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Flashcards in Respiratory Tract Infections Deck (54):
1

Name three main groups of respiratory tract infections

Upper respiratory tract infections

Bronchitis

Pneumonia

2

What anatomy is affected in upper respiratory tract infections?

pharynx, larynx, trachea

3

Which are mainly caused by bacteria / viruses?
- Upper respiratory tract infections
- Bronchitis
- Pneumonia

Upper respiratory tract infections
- viral
- if bacterial - may be quinsy, acute sinusitis

Bronchitis
- viral (90%)

Pneumonia
- bacterial

4

What treatment is recommended for viral upper respiratory tract infections?

No specific treatment. Rest

5

Which upper respiratory tract infections are more serious?

Bacterial ones, eg quinsy, acute sinusitis

6

What is quinsy?

upper respiratory tract infection
caused by bacteria
a peritonsillar abcess
follows tonsillitis

7

What are symptoms of quinsy?

unilateral sore throat
painful to swallow (odynophagia)
systemic upset / feel unwell
hot potato voice

8

What is treatment for quinsy?

surgical insertion and drainage (of abcess)
antibiotics

9

What causes acute sinusitis?

Often viral, sometimes bacterial

10

What are symptoms of acute sinusitis?

facial pain, headache, toothache
fever, malaise, nasal symptoms, post-nasal drip

11

What is a complication of acute sinusitis?

Brain abcess
therefore ensure acute sinusitis is treated properly

12

What is treatment for acute sinusitis?

Antibiotics is severe / persistant

13

What are common upper respiratory tract infections in children?

Acute epiglottitis

Croup

14

What causes acute epiglottitis?

Haemophilus influenzae B

15

What is prevention for acute epiglottitis?

vaccination for haemophilus influenzae B

16

What is croup?

acute obstructive laryngo-tracheo-bronchitis

17

What causes croup?

virus

18

Why are children more at risk of fatal respiratory tract infections?

they have narrower airways - easier to block if issue

19

What is main symptom in children with upper respiratory tract infections?

Stridor - inspiratory sound (because in upper airway, therefore sound made in larynx)

20

Which disease should you never examine the patient's throat / mouth?

Children with acute epiglottitis
- risk of actue fatal upper airway abstruction
- ie block airway when airway tipped backwards

21

What should you do as a dentist if suspected acute epiglottitis?

- admit to hospital
- DO NOT examine throat

22

What are symptoms of acute epiglottitis?

fever, drooling (hard to swallow), stridor
- in a child

23

Name the lobes in left / right lung?

Left = upper and lower lobe

Right = upper, middle and lower lobe

24

What is best treatment for bronchitis?

Rest and fluids
Takes 12-13 days to recover (same if AB taken)

If COPD, asthmatic:
- give AB

25

Why should pt with COPD be given AB for bronchitis?

They have a lower respiratory reserve.
ie our airways are wider, therefore we have a higher reserve if we become ill and our airways narrow.

26

What are main causes of bronchitis?

H. influenzae
S. pneumoniae

27

What are symptoms of bronchitis?

cough and spit

28

What medication is given for bronchitis?

Amoxycillin or Clarithromycin

If allergy, give Doxycycline

29

Why aren't AB given for all respiratory tract infections?

- increase cost / resistance / side effects

30

What is the main worry about NOT giving AB to treat a respiratory tract infection?

If it's pneumonia - could be rapidly fatal if not diagnosed / treated

31

What is pneumonia?

acute respiratory illness
involving alveoli - fill with organisms, exudate = lung consolidation
often bacterial

32

What are lower respiratory tract infections?

Bronchitis

Pneumonia

33

Why can pneumonia be rapidly fatal?

Impaired gas exchange
Bacteraemia - sepsis - kidney / lung damage

34

What does histology look like in pneumonia?

alveoli filled with cells, not air

35

What does xray look like in pneumonia?

White clouds where alveoli filled
Air filled bronchi still visible
Shadowing

36

What are symptoms of pneumonia?

Cough, PLUS:
- tachypnoea
- pleuritic pain (esp on inhalation, sharp pain)
- new focal signs in chest (abnormal sounds)

esp if systemically unwell (fever, rigor, tachycardia, sweating)

37

Why can pleuritic pain be an issue in pneumonia?

Bacteria has travelled from
alveoli - pleura - pleuritic space

38

When should treatment for respiratory tract infections start?

ASAP (before organism is known - tests may not be conclusive)

39

How can organisms be identified in respiratory tract infections?

- sputum culture (high sensitivity, low specificity)
- blood culture (high specificity, low sensitivity)
- bronchoalveolar lavage / percutaneous aspirate - rare
- antibody titres (retrospective)

40

What is bronchoalveolar lavage?

- insert bronchoscopy tube into lungs
- squirt fluid into small part of lung
- collect this fluid for analysis
- rare, but used in lung disease diagnosis

41

What is percutaneous aspirate?

- needle access via skin into lungs
- aspirate sample of lung using needle
- analysis sample to diagnose lung disease

42

What is an antibody titre?

- test that measures antibodies in blood
- used in lung disease diagnosis

43

What specific symptoms relate to different organisms causing pneumonia?

NONE!
There are no symptoms / signs / xray changes associated with different pneumonia-causing organisms.

Organisms present often depends on method of disease contraction
- community acquired
- hospital acquired
- aspiration pneumonia
- immunocompromised

44

How can pneumonia be acquired?

- community acquired
- hospital acquired
- aspiration pneumonia
- immunocompromised

45

What is aspiration pneumonia?

If pt is unconscious, they can inhale vomit.
- no cough reflex
- organism often from oral cavity

46

What % bacteria / viruses cause community acquired pneumonia?

Streptococcus pneumoniae 60-75%
Haemophilus influenzae 4-5%
Legionella Sp 2-5%
Chlamydia Sp 7-16%
Mycoplasma pneumoniae 5-18%

Viruses 4-12%

47

Is streptococcus pneumoniae gram +ve / -ve?

gram +ve

48

Which community acquired organisms can penicillin combat?

Strep. pneumoniae
Haemophilus influenzae

49

Which community acquired organisms can clarithromycin combat?

Atypical organisms:
Legionella Sp
Chlamydia Sp
Mycoplasma pneumoniae

50

Which groups of antibiotics and specific antibiotics are used in treatment of community acquired pneumonia?

Penicillin
- benzylpenicillin
- amoxycillin

Macrolides
- erythromycin
- clarithromycin

51

Which bacteria are penicillins most effect against?

Streptococcus pneumoniae

52

Which bacteria are macrolides most effect against?

Atypical organisms:
Legionella Sp
Chlamydia Sp
Mycoplasma pneumoniae

53

What type of antibiotic would you give a young child with respiratory tract infection?

Macrolides (clarithromycin / erythromycin)
- young ppl usually have atypical organisms.

54

What is a good combination of antibiotics to give in community acquired pneumonia treatment and why?

amoxycillin and clarithromycin
- covers range of bacteria causing community acquired pneumonia
- amoxycillin is well absorbed and has a broader spectrum