Respiratory Tract Infections Flashcards by Giulia Uitenbosch

What are the two main subgroups of respiratory tract infection?

Upper and lower RTI

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What are the causes of RTI?

Pathogens (primary, facultative, opportunistic)
Damage to mucociliary escalator
Pulmonary secretions

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What are the common classifications of pneumonia and examples of them?

Anatomical (broncho, lobar, segmental pneumonia)
Circumstantial (aspiration, nosocomial, community acquired)
Microbiological (causative pathogen)

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What characterises bronchopneumonia?

Base of lungs
Some alveolar damage
Opportunistic pathogen
Doesn't normally involve pleura
Hypoxaemia via V/Q mismatch

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What characterises lobar/segmental pneumonia?

Whole lobe/segment involved
Hypoxaemia via shunt
Primary pathogen
Community acquired, young people
Can involve pleura = pleurisy

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What are some complications of pneumonia?

Bronchiectasis
Lung abscess
Fibrosis and scarring
Organising pneumonia (can be cryptogenic, may look like tumor)
Empyema/Pleurisy

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What causes hypoxaemia in bronchopneumonia?

V/Q mismatch (alveoli hypoventilate but still work a bit)

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What is the most common cause of hypoxaemia in lung diseases?

V/Q mismatch

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What causes hypoxaemia in lobar pneumonia?

Shunt (total loss of alveolar ventilation)

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What causes cor pulmonale?

RV hypertrophy caused by increase in pulm pressure, caused by vasoconstriction, caused by hypoxaemia

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What type of pneumonia is most commonly associated with lung abscesses?

Aspiration pneumonia

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What can be causes of recurrent respiratory tract infection?

Tumour/foreign body
Systemic damage (HIV)
Localised lung damage (bronchiectasis)
Generalised lung damage (COPD)

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What are the main signs of pneumonia?

Hypotension
Fever 
Tachycardia
Basal crackles
Dull on percussion
Increased vocal resonance

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What are the main symptoms of pneumonia?

Nonspecific malaise, fever, weight loss
Dry or productive cough (not always)
May be wheezy
Coloured sputum

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What are the main investigations for pneumonia?

Blood test (CRP, serum, FBC)
CXR
Legionella test
HIV test
Blood culture
Throat swab
Sputum culture (not normally done in practice)

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What is the process of pathogenesis in pneumonia?

Infection 
Acute inflammation
Neutrophil involvement
Suppuration
Pus filling alveoli causing consolidation

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What are the criteria for the CURB65 classification in pneumonia?

C - confusion
U - blood urea >7
R - respiratory rate >30
B - diastolic blood pressure <60
65 - age over 65

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What are the treatment options for pneumonia?

CURB 0-1 –> amoxycillin or clarythromycin/doxacycline
CURB 2-3 –> amoxycillin (or levofloxacin) + clarythromycin
CURB 3-5 –> co-amoxiclav (+levofloxacin) + clarythromycin

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What treatment should be given in case of aspiration pneumonia?

Amoxycillin (or levoflacin) + metronidazole (against anaerobes)

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Why should public health be involved in cases of legionella-associated pneumonia?

Because it may be due to contaminated water and other people may be affected

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What complications can arise from pneumonia?

Acute kidney injury
lung abscess/empyema
sepsis
ARDS

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What non-pharmacological treatment should also be considered in pneumonia?

Oxygen
CPAP/ventilation/intubation
IV fluids (reverse acute kidney injury)

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What are some of the potential differential diagnoses for pneumonia?

tuberculosis
lung cancer
pulmonary oedema
pulmonary embolism

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What is a useful diagnostic tool for empyema?

Thoracentesis (fluid aspiration)
CT scan
Ultrasound scan

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What organisms can cause empyema?

Strep pneumoniae Staph aureus Anaerobes

What can be signs/symptoms of empyema?

Pleuritic chest pain | Swinging fever

How to treat empyema?

Amoxycillin + metronidazole (anaerobes) Drainage of fluid Fibrinolytics to remove pyogenic membrane and allow fluid to drain away Surgery if doesn't improve

What confirms a diagnosis of empyema?

``` pH <7.20 Putrid smell (anaerobic) ```

For which LRTIs should a sputum culture be taken?

Lung abscess | Bronchiectasis

What disease can be associated with bronchiectasis?

Cystic Fibrosis

What are some of the symptoms of bronchiectasis?

very productive chronic cough (lots of sputum) | Sometimes SoB, haemoptysis, wheeze, finger clubbing

What are some of the symptoms of a lung abscess?

non-specific fever, weight loss, malaise

What investigations should be done for bronchiectasis?

``` sputum culture high resolution CT scan genetic testing for CF testing for hypogammaglobulinaemia testing for allergic aspergillosis ```

What is the main difference between pneumonia and bronchitis?

Bronchitis only affects the bronchi | Pneumonia affects the lung tissue itself

What is the main difference between community acquired and hospital acquired pneumonia?

they are normally caused by different organisms

Who is normally affected by bronchiolitis?

Infants

What causes bronchiolitis?

Respiratory syncytial virus (RSV)

What are common organisms to cause bronchitis in children?

Haemophilus influenza | Pneumococcus

What normally precedes bronchitis in children?

Viral URTI (eg RSV, adenovirus)

Can you hear crackles in bronchiolitis in infants?

Yes

Can you hear crackles in bronchitis in children?

What investigations should be done for bronchiolitis?

Snot sample | O2 saturation to check severity

What is the best treatment for bronchitis and bronchiolitis in children?

None, observation | otherwise oxygenation, hydration, nutrition

What treatment options should be given to children with LRTI/pneumonia which is moderate/severe?

Oral amoxycillin or clarythromicin | IV if child is vomiting

When should a LRTI be referred as pneumonia in children?

When there is focal damage, high fever and crackles on auscultation

Should a CXR be done in children with suspected pneumonia/LRTI?

What is the most effective way of avoiding pertussis (whooping cough)?

vaccination

What treatment should be given for tracheitis in children?

Co-amoxiclav

Out of tracheitis, bronchitis, bronchiolitis, pneumonia, empyema in children, which ones should get antibiotics if needed and which ones?

``` Tracheitis - augmentin Bronchitis - none Bronchiolitis - none Pneumonia/LRTI - if needed, oral amoxycillin (if allergic, clarythromycin) empyema - IV antibiotics ```

What are some of the common URTIs in children?

Rhinitis (rhinovirus) Otitis media Pharyngitis/tonsillitis Croup

With what other URTI can croup be mistaken and why?

Epiglottitis | Inspiratory stridor in both (obstruction)

What differentiates croup from epiglottitis?

Croup - barking cough, no drooling | Epiglottitis - drooling, no cough

Is croup or epiglottitis a medical emergency, and what to do?

Epiglottitis | Immediate intubation and antibiotics

What is the treatment for rhinovirus?

Nothing, it's self limiting

What is an important consideration for rhinovirus in children?

It may cause a secondary bacterial LRTI (bronchitis, bronchiolitis)

What is the main symptom of otitis media in children, and what is the most effective treatment?

Pain | Analgesics

What is the main course of action in URTI in children?

``` No treatment (or analgesics) Observe - normally self limiting ```

What investigation should be done when tonsillitis/pharyngitis is suspected?

throat swab (bacterial vs viral)

What treatment should be given for tonsillitis/pharyngitis?

Viral - nothing | Bacterial - 10 days penicillin (not amoxycillin!)

What treatment can be given for croup?

Oral corticosteroids (dexamethasone)

When should croup be treated?

If severe

What are the possible outcomes of primary TB infection?

- resolution - latency - progression

What are the possible outcomes of latent TB, and where can it happen?

- disease progression later in life | - can occur in any organ

What are the possible causes for post primary tuberculosis?

- reactivation of latent TB | - re-infection of TB from other source

What is the name given to the first lesion in the lung caused by TB?

Ghon focus

What is the Ghon complex and how does it form?

``` ghon focus (lung lesion) + lymph node involvement forms because macrophages bring parts of M tuberculosis to the nearest lymph node ```

What is miliary TB?

it's a presentation of progressive TB with many small granulomata in lungs

What are the possible symptoms of tuberculosis?

``` symptoms not always present fatigue, malaise, weight loss cough haemoptysis SoB pleuritic chest pain ```

What main tests are involved in TB diagnosis?

``` 3 sputum samples for 3 days CXR Bronchoscopy (+biopsy) CT thorax IGRA Mantoux/Heaf test ```

What are the three samples of sputum used for in TB diagnosis?

Sputum smear - ZN staining Sputum culture Sputum PCR

In which case would IGRA be used for TB diagnosis, and give examples of IGRA tests

If sputum not collectable/can't isolate organism Interferon Gold T-Spot

What is the basis for IGRA tests?

Increased gamma interferon produced by Th cells if TB present

Why can IGRA tests not always be reliable?

Because they can give false positives or false negatives

What screening tests are used for TB?

Tuberculin skin tests: Mantoux test (single skin prick) or Heaf test (multiple pricks)

What should be done if Heaf test on a child without BCG vaccine is positive?

CXR: If CXR normal - prophylaxis treatment If CXR abnormal - treat for TB

What should be done if a sputum sample can't be collected or an organism can't be isolated in suspected case of TB?

CT scan thorax Bronchoscopy (+biopsy) If there is pleural effusion: pleural aspiration

What is the treatment for TB and its duration?

4 drugs for 2 months (rifampicin, isoniazid, ethambutol, pyrazinamide) 2 drugs for 4 months (rifampicin, isoniazid)

What are the common side effects of TB medication?

Rifampicin - orange body fluids, increased enzyme metabolism, hepatitis, oral contraceptive inactivated Isoniazid - hepatitis, peripheral neuropathy Ethambutol - optic neuropathy Pyrazinamide - gout

Respiratory Tract Infections Flashcards

(78 cards)