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Flashcards in Respiratory Tract Infections Deck (16)

What is quinsy?

A peritonsillar abscess that:
Follows tonsillitis, presents with a unilateral sore throat, painful swallow, systemic upset, 'hot potato voice', is of bacterial cause. Treated with surgical incision and drainage and antibiotics


What are life threatening upper respiratory Tracy infections in children?

Acute epiglotitis (harmophilus influenzae)
Croup (acute vital obstructive laryngo-tracheo-bronchitis)
Look out for stridor!


What to do if acute epiglotitis is suspected? (Fever, drooling, stridor in a child)

Do not examine the throat!! Otherwise risk of acute fatal upper airway obstruction. Admit to hospital immediately.


What to do about acute bronchitis? (H.influenzae or s.pneumoniae are the usual organisms)

Treatment only if underlying lung disease eg COPD as antibiotics shown to have a similar effect to placebo's. But if antibiotics give: amoxycillin or clarithromycin.


What is pneumonia?

-acute respiratory illness involving lung alveoli, often bacterial
-alveoli fill with organisms and inflammatory exudate, causing lung consolidation (seen as shadow on CXR)
-potentially serious because of impaired gas exchange (hypoxia) and risk of bacteraemia
-can be a pointer that there's an underlying disease


What are the signs of pneumonia?

Pleuritic pain
New focal signs in the chest
Esp if systematically unwell (fever, rigor, tachycardia, sweating)


How can the organism in pneumonia be identified? (Treatment usually started before the organism is known)

Sputum culture (high sensitivity, low specificity)
Blood culture (high specificity, low sensitivity)
Bronchoalveolar lavage/percutaneous aspirate
Antibody titres


What's the best clue to find out the causative organism in pneumonia?

The circumstance in which the infection occurs:
-community acquired
-hospital acquired
-aspiration pneumonia
-in the immunocompromised host


What's the organism in community acquired pneumonia? And the antibiotic used to treat it?

Streptococcus pneumoniae
Ab: penicillins: benzylpenicillin or amoxycillin are most active against s.pneumoniae and macrolides (eg erythromycin or clarithromycin) are also active against atypical organisms


What's the organism and the antibiotic given to treat hospital acquired pneumonia?

Organisms: gran neg bacilli, staph aureus
Ab: anti-pseudomonas beta-lactam by iv. +- aminoglycoside by iv


What are the bacterial flora of the mouth?

90% anaerobes
10% aerobes mainly gran positive cocci


What are the antibiotics in aspiration pneumonia?

Benzylpenicillin and flucloxacillin.
Or: co-amoxiclav


What are the complications of pneumonia?

-empyema (pus in pleural cavity) needs surgical drainage
-lung abscess (collection of pus in lung) needs prolonged antibiotics
-bacteraemia (positive blood culture) risk of multi organ failure


Key clinical questions:

Is the infection in the upper or lower respiratory tract? Is it pneumonia?
What's the causative organism?
Is treatment needed? Antibiotic? Supportive therapy? Admission?


What resp infections are notifiable?

TB, legionella infection


Which disease are upper and which are lower respiratory?

Upper: tonsillitis, pharyngitis, sinusitis common coke etc
Lower: bronchitis, pneumonia