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Infectious respiratory disorders Flashcards

(63 cards)

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1
Q

Cause of acute bronchitis

A

Usually viral (influenza, rhinovirus or RSV / respiratory synctival virus) but can be bacteria

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2
Q

Sx and signs and risk factors for acute bronchitis

A

Cough
May have pleuritic or retrosternal pain
May have coarse crepitations or wheeze
Cough lasts for 7-10 days but may persist for 3 weeks

Smoking is a RF

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3
Q

Management for acute bronchitis

A

Consider 7 days delayed antibiotic use - amoxicillin 500mgs TDS for 5 days
Symptoms resolve with rest and paracetamol after 3 weeks

Immediate Abx if over 80 yrs or hospitalised over past yr

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4
Q

Signs and symptoms of influenza

A

Fever
Malaise
Headache
Cough - unproductive
Chills
Myalgia
Nasal congestion

Fatigue, irritability, diarrhoea and vomiting in children

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5
Q

Influenza treatment

A

Self limiting
Paracetamol / ibuprofen
Fluids
Rest
Avoid smoking
Decongestants
Lozenges
Saline nose drops

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6
Q

How is the flu vaccine given to children

A

Nasal spray if under 6 months with long term health condition
Injection between 6 months and 24 month
Nasal spray between 2-17 yrs

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7
Q

Pneumonia risk factors

A

Infants and elderly
Smoking
Alcohol excess - aspiration pneumonia
Obstructive - COPD
Bronchiectasis
Immunosuppression
Hospitalisation

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8
Q

Name all the common and uncommon pathogens that cause pneumonia

A

Most common - streptococcus pneumonia
Common - staphylococcus aureus, mycoplasma pneumonia, haemophilia influenza

Uncommon - klebsiella pneumonia, strep pyogenes, pseudomonas, aeruginosa, coxiella burnetti, chlamydia psittaci, actinomyces israeli

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9
Q

Symptoms of pneumococcal pneumonia / strep pneumonia

A

Cough
Purulent sputum
Fever
Aches and pains
Vomiting
Anorexia
Pleuritic chest pain
Dyspnoea

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10
Q

Complications of pneumococcal pneumonia/ strep pneumonia

A

Organisation of exudate
Pleural effusion
Lung abscess
Bacteraemia may cause ENDOCARDITIS, MENINGITIS, ARTHIRITIS, OTITIS MEDIA

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11
Q

Management of pneumococcal pneumonia

A

Penicillin
Cephalosporin

Do CURB65 score Ito see if we need to admit

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12
Q

What parameters are in the CURB65 score

A

Confusion
Urea
RR over 30
BP - systolic under 90 or diastolic under 60
Age - 65 and over

Admit if score is 2-5

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13
Q

Investigations for pneumonia

A

CURB65 - to see if admission is needed
Sputum gram stain - gram positive cocci suggests streptococcus pneumonia

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14
Q

What is atypical pneumonia and its causes

A

Caused by less common pathogens which are NOT DETECTABLE ON GRAM STAIN
- mycoplasma pneumoniae
- chlamydophila pneumoniae
- legionella pneumoniae

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15
Q

Mycoplasma presentation and complications

A

Insidious presentation with dry cough, sore throat and flu like symptoms

Myocarditis, meningo-encephalitis, maculopapular rash, haemolytic anaemia

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16
Q

Mycoplasma pneumonia investigation findings

A

Chest X ray findings
- homogenous dense lobar consolidation
- patchy consolidation
- nodular opacity
- bilateral parahilar infiltration

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17
Q

Mycoplasma pneumonia treatment

A

Macrolides - Erythromycin / clarithromycin
Doxycyclines - Tetracycline

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18
Q

Legionella pneumonia presentation and complications (complications may present as symptoms in exam questions)

A

Contaminated air condition
Coughs
Chills
High Temperature
Myalgia
Nausea
Diarrhoea
Vomiting

Complications - confusion, hepatitis, renal impairment - PROTEINURIA, HYPONATRAEMIA, confusion, lung abscess, empyema, hypotension

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19
Q

Legionella pneumonia investigations

A

CXR
Blood cultures
LEGIONELLA SEROLOGY/URINE ANTIGEN

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20
Q

Legionella pneumonia management

A

Erythromycin 14 - 21 days
Rifampicin BD in combination for severely ill patients

Some cases don’t respond and may die due to respiratory failure

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21
Q

Chlamydia pneumonia presentation

A

Pharyngitis
Hoarseness
Otitis media followed by pneumonia

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22
Q

Chlamydia pneumonia diagnosis / investigations

A

Chlamydial PCR of nasopharyngeal swab or sputum or pleural fluid

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23
Q

Chlamydia pneumonia treatment

A

Tetracycline
Macrolides - AZITHROMYCIN - first line
Fluoroquinolones

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24
Q

Common causative pathogens of nosocomial pneumonia (hospital acquired pneumonia)

A

Pseudomonas aeruginosa
Staphylococcal aureus
Enterobacteriaceae e.g. Klebsiella, e.coli, enterobacter

Anaerobic organisms acquired in under 48 hrs of admission to hospital

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25
What is staphylococcal aureus pneumonia and it’s cause
Widespread infection with ABSCESS formation Secondary to influenza virus infection in immunocompromised people Can also come from staphylococcal septicaemia where puncture sites introduce the infection e.g. intravenous drug users
26
Staphylococcal aureus pneumonia management
Flucloxacillin Erythromycin
27
Klebsiella pneumonia presentation
High fever Rigor Pleuritic pain Purulent, gelatinous or blood stained (haemoptysis) sputum Alcoholism Diabetes COPD Elderly
28
Klebsiella pneumonia investigation findings and management
Massive consolidation and excavation of one or more lobes (often upper lobes) on CXR Cefuroxime
29
What causes pseudomonas aeruginosa pneumonia
Pseudomonas aeruginosa bacteria - common pathogen in Bronchiectasis and cystic fibrosis and hospital acquired infection especially in intensive therapy unit or post surgery
30
Pseudomonas pneumonia diagnosis and management
Sputum culture Antipseudomonal penicillin e.g. ticarcillin, piperacillin Ceftazadime Meropenem Ciprofloxacin
31
Which type of pneumonia occurs in immunosuppressed people
Pneumocystic jirovecii pneumonia
32
Pneumocystic jirovecii presentation
Dry cough Exertional dyspnoea and desaturation Fever Bilateral crepitations
33
Pneumocystic jirovecii pneumonia diagnosis / investigations
Sputum Bronchoalveolar lavage CXR normal or bilateral perihilar interstitial shadowing
34
Pneumocystic jirovecii pneumonia treatment
High dose co-trimoxazole, pentamidine Steroid if hypoxaemia Prophylaxis if low CD4 count
35
What investigations need to be done for patients admitted with pneumonia
FBC for WBC U+Es for urea LFTs for albumin Sputum culture Chest X-Ray Blood cultures
36
What is acute bronchiolitis and what is it caused by
LRTI in children (usually under 2) that affects bronchioles Respiratory syncytial virus (RSV) - most common cause Rhinovirus Parainfluenza Influenza Adenovirus Coronavirus
37
Acute bronchiolitis presentation and clinical findings
Persistent cough Tachypnoea Chest recession Wheezing Rales Preceded by URTI symptoms - nasal congestion / rhinorrhoea 1-3 days before!!!! Under 2 Clinical findings - bilateral diffuse expiratory wheezing and no crackles (infection not in lobes)
38
Acute bronchiolitis diagnosis and management
Clinical diagnosis Usually resolves within 1-2 weeks Admit if hypoxia, lethargy, dehydration, respiratory distress e.g. Nasal flaring, cyanosis etc… After admission treat with inhaled bronchodilator, IV fluids and oxygen
39
RSV risk factors
Chronic lung disease Under 5kg Cyanotic congenital heart disease Immunocompromised Exposure to tobacco smoke in utero Premature birth
40
Symptoms of RSV
Cough Rhinorrhoea Low grade fever Wheezing Occasional hypoxia Malaise
41
RSV management
Supportive - hydration and oxygenation
42
What is croup
Barking cough Upper respiratory tract infection in infants and toddlers
43
Croup presentation
Infant / toddler Barking cough - inspiratory stridor Hoarse cry Coryzal
44
Cause of croup
Parainfluenza viruses
45
Croup investigations and management
Clinical diagnosis - modified westley scoring system for croup Supportive management but if severe - dexamethasone - nebulised budesonide or adrenaline
46
Cause and presentation of pertussis / whooping cough
Cough with paroxysms Post cough emesis Before vaccination received Caused by bordatella pertussis
47
Pertussis / whooping cough investigation and management
Nasopharyngeal swab - serology for anti pertussis toxin IgG - PCR Admit and oxygen if cyanosis Macrolides - clarithromycin / azithromycin - reduces infective period
48
Acute epiglottitis presentation
Muffled voice (hot potato) Hoarse cry Stridor Drooling Fever Painful/inability to swallow Tripod sign
49
Acute epiglottitis investigation and management
DONT LOOK Lateral neck X-RAY - thumbprint sign Emergency referral - airway management, laryngoscopy, IV antibiotics, surgical tracheostomy, manage fever
50
What is tuberculosis caused by and risk factors
Mycobacterium tuberculosis Close contact with TB pt Homeless or drug users HIV positive or immunocompromised Elderly
51
Tuberculosis symptoms
Night sweats Cough Weight loss Loss of appetite Tiredness Haemoptysis Breathlessness Pleuritic pain
52
Active TB diagnosis / investigations !!!
Chest X-RAY 3 consecutive Sputum sample and culture (one in early morning) - acid fast bacilli smear, mycobacterial cultures and NAAT Decreased breath sounds Consolidation in upper lobes Hilar lymphadenopathy
53
What is miliary tuberculosis
Disseminated disease through haematogenous spread
54
Latent TB diagnosis / investigations
Tuberculin skin test - Mantoux test (positive if skin induration over 5mm after injecting tuberculin into forearm) Interferon gamma release assay (IGRA)
55
Latent TB management
Further investigations to exclude active TB - chest x ray - for granulomas/nodules - physical examination - sputum for mycobacterium culture and NAT and acid fast bacilli smear If confirmed not active - Isoniazid (with pyridoxine - vit B6 to prevent peripheral neuropathy side effect or isoniazid) and Rifampicin for 3 months Or - isoniazid (with pyridoxine - vit B6) for 6 months
56
Active TB treatment !!!!
If no CNS involvement (spinal tuberculosis), start treatment without waiting for culture results Must continue course without missing a single day or will need to start all over again Notify to public health England Isoniazid with pyridoxine, Rifampicin, pyrazinamide and ethambutol for 2 months (RIPE) Then isoniazid with pyridoxine and Rifampicin for a further 4 months
57
Rifampicin precaution and warning
No hormonal contraception for 8 weeks after Rifampicin Side effects - urine turns red, sweat and tears may also be red
58
Complications of TB
Pleural effusion Empyema (collection of pus) Pneumothorax Laryngitis Enteritis Mycetoma with aspergillus fumigatus (fungus ball) Cor pulmonale - if lots of fibrosis Death
59
What is the difference between pleural effusion and pleural oedema
Pleural effusion - excess fluid around lungs in pleural Pleural oedema - fluid inside alveoli (inside lung)
60
Types of pleural effusion
Transudative - only fluid Exudative - proteins and LDH in fluid
61
Causes of Transudative pleural effusion
Chronic heart failure Liver disease Nephrotic syndrome Pulmonary embolism End stage kidney disease
62
Causes of Exudative pleural effusion
Infection Cancer Autoimmune Drugs Pulmonary embolism
63
Pleural effusion diagnosis and treatment
Seen on chest X-RAY Diagnosed and managed with thoracentesis

Respiratory (5 decks)

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