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Respiratory infections Flashcards

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1
Q

What are the complications of coryza?

A

sinusitis and acute bronchitis

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2
Q

What symptoms does sinusitis cause?

A
  • frontal headache
  • retro-orbital pain
  • maxillary sinus pain
  • toothache
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3
Q

What is the treatment for acute sinusitis?

A
  • decongestant
  • nasal steroids
  • pseudoephedrine
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4
Q

For what group of people is epiglottitis life threatening?

A

infants due to obstruction

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5
Q

What is quincy?

A

a complication of tonsillitis that is a tonsillar abscess that can be drained

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6
Q

What are the symptoms of strep throat?

A
  • yellow exudates
  • pus
  • sore throat
  • dysphagia (can’t swallow)
  • dysphonia
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7
Q

What are the features of acute bronchitis?

A
  • productive cough
  • fever occasionally
  • normal CXR and examination
  • may have transient wheeze
  • no treatment
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8
Q

What are the features of an acute exacerbation of COPD?

A
  • increased sputum
  • more wheeze
  • more breathless
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9
Q

What is the treatment for an acute exacerbation of COPD?

A
  • amoxicillin or doxycycline will be prescribed
  • bronchodilator inhalers and a short course of steroids
  • do ABGs and CXR
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10
Q

What are the symptoms of pneumonia?

A
  • cough
  • tiredness
  • sweats and rigors
  • confusion, diarrhoea and abdominal pain in older people
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11
Q

What will be seen in pneumonia on examination?

A
  • fever
  • tachypnoea
  • crackles and rub
  • cyanosis
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12
Q

What tests would be done for pneumonia patients?

A
  • blood culture
  • serology
  • arterial gases
  • full blood count
  • urea
  • liver function
  • CXR
  • CURB 65
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13
Q

What is the CURB 65 score?

A 
C is new onset confusion
U is urea over 7
R is respiratory rate over 30 
B is blood pressure of less than 90 systolic or 61 diastolic 
65 or older
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14
Q

What is the increase in mortality for pneumonia in COPD patients?

A

10% increase

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15
Q

What are the symptoms of legionella pneumonia?

A

GI disturbance and confusion rather than chest disturbance

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16
Q

What are the symptoms and the special feature of mycoplasma pneumonia?

A

causes paroxysmal cough and the bacteria has no cell wall

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17
Q

What is the presentation of flu?

A
  • fever
  • malaise
  • myalgia
  • headache
  • cough
  • prostration
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18
Q

What are the viruses that cause flu?

A

influenza A and B, parainfluenza, haemophilus influenza (bacteria)

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19
Q

What virus can have antigenic shift?

A

influenza A

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20
Q

How is a virus detected?

A

PCR using a nasopharyngeal swab

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21
Q

What are the symptoms of bronchiolitis?

A

fever, coryza, cough and wheeze

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22
Q

What are the more severe symptoms of bronchiolitis?

A

grunting, lowered Pa O2 and intercostal drawing

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23
Q

What are the complications of bronchiolitis?

A

respiratory or cardiac failure

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24
Q

What is done in hospitals when there is an epidemic of bronchiolitis?

A

cohort nursing

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25
What is metapneumovirus and how is it treated?
newly discovered virus that is confirmed with PCR, nasopharyngeal/ throat swab or by bronchoalveolar lavage
26
What are the three ways that pneumonia can be classed by?
clinical setting, organism or morphology
27
What is lobar pneumonia and what bacteria causes it?
it is a confluent consolidation involving a complete lung lobe mostly due to streptococcus pneumoniae
28
What is the pathology of pneumonia?
- exudation of fibrin-rich clot - neutrophil infiltration - macrophage infiltration - resolution
29
What are the complications of pneumonia?
organisation and fibrous scarring, abscess, bronchiectasis or empyema
30
What is bronchopneumonia?
infection in airways spreading to adjacent alveolar lung (pre-existing disease)
31
What is a lung abscess?
localised collection of pus which is tumour-like
32
What are the symptoms of a lung abscess?
chronic malaise and fever
33
What is bronchiectasis?
abnormal fixed dilation of the bronchi so dilated airways accumulate purulent secretions
34
What are the two examples of chronic suppuration?
abscess and bronchiectasis
35
What type of infection is TB?
mycobacteria
36
What is the pathology of TB?
delayed hypersensitivity....tissue damage due to self T cells causing tissue necrosis, scarring and granulomatous inflammation
37
What is primary TB?
the first exposure and up to 5 years afterwards
38
What is the initial response to TB entering the body?
organism is inhaled and phagocytosed, this guest the hilarity lymph nodes so there is immune activation leading to granulomatous response in nodes
39
What is secondary TB?
reinfection or reactivation, disease will remain in apices but can spread by airways or bloodstream
40
How is secondary TB seen?
fibrosing and cavitating apical lesions
41
Why is there reactivation of TB?
high dose, more virulent organism or decreased T cell function (due to age, HIV or immunosuppressive therapy like steroids or chemotherapy)
42
How many weeks does it take the body to recognise TB?
8 weeks
43
What is the main age group that gets TB?
25-34 and occasionally 75-84
44
What class of person usually gets TB?
immigrants, socially deprived, suppressed immune systems
45
What are the symptoms of TB?
- night sweats - fever - malaise - anorexia - weight loss
46
What is seen win examination with pulmonary TB?
- cough - haemoptysis - crepitations - bronchial breathing
47
What is seen on a TB X-ray?
patchy nodular shadowing mainly in the upper lobes with dry cavitation and enlarged mediastinal nodes
48
What are the types of TB from worst to best?
- miliary - meningeal - widespread pulmonary - localised pulmonary - localised extra pulmonary - lymph node - healthy but contact with latent
49
How do you make the diagnosis of TB?
- history and examination - simple blood tests - radiology and imaging - microbiology and histology (sputum to find M. tuberculosis or M. Bovis which takes 6 weeks, gastric washings, bronchoalveolar lavage, biopsies) - microscopy (ziehl-nielson) - culture and look for caseous necrosis and acid-fast bacilli-positive organisms
50
What is the treatment for active TB?
Active TB: 4 drugs for two months (Rifampicin, Isoniazid, Pyrazinamide and Ethambutol), then 2 drugs for 4 months (Rifampicin and Isoniazid)
51
What is the treatment for latent TB?
Latent TB: 2 drug for 3 months (Rifampicin and Isoniazid) or 1 drug for 6 months (Isoniazid)
52
What are the common gram positive upper respiratory tract colonisers?
- strep pneumoniae - strep pyogenes - staph aureus
53
What are the common gram negative upper respiratory tract colonisers?
- haemophilus influenza | - mortadella catarrhalis
54
What are the defences in the upper respiratory tract against infection?
- hairs - ciliated epithelia - IgA in the nasopharynx and saliva - cough in the oropharynx
55
What is acute bronchitis?
infection and inflammation of the bronchi with productive cough and sometimes wheeze and/or fever
56
What is the microbiology of acute bronchitis?
90% viral so antibiotics are not given
57
What is seen in the CXR and chest examination of acute bronchitis?
normal
58
What microorganisms are the cause of COPD?
- haemophilus influenzae - mortadella catarrhalis - strep pneumoniae - gram negatives and others
59
What are the typical and atypical infections of the lower respiratory tract?
strep pneumonia is typical | atypical is mycoplasma, legionella, chlamydia, viruses etc
60
What is the most common organism for community acquired pneumonia?
streptococcus penumoniae
61
What are the microbiological features of strep pneumonia?
- capsule which is the key virulence factor - alpha haemolysis is green/brown - gram positive
62
What is the type of person that is affected by legionella?
older person ex-smoker warmish country
63
How is legionella detected?
not by culture but by urine analysis
64
What is the main treatment for legionella?
quinolone but there is a big risk of C.diff here
65
What are the symptoms of walking pneumonia?
rash with dark outer ring with pale ring then dark middle spot
66
Why can't amoxicillin be given to walking pneumonia patients?
no cell wall
67
Who tends to get staph pneumonia?
intravenous drug users
68
How long are you in hospital before it becomes hospital acquired pneumonia?
three days
69
What is the microorganism that causes whooping cough?
bordetella pertussis which is a gram negative coccobacillus
70
How is whooping cough diagnosed?
bacterial culture or PCR
71
How do you diagnose a common respiratory tract infection?
gram, culture, serology or PCR
72
What are the factors affecting which antibiotic is used?
- antibiotic spectra - severity of infection - unusual pathogen clues
73
What are the risk factors for chronic pulmonary infection?
- abnormal host response so immunodeficiency and immunosuppression - abnormal innate host defence (damaged bronchial mucosa, abnormal cilia or abnormal secretions) - repeated insult (recurrent aspiration or indwelling material)
74
What is the mortality from abscess?
10%
75
What is the mortality from empyema?
20%
76
What is the presentation of pulmonary abscess?
- lethargy - tiredness - weakness - cough - usually preceding injury so staph pneumonia, flu , cavitating pneumonia
77
What are the pathogens involved with pulmonary abscess?
strep, staph, e-coli or gram negatives for bacteria or aspergillum for fungi
78
What is septic emboli?
when an infection moves in the body and lodges in the lungs
79
What is empyema?
pus in the pleural space usually associated with pneumonia
80
Out of the three types of effusion, which ones need a chest drain?
- complicated parapneumonic effusion and empyema need a chest drain - simple parapneumonic effusion doesn't need a chest drain
81
How do you diagnose empyema?
- clincial suspicion - CXR (D sign) - USS (best way) - CT
82
What is the treatment for empyema?
broad spectrum IV antibiotics so amoxicillin and metronidazole or directed oral antibiotics by culture
83
What is bronchiectasis?
localised and irreversible widening of the airways that are easily inflamed and collapsible, there is airflow obstruction and impaired clearance of secretions
84
What is the presentation of bronchiectasis?
recurrent chest infections or multiple prescriptions of antibiotics with no or short lived response
85
What is the catch with CT and bronchiectasis?
just because it's on the CT doesn't mean there is disease and just because it's not on the CT doesn't mean there is no disease
86
What is seen on the CT with bronchiectasis?
airway will be bigger than the accompanying pulmonary artery signet ring appearance
87
What is the treatment for chronic bronchial sepsis?
- stop smoking - flu and pneumococcal vaccine - antibiotics
88
How is chronic bronchial sepsis seen?
all the hallmarks of bronchiectasis and confirmed positive sputum results

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