Resp Week 3 Flashcards
1
Q
What are the 3 types of lung infections?
A
they can be primary, faculitative or oppertunistic
2
Q
Define bronchitis
A
Large airway inflammation
3
Q
Define bronchiolitis
A
Small airway inflammation
4
Q
Define pneumonia
A
Establishment of infection in the soft lung tissue
5
Q
What are the 4 different pneumonia patterns?
A
- Bronchopneumonia
- Segmental
- Lobar
- Hypostatic
6
Q
Describe bronchopneumonia
A
Infection of the lungs which is multifocal
7
Q
Describe segmental pneumonia
A
One or more part of the lung involved
8
Q
Describe lobar pneumonia
A
Same process as segmental but to different extent
9
Q
Describe hypostatic pnuemonia
A
Localisation of the infectious process in the lower zones of both lungs and relates to other diseases such as COPD and Cardiac failure, where excess secretions accumulate in the lungs (lower zones) which increases chances of infection
10
Q
Describe the consequences of pneumonia
A
Pleurisy, pleural effusion and empyema
Organisation (mass leison)
Lung abscess
Bronchiectasis
11
Q
Describe the respiratory tracts defence mechanisms
A
- General immune system (hummoral and cellular immunity)
- Respiratory tract secretions
- Upper resp tract can act as a ‘filter’ to stop larger microorganisms
- Macrophage mucocillary escalator system
12
Q
What is bronchiectasis
A
Patholigical dilatation of bronchi due to:
- Severe infective episode
- Reccurent infections
- Proximal bronchial obstruction
- Lung parenchymal destruction
13
Q
What are some common viral agents?
A
- Adenovirus
- Influenza A,B
- RSV
- Rhinovirus
- Paraflu I, III
14
Q
Describe croup
A
The inflammation of the larynx and trachea in children, associated with infection and causing breathing difficulties
15
Q
What are the most common URTI’s
A
- Croup
- Acute tonsilitis
- Otitis media
16
Q
What can rhinitis prodrome to?
A
Pneumonia
Bronchiolitis
Meningitis
Septicaemia
17
Q
What is otis media?
A
An infection of the middle eat that causes inflammation and a build up of fluid behind the eardrum
18
Q
Describe the clinical relevance of Otis media
A
- Common, self limiting primary viral infection
- Secondary infection with Pneumococcus / Haemophilous influenzae
- Causes spontaneous rupture of ear drum
- Antibiotic treatment doesn’t usually help
19
Q
What are the side effects of Augmentin?
A
- high rates of diarrhoea
- Nappy Rash
20
Q
Why must you be hesistant in the prescription antibiotics for URTIs
A
- Abx may take 2-3 days to work
- Side effects are bad
- End point is the same as for treatment compared no treatment
21
Q
What is the dilemma posed by treating tonsillitis and pharyngitis
A
- Need to determine if infection is viral or bacterial
- Either do nothing or prescribe 10 days of penicillin
DO NOT PRESCRIBE AMOXICILLIN
22
Q
How do you treat croup?
A
Oral dexamethasone
23
Q
What causes croup?
A
Para’flu 1
24
Q
What is epiglottitis
A
Inflammation of the epiglottis - uncommon but can be fatal, needs to be treated fast
25
What is the treatment for epiglottitis
Intubation and broad spectrum abx
26
What are the symptoms for croup?
Coryza
Stridor
Hoarse voice
barking cough
27
What are the symptoms for epiglottitis
Stridor
| Drooling
28
Describe tracheitis
= Infection of the trachea
- Uncommon
- Described as 'croup which does not get better'
- Fever
- 'Barking cough'
- Treat with Augmentin
29
Describe Bronchitis
- Common
- Endobronchial infection
- Loose rattly cough started with URTI
- Post-tussive vomit
- Chest free of wheeze/Crepitations
- Mostly self limiting conditioning
- May damage cilia, causing substances to pool, which may lead to further infection
30
Describe bronchiolitis
=Infection for small airways, not large
- Affects 30-40% of infants
- Usually RSC, others include paraflu III, HMPV
- Nasal stiffness, tachypnoea, poor feeding
- Crackles and or wheeze
- <12 months old, one off infection
31
Describe the treatment of pneumonia in children
Oral amoxycillin is first line
Oral macrolide second choice
Only IV if vomiting
32
Compare LRTIs and Bronchiolitis
```
LRTI
- In all ages
- More rapid onset of symptoms
- Fever
Bronchiolitis
- Aged <12 months
- 3 days before reached peak
- Fever Rarely >38 degrees
```
33
Would you prescribe abx for tracheitis, if so which one?
Yes, augmentin
34
Would you prescribe abx for bronchitis, if so which one?
No
35
Would you prescribe abx for pneumonia, if so which one?
Yes, if symptoms are moderate, Oral amoxicillin, then oral macrolide, only Iv if vomiting
36
Would you prescribe abx for bronchiolitis, if so which one?
No
37
Would you prescribe abx for empyema, if so which one?
Yes, IV abx (and perhaps chest drainage)
38
What are common lower respiratory tract issues?
- Acute bronchitis
- Exacerbation of COPD
- Pneumonia
- Empyema
- Lung abscess
- Bronchiectasis
39
Describe acute bronchitis
=Inflammation of the bronchi
- Temporary <3 weeks
- Cough and sputum
- Usually viral
- Supportive management
40
What are the symptoms of a COPD exacerbation?
- Changes in colour of sputum
- Fevers
- Increased breathlessness
- Wheeze
- cough
41
What are some of the causes of
| COPD exacerbation?
Stretococcus pneumoniae
Haemophilus influenzae
Moraxella cararrhalis
Viral
42
What is the treatment for an exacerbation of COPD
```
Steroids
Abx:
- Amoxicillin
- Doxycycline
- Co-trimoazole
- Clarithromycin
Nebulisers if severe
```
43
What are the 3 different forms of pneumonia (anatomically classed)
Bronchopnueomia
Lobar pneumonia
Interstitial pneumonia
44
What are the symptoms of pneumonia
- Fever, rigors, myalgia
- Cough and sputum
- Chest pain (pleuritic)
- Haemoptysis
(rusty brown sputum = streptococcus pneumoniae)
45
What are the signs of pneumonia
- Tachypnoea
- Tachycardia
- Reduced expansion
- dull percussion
- Bronchial breathing
- Crepitations
- Vocal resonance
46
What investigations are used in pneumonia?
Bloods
CXR
Sputum culture
Legionella urinary antigen
47
What are the typical community acquired bacteria which cause pneumonia?
Strep-pneuoniae
Haemophilus influenza
Myocplasma pneumoniea (tends to come round every 4-5 years with extra pulmonary complications)
48
What is legionella pneuophilla associated with?
Fresh water and air conditioning
49
What is chlamydia pneumonia associated with?
Coronary heart disease
50
What is chlamydia psittaci associated with?
BIRDS BRO. #pigeonsarenotreal
51
What is moraxella catarrhalis associated with?
COPD
52
What is staphlococcal aureus associated with?
typically comes after flu infection
53
What are the typical nosocomial infections that cause pneumonia?
Enterobacteria
Staph aureus
Pseudomonas aerigunosa
Klebsiella pneuomia
54
What is Pseudomonas aerigunosa associated with?
Green foul smelling sputum
55
What is Klebsiella pneumonia associated with?
Aspiration events, more common in alcoholics
56
What is used to score severity in pneumonia?
CURB 65
57
Describe the parameters of CURB 65
```
One point for every worrying factor
C=confusion
U=Blood urea>7mmol/L
R=Resp rate >30
B=Systolic BP <90, Diastolic BP <60
65 = if aged 65 or over
```
58
What is the procedure for hospital admission from the CURB 65 Score?
```
0-1 = low risk, can be treated in community
2 = moderate risk, hospital treatment required
3-5 = high risk and need for ITU
```
59
What is the treatment of a patient presenting with pneumonia, with a CURB score of 0-1 (include an alternative for a penicillin allergy and a duration of administration)
Abx - amoxicillin
abx if penicillin allergic - clarithromycin or doxycycline
Duration - five days
60
What is the treatment of a patient presenting with pneumonia, with a CURB score of 2 (include an alternative for a penicillin allergy and a duration of administration)
Abx - Amoxicillin + Clarithromycin
Abx if penicillin allergic - Levofloxacin
Duration - 5-7 days
61
What is the treatment of a patient presenting with pneumonia, with a CURB score of 3-5 (include an alternative for a penicillin allergy and a duration of administration)
abx = Co-amoxiclav + clarithromycin
abx ic penicillin allergic = levofloxacin + co-trimoxazole
duration = 7-10 days
62
What are the causes of bronchiectasis?
- Idiopathic
- Childhood infection
- CF
- Cilliary dyskinesia
- Hypogammaglobulinaemia
- Allergic broncho-pulmonary aspergillosis (ABPA)
63
What are the symptoms of bronchiectasis?
```
Chronic productive cough
SOB
Reccurent LRTI
Haemoptysis
Finger clubbing
Crepitations
Wheeze
Obstructive spirometry
```
64
Define an endemic
The constant presence and or usual prevalence of a disease or infectious agent in a population within a geographic area
65
Define Epidemic
An increase, often sudden , in the number of cases of a disease above what is normally expected in that population in that area
66
Define outbreak
Carries the same definition of epidemic, but is often used for a more limited geographical area
67
Define Pandemic
An epidemic that has spread over several countries or continents usually affecting a large number of people
68
Describe the mycobacteria that causes TB
- Ubiquitous in the soil and water
- Non motile
- Very slow growing
- Aerobic (predilection for apices of lungs)
69
What is unique about the mycobacterium that causes TB
Has a very thick fatty cell wall
| - Resistant to acids, alkali and detergents
70
Describe the transmission of TB
Airborne (pulmonary and laryngeal TB spreads, others not so much)
- Someone with TB in their lungs coughs/sneezes/yells.sings
- Someone else breaths that bacteria in
- Usually requires prolonged close contact
71
Why is outdoor TB eliminated
Due to the UV radation and dilation in open air
72
What is the exception of how TB can spread?
Mycobacterium bovis, which can be spread by consumption of unpasteurised infected cows milk
73
Describe the primary infection of TB
- No preceding exposure or immunity
- Mycobacteria spread via lymphatics to draining hilar lymphnodes
- Usually no symptoms, can be fever, malaise, erthema nodsum, rarely chest signs
IN THE MAJORITY (85%)
- initial lesion + local lymph nodes
- Heals with or without scar, may calcify
- Associated with development of immunity to tuberculoprotien
74
What are the 3 outcomes after a TB infection?
Cleared -> cured
Contained -> Latent
Progressive disease
75
Describe what happens if TB progresses
- Primary infection progresses to TB bronchopneumonia
- Primary focus continues to enlarge (cavitation)
- Enlarged hilar lymph nodes compress bronchi, lobar collapse
- Enlarged lymph node discharges into bronchus
Poor prognosis
76
Describe the pharmacological management of TB
- Multiple Drug therapy is essential
- Single agent treatment leads to drug resistant organisms in 14 days
- Therapy musct continue for at least 6 months
- Legal requirement to notify all cases
- Tests for HIV, HEP B and C
4: 2/2:4, 1st number = number of drugs, 2nd = duration in months
