Lower Respiratory Tract Infections And Pneumonia Flashcards Preview

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Flashcards in Lower Respiratory Tract Infections And Pneumonia Deck (32)
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1

What types of microorganisms are microbiome of the upper respiratory tract?

Strep viridans
Neisseria species
Anaerobes
Candida species
(Strep pneumoniae)
(Strep pyogenes)
(Haemophilus influenzae)

2

Describe some of the first defences of the respiratory tract

Muco-ciliary clearance
Cough and sneezing reflex
Mucosal immune system - lymphoid follicles of pharynx and tonsils, alveolar macrophages, secretory IgA and IgG

3

Name some general types of problems that can compromise respiratory defences

Poor swallowing
Abnormal ciliary function
Abnormal mucus
Dilated airways
Defects in host immunity

4

Name some common upper respiratory tract infections

Rhinitis
Pharyngitis
Laryngitis
Sinusitis
Otitis media
Epiglottitis
Tracheitis

5

What are the most common viruses of the respiratory system?

Rhinovirus
Coronavirus
Influenza
Respiratory syncytial virus (RSV)

6

Bacterial super-infections in the respiratory tract can lead to ...

Mastoiditis
Meningitis
Brain abscess

7

Name some common lower respiratory tract infections

Bronchitis
Bronchiolitis
Bronchiectasis
Pneumonia
Empyema
Lung abscess

8

Describe acute bronchitis

Inflammation of the medium sized airways
Mainly in smokers
Cough, fever, increased sputum, shortness of breath
CXR = normal

9

What are the types of organisms causing acute bronchitis?

Viruses
Strep pneumoniae
H influenza

10

What is the treatment of acute bronchitis?

Bronchodilation
Physiotherapy
+/- antibiotics

11

What is pneumonia and its presentation?

Inflammation of lung alveoli
Fever
Cough (+/- sputum)
Pleuritic chest pain
Shortness of breath
Rigors
Malaise/nausea/vomiting
Often localising signs and abnormal CXR

12

What are the different ways of classification of pneumonia?

By clinical setting (CAQ, HAQ)
By presentation (acute, chronic)
By organism (bacterial, viral, fungal)
By lung pathology (lobar, broncho, interstitial)

13

What is pneumonitis?

Non-infective inflammatory disease

14

Describe the pathogenesis of pneumonia

Acute inflammatory response
Exudation of fibrin rich fluid
Neutrophil infiltration
Macrophage infiltration

15

What underlying factors predispose to pneumonia?

Pre-existing lung disease
Immunocompromsied
Geography, seasons, epidemics
Travel
Exposure to animals

16

What are the typical community causes of pneumonia?

Strep pneumoniae
H influenzae

17

What should you look for on examination of someone with pneumonia?

Pyrexia
Tachycardia
Tachypnoea
Bronchial breathing
Cyanosis
Dullness to percussion
Tactile vocal fremitus
Crackles

18

What investigations should you do in someone with suspected pneumonia?

FBC
Urea and electrolytes
CXR
CRP
Arterial blood gases

19

What microbiological samples/investigations could you order in pneumonia?

Sputum culture
Blood culture
Broncho-alveolar lovage fluid (BAL)
Nose and throat swabs
Urine
Serum (antibody test)

20

What does the CURB-65 score for pneumonia assess?

Confusion
Urea > 7 mmol/L
Resp rate >30
BP <90 s / <60 d
> 65 years
(Score of 2+ means admit to hospital)

21

What is the antibiotic treatment for mild-moderate pneumonia?

Amoxicillin
Doxycycline/erythromycin/clarithromycin

22

What is the antibiotic treatment for moderate to severe pneumonia?

Co-amoxicillin and clarithromycin/doxycycline

23

What are the possible outcomes of acute bacterial pneumonia?

Resolution with some organisation (fibrous scarring)
Lung abscess (liquefactive necrosis)
Bronchiectasis
Empyema

24

Which organisms cause atypical pneumonia?

Organisms without a cell wall
Mycoplasma
Legionella
Chlamydia
Coxiella

25

Why do we need different treatments for atypical pneumonia?

Cell wall active antibiotics don't work eg. Penicillins
As the organisms don't have cell walls

26

What Abx do we use for atypical pneumonia?

Macrolides (eg. Erythromycin/clarithromycin)
Tetracyclines (eg. Doxycycline)

27

Describe viral pneumonia

Damage to cells lining the airways/alveoli by virus and immune cells
Fluid filled air spaces - interferes with gas exchange
Can get severe necrosis
Patchy or diffuse ground glass opacity of CXR

28

Which viruses can cause viral pneumonia?

Influenza/parainfluenza
RSV
Adenovirus

29

Describe the causes the hospital acquired pneumonia

Staph aureus
Enterobacteriaciae
Pseudomonas species
Haemophilus influenzae
Fungi

30

What treatments do we use to treat HAQ pneumonia?

First line = co-amoxiclav
Second line = pipperacilin/tazobactam/meropenem