Disease - bronchial sepsis

Question 1

Pharyngitis

Answer 1

Sore throat
Bacterial - GP A streptococci, Corynebacterium diptheriaee
Viruses (most common) - EBV, adenovirus, enterovirus, HSV

Question 2

Epiglottis

Answer 2

Can lead to obstruction of the airway
More common in childhood
Usually H Influenza B
Signs/symptoms = drooling, dysphonia, dysphagia, drawn face, stridor breathing on inspiration
Medical (ENT) emergency - secure the airway
IV Cefuroxime

Question 3

Bronchitis

Answer 3

Acute - Viral = yellow sputum, Bacterial = green

Chronic - smokers if constant inflammation of airways, burning, scaring

Question 4

Tracheitis

Answer 4

Often no sputum
Loud and dry barking cough
Normally adults and rarely children
Normally viral

Question 5

Pneumonia

Answer 5

Inflammation and consolidation of lung tissue caused by an infectious agent
Clinically = acute LRTI, usually associated to fever, signs and symptoms in the chest and an abnormal CXR
Most common infectious cause of death, 6th leading cause of death
20-50% mortality of admitted patients
Leading cause of hospital infection deaths

Question 6

Risk factors for Pneumonia

Answer 6

Travel - TB, legionella (Mediterranean), Pseudomonas (SE Asia, N Australia)
Age
Alcoholism, institutions, nutrition, co-morbidities

Question 7

Symptoms of pneumonia

Answer 7

Fever, cough, SOB, right pleuritic chest pain, rigors, minimal cough, sudden onset, headache/myalgia, Coryza/pharyngitis, vomiting, general malaise

Question 8

General signs of pneumonia

Answer 8

Temperature (+/-), confusion, tachypnoea, tachycardia and hypotension (last 3 = signs of shock)

Question 9

What chest signs are present in pneumonia?

Answer 9

Decreased PN
Crackles
Bronchial breathing
Increased VR

Question 10

Other signs that can be present

Answer 10

Generally unwell, dehydrated, palmar erythema, high PR and RR, low BP, crackles and pleural rub, sats @ 90% (28% FiO2)

Question 11

What investigations should be carried out?

Answer 11

Sputum - AFB, general culture and gram stain
Urine - legionella antigen and measure output
Blood - cultures, WBC (severe 20), urea (Severe >7mm)
ECG - check for any ischemic changes that might occur
CXR - bilateral changes
ABG - esp if HR > 20, want to know if Tachypnoea is present

Question 12

CURB65 score

Answer 12

Confusion
Urea > 7
RR > 30
BP - systolic 65

Question 13

How do you treat uncomplicated Pneumonia?

Answer 13

PO Amoxicillin
+
PO Clarithromycin

Question 14

How do you treat complicated pneumonia?

Answer 14

IV Cefuroxime or IV Augmentin
+
PO Clarithromycin

Question 15

How do you treat atypical Pneumonia?

Answer 15

Clarithromycin
+
IV Rifampicin

Question 16

How do you treat Cavitation or Aspiration?

Answer 16

IV Cefuroxime
+
Metronidazole

Question 17

What are some complications of pneumonia?

Answer 17

Empyema, ARDS, Abscess, Bronchiectaisis, PE

Question 18

What fluids do you give to raise SBP?

Answer 18

Colloidal IV fluid

Question 19

Typical pneumonia

Answer 19

Abrupt onset, high fever, purulent sputum and focal consolidation

Question 20

Atypical pneumonia

Answer 20

Gradual onset, dry cough, myalgais, headache

Question 21

Streptococcus pneumonia

Answer 21

Gram +ve, lives in resp tract and multiplies rapidly
Abrupt onset
medical emergency
commenest bacterial infection and most likely to kill

Question 22

Haemopilus influenza

Answer 22

Bacterial
UTRI common
usually encapsulated
small effusion can occur but empyema/cavitation is rare

Question 23

Bronchopneumonia

Answer 23

Patchy white shadows around the lung

Question 24

Staphylococcus aureus

Answer 24

Gram +ve, spreads via airways if viral or Bacteraemia (e.g. endocarditis)
Lung tissue lysis = cavitation occurs
Septicaemia, empyema and abscesses are common
Lives in or on the skin - causes abscesses on skin
IV drug users = high risk

Question 25

Klebsiella

Answer 25

``` Gram -ve, normally from the GI tract Colonises e=the oropharynx Nosocominal and co-morbidities (nursing homes), immunosuppressed people, those vomiting regularly Haemoptysis Poor prognosis but treatable with ABs ```

Question 26

Escherichia Coli

Answer 26

Gram -ve Comorbidity, chronically ill patients Aspiration and often lower right lobes Poor Prognosis

Question 27

Pseudomonas aeriginosa

Answer 27

G-ve, chronically ill, structural lung disease Gradual onset, copious green sputum Never cleared and a constant battle CAN'T be treated with PENICILLIN

Question 28

Ligionella pneumophilia

Answer 28

G -ve intracellular, from water/air-con Immunosuppressed Dry cough, fever, myalgia, diarrhoea, rash Oliguria, acute renal failure, rhabdomyolysis, HSM 5-30% mortality Treat with Clarythromycin

Question 29

Mycoplasma pneumoniae

Answer 29

Occurs in closed populations, 50% UTRI Arthralgais, LNs, myalgia, diarrhoea, myocarditis, meningitis, hepatitis, immune haemolytic anaemia, skin eruptions, vomiting Treatable

Question 30

Chlamydia psttacci

Answer 30

Intracelluar bacterium, from birds | Fever, myalgia, chest pain, wt loss, dry cough, haemoptysis, cavitation, effusion, millary TB

Question 31

Pneumocystis carinii

Answer 31

Fungus (can be bacterial) Immunocompromised (HIV, chemo) Progressive SOB, dry cough, fever, wt loss, minimal signs - chest normally sounds clear but are hypoxic, CXR anything Can lead to death and can infect others if missed.

Question 32

Fungal (aspergillus Cryptococcus)

Answer 32

V rare in healthy people Immunocompromised, similar to bacterial pneumonia Cavitation is common, haemoptysis, wt loss Poor prognosis

Question 33

If a person is generally healthy what is the likely cause off pneumonia?

Answer 33

Strep pneumoniae | From water, birds, occupation

Question 34

If a patient has hospital acquired pneumonia, what is the likely cause?

Answer 34

Gram -ve Strep aureus MRSA

Question 35

Immunocompromised, likely cause?

Answer 35

PCP, Tb, Fungal

Question 36

Nasal cavity cause?

Answer 36

URTI, normally viral

Question 37

Pharyngitis cause?

Answer 37

Most likely strep (possible abscess behind tonisls) Diptheria Viruses

Question 38

Epiglotitis cause?

Answer 38

Usually Haemophilus Influenza B

Question 39

Bronchitis cause?

Answer 39

``` Acute = virus/bacteria Chronic = smoking ```

Question 40

If the infection is below the bronchus what is it?

Answer 40

Pneumonia, infection of the lung tissue.

Question 41

Lung symptoms of TB

Answer 41

Cough (80%), chest pain, fever/night sweats (55%), wt loss (70%) and haemoptysis (8%)

Question 42

Non-pulmonary symptoms of TB

Answer 42

Can affect anywhere in the body! Lymphadenopathy, fatigue, GI, CVS, CNS, Bones, GU tract 25% of elderly patients present with non-specific symptoms.

Question 43

Investigations for TB

Answer 43

Sputum culture - AFB Urine, blood, ECG, CXR (pleural effusion, cavity amongst shadow, millary TB) Heaf/Mantoux, PCR (except blood) and histology

Question 44

What is the Quadruple therapy for TB?

Answer 44

``` Rifamicin Isoniazad Pyrazinamide Ethmbutol For 2 months minimum ```