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Flashcards in Respiratory Tract Infection Deck (62):
1

Name 4 conditions that affect the lower respiratory tract i.e. below the vocal cords?

1. Acute bronchitis
2. Acute exacerbation of chronic bronchitis
3. Pneumonia
4. Influenza

2

What condition is an acute viral infection of the nasal passages, often accompanied by sore throat, sometimes a mild fever, spread by droplets and fomites and complications can include sinusitis or acute bronchitis?

Common cold - coryza

3

What condition is preceded by a common cold and involves purulent nasal discharge?

Acute sinusitis

4

Name 3 special respiratory tract conditions?

Acute tonsillitis and quinsy
Diphtheria
Acute epiglottitis in children

5

Which special condition is life threatening due to toxin production, characteristic pseudo-membrane and is not seen in the UK due to vaccination?

Diphtheria

6

What is acute bronchitis preceded by?

The common cold

7

What is the term for "the cold which goes to the chest"?

Acute bronchitis

8

Give 5 clinical features of the common cold?

1. Productive cough
2. Fever - minority of cases
3. Normal chest examination
4. Normal CXR
5. May have transient wheeze

9

Are antibiotics used to treat acute bronchitis?

No

10

What are these clinical features a sign of: usually preceded by upper respiratory tract infection, worsening of sputum production which is now purulent, more wheezy and breathless?

Acute exacerbation of chronic bronchitis

11

What is a sign of right heart failure?

Ankle oedema

12

In acute exacerbation of chronic bronchitis - what 5 features may you find on examination?

1. Breathless
2. Wheeze
3. Coarse crackles
4. May be cyanosed
4. In advanced disease - ankle oedema

13

What are the three management methods of an acute exacerbation of chronic bronchitis in primary care?

Antibiotic e.g. deoxycycline or amoxicillin
Bronchodilator inhalers
Short course of steroids in some cases

14

How would you manage a patient with acute exacerbation of chronic bronchitis in hospital?

Measure arterial blood gases
CXR to look for other diseases

Give oxygen if has respiratory failure

15

What are cough, pleurisy, haemoptysis, dyspnoea, preceding URTI, abdominal pain and diarrhoea all a symptoms of?

Pneumonia

16

What are these clinical signs of - fever, rigors, herpes iabialis, tachypnoea, crackles, rub, cyanosis and hypotension?

Pneumonia

17

What are two investigaitons you would do for pneumonia?

Blood culture
Serology

18

What are 5 other tests you would do other than blood culture and serology for pneumonia?

Arterial gases
FBC
Urea
Liver function
CXR

19

What is the scoring system used for pneumonia?

CURB65

20

Explain the CURB65 score?

C - New onset of confusion
U - Urea > 7
R - Respiratory rate >30/min
B - Blood pressure (systolic

21

What are 4 other severity markers for pneumonia?

Temperature 40
Cyanosis PaO2 30
Multi-lobar involvement

22

Name the top pathogen in pneumonia?

Strep pneumoniae (pneumococcus)

23

Name 7 other pathogens in pneumonia, other than Strep pneumoniae (pneumococcus)

H. Influenzae
Mycoplasma pneumoniae
Influenza
Chicken pox - in adult smokers
Legionella
Coxiella burnetti
Chlamydia psittaci

24

What are the 5 management steps for community aquired pneumonia?

1. Antibiotics
2. Oxygen maintain SaO2 94-98%
3. Fluids
4. Bed rest
5. No smoking

25

Give 4 complications of pneumonia

1. Respiratory failure
2. Pleural effusion
3. Empyema
4. Death

26

What can be noted on a CXR for empyema?

D-shaped pleural opacity

27

What do you need for hospital aquired pneumonia?

Extended gram negative cover

28

What do you need for aspiration pneumonia?

Anaerobic cover

29

What can bacterial pneumonia be one of the presenting features of?

HIV

30

What are these clinical features a sign of - incubation 1-4 days, abrupt onset fever, chills, headache, sore throat, myalgia, malaise, anorexia, dry cough, clear nasal discharge and signs of complications?

Influenza

31

What are 5 complications of influenza, excluding death?

Primary viral pneumonia
Secondary bacterial pneumonia
Myositis (skeletal and cardiac)
Encephalitis
Depression

32

What are the clinical features of primary viral pneumonia?

Dry cough, bloody sputum and respiratory failure within 24 hours of onset of initial fever

33

Name a class of anti-viral drugs

Neuraminidase inhibitors

34

Name 2 neuraminidase inhibitors

Zanamavir (Relenza) disc haler
Oseltamivir (Tamiflu) oral

35

What are these benefits of - reduced duration of symptoms by one day, reduced use of antibiotics, might reduce infectivity, no data on mortality?

Oseltamivir

36

Name 4 conditions that affect the upper respiratory tract i.e. above the vocal cords

1. Common cold - coryza
2. Sore throat - pharyngitis
3. Sinusitis
4. Epiglottitis

37

What are these clinical symptoms of - fever (high, abrupt onset), malaise, myalgia, headache, cough (initially dry and painful, becomes productive and less painful) and prostration?

Influenza

38

What are the two causes of classical flu?

Influenza A virus
Influenza B virus

39

How is influenza transmitted?

By droplets, or through direct contact with respiratory secretions of someone with the infection

40

What are 4 complications of flu?

1. Primary influenzal pneumonia
2. Secondary bacterial pneumonia
3. Bronchitis
4. Otitis media

41

Name a highly pathogenic avian flu that is a future threat?

Influenza A H5N1

42

How is lab confirmation of influenza done?

Direct detection of virus - PCR

43

How are samples of influenza virus taken?

Nasopharyngeal swabs

44

What type of vaccine is given to healthcare workers to prevent flu?

Killed vaccine

45

What vaccine for prevention of flu is more effective in children agen 2-17?

Live attenuated vaccine

46

Name 3 other causes of CAP?

Mycoplasma pneumoniae
Coxiella burnetii
Chlamydia

47

What do mycoplasma, coxiella and chlamydophila psittaci all respond to?

Tetracycline and macrolides

48

What two methods are used for lab confirmation of mycoplasma, coxiella and chlamydophila psittaci?

By serology
By virus detection - PCR

49

Name an atypical cause of pneumonia which is a common cause of CAP in older children and young adults, also with person to person spread?

Mycoplasma pneumoniae

50

What does coxiella burnetii cause?

Q fever

51

Which bacteria is uncommon, sporadic zoonosis, sheep and goats and has a complication of culture negative endocarditis?

Coxiella burnetii

52

What does Chlamydophila psittaci cause?

Psittacosis

53

What bacteria is uncommon, sporadic zoonosis, caught from pet birds and the disease presents as pneumonia?

Chlamydophila psittaci

54

What condition occurs in 1st or 2nd year of life, fever, coryza, cough and wheeze? In severe cases grunting, decreased PaO2 and intercostal/sternal indrawing?

Bronchiolitis

55

What are >90% of cases of bronchiolitis due to?

Respiratory Syncytial Virus

56

How do you lab confirm bronchiolitis?

PCR on throat or pernasal swabs

57

What are most children antibody positive by age 5 for?

Metapneumovirus

58

What may be second only to RSV in bronchiolitis?

Metapneumovirus

59

How do you laboratory confirm metapneumovirus?

PCR

60

What is Chlamydia trachomatis?

An STI which can cause infantile pneumonia

61

How is Chlamydia trachomatis diagnosed?

By PCR on urine of mother or pernasal

62

How is Chlamydophila pneumoniae transmitted?

Person to person