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Flashcards in Infections Deck (131):
1

What are upper respiratory tract infections?

Common cold (coryza), sore throat (pharyngitis), sinusitis, epiglottitis, tonsillitis and quinzy, diphtheria

2

What are complications of the common cold?

Acute bronchitis and sinusitis

3

What are some organisms causing the common cold?

Adenovirus, respiratory syncytial virus, rhinovirus

4

What is the severe type of sinusitis?

Erythroid

5

What is a sign of epiglottitis and what should you never do?

Drooling- never open mouth as they will choke

6

What is quinzy?

Tonsil abscess

7

What makes diphtheria life threatening?

Toxin production

8

What are lower respiratory tract infections?

Acute bronchitis, COPD exacerbations, influenza, pneumonia

9

What are signs of acute bronchitis?

Cough, fever, possible wheeze

10

What is the treatment for acute bronchitis?

No antibiotics generally, maybe in those with a chronic lung disease

11

What happens in a COPD exacerbation?

Increased sputum, wheeze and dyspnoea

12

What are signs of a COPD exacerbation?

Respiratory distress, wheeze, coarse crackles, cya nosed, ankle oedema

13

What is the treatment for an acute exacerbation of COPD?

Amoxicillin (or doxycycline), steroids and bronchodilators

14

What additional things would be added to the treatment of a COPD exacerbation in secondary care?

CXR, ABG, oxygen if there is respiratory failure

15

What are symptoms of influenza?

Fever, malaise, myalgia, headache, cough, prostration

16

What are 8 signs of pneumonia?

Fevers, rigorous, herpes labialis, tachypnoea, crackles, rub, cyanosis, hypertension

17

What symptoms are particularly common in legionella?

GI disturbance and confusion

18

Besides CURB65, what are other severity markers of pneumonia?

Severe high or low temperature, WBC count <4 or >30, cyanosis and multi-lobar involvement

19

What investigations do you do to diagnose pneumonia?

Blood culture, serology, CXR, ABG, FBC, urea, liver function

20

How do you manage CA pneumonia?

Antibiotics, bed rest, fluids, oxygen, no smoking

21

What are complications of pneumonia?

Respiratory failure, pleural effusion, empyema, fibrous scarring, abscess, bronchiectasis, death

22

What is the further management needed for HA pneumonia?

Further gram negative cover

23

What is the further management needed for aspiration pneumonia?

Further anaerobic cover

24

What type of organisms tend to colonise the upper respiratory tract?

Gram + alpha haemolytic strep, beta haemolytic strep, gram negatives

25

What is an example of a gram positive alpha haemolytic strep?

Streptococcus pneumoniae

26

What is an example of a beta-haemolytic strep?

Streptococcus pyogenes

27

What are examples of gram - bacteria colonising the upper respiratory tract?

Haemophilus influenzae, moraxella catharalis

28

What bacteria causes TB?

Mycobacterium tuberculosis

29

What type of bacteria is m. tuberculosis?

Acid alcohol fast bacilli

30

How do you treat TB?

2 months rifampicin, isoniazid, pyrazinamide and ethambutol (RIPE), 4 months RI

31

What are the 3 'influenza' viruses?

Influenza A/B (classical), parainfluenza virus (flu-like illness), haemophilus influenzae (a bacterium and not a direct cause of flu)

32

How do you treat influenza?

Bed rest, fluids, paracetamol, possibly antivirals e.g. olselamivir

33

What type of influenza is involved in pandemics?

Type A

34

What is the main cause of bronchiolitis?

Respiratory syncytial virus

35

How do you treat bronchiolitis?

Supportive therapy

36

What organism is known to cause infantile pneumonia?

Chlamydia trachomatis

37

What is chlamydia pneumoniae?

A mild respiratory tract infection

38

What causes epiglottitis?

Haemophilus influenzae type B

39

How do you treat epiglottitis?

Ceftriaxone

40

Who is epiglottitis more common in?

Immune compromised/suppressed

41

What are some bacteria causing a COPD exacerbation?

Haemophilus influenzae, moraxella catarrhalis, streptococcus pneumoniae (also some gram -'s)

42

When do you treat a COPD exacerbation?

Whenever there is increased sputum purulence, new changes on CXR or pneumonia

43

What are some organisms involved in CF?

strep pneumoniae, haemophilus influenzae, staph aureus, burkholderia Cepacia, pseudomonas auriginosa

44

What are symptoms of whooping cough?

Cold like symptoms for 2 weeks, paroxysmal coughing, vomiting

45

What causes whooping cough and what kind of bacteria is this?

Bartedella pertussis- gram - cocco bacillus

46

When should you give antibiotics for a whooping cough?

If the cough has lasted <21 days

47

How is whooping cough diagnosed?

Culture from swab or PCR, serology, history and exam

48

What are the top 5 organisms causing CAP?

1) Strep. pneumoniae
2) Haemophilus. influenzae
3) Mycoplasma. pneumoniae
4) Staphylococcus. aureus
5) Gram -'s e.g. Coxiella. burnetti

49

What are some atypical organisms causing CAP?

Legionella, moraxella. catarrhalis, chlamydia

50

What CAP causing organism is most common in children and young people?

Mycoplasma pneumoniae

51

What does mycoplasma pneumoniae show on a CXR?

Reticulo-nodular shadowing/patchy consolidation of 1 lobe

52

What does staph. aureus show on a CXR?

Bilateral cavitation bronchopneumonia

53

Where does legionella commonly come from?

Colonised hot water tanks

54

What does legionella show on a CXR?

Bi-basal consolidation

55

What are some examples of aspiration pneumonia as well as the common ones?

Klebsiella pneumoniae, E.coli, pseudomonas auriginosa

56

Who is Klebsiella pneumoniae common in and where is it commonly found?

Alcohol abuse- often in the upper lobes

57

What is the common bacteria in the immunocompromised?

Pneumocystis Jirovecii (PCP)

58

How do you treat PCP?

Co-trimoxazole

59

What else is common in immunocompromised?

Aspergillis

60

What are the 2 most common causes of HAP?

Staph aureus and gram - enterobacteria

61

What are other causes of HAP?

Pseudonomas, Klebsiella, Bacteroides, Clostridia

62

What is common in bronchiectasis?

Pseudonomas

63

What is TB infection?

The immune system has not completely cleared the disease

64

What is TB disease?

Showing symptoms of TB

65

How do diseases of lower lung lobes usually come about?

Through the bloodstream

66

How do diseases of upper lung lobes usually come about?

Through inhaled pathogens

67

What are 11 features of TB?

Weight loss, fevers, night sweats, malaise, pain, bowel obstruction, headache, fits, drowsy, cough

68

What confirms a diagnosis of TB?

Staining characteristics, culture

69

What will the radiology for TB show?

Upper lobe predominance with cavity formation?

70

What can happen when taking rifampicin?

It can cause other current medication not to work very well

71

Where does TB live in the body?

In macrophages

72

How long does it take to be non-infectious from TB?

1-2 weeks

73

What does single agent resistance usually target in TB and how is treatment changed?

Usually just affects isoniazid- treatment is prolonged

74

Was is commonly affected by MDR in TB?

Rifampicin and isoniazid

75

What are signs of latent TB?

No evidence of active TB, evidence of previous TB infection, calcification on x-ray

76

What tests can be used to test for previous TB exposure?

Interferon gamma release assay, mantoux test

77

What are TB drugs associated with and who is this more common in?

Disturbance of liver function- more common in women

78

What people have the highest rates of TB?

HIV

79

What are some viruses which can cause pneumonia?

Influenza, parainfluenza, measles, varicella-zoster, respiratory syncytial virus

80

What is lobar pneumonia?

Consolidation involving a whole lung lobe?

81

What organism most commonly causes lobar pneumonia?

Strep. pneumoniae

82

Who is lobar pneumonia more commonly found in?

Otherwise healthy young adults

83

What is the basic pathology behind lobar pneumonia?

Fibrin rich fluid, neutrophil infiltration, macrophage infiltration, resolution

84

What is bronchopneumonia?

Starts in the airways and spreads to adjacent alveolar lung

85

What context is bronchopneumonia most commonly seen in?

People with pre-existing disease

86

What is important to remember about the organisms causing bronchopneumonia?

They can be more varied

87

What type of pneumonia can commonly lead to abscess?

Aspiration pneumonia

88

What is bronchiectasis?

Abnormally fixed dilation of the bronchi usually due to fibrous scarring followed by infection

89

What accumulates in bronchiectasis?

Purulent secretions

90

What type of reaction is TB?

Delayed type IV hypersensitivity reaction- granulomas with necrosis

91

How does TB exert pathogenicity?

Avoids phagocytosis and stimulates a host T cell response

92

What happens in primary TB?

The inhaled organism is phagocytosed and carried to hilar lymph nodes

93

What happens in secondary TB?

Reinfection or reactivation of the disease in a person with some immunity.

94

Where does the disease tend to be in secondary TB?

Usually localised at the apices but can spread to the airways and bloodstream

95

Where does primary TB tend to be?

There is a small focus in the periphery of the midzone and large hilar lymph nodes

96

What is an important differential diagnosis in secondary TB?

Cancer

97

What makes TB reactivate?

Decreased T cell function or immunosuppressive therapy

98

What virus is common in the immunosuppressed?

Cytomegalovirus

99

What fungi is common in the immunosuppressed?

Aspergillus, candida, pneumocystis

100

What medication counts as being immunosuppressed?

Steroids and cancer treatment

101

What are differentials for a pulmonary infection?

Lung cancer, abscess, empyema, bronchiectasis, CF

102

What are risk factors for developing chronic lung infections?

Immunosuppressed/immunodeficiency, abnormal host defence, repeated insult, immunoglobulin deficiency

103

What does IgA deficiency predispose to?

Recurrent acute infections, not chronic

104

What does an intrapulmonary abscess present with?

Weight loss, lethargy, weakness, cough

105

What is common in people with an intrapulmonary abscess?

A preceding illness

106

What are some pathogens causing intrapulmonary abscess?

Bacterial (strep, staph, e-coli, gram -'s) or fungi (aspergillus)

107

What can be causes of septic emboli and who is this common in?

Right sided endocarditis, infected DVT, septicaemia, common in PWID

108

What is empyema?

Pus in the pleural space

109

What are empyemas common following?

Pneumonia, and there is often a progression from effusion to empyema

110

What type of organisms cause empyema? What is the exception to this?

Usually aerobic organisms, anaerobic in severe pneumonia or poor dental hygiene

111

What tests are done for empyema?

CXR- will show white out 'D sign', CT and ultrasound

112

How do you treat empyema?

Broad spectrum IV antibiotics (amoxicillin, metronidazole) initially followed by oral antibiotics directed towards the specific organism for at least 14 days

113

How would you describe the bronchi in bronchiectasis?

Inflamed and easily collapsible

114

What does bronchiectasis present as?

Recurrent 'chest infections' and antibiotic prescriptions with no or little response . There is also persistent sputum production and a cough

115

How do you test for bronchiectasis?

High resolution CT

116

What is the presentation of bronchial sepsis?

Similar to bronchiectasis but with no evidence of that following tests

117

Who is bronchial sepsis common in?

Young people or adults in healthcare or older people with COPD or other airway diseases

118

What should the diagnosis of a chronic infection always lead to?

A check for underlying immunodeficiency

119

What is the main cause of the problem in CF?

A defect in the cystic fibrosis transmembrane conductance regulator- a chloride channel found in lumen cells

120

What does the CFTR channel do in normal people?

Transport of chlorine into the lumen of the lungs- it is ATP regulated and inhibits sodium and some other channels

121

What happens when the CFTR channel fails?

Sodium and water leaks into other cells which causes dehydration of the lumen.

122

What are the consequences of dehydration of the lumen in CF?

Salty sweat, intestinal blockage, fibrotic pancreas, failure to thrive, recurrent bacterial lung infections, absence of vas deferens

123

How many different classes of CFTR mutations are there and which is the worst?

5 different classes- Class I is the worst as there is no CFTR synthesis

124

What are some signs of CF in adulthood?

Upper lobe bronchiectasis, colonisation with staph, infertility and low weight

125

What treatment do you give if a CF patient is colonised with staph aureus?

Flucloxacillin oral or septrin oral

126

What treatment do you give if pseudomonas colonises a CF patient?

Oral azithromysin, nebulised colomycin, tobramycin and aztreonam and inhaled tobramycin

127

What can exacerbations of CF be managed by?

Antibiotics, physiotherapy, adequate hydration and increased dietary input

128

How many antibiotics should be given to CF patients and why?

Always 2 to reduce resistance

129

What antibiotics do you give to a CF patient with cepacia?

Temocillin

130

What is the G551D mutation in CF?

A class III mutation; there is a normal CFTR but a non-functioning channel

131

What drug can help in G551D mutations and why is it rarely used?

Ivacaftor- it is extremely expensive