Respiratory tract infections

Question 1

baby?

Answer 1

:)

Question 2

what bacteria are normally colonised in the upper respiratory tract

Answer 2

staphylococcus
streptococcus pneumoniae
viridans steptococcus
haemophilus . 
anearobes 
the alveoli also contains a microbiome of normal microbes

Question 3

Causes of rhinosinusitis

Answer 3

viral mostly - rhinovirus, influenza and para-influenza
bacterial is less often 
streptococcus pneumoniae
haemophilus influenzae
moraxella catarrhalis

Question 4

bacterial rhinosinusitis

Answer 4

bi-phasic illness
lasts more than 10 days
secondary to infection to allergic/ viral rhinitis

Question 5

red flags of rhinosinusitis

Answer 5

severe/ persistent headache
periorbital oedema
visual changes
opthalmoplegia 
cranial nerve palsy
altered mental state
neck stiffness
papilloedema

Question 6

complications of rhinosinusitis

Answer 6

pre-orbital/ orbital cellulitis 
subperiosteal abcess
osteomyelitis
meningitis
intracranial abcess
septic cavernous sinus
thrombosis

Question 7

treatment for viral rhinosinusitis

Answer 7

will self-resolve
supportive therapy - analgesics, intranasal steroids if it lasts longer than 10 days
decongestants

Question 8

treatment for bacterial rhinosinusitis

Answer 8

will self resolve
supportive therapy - can give back up antibiotics to be take if not resolving in 5-7 days
evidence is poor

Question 9

symptoms of rhinosinusitis

Answer 9

nasal congestion
green nasal discharge
headache - frontal, constant and worse on leaning forward

Question 10

common cold

Answer 10

benign self-limiting syndrome

Question 11

causes of the common cold

Answer 11

rhinovirus 
coronavirus
influenza
parainfluenza
respiratory syncytial virus

Question 12

how is the common cold transmitted?

Answer 12

direct transmission
hand contact - up to 2 hours on skin
sneezing or coughing - tissues do not support virus transmission
large droplets from close contact or 8 hours on external surfaces

Question 13

how much does the common cold cost per year?

Answer 13

$40 billion due to time off work

Question 14

effective treatments for common cold

Answer 14

supportive
nasal decongestants
antihistamines combination
analgesics

Question 15

Ineffective treatments for common cold

Answer 15

antibiotics
antivirals
vitamin C
echinacea - herb
codeine
intranasal glucocorticoid

Question 16

symptoms of common cold

Answer 16

dry cough
sore throat
tiredness - malaise
runny nose - rhinorrhea

Question 17

symptoms of acute pharyngitis

Answer 17

sore throat
difficulty swallowing
swollen tonsils
swollen lymph nodes

Question 18

acute pharyngitis

Answer 18

tonsilitis

Question 19

causes of viral tonsilitis

Answer 19

adenovirus
rhinovirus
coronavirus

Question 20

adenovirus

Answer 20

fatigue

Question 21

rhinovirus

Answer 21

nasal congestion

Question 22

coronavirus

Answer 22

cough

Question 23

bacterial tonsilitis

Answer 23

group A, C and G

streptococcus

Question 24

what are the symptoms of bacterial tonsilitis

Answer 24

acute onset sore throat
fever
patchy tonsilar exudate
pharyngeal edema
tender anterior cervical lymphdenopathy
scarlatiniform rash

Question 25

less common causes of tonsilitis

Answer 25

``` infectious mononucleosis (mono) Epstein-Barr Virus - EBV ```

Question 26

symptoms of infectious mononucleosis

Answer 26

high fever | prominent posterior cervical lymphdenopathy

Question 27

symptoms of EBV

Answer 27

splenomegaly and atypical lymphocytosis

Question 28

what is splenomegaly

Answer 28

abnormal enlargement of the spleen

Question 29

what tonsilitis needs antibiotics?

Answer 29

GBS

Question 30

prescribing antibiotics for acute sore throat

Answer 30

scoring systems depending on score of fever and pain

Question 31

back up antibiotics

Answer 31

not needed immediately | for use if no improvement of symptoms in 3-5 days or if the symptoms worsen .

Question 32

symptoms of bronchiolitis

Answer 32

``` fever cough wheezing increased respiratory rate poor feeding ```

Question 33

bronchiolitis

Answer 33

viral infection of the small airways prodromal upper respiratory tract infection followed by secondary inflammation of bronchi/ bronchioles caused by respiratory syncytial virus seasonal outbreaks in autumn and winter leading cause of admission for 0-5 year olds peak incidence at 2 years old .

Question 34

clinical course of bronchiolitis

Answer 34

``` day 0 - upper respiratory symptoms day 2 - lower respiratory symptoms day 3-5 - peak illness day 15 - cough resolves 90% fully resolved within 3 weeks ```

Question 35

risk factors for severe disease from bronchiolitis

Answer 35

``` apnoea respiratory failure prematurity low birth weight age - less than 12 weeks]chronic lung disease anatomical defects congenital heart disease immunodeficiency neurological disease ```

Question 36

treatment for bronchiolitis

Answer 36

NICE guidance promotes supportive care and non-invasive ventilation in acute respiratory failure .

Question 37

when to discharge someone with bronchiolitis?

Answer 37

clinically stable taking oral fluids oxygen sats greater than 92%

Question 38

what treatments should not be used?

Answer 38

``` antibiotics hypertonic saline adrenaline salbutamol montelukast ipratropium bromide systemic or inhaled corticosteroids ```

Question 39

symptoms of pneumonia

Answer 39

``` worsening cough with green sputum lower right sided chest pain with inhalation fatigue confusion high fever chills clamminess blueness skin SOB pleuritic chest pain hemoptysis - coughing up blood aches headaches loss of appetite mood swings low BP nausea vomiting pain in joints ```

Question 40

what is used to measure the severity of pneumonia?

Answer 40

CURB 65

Question 41

CURB 65

Answer 41

``` confusion urea - >7mmol respiratory rate over 30 blood pressure less than 90/60 older than 65 ```

Question 42

classification of CURB 65 scores

Answer 42

less than 1 = <3% risk of death - ambulatory 1-2 = 9% risk of death - admit more than 3 = 40% risk of death - HDU/ITU

Question 43

Causes of community acquired pneumonia

Answer 43

typical - viewed on a gram stain and sensitive to beta-lactams atypical - cannot be viewed on gram stain, require other antibiotics other causes

Question 44

typical causes of CAP

Answer 44

``` streptococcus pneumoniae haemophilus influenzae moraxella catarrhalis staphylococcus aureus group A strep aerobic gram -ve anearobes - associated with aspiration ```

Question 45

Atypical causes of CAP

Answer 45

``` legionella spp mycoplasma pneumoniae chlamydia pneumoniae chlamydia psittaci coxiella burnetii ```

Question 46

other causes of CAP

Answer 46

``` viral funcgal TB influenza A and B rhinovirus parainfluenza RSV ```

Question 47

Hospital acquired pneumonia

Answer 47

occurs more than 48hrs after admission to hospital . Increased risk by mechanical ventilation as the tube provides a surface for bacteria to live/ reproduce

Question 48

pathogens that cause HAP

Answer 48

``` Staphylococcus aureus pseudomonus aeruginosa klebsiella enterobacter acinetobacter E coli ```

Question 49

Treatment of pneumonia

Answer 49

antibiotic therapy based on local guidance

Question 50

treatment for CAP

Answer 50

penicillin tetracyclines macrolides e.g. clarithromycin

Question 51

treatment for HAP

Answer 51

broad spectrum penicillin or Carbopenum e.g. co-amoxiclav | Aminoglycosides - gentamicin

Question 52

complications of pneumonia

Answer 52

``` pleural effusion empyema respiratory failure acute respiratory distress syndrome cavitating disease abscess ```

Question 53

what is epyema?

Answer 53

collection of pus in the pleural cavity