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med year 3 > Respiratory Tract Infections > Flashcards

Respiratory Tract Infections Flashcards

1
Q

what are URT infections

A

primarily viral, everything above vocal chords to mouth and nose

  • common cold, sinusitis, pharyngitis, laryngitis
  • do not require antibiotics
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2
Q

what are the LRT infections

A

acute bronchitis, pneumonias, TB, influenza,

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3
Q

overview of acute bronchitis

A

50% viral, 25% bacterial, 25% mixed

  • treat with antibiotics, measure PCT and CRP
  • treat inflammatory component with ICS
  • treat repiratory failure
  • symptoms include cough with yellow-green phlegm
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4
Q

what is pneumonia?

A

a LRTI causing inflammation of lung tissue and sputum filling airways and alveoli

  • when presenting say: signs of a LRTI (fever/cough or bronchial breathing) and CXR changes
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5
Q

how do you classify pneumonia?

A

community acquired = gram positive

hospital acquired = gram negative neg or staph aureus

fungi

unusual organisms / fungi

aspiration pneumonia

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6
Q

what is aspiration pneumonia?

A

from upper respiratory or GI tract

involves right lower lobe

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7
Q

what is hospital acquired pneumonia?

A

new onset of symptoms more than 48 hours after patients admission to hospital

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8
Q

what is ventilator acquired pneumonia

A

HAP in patients on mechanical ventilation

within 4-5 days of admission

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9
Q

how does pneumonia present?

A 
SOB
cough - sputum
fever
haemoptysis
pleuritic chest pain 
delirium 
abdominal pain 
sepsis
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10
Q

what are the clinical signs of pneumonia

A 
tachypnea 
tachycardia
hypoxia
fever
confusion
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11
Q

how does pneumonia present on a chest x-ray

A

alveoli filled with neutrophils = consolidation

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12
Q

what can you hear in a patient with pneumonia?

A

bronchial breath sounds - harsh breath sounds loud on inspiration and expiration

focal coarse crackles

dullness to percussion bc consolidation

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13
Q

how do you assess the severity of pneumonia?

A

CURB-65
predicts mortality and score 1 = treat at home, score >1 hospital admissions
score >2 ICU

c- confusion
u-urea >7
R - resp rate >30
b - blood pressure

65 - age 65 and >

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14
Q

what are the common microbes causing pneumonia

A

strep pneumonia
haemophilius influenzae
moraxella catarrhalis: in immunocompromised patients
PA in CF patients and staph A as well

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15
Q

what is atypical pneumonia

A

organism that cannot be cultured and doesn’t respond to gram staining or penicillins
treated with macrolides or tetracyclines eg doxy

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16
Q

what are the organisms causing atypical pneumonia?

A

legionella pneumophila; can cause SIADH hyponatremia
in infected waters

mycoplasma pneumoniae (rashes)

chlamydia psitacci from infected birds

chlamyodphila pneumoniae: school aged with wheeze

coxiella burnetti: exposure to animals, have a flu

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17
Q

what is fungal pneumonia?

A

pneumocystis jivorecci
immunocompromised
dry cough, SOB on exertion, night sweats

co-trimoxazoles/ trimethoprim

18
Q

what are the investigations for pneumonia?

A

CURB 0-1 = none

  • CXR
  • o2 sats, ABG
  • FBC: WCC, Hb, platelets for inflammation
  • viral swab!! and blood cultures
  • urinary pneumococcal antigen
  • CRP
  • U&E’s
  • LFT’s = sepsis
  • lactate for sepsis
19
Q

what is the treatment for CAP pneumonia

A

local guidelines
moderate, severe or septic: IV antibiotics then switch to oral

5 day (mild: amoxicillin or clarithryomycin) or 7 day course of dual amoxicillin AND macrolide

20
Q

what is the treatment for HAP?

A
  • broad spectrum b lactamase stable antibiotics such as co-amoxiclav together with a macrolide
21
Q

what do you do if pneumonia is very hard to treat/not responding?

A

piperacillin-tazobactam

then change to narrow spec like benzylpenicillin

also continue clarithromycin to cover for atypical causes

22
Q

what are the complications of pneumonia?

A

sepsis
pleural effusion = fluid in pleural cavity
empyema - pus in pleural space (drain and antibiotic)
lung abscess - pus in non pre-formed space

VTE
death

23
Q

what causes pneumonia in children?

A

neonates: e coli, strep b and listeria
1-6 months: chlamydia trachomatis, staph a and RSV
6m-5 years is RSV and para-influenzae

24
Q

what do CXR look like in diff conditions?

A

LOOK AT IMAGES
COVID: may be normal, peripheral bilateral consolidation

CAP - shadowing and consolidation

COPD: hyperexpansion an and reduced air markings

Lung cancer: pneumonia or recurrent infections

25
Q

what is TB?

A

infectious disease caused by mycobacterium tuberculosis

26
Q

descibe the TB bacteria

A

bacillus, wax coating
acid fast
zeil-neelsen stain

27
Q

where is TB most common?

A

south asia, africa, immunocompromised

28
Q

what are the RF for TB

A

known contact with active TB
immigrants from areas of high TB prevalence
immunosuppression
homeless people, drug users, alcoholics

29
Q

what is the pathophysiology of TB?

A

bacteria are slow dividing with high oxygen demands

spread by inhaling infected droplets

spreads through lymphatics and bloods

granulomas containing the bac form around the body

30
Q

what is active TB?

A

active infection in various areas
IS can clear it
normally IS may encapsulate site of infection and stop progression of disease = latent TB
reactivation - secondary TB
mostly affects the lungs bc the bacteria gets lots of oxygen there

31
Q

what is extrapulmonary TB

A

affects lymph nodes = abscess

affects pleura, CNS, pericardium, GI, GUI, bones and joints

32
Q

vaccine for TB?

A

BCG
intradermal
live attenuated
done on a negative mantoux test

33
Q

what is the presentation of TB?

A 
chronic, worsening symptoms 
lethary
night sweats or fever
weight loss
cough 
lymphadenopathy 
erythema nodosum
34
Q

how do you test for TB?

A

-mantoux test: inject tuberculin intradermally, after 72 hours >5mm is positive, then assess for active disease

interferon gamma release assays

CXR

sputum samples for cultures

35
Q

what is the interferon gama release assay

A

mix blood sample w antigens from TB bacteria
previous infection = WCC sensitised so reaction

  • used to test for latent TB
36
Q

what does a CXR look like on someone with TB?

A

primary: patchy consolidation, pleural effusions and hilar lymphadenopathy
reactivated: consolidation with cavitation typical of upper zones
military: millet seeds, spread evenly throughout lung fields

37
Q

how do you manage latent TB?

A

patients at risk of reactivation: isoniazid and rifampicin for 3 months
or
isoniazid for 6m

38
Q

how do you manage acute pulmonary TB?

A

RIPE:
rifampicin and isoniazid for 6m
pyrazinamide and ethambutol for 2 months

pyroxidine prophylactically

39
Q

what are the side effects of TB medication?

A

isoniazid: peripheral neuropathy hence propphylaxis of pyroxidine

rifampicin - red urine and tears bc p450 enzymes
- reduces pill effectiveness

ethambutol - colour blindness and visual acuity

40
Q

how do you treat extrapulmonary TB?

A

corticosteroids

41
Q

how do you assess for breathlessness?

A

MRC dyspnoea scale

1- only SOB on exercise
2-SOB when on hill or hurrying up
3- stops after 1 mile or 15 mins, slow walking
4 - stops for breath after 100 yards
5 - too breathless to leave house or do ADL

med year 3 (25 decks)

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