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Year 3 Medicine Block > RESP: Infections > Flashcards

RESP: Infections Flashcards

1
Q
A
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2
Q

Pneumonia on a chest xray?

A

Consolidation and air bronchogram

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3
Q

Signs of pneumonia

A 
Usually signs of sepsis:
Tachycardia
Tachypnoea
Hypoxia
Hypotension
Fever
Confusion
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4
Q

Chest signs of pneumonia

A

Bronchial breath sounds-
Focal coarse crackles
Dullness to percussion

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5
Q

Severity assessment for pneumonia

A 
CURB-65 (CRB-65 in community)
C- Confusion
U- Urea> 7
R- RR> 30
B- BP < 90 systolic or < or equal to 60 diastolic
65- age greater than or equal to 65
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6
Q

What is atypical pneumonia?

A

Pneumonia caused by organisms that cannot be cultured by gram staining

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7
Q

What are bronchial breath sounds?

A

In pneumonia- harsh breath sounds equally loud on inspiration and expiration

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8
Q

What are focal coarse crackles?

A

Air passing through sputum in airways similar to using a straw blow air through a drink

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9
Q

What is CURB-65 for?

A

Predicts mortality: (1= 5% 3= 15%, score 4/5= 25%) and whether pt should be treated at hospital
0/1- consider treatment at home
greater than/equal to 2- consider treatment at hospital
greater than/equal to 3- consider intensive care assessment

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10
Q

How do you get Legionnaires’ disease?

A

Infected water supply or air condition units

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11
Q

What complication can Legionnaires’ disease cause?

i.e. note on bloods as a clue

A

Hyponatraemia–> SIADH

Lymphopenia

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12
Q

Typical Legionnaires’ exam patient?

A

Cheap hotel holiday and presents with hyponatraemia and lymphopenia

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13
Q

What are some investigations you might do for lung abscess?

A

CXR :

  • Fluid-filled space within an area of consolidation
  • air-fluid level is typically seen

sputum and blood cultures

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14
Q

Complications of mycoplasma pneumoniae?

A 
haemolytic anaemia 
Erythema multiforme 
meningioenchepalitis 
Guillan barre syndrome 
bullous myringitis: painful vesicles on the tympanic membrane
pericarditis/myocarditis
gastrointestinal: hepatitis, pancreatitis
renal: acute glomerulonephritis
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15
Q

Causative organism for fungal pneumonia?

A

Pneumocystis jiroveci

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16
Q

Who is at risk of fungal pneumonia?

A

Immunocompromised- esp HIV patients with low CD4 count

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17
Q

How does fungal pneumonia present?

A

Dry cough with sputum production
SOB on exertion
Night sweats

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18
Q

Complications of pneumonia?

A 
Sepsis
Pleural effusion
Empyema
Lung abscess
Death
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19
Q

Causes of pneumonia?

A

Streptococcus pneumoniae (accounts for around 80% of cases)
Haemophilus influenzae
Staphylococcus aureus: commonly after influenza infection
atypical pneumonias (e.g. Due to Mycoplasma pneumoniae)

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20
Q

What is a lung abscess?

A

well-circumscribed infection within the lung parenchyma

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21
Q

What are the causes / RF for a lung abscess?

A

Secondary to aspiration pneumonia e.g.
Poor dental hygiene
stroke (reduced consciousness)

infective endocarditis - haematogenous spread

direct extension - empyema

Bronchial osbtruction (secondary to lung tumour)

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22
Q

What are some of the microbial causes of lung abscess?

A

often polymicrobial

Monomicrobial causes:
Staphylococcus aureus
Klebsiella pneumonia
Pseudomonas aeruginosa

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23
Q

What are some of the symptoms of lung abscess?

A

Develop over weeks (like subacute pneumonia)

Systemic: night sweats / weight loss
Fever
productive cough (foul sputum, rarely haemoptysis)
chest pain 
SOB
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24
Q

What are some of the signs you would see on examination of a lung abscess?

A

dull percussion

bronchial breathing

clubbing may be seen

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25
Q

What are some investigatioins you might do for lung abscess?

A

CXR :

  • Fluid-filled space within an area of consolidation
  • air-fluid level is typically seen

sputum and blood cultures

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26
Q

How would you manage a lung abscess?

A

IV antibiotics

Percutaneous drainage may be required

Rare: surgical resection

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27
Q

What is a Parapneumonic effusion?

A

Parapneumonic effusions are effusions caused by an underlying pneumonia.

Simple - not infected

Complicated- effusion develops once infection has spread to the pleural space.

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28
Q

How is empyema, a simple parapneumonic effusion and complicated parapneumonic effusion related?

A

Three conditions = a spectrum of pleural inflammation in response to infection.

From a simple parapneumonic effusion to empyema.

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29
Q

What are RF for empyema ?

A 
recent pneumonia
iatrogenic intervention in the pleural space
thorax trauma 
Immunocompromised e.g. diabetes
co-morbidities make pneumonia more likely 
lung disease 
male sex
young or old age
alcohol abuse
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30
Q

If empyema or a complicated parapneumonic effusion is diagnosed what must be done urgently?

A

Insert a chest drain

+ long course of AB

if no improvement with AB and drainage - surgery or fibrinolytics

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31
Q

How do causative pathogens differ from comminity acquired and hospital acquired empyema?

A

Community: Streptococcus pneumoniae, and staphylococci

Hospital: staphylococci (particularly MRSA)

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32
Q

What is type 1 respiratory failure?

A

Pa02<8kPa; PaC02 Normal

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33
Q

Causes of type 1 respiratory failure?

A 
Asthma 
Congestive HF 
Pulmonary Embolism 
Pneumonia 
Pneumothorax
34
Q

What is type 2 respiratory failure?

A

Pa02<8kPa; PaC02 > 6kPa

35
Q

Causes of type 2 respiratory failure?

A

Obstructive lung disease e.g. COPD
Restrictive lung disease e.g. IDL
Depression of respiratory centre e.g. opiates
NMJ disease e.g. Guillan barre syndrome, MND
Thoracic wall disease- rib fracture

36
Q

What is ARDS?

A

Increased permeability of alveolar capillaries–> fluid accumulation in alveoli- non-cardiogenic pulmonary oedema

37
Q

Causes of ARDS?

A

Pulmonary: chest sepsis, aspiration, pneumonia, trauma, smoke inhalation
Non-pulmonary: DIC, acute pancreatitis, drug OD

38
Q

Presentation of ARDS?

A

Acute onset respiratory failure which fails to improve with supplemental O2.

Symptoms of severe dyspnoea, tachypnoea, confusion and presyncope

39
Q

Examination findings in ARDS?

A

fine bibasal crackles but no other signs of HF

40
Q

Investigations for ARDS?

A

Cxr with bilateral alveolar infiltrates w/o any other features of HF

41
Q

Management of ARDS

A 
V serious 
ICU 
Ventilatory support 
Haemodynamic support 
DVT prophylaxis 
Abx only if infectious cause for ARDS
42
Q

(SARS-CoV-2) can cause viral pneumonia. What is the triad of symptoms hospitalised patients get?

A

Hypoxia
Lymphopenia
Bilateral, lower zone changes on CXR

43
Q

What is hospital management for SARS-CoV-2?

A
  1. O2 supplementation
    some may need CPAP / invasive ventilation
  2. Dexamethasone ( consider Tocilizumab +/- Remdesivir)
  3. AB may be needed if superadded bacterial infection
44
Q

What is Influenza?

A

Flu

Single stranded RNA virus.

most common cuaes of viral pneumonia in immunocompromised adults

45
Q

What serotypes of inluenza are there?

A

Three serotypes of influenza - A, B and C

Serotype- determined by surface antigens haemagglutinin and neuraminidase. These are rearranged in host organisms e.g. birds /animals = different strains e.g. Influenza A H5N1 (avian influenza)

46
Q

How is influenza transmitted?

A

via respiratory secretions

VVV contagious

47
Q

How long is incubation period for influenza?

A

typically 1-4 days

48
Q

How long is a pt infectious for with influenza after incubation period ?

A

patients can remain infectious for 7-21 days

49
Q

What are the symptoms of influenza?

A

Fever ≥ 37.8°C

Non-productive cough

Myalgia

Headache

Malaise

Sore throat

Rhinitis

50
Q

What are some pulmonary complications of Influenza?

A

Viral pneumonia,

secondary bacterial pneumonia,

worsening of chronic conditions e.g. COPD and asthma

51
Q

What are some Cardiovascular complications of Influenza?

A

Myocarditis

Heart failure

52
Q

What are some neurological complications of Influenza?

A

Encephalopathy

53
Q

What are some GI complications of Influenza?

A

Anorexia and vomiting are common

54
Q

How do you diagnose Influenza?

A

Routine viral culture

Rapid reverse transcriptase PCR tests are now available.

55
Q

What is the management of Influenza?

A
  1. Supportive (analgesia, antipyretic, fluids, oxygen)
  2. Antiviral treatment with neuraminidase inhibitors e.g. Oseltamivir (‘Tamiflu’)
  3. Infection control and respiratory isolation to prevent onward transmission
56
Q

What are the vaccine options for Influenza? Who is it recommended for?

A
  1. Inactivated vaccine tailored each year according to recent outbreaks.
    It provides partial protection against influenza
  2. those over 65, with chronic conditions. Healthcare workers and nursing home residents.
57
Q

What are some general clinical features of TB?

A
  1. Fever
  2. Night sweats
    drenching)
  3. Weight loss (weeks – months)
  4. Malaise
58
Q

What are some clinical features of Respiratory TB?

A

cough ± purulent sputum/haemoptysis

pleural effusion

59
Q

What are some clinical features of NON- Respiratory TB?

A

Skin (erythema nodosum)

Lymphadenopathy;

Bone/joint; (stiffness, abscess, swelling)

Abdominal; (pain/diarrhoea/distention)

CNS
(meningitis);

Genitourinary; (flank pain, dysuria, polyuria)

Miliary (disseminated);

Cardiac (pericardial effusion)

60
Q

What are you differentials for Haemoptysis : infection related?

A

Pneumonia

Tuberculosis

Bronchiectasis / CF

Cavitating lung lesion (often fungal

61
Q

What are you differentials for Haemoptysis : Malignancy related?

A

Lung cancer

metastases

62
Q

What are you differentials for Haemoptysis : Haemorrhage related?

A

Bronchial artery erosion

Vasculitis

Coagulopathy

63
Q

What are some differentials for Haemoptysis? Other (resp = clue)

A

PE!

64
Q

List some RISK FACTORS for TB ?

A

Past history of TB

TB contact

Born in a country with high TB incidence

Travel to country with high incidence of TB

Immunosuppression–e.g. IVDU, HIV, organ transplant, renal failure/
dialysis, malnutrition/ low BMI, DM, alcoholism

65
Q

What are the immediate management principals for a pt with Resp TB (before investigations)

A

ABCDE approach

Admit to side room + start infective control measure (e.g. masks + negative pressure room.)

66
Q

What are the management principals for a pt with Resp TB (lab investigations)

A
  1. Productive cough - 3 x sputum samples (acid-fast Ziehl-Neelsen stain) + TB culture
  2. NO productive cough - consider bronchoscopy
  3. Routine bloods
    LFTs + HIV test + vit D levels
67
Q

What are the management principals for a pt with Resp TB (imaging)

A
  • CXR

- Consider CT chest if suspect pulmonary TB (CXR normal / no clinical features)

68
Q

What to do if your diagnosis is split between pneumonia and TB?

A

Start Antibiotics for pneumonia as per CURB-65

69
Q

What should you do if pt is critically unwell and there is a likelihood of TB?

A

Start TB treatment AFTER samples sent

70
Q

How long does TB culture take? What does this mean?

A

Culture takes 6-8 weeks.

Means treatment often started before confirmed diagnosis.

Novel PCR test (Gene Xpert) available in some centre - gives immediate info on drug sensitivites / resistance.

71
Q

What role do specialist nurses play in TB management?

A

Notify pt cases to specialist nurses as they:

support pt during investigation, treatment, pubic health issues AND initiate contact tracing!

72
Q

What is standard Anti-TB therapy regimen?

A

FIRST 2 MONTHS:
4: (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol)

NEXT 4 MONTHS
2: (Rifampicin, Isoniazid)

TOTAL: 6 months minimum (can vary)

73
Q

Why is weight important in Anti-TB therapy?

A

dose of anti-TB is weight dependant.

74
Q

Which bloods is it essential to check before commencing anti-TB treatment?

A

LFTS

75
Q

Which anti-TB drug requires eye test?

A

Ethambutol (E for eyes)
need to check visual acuity before giving.

Side effect - can cause Retrobullar neuritis

76
Q

What strategies can be used to ensure compliance ?

A

Directly observed Therapy (DOT)

77
Q

What investigation if suspect CNS TB?

A

MRI Brain

78
Q

What are major side effects of Rifampicin?

A

Hepatitis
rashes
febril reactions
orange / red secretions - sweat / urine / contact lenses

Drug interactions - warfarin / COCP

79
Q

What are major side effects of Isoniazid?

A

Hepatitis
rashes
peripheral neuropathy
psychosis

80
Q

What are major side effects of Pyrazinamide?

A

Hepatitis
rashes
vomitting
arthralgia

Year 3 Medicine Block (56 decks)

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