Drugs Flashcards
(110 cards)
1
Q
Rhinitis: Two viruses
A
Rhinovirus
Coronavirus
2
Q
Rhinitis: Incubation time
A
1-3 days
3
Q
Rhinitis: Bacteria…
A
secondary infection following unresolved viral rhinitis
4
Q
Rhinitis: transmission
A
1) common: shaking hands
2) droplet: touching infected object/ own mucous membrane
3) air-borne: sneezing/coughing
5
Q
Rhinitis?
A
inflammation of nasal mucosa
6
Q
Rhinitis: clinical features
A
mild fever
nasal discharge
obstruction
7
Q
Rhinitis: treatment & management
A
analgesics
nasal decongestants
steam inhalation
8
Q
Rhinitis: antibiotics?
A
treatment for secondary bacterial infections
9
Q
Rhinitis: complication
A
Bacterial sinusitis
Otitis media
10
Q
Sinusitis?
A
Inflammation/ swelling of tissue lining of sinuses
11
Q
Sinusitis: Viruses
A
Rhinovirus
Influenza virus
12
Q
Sinusitis: Bacteria
A
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
13
Q
Sinusitis: clinical features
A
Fever
Nasal blockage- diff to breathe via nose
Pain/tenderness/swelling around paranasal sinus
14
Q
Sinusitis: Diagnosis
A
X-ray
MRI
*check air-fluid level in sinuses
15
Q
Sinusitis: Treatment
A
1) Corticosteroid:
fluticasone|triamcinolone|budesonide
2) Antibiotics
Amoxycillin-clavulanic acid| Cephalosporin
16
Q
Sinusitis: Complication
A
Intracranial spread:
meningitis, brain abscess
Systemic:
bacteremia| pneomonia| multiple organ failure
17
Q
Otitis media?
A
Infection of middle ear
in children < 5 yrs old
18
Q
Otitis media: Viruses
A
RSV
Rhinovirus
Coronavirus
19
Q
Otitis media: bacteria
A
S.pneumoniae
H.influenzae
Moraxella catarrhalis
20
Q
Otitis media: clinical features
A
Fever
Ear ache (otalgia) - throbbing pain
21
Q
Otitis media: treatment
A
Antibiotics:
Amoxycillin-clavulanic acid
Cephalosporins
Nasal decongestants
22
Q
Pharyngitis?
A
infection/ irritation of pharynx/tonsil
-sore throat-
23
Q
Pharyngitis: viruses
A
Corona C
Adeno A
Rhino R
RSV
EBV
24
Q
Pharyngitis: bacteria
A
S.pyogenes
H.influenzae
Chlamydophila pneumoniae
Mycoplasma pneumoniae
25
Pharyngitis: clinical features
Sore throat
Fever
Odynophagia [ painful swallowing ]
26
Pharyngitis: symptoms
1. sudden onset
2. fever
3. headache
4. tender cervical adenopathy
5. tonsillar | pharyngeal swelling | exudate
6. **absence of cough**
27
Pharyngitis: diagnosis
throat swabs
28
Pharyngitis : treatment
VIRAL
1. self limiting
2. oral corticosteroids [ 1-2 days ]
3. lozenges &
benzocaine | lidocaine mouth rinses
4. NSAID - ibuprofen
BACTERIA
1. 6-10 day course - Amoxicillin
29
Pharyngitis: complication
Mainly in bacterial pharyngitis
*sinusitis
*otitis media
*epiglotittis
*pneumonia
*mastoiditis
30
Epiglotittis: common ?
young children: 6-36 months
31
Epiglotittis: DD
Laryngotracheobronchitis
32
Epiglotittis: Viruses
RAPE C
Rhino
RSV
Adeno
Parainfluenza virus
Enterovirus
Corona
33
Epiglotittis: clinical features
CSFR
fever
runny nose
sore throat
cough/ stridor
34
Bronchitis?
inflammation of bronchus
35
Acute Bronchitis: time
3 weeks
36
Acute Bronchitis: affects ?
Children < 5 yrs old
37
Acute Bronchitis: viruses
CAMI
Common cold
Adeno
Measles
Influenza virus
38
Acute bronchitis: symptoms
cough - with | w/out sputum
39
Chronic bronchitis?
Productive cough with purulent sputum
for 3 months in a year
over 2 successive years
40
Chronic bronchitis: affects?
Adults > 40 yrs old
41
Chronic bronchitis: damage caused by?
cigarette smoking
air pollution
42
Chronic bronchitis: Treatment and management
life-style changes
– cessation of tobacco use
bronchodilators and steroids
– open up airways
ANTIBIOTICS : X routinely prescribed
* bronchitis mainly caused by virus
* may be recommended for individuals with
(a) weakened immune system
(b) cystic fibrosis
43
Chronic bronchitis: complication
pneumonia
44
Bronchiolitis?
Inflammation of the bronchioles
- bronchioles clog up with mucus
45
Bronchiolitis: occurs mainly?
children < 2 years
46
Bronchiolitis: Viruses
RSV
Parainfluenza virus
Adeno
47
Bronchiolitis: symptoms
- fever
- difficulty in breathing
- decreased appetite
48
Bronchiolitis: Treatment
- oxygenation to help breathing
- hydration
49
Pneumonia?
Infection of the lung parenchyma
50
Pneumonia: risk in ?
infants < age 2
adults > age 65
51
Pneumonia: types
community-acquired pneumonia
-healthcare-associated pneumonia
52
Pneumonia: signs & symptoms
chest pain during breathing and coughing
productive cough
shortness of breath
53
Pneumonia: viruses
Influenza virus
Adenovirus
RSV (in children)
Parainfluenza virus (in children)
SARS-CoV2
54
Pneumonia: Bacteria
Streptococcus pneumoniae
Mycoplasma pneumoniae
55
Pneumonia: Fungi
- in immunocompromised patients
- occurs following inhalation of spores
Cryptococcus neoformans
Blastomyces dermatitidis
Pneumocystic jirovecii
56
Pneumonia: treatment
bacterial pneumonia – antibiotics
viral pneumonia – rest and take plenty of fluids, antivirals
57
58
Health-care associated pneumonia
Occurs in hospitalized patients
Important cause of death due to health-care associated infections
59
Health-care associated pneumonia: factor
artificial ventilation
60
Health-care associated pneumonia: causes
Staphylococcus aureus
Gram negative bacteria:
Klebsiella
Pseudomonas
Acinetobacter
which are often antibiotic-resistant
61
Community-acquired pneumonia
Acquired outside the hospital
62
Community-acquired pneumonia:
TYPICAL PATHOGENS
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
63
Community-acquired pneumonia:
ATYPICAL PATHOGENS
Legionella pneumophilia
Mycoplasma pneumoniae
Chlamydia pneumoniae
64
Aspiration pneumonia
Most commonly occurs when
gastric / intestinal content is aspirated
65
Aspiration pneumonia: risk
unconscious persons
alcoholics
epileptics
anaesthesised patients
66
Aspiration pneumonia: common site
right lower lobe of the lung
67
Aspiration pneumonia: Causative agents
mixture of aerobic and anaerobic bacteria
68
Pneumonia: investigations
**Radiology**
Chest X-ray
**Microbiology**
Sputum and blood culture – not very sensitive nor specific
Serological tests for atypical pathogens
69
Pneumonia: complications
Bacteraemia
Breathing difficulty, particularly patients with underlying chronic lung diseases
Pleural effusion
Lung abscess
70
Pleural effusion?
Collection of fluid in the pleural cavity
71
Pleural effusion: types
infectious – exudate
non-infectious for example in congestive cardiac failure – transudate
72
Pleural effusion: Empyema
when the fluid is pus
73
Pleural effusion: causes
leakage from other organs – usually in patients with congestive heart failure
infections – tuberculosis, secondary to pneumonia
cancer, particularly lung cancer
74
Pleural effusion: Clinical feature
Shortness of breath
Pleuritic pain
Fever, cough
75
Pleural effusion: Investigation
• Microbiological diagnosis
- culture of a pleural tap
• Chest x-ray
76
Pleural effusion: treatment
Treat the medical conditions that cause the pleural effusion
antibiotics – pneumonia
diuretics – congestive heart failure
77
Pleural effusion: Procedures
• Thoracentesis – fluid taken for testing
• Pleural drain
• Pleurodesis
78
Influenza: types
influenza A and B cause seasonal
epidemics during winter in the US
only influenza A known to cause flu
pandemics
influenza C cause mild illness
79
Influenza: flu
Spanish flu: H1N1 virus
Asian flu: H2N2 virus
80
Influenza A viruses:
subtypes based on two proteins
on the surface of the virus
hemagglutinin (H)
neuraminidase (N)
81
Influenza A viruses: pandemics
result in new H and/or new H and N
proteins in influenza viruses:
a new influenza A subtype in humans
82
Influenza: transmission
droplet contact
83
Influenza: Clinical features
marked systemic symptoms
➢ fever, headache, myalgia
respiratory symptoms
➢ cough, sore throat, nasal congestion and discharge
84
Influenza: complication
- influenza virus pneumonia
- secondary bacterial pneumonia
Streptococcus pneumoniae
Haemophilus influenzae
85
Influenza: Investigations
RT-PCR – preferred diagnostic tool
Rapid antigen test – antigen detection
virus isolation for epidemiological purposes and for production of vaccines
86
Influenza: Treatment
symptomatic – decrease fever, relieve cough
antiviral drugs:
amantadine
rimantadine
zanamivir
osteltamivir
87
Influenza: Prevention
annual vaccination
hygiene – wash hands frequently, wear mask
88
Zoonotic influenza
type of influenza that originates from animal strains
Do not usually infect humans
89
90
Avian flu
Influenza H5N1 virus
Serology, virus isolation
91
Swine flu
Influenza H1N1 virus
RT-PCR
92
Avian flu & Swine flu
Direct or indirect contact with infected animals or their saliva/feces
Influenza-like illness, severe respiratory illness
Treatment :
-Neuraminidase inhibitor
zanamivir, osteltamivir
Prevention: vaccination
93
94
Influenza-like illness (ILI)
milder disease presented and managed in the primary care / out- patient setting
measured fever of ≥ 38°C and cough
with onset within the last ten (10) days
95
Influenza-like illness (ILI): Viruses
- Influenza virus
- RSV
- Rhinovirus
- Adenovirus
- Parainfluenza virus
- Coronavirus
96
Influenza-like illness (ILI): Bacteria
Co-infection
- Streptococcus pneumoniae
- Haemophilus influenzae
- Staphylococcus aureus
97
Influenza-like illness (ILI) : Diagnostic test
PCR
98
Severe acute respiratory illness (SARI)
- history of fever or measured fever
of ≥ 38°C
- and cough
- with onset within the last ten (10) days
- and **requires hospitalization**
99
SARI : Covid-19
similar symptoms with influenza
– fever, cough, sore throat, headache
differences
➢ gradual onset
➢ breathlessness
➢ new loss of taste and smell
100
SARI: transmission
person-to-person contact
101
Immunocompromised patients
treatment with immunosuppressive and cytotoxic therapies
organ transplantations
high dose of corticosteroid treatment
102
Immunocompromised patients: hematologic disease
✓ aplastic anemia
✓ neutropenia
✓ lymphoma/leukemia
103
Immunocompromised patients
Neutropenia
Cause
Chemotherapy, aplastic anemia, acute
leukemia
Pathogen:
S. aureus,
Enterococcus spp
P.aeruginosa
E. coli
Aspergillus
Candida spp,
104
105
106
Immunocompromised patients
Cell-mediated immunity
Cause:
Lymphoma, organ transplantation,
treatment (cyclosporine, high dose
corticosteroids
Pathogens:
• Pneumocystic jirovecii
• Legionella pneumophila
• Mycobacterium tuberculosis
• Herpes viruses – CMV
107
Immunocompromised patients
Antibody deficiency
Cause:
Chronic lymphocytic leukemia,
lymphoma, myeloma
Pathogen :
S. pneumoniae
H. influenzae
108
Immunocompromised patients:
risk for lung infections
bacterial pneumonia
mycobacteria infections
viral infections
➢ (CMV) (RSV)
parainfluenza virus
influenza A virus
adenovirus
coronavirus
fungal infections
➢ Aspergillus fumigatus
Candida albicans
Cryptococcus neoformans,
Pneumocystis jirovecii
109
Pathogenesis: URTI
• Pathogens gain entry to the respiratory tract
- by inhalation of droplets
- invade the mucosa
• Epithelial destruction– redness, edema, haemorrhage, sometimes an
exudate
• Immune responses
- humoral immunity – IgA
- macrophages, monocytes, neutrophils, eosinophils
- inflammatory cytokines
110
Pathogenesis: LRTI
• Pathogens enter the distal airway
- by inhalation, aspiration or by hematogenous seeding/spread
• Multiplies in or on the epithelium
• Causing inflammation, increased mucus secretion, impaired mucociliary
function
• Other lung functions may also be affected
