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Respiratory infection Flashcards

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1
Q

What are the 3 types of microorganism pathogenicity?

A

Primary- these will always make you sick
Facultative- require some”help” to infect host
Opportunistic- will infect only immunocompromised

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2
Q

What are some examples of upper respiratory tract infections? 6

A 
Common cold
Sore throat
Croup (acute laryngeotracheobronchitis)
Laryngitis
Sinusitis
Acute epiglottitis
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3
Q

What are some examples of lower respiratory tract infections?

A

Bronchitis
Bronchiolitis
Pneumonia

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4
Q

What is a respiratory tract defence mechanism in the lungs?

A

Macrophage mucociliary escalator system

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5
Q

How does the MMES work?

A

Cilia ‘beat’ and transport mucus and fluid on the surface out of the lungs, and a cough then clears mucus from the throat

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6
Q

What is the function of alveolar macrophages in the MMES?

A

Phagocytose pathogens and use mucus to transport cell debris up to throat

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7
Q

What happens if the MMES fails?

A

Secretions and foreign materials are retained in the lung

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8
Q

What are the 3 ways in which pneumonia can be classified?

A

Microbiologically
Anatomically
Aetiologically

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9
Q

What are the different ways of classifying pneumonia useful for?

A

Anatomical- understand how it looks and where it is
Aetiological- understand circumstance in which pneumonia occurred and predict likely infecting agents
Microbiological- determining appropriate treatment

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10
Q

What are the aetiological classes of pneumonia?

A 
Community acquired
Hospital acquired
In the immunocompromised
Atypical
Aspiration 
Recurrent
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11
Q

What are the different patterns of pneumonia?

A 
Bronchopneumpnia
Segmental
Lobar
Hypostatic
Aspiration
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12
Q

What is bronchopneumonia?

A

Patchy infection of the small airways

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13
Q

Describe the spread of bronchopneumonia

A

Doesn’t spread far

Often bilateral

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14
Q

What causes lobar pneumonia to spread throughout an entire lobe?

A

Aggressive organisms cause a large tissue reaction, creating more inflammatory exudate that washes bacteria throughout the lobe

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15
Q

What can happen if the pleura are involved in pneumonia?

A

Pleurisy
Pleural effusion
Empyema

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16
Q

What are the outcomes of pneumonia?

A

Pleural involvement
Lung abscess
Bronchiectasis
Scar tissue formation

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17
Q

How can pneumonia case bronchiectasis?

A

MMES doesn’t work and the area becomes infected

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18
Q

What types of scar tissue can form from pneumonia and how?

A

Mass lesion

COP- small points of scar tissue where there was pus

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19
Q

What can cause recurrent lung infection?

A

Local bronchial obstruction
Local pulmonary damage
Generalised lung disease
Non-respiratory caused e.g. immunocompromised or aspiration

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20
Q

What is the airflow in the upper respiratory tract like and why?

A

Turbulent to allow for saturation

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21
Q

What is the airflow in the trachea like and why?

A

Laminar to allow air to flow into he lungs

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22
Q

What is the airflow like in the acini and why?

A

Turbulent to allow for gas diffusion

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23
Q

What is normal PaO2?

A

10.5-13.5 kPa

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24
Q

What is abnormal PaO2?

A

<8 kPa

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25
What is normal PaCO2?
4.8-6 kPa
26
What is abnormal PaCO2?
>6.5 kPa
27
What are the 4 abnormal states associated with hypoxaemia?
V/Q imbalance Diffusion impairment Alveolar hypoventilation Shunt
28
What reaction do the lungs have to hypoxia?
In areas that are under ventilated, vessels constrict as a protective mechanism
29
What causes hypoxaemia in COPD?
V/Q imbalance due to airway obstruction Alveolar hypoventilation due to decreased respiratory drive Diffusion impairment due to loss of alveolar surface area Shunt during acute exacerbation
30
What is chronic car pulmonary?
Hypertrophy of right ventricle due to disease affecting structure and/or function of the lung
31
What is rhinitis?
Stuffy, runny nose caused by irritation of mucous membranes in the nose
32
What is the progression of rhinitis?
Usually self limiting and last 2-7 days | Can progress to pneumonia, meningitis, septicaemia
33
What is otitis media?
Ear infection, causing pin and a red, bulging drum
34
What is the progression and treatment of otitis media?
Self limiting, usually lasts 3-4 days | Antibiotics ineffective, treat with analgesics
35
What are the 2 causes of tonsillitis an pharyngitis and what are the treatments?
Viral- no treatment | Bacterial- 10 days penicillin
36
How do you differentiate between viral and bacterial tonsilitis?
Throat swab and culture | This usually takes too long, so "wait and see" as viral only lasts 2-3 days
37
How do you tell between croup and epiglottitis?
Croup- child is "well", strider, hoarse voice, barking cough | Epiglottitis- child very unwell, stridor, leaning forward, drooling, temperature and tachycardia
38
What is the treatment of croup?
Oral dexamethasone
39
What are the symptoms of pneumonia?
``` Malaise Fever Chest pain Cough Purulent sputum Dyspnoea Often headache presenting symptom ```
40
What are the signs of pneumonia?
``` Pyrexia Tachpnoea Central cyanosis in severe Dullness on percussion of affected lobe Bronchial breath sounds Inspiratory crepitations Increased vocal resonance ```
41
What are the necessary investigations for pneumonia?
``` Serum biochemistry and full blood count Chest xray Blood cultures Throat swab Urinary legionella antigen Sputum microscopy and culture ```
42
What are the common microbiological causes of pneumonia?
Strep, pneumonia Haemophilus influenzae All viruses
43
What is the pneumonia severity scoring system?
``` Confusion Urea- blood urea > 7 Respiratory rate > 30 Blood pressure- diastolic < 60 65- over ```
44
What is the treatment for pneumonia?
CURB 0-1- amoxicillin or clairithromycin CURB 2- amoxicillin and clairithromycin/levofloxacin CURB 3-5- Coamoxiclav and clairithromycin or levofloxacin Oxygen IV fluids CPAP Intubation and ventilation
45
What are the complications of pneumonia?
``` Septicaemia Acute kidney injury Empyema Lung abscess Haemolytic anaemia ARDS ```
46
What is the differential diagnosis for pneumonia?
``` Pneumonia TB Lung cancer Pulmonary embolism Pulmonary vasculitis Cardiac failure ```
47
What is empyema?
Pockets of pus inside the lungs
48
What are the signs and symptoms of empyema?
Chest pain Lack of energy High swinging fever
49
How do you diagnose empyema?
CT thorax Pleural ultrasound Pleural aspiration- pH<7.2
50
What is the treatment of empyema?
Chest drain IV antibiotics Surgery if not responding
51
What are the symptoms of lung abscess?
Lethargy Weight loss High, swinging fever
52
How do you diagnose a lung abscess?
CT thorax | Sputum culture
53
How do you treat a lung abscess?
Prolonged antibiotics | Chest drain
54
What are the causes of bronchiectasis?
``` Idiopathic Immotile cilia syndrome Cystic fibrosis Childhood infections Hypogammaglobulinaemia Allergic bronchopulmonary aspergillosis ```
55
What are the symptoms of bronchiectasis?
``` Chronic cough Daily sputum production Wheeze Dyspnoea Tiredness Flitting chest pains Haemoptysis ```
56
What are the signs of bronchiectasis?
Clubbing | Coarse inspiratory crepitations
57
How do you diagnose bronchiectasis?
``` CT thorax Sputum culture Serum immunoglobulins Total IgE and aspergillosis precipitins CF genotyping ```
58
What is the treatment for bronchiectasis?
Chest physio Antibiotics Inhaled therapy- B2 agonist and corticosteroid
59
How are microscopy and culture of sputum used to diagnose chest infections?
Gram stain sputum for organisms and pus | Culture for respiratory pathogens (Strep pneumonia, H influenzae, moraxella catarrhalis)
60
How do you diagnose TB?
ZN or auramine phenol stain Acid and alcohol fast bacilli Extended culture for mycobacteria
61
How is antigen detection used for microbiological diagnosis of chest infection?
Detect specific antigen immunologically | Legionella and pneumococcal antigens can be detected in urine, and viruses in nasopharyngeal secretions
62
How is latex agglutination used for microbiological diagnosis of chest infection?
Latex particles are coated in monoclonal antibodies specific for organism in question and mixed with clinical specimin Visible clumping if present
63
How is ELISA used for microbiological diagnosis of chest infection?
Specific antibody detects antigen and linked enzyme produces colour change
64
How is DNA detection used for microbiological diagnosis of chest infection?
Polymerase chain reaction of throat swab or other respiratory sample
65
What is serological diagnosis?
Measure host antibody response to an organism
66
When is serological diagnosis made?
Difficult to culture/detect organisms
67
What are the principles of serological diagnosis?
IgM marker for current infection IgG marker for previous infection Rising titre
68
What causes TB?
Mycobacterium TB | Mycobacterium bovis- bovine TB
69
What is the typical structure an growth of mycobacteria?
Non notice bacillus Slow growth and progression Aerobic Very thick cell wall
70
Why is the cell wall of mycobacteria important?
Thick wall resistant to acids, alkalis, detergents and neutrophil and ,macrophage destruction
71
How is TB transmitted?
Inhalation of cough/sneeze droplets
72
How is bovine TB transmitted?
Ingestion of infected cows' milk | Mycobacterium deposited in cervical and intestinal lymph nodes
73
What is the body's immunological response to TB?
Macrophages recognise the bacteria and ingest it Antigens are presented to T helper cells, which activate the macrophages and allow them to 'kill' the TB This releases toxins and can cause tissue damage
74
What is the body's response to an accumulation of immune cells in TB?
Accumulation of macrophages, epithelia and Langhan's causes a granuloma- specifically central caveating necrosis in TB
75
In primary infection of TB, what usually happens?
Usually no symptoms | Initial lesion spreads to draining hilar lymph nodes, which then heals with or without a scar
76
In primary infection of TB, what happens in the minority?
Infection progresses and focus continues to enlarge Enlarged hilar lymph nodes compress bronchi and there is lobar collapse Enlarges lymph nodes discharge into bronchus
77
What is post primary infection?
Reactivation of mycobacterium from latent primary infection disseminated by blood stream around the body or a new reinfection from outside source
78
What are the differences in symptoms between primary and post primary infection?
Fever malaise, weight loss, night sweats in post primary- systematically unwell Primary often shows no symptoms
79
How is TB diagnosed?
3 sputum specimens on successive days- sputum smear, culture and PCR Chest xray
80
What investigations are carried out for TB if sputum is negative?
CT thorax Bronchoscopy Pleural aspiration and biopsy
81
What are you looking for on a TB chest xray?
Patchy shadowing | Cavitation and calcification
82
What is treatment of TB?
Multiple drug therapy for at least 6 months Rifampicin and isoniazid for 6 months Ethambutol and pyrazinamide for the first 2
83
What must be done after diagnosing TB?
Legally report | HIV test
84
What are the side effects of rifampicin?
Orange urine and tears Induced liver enzymes- prednisone, anticonvulsants and the pill ineffective Hepatitis
85
What are the side effects of isoniazid?
Hepatitis | Peripheral neuropathy
86
What are the side effects of ethambutol?
Optic neurpathy
87
What are the side effects of pyrazinamide?
Gout
88
What is the process of TB screening in under 16s?
Tuberculin test If +, chest xray If -, repeats after 6 weeks and give BCG
89
What is the process of screening in over 16s?
Chest xray If -, discharge and reassure If +, Investigate for TB

Respiratory AM (10 decks)

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