB

A

alveoli become filled with pus which impairs gas exchange

65
Q

what common chest pain do pt with pneumonia get

A

commonly pleuritic in nature and worse when coughing

66
Q

what are some other non-pulmonary signs of pneumonia

A

confusion, abdo pain, diarhhoea and vomitting

67
Q

Myalgia (pain or tenderness of the muscles) and arthralgia (discomfort of the joints) are common, especially in which infections

A

legionella or mycoplasma

68
Q

what is the major red flag conditions in someone with pneumonia

A

sepsis

69
Q

what is sepsis

A

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
Q

Diagnosisng pneumonia:

what could the FBC show

A 
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
Q

Diagnosisng pneumonia:

what could U&E show

A

urea and creatinine could be raised in AKI which could be a sign of sepsis

72
Q

Diagnosisng pneumonia:

why would LFT be deranged q

A

can be a reflection of reduction in liver perfusion associated with sepsis

73
Q

Diagnosisng pneumonia:

what inflammatory marker would be raised

A

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
Q

what measurement is used as a general marker of illness severity and is used in sepsis scoring system

A

lactate as it is a product of anaerobic respiration

75
Q

what is the limitation of a CXR

A

cannot distinguish the different causes of pneumonia based on the CXR alone

76
Q

in what situations would a CT scan be performed

A

in cases where. lung abscess or empyema are suspected

77
Q

when should blood cultures be taken

A

any patient with a fever in hospital

78
Q

PCR can detect which kind of pathogens

A

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
Q

what is the infective organism that causes TB

A

mycobacterium acid-fast bacillus AFB

80
Q

what should patients presenting with pneumonia be offered a HIV test

A

this is a common presentation of HIV in an undiagnosed individual

81
Q

why cant you use a penicillin to treat an atypical cause. of pneumonia

A

they don’t process a cell wall on which penicillins or cephalosporins can act

82
Q

typical causes of CAP are

A

streptococcus pneumonia
haemophilus influenza
klebsiella pneumoniae
staph. aures

83
Q

IVDU and chronic lung pathology individuals are at risk from getting which causative agent of pneumonia ?

streptococcus pneumonia
haemophilus influenza
klebsiella pneumoniae
staph. aures

A

Staph. aures

84
Q

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

A

klebsiella pneumoniae

85
Q

what are the most common viral causes of pneumonia

A

influenza A and B

however coronaviruses should be considered

86
Q

Pneumonia due to influenza is often complicated with a post viral superinfection with bacteria or in severe cases with fungi like aspergillus

A
87
Q

in the UK what is the most common cause of fungal pneumonia

A

pneumocystis jivoreci

88
Q

what is the most common complication of pneumonia that complicates around 50% of cases

A

pleural effusion

note that sepsis can also complicate pneumonia

89
Q

how does the causative agent differ in children

A
  • 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
Q

how do you define hospital acquired pneumonia

A

new onset of symptoms along with a compatable X-ray developing more than 48 hours after the patients admission to hospital

91
Q

What is VAP

A

ventilator acquired pneumonia

92
Q

What is the different between early and late onset HAP

A

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
Q

what specimen samples can you take to look for infection

A
  • Sputum
  • Broncho-alveolar lavage: in ventilated patients, direct sampling of deep respiratory secretions is possible and produces good quality results
94
Q

what are the risk factors for HAP

A
  • 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
Q

what is the sepsis 6

A 
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
Q

in a FBC;

is neutrophillia common in bacteria or viral causes

A

bacterial

97
Q

in a FBC;

is neutropenia common in bacterial or viral causes

A

viral

98
Q

in a. FBC

what is lymphopenia suggestive of

A

severe infections

99
Q

when dealing with HAP the common organisms that should be considered are

A

Staphylococci (including MRSA)
enterococci
Gram negative bacili (such as E-coli or pseudomonas

100
Q

NICE. guidelines recommend which antibiotics as first line for severe HAP and which antibiotics for non-severe HAP

A

tazocin

co-amoxiclav

101
Q

which lobe is aspiration pneumonia most common in and why

A

the right lobe as the right main bronchus is straighter from the trachea compared to the left

102
Q

Answer with effusion, consolidation or both;

which produce opacification of the lung field

A

both

103
Q

Answer with effusion, consolidation or both;

the margins of opacification are not as clear

A

consolidation

104
Q

Answer with effusion, consolidation or both;

the margins of opacification are quite clear

A

effusion

105
Q

Answer with effusion, consolidation or both;

the opacification is dense are there are non markings visible in the lung field

A

effusion

106
Q

Answer with effusion, consolidation or both;

you can see air bronchograms, so the opacification is not dense

A

consolidation

Medicine Y3 TCD 1-12 (30 decks)

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