respiratory tract infections

Question 1

is stridor upper or lower respiratory tract infection ?

Answer 1

upper

Question 2

expiratory wheeze or crackles - what type or RT

Answer 2

lower

Question 3

what is the first sign of HIV

Answer 3

thrush - fungal infection in throw that can cause oesophagitis

Question 4

Case 1 - Jarad , 49 , asthmatic - 10 day history of nasal congestion, green nasal discharge , headache which is frontal and constant and worse when he leans forward - what are your first thoughts

Answer 4

green - bacterial
sinuses - headache when you press over them which makes them worse - worse on leaning forward as you put pressure on that area

thinking could be rhino sinusitis

Question 5

is normal viral sinusitis ( rhino sinusitis) self resolving

bacterial sinusitis is bi phasic illness meaning often they had viral leaving tissues more vulnerable to infection and bacterial will get in there causing a secondary infection - do these last more or less than 10 days

Answer 5

yes - viral less than 10 days

bacterial more than 10 days

Question 6

sinusitis is where the sinuses become swollen and are usually caused by an infection - causing pain in face and nose- what bacteria most often cause this

Answer 6

streptococcus pneumonias
haemohilus influenza
mortadella catarrali ( pathogens that live there)

Question 7

what are the red flags if someone with asthma comes in with headache and pain

Answer 7

severe or persistent neck stiffness ( meningitis ) 
periorbital oedema ( cellulitis - visual change) 

ophthalmoplegia - paralysis or weakens of the eye muscles
cranial nerve palsy
altered mental state and neck stiffness

Complications 
Periorbital- orbital cellulitis 
Subperiosteal abscess
Osteomyelitis of sinus 
Meningitis 
Intracranial abscess 
Septic cavernous sinus thrombosis

Question 8

what supportive therapy can you have for viral rhinosinustiis

Answer 8

analgesics
intranasal steroids for over 10 days
decongestants

Question 9

can you give antibiotics to treat bacterial rhinosinustiis

Answer 9

5-7 days if not resolving

Question 10

case 2 lady 26 with 5 day history of dry cough, sore throat , tiredness ( malaise) and runny nose ( rhinorrhea(free discharge of a thin nasal mucus fluid))
how can it be transmitted

Answer 10

most common upper respiratory tract infection that is the common cold

Direct transmission - hand contact up to 2 hours on skin
Sneezing or coughing - tissues don’t support virus transmission
Large droplets from close contact or 8 hours on external surfaces

Question 11

effective treatments for the common cold

Answer 11

supportive
nasal decongestants
analgesics

Question 12

complications of common cold ( rhinovirus, coronavirus , infleuzna )

Answer 12

Acute rhinosinusitis
Lower RT infection
Asthma exacerbation
Acute otitis media

Question 13

Case 3 - 31year old with 2w history of sore throat and difficulty swallowing what is most likely diagnosis

Answer 13

acute pharyngitis - tonsillitis

examination reveal swollen tonsils and lymph glands

nasal congestion and cough with a viral tonsillitis

Question 14

in a bacterial tonsillitis what do you see on the tonsils

Answer 14

exudate/puss
pharyngeal oedema and tender anterior cervical lymphadenopathy

normally by Group A strep

Question 15

what is the difference between tonsillitis and strep throat

Answer 15

tonsillitis is viral or bacterial and strep throat caused by specific type of bacteria - Group A strep

Question 16

splenomegaly

Answer 16

enlarged spleen - caused by underlying illness such as liver diseases, cancers , inflammatory disease and infection

Question 17

if not viral tonsillitis what do you need to give the patient to treat them

Answer 17

penicillin

Question 18

feverapain score measures certain aspects of the illness and depending on this determines what treatment you get

Answer 18

for strep pharyngitis

centor score (ever >38.5°C, swollen, tender anterior cervical lymph nodes, tonsillar exudate and absence of cough) are an algorithm to assess the probability of group A β haemolytic Streptococcus (GABHS) as the origin of sore throat, developed for adults.)

Question 19

Case4 -LRT , 2 year old boy with 2 day history of sniffly cold and runny nose, presenting with fever and cough and wheezing and increased respiratory rate with poor feeding.

Answer 19

most likely bronchiolitis
caused by viral infection (respiratory syncytial virus)

90% roscoe within 3 weeks

Question 20

what are these risk factors for 
prematurity below 36weeks 
low brith weight 
under 12 weeks 
chronic lung disease 
congenital heart defects 
immunodeficiency

Answer 20

severe disease

Question 21

treatment for bronchiolitis is

Answer 21

nothing normally as should self resole

discharge when
clinically stable
taking oral fluids
Sp02 start are above 92%

Question 22

what should you not use when treating bronchiolitis

Answer 22

antibiotics
hypertonic slaine 
adrenaline - nebuliser 
salbutamol 
ipratropium bromide - COPD 
montelukast - good efficacy is asthma 
inahled or systemic corticosteroids

Question 23

in broniectasis why is hypertonic saline good ?

Answer 23

airway clearance by increasing hydration or the airway surface layer and mucus making it easier to cough and breast up the phlegm

Question 24

In Respiratory failure - lungs cease capacity to exchange oxygen for CO2 - if you get to much C02 blood turns to acid - non invasive ventilation - push air in and out of lungs to make lungs exchange co2 for oxygen so makes blood less acidic
what are two primary methods for this

Answer 24

CPAP ( continuous pressure - opens up respiratory failure good in type 1 respiratory failure) and then BiPAP( bi level - two levels of ventilation of air being forced into lungs at two different pressures - opens up then more again going to help exchange - type 2 respiratory failure)

Question 25

what the difference between type 1 and type 2 respiratory failure

Answer 25

type 1 involves low oxygen and normal or low carbon dioxide levels. Type 2 involves low oxygen with high carbon dioxide levels

Question 26

Case 5 - LRT - 67yr with 4 day history with worsening cough and green sputum , lower right sided chest pain with breathing in and fatigue and confusion most likely?

Answer 26

pneumonia

Question 27

what are the Sx of pneumonia

Answer 27

``` headaches loss of appetite high fever and chills clammy and blue skin low blood pressure cough with sputum SOB pleuritic chest pain hemoptysis muscle fatigue high heart rate vomiting high temp and repsriaotry rate ```

Question 28

how can you score pneumonia

Answer 28

``` CURB65 confusion urea above 7.0mmol respiratory rate blood pressure below 90 systolic or below 60 diastolic above 65 years old if you have a crib score below 1 - ambulatory 1-2 is asdmit above 3 - ITU 40% risk of death ```

Question 29

GCS

Answer 29

glasgow coma scale used to measure a person level of consciousness after a brain injury eyes verbal and motor responses assessed

Question 30

cause of CAP

Answer 30

no cause normally found typical - viewed as stain , atypical cannot be viewed ``` strep penuomoa haemophilus influenza mortadella catarrhlais staph aureus group a strep rhinovirus chlamydia pneumonia ```

Question 31

HAP pneumonia occur over 48 hours after admission | what pathogens can accuse this

Answer 31

S-aureus pesodomonus aeruginosa e-coli

Question 32

VAP - mechanical ventilation infections - in ICU CAP - penicillin or macrocodes like clarithromycin HAP - penicillin what are the complications

Answer 32

``` pleural effusion empyema( pus in the pleura) repsriaotry failure acute RDS caveating disease access ```

Question 33

what is the curb 65 score

Answer 33

The CURB-65 calculator can be used in the emergency department setting to risk stratify a patient's community acquired pneumonia. The CURB-65 Score includes points for confusion and blood urea nitrogen, which in the acutely ill elderly patient, could be due to a variety of factors.

Question 34

what is antibiotic stewardship

Answer 34

Antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients. Improving antibiotic prescribing and use is critical to effectively treat infections, protect patients from harms caused by unnecessary antibiotic use, and combat antibiotic resistance.

Question 35

what is the R number

Answer 35

R is the number of people that one infected person will pass on a virus to, on average If the R value is higher than one, then the number of cases increases. But if the R number is lower the disease will eventually stop spreading, because not enough new people are being infected to sustain the outbreak. An R value between 0.7 and 1.1 means that, on average, every 10 people infected will infect between 7 and 11 other people.