5. Respiratory Infections

How is Influenza primarily transmitted?

Aerosolized droplets from coughing and sneezing.

What is the incubation period for Influenza?

1–4 days.

Which Influenza type causes global pandemics?

Influenza A.

Differentiate between Antigenic Drift and Antigenic Shift.

Drift: Minor antigenic changes due to point mutations; responsible for epidemics.

Shift: Major antigenic changes (new subtype) due to gene reassortment; responsible for worldwide pandemics.

According to the CDC, who should receive the Influenza vaccine?

Everyone > 6 months of age.

Can a patient with an egg allergy (limited to hives) receive the flu vaccine?

Yes, they can use any vaccine; the amount of egg protein is negligible.

Which populations should NOT receive the Live Attenuated Influenza Vaccine (nasal spray)?

Pregnant women, children < 2 years old, asthmatics, and immunocompromised patients.

What is the window for starting antiviral treatment (e.g., Oseltamivir) for maximum benefit?

Within the first 48 hours of illness.

What is the most common complication of Influenza?

Secondary bacterial pneumonia (usually S. pneumoniae or S. aureus).

Define Community Acquired Pneumonia (CAP).

Pneumonia occurring in a patient in the community without extensive healthcare contact.

Define Hospital Acquired Pneumonia (HAP).

Pneumonia occurring ≥48 hours after admission that was not incubating at admission.

What is the most common viral cause of pneumonia in immunocompetent adults (past 3 years)?

SARS-CoV-2.

Which viral pneumonia is associated with "diffuse bilateral infiltrates" and calcified nodules later in the disease course?

Varicella pneumonia.

What is the most common cause of Community Acquired Pneumonia (CAP)?

Streptococcus pneumoniae.

Describe the classic sputum appearance in Pneumococcal Pneumonia.

Bloody or "rusty" sputum.

Which pathogen should be suspected in a young, previously healthy patient with severe pneumonia following a viral infection (like the flu)?

Staphylococcus aureus (specifically MRSA).

What are the radiographic hallmarks of Staphylococcus aureus pneumonia?

Patchy consolidation, rapid progression, cavitation/necrosis, and empyema.

Which pathogen is associated with "currant jelly" sputum and is common in alcoholics?

Klebsiella pneumoniae.

Which organism causes "Walking Pneumonia" and is the 2nd most common cause of CAP?

Mycoplasma pneumoniae.

What specific physical exam finding is associated with Mycoplasma pneumoniae?

Bullous myringitis (blisters on the eardrum).

What is the vector/source for Chlamydia psittaci (Psittacosis)?

Birds (parrots, poultry).

Which atypical pneumonia is associated with contaminated water systems (AC units, whirlpools)?

Legionella pneumophila.

What symptoms distinguish Legionnaires’ disease from other pneumonias?

GI symptoms (diarrhea, nausea, abdominal pain) and confusion.

What lab abnormality is common in Legionnaires’ disease?

Hyponatremia (low sodium).

What is the drug of choice for treating Atypical Pneumonias (outpatient)?

Azithromycin (Z-Pak) or Doxycycline.

What does the CURB-65 score measure?

It estimates mortality in CAP to determine if a patient needs hospital admission.

What are the components of CURB-65?

Confusion, Urea (BUN > 19), Respiratory Rate (≥ 30), Blood Pressure (< 90/60), 65 (Age ≥ 65).

How is a CURB-65 score of 2 managed?

Moderate severity; hospitalization should be considered.

What is the standard antibiotic regimen for healthy outpatient CAP with no comorbidities?

Amoxicillin OR Doxycycline OR a Macrolide (if resistance is <25%).

Is acute bronchitis usually bacterial or viral?

Viral (>90% of cases).

What is the treatment for acute bronchitis in a healthy patient?

Symptomatic relief only; NO antibiotics.

What are the three phases of Pertussis (Whooping Cough)?

1. Catarrhal: Malaise, runny nose, mild cough.

2. Paroxysmal: Severe coughing spells, inspiratory whoop, post-tussive vomiting.

3. Convalescent: Cough subsides.

What is the first-line treatment for Pertussis?

Azithromycin or Clarithromycin (Macrolides).

When should the Tdap booster be given to adolescents?

Between ages 11 and 12 years.

Why is Tdap recommended for pregnant mothers after 20 weeks gestation?

To transfer antibodies to the fetus and minimize the risk of pertussis in the newborn.

What are aerosolized droplets?

Small droplets that spread infectious agents when a person coughs or sneezes.

What is the significance of the 48-hour window for antiviral treatment of Influenza?

It is crucial for maximizing the effectiveness of antiviral medications.

What demographic is particularly vulnerable to complications from Influenza?

The elderly, young children, and immunocompromised individuals.

How is Streptococcus pneumoniae identified in laboratory tests?

Through culture and sensitivity testing.

What physical symptoms are commonly observed in pneumonia?

Cough, fever, chills, and difficulty breathing.

What role does adequate hydration play in pneumonia management?

It helps thin mucus secretions and promotes easier breathing.

What are the long-term effects of untreated pneumonia?

Potential lung damage, respiratory failure, and chronic respiratory issues.

What should be included in patient education regarding Influenza prevention?

Vaccination, hand hygiene, and avoiding close contact with sick individuals.

What chronic conditions may increase the risk of pneumonia?

COPD, asthma, diabetes, and heart disease.

What is a notable difference between community-acquired and hospital-acquired pneumonia?

Hospital-acquired pneumonia occurs after 48 hours of admission.

What is the significance of chest imaging in pneumonia diagnosis?

To evaluate the presence, extent, and nature of lung infection.

What medication is commonly prescribed for bacterial pneumonia?

Antibiotics tailored to the specific pathogen.

What is the impact of smoking on respiratory infections?

It increases susceptibility to infections and worsens disease outcomes.

How do vaccines help in preventing Influenza outbreaks?

They stimulate immunity against specific Influenza strains.

What is an essential preventive measure for patients hospitalized for pneumonia?

Early mobilization and breathing exercises to prevent further complications.

What common tests are performed to diagnose pneumonia?

Chest X-ray, sputum culture, and blood tests.

How can antibiotics inadvertently contribute to pneumonia?

Overuse can lead to antibiotic-resistant organisms.

What are the key signs of pneumonia in children?

Rapid breathing, fever, and difficulty feeding.

What characterizes Chlamydia psittaci pneumonia?

It often follows exposure to infected birds.

What type of bacteria does Mycoplasma pneumoniae belong to?

It is a type of atypical bacteria.

What protective measures should be taken to minimize the risk of pneumonia in healthcare settings?

Adherence to infection control protocols and vaccination of staff.

What is the prognosis for most patients with community-acquired pneumonia?

Generally good with appropriate treatment.

What is the mechanism of action of Azithromycin in treating pneumonia?

It inhibits bacterial protein synthesis.

What underlying condition might increase the likelihood of Atypical Pneumonia?

Chronic lung disease or recent viral infection.

Why is it important to distinguish between bacterial and viral pneumonia?

To determine the appropriate treatment approach.

What is a common misconception about bronchitis treatment?

That antibiotics are necessary, when most cases are viral.

What are the potential complications of untreated pertussis?

Pneumonia, seizures, and weight loss in infants.

What role does fever play in the context of pneumonia?

It is a sign of infection and can aid in the immune response.

What is the preferred method of administration for the Tdap vaccine?

Intramuscular injection.

How do ventilation practices influence risk factors for pneumonia in hospitals?

Inadequate ventilation can increase airborne pathogens.

What are the primary tools used in the diagnosis of atypical pneumonia?

Clinical history, serological tests, and PCR assays.

What symptom is characteristic of Staphylococcus aureus pneumonia?

Severe respiratory distress and high fever.

Why is hydration important in managing pulmonary infections?

It helps to maintain mucus clearance and lung function.

What is the benefit of using a Macrolide in pneumonia treatment?

It covers atypical pathogens effectively.

What are the most effective breathing exercises for pneumonia patients?

Diaphragmatic and pursed-lip breathing.

What unusual finding might suggest Legionella pneumonia?

Hyponatremia and gastrointestinal symptoms.

What key advice should be given to patients with pneumonia during follow-up?

Monitor breathing patterns and follow-up appointments closely.

How can public health campaigns help in reducing pneumonia incidence?

By promoting vaccination and awareness of risk factors.

What is a major challenge in treating pneumonia in elderly patients?

Their comorbidities and possible atypical presentations.

What information can a blood test provide in the context of pneumonia?

White blood cell count and presence of infection markers.

What benefits does education on respiratory hygiene offer?

It can significantly reduce the transmission of infections.

In what scenarios is outpatient treatment for pneumonia considered?

If patients are stable and lack significant comorbidities.

What is the importance of careful history-taking in pneumonia cases?

To identify potential exposures and previous health issues.

What could elevated BUN levels indicate in pneumonia patients?

Dehydration or potential organ dysfunction.

What is the main reason for việc viral bronchitis protocol in treatment?

It helps avoid unnecessary antibiotic prescriptions.

How can differentiating between viral and bacterial pneumonia impact treatment?

It prevents misuse of antibiotics and reduces resistance.

What viral illnesses often precede bacterial pneumonia?

Influenza and respiratory syncytial virus (RSV).

How is community-acquired pneumonia managed in children?

Based on age, severity, and specific pathogens involved.

What increased respiratory condition is shown after recent COVID-19 infections?

Post-viral pneumonia or exacerbations of chronic conditions.

What exercise can assist in residual recovery post-pneumonia?

Gradual increase in physical activity, as tolerated.

What educational topics should be included for parents regarding pertussis?

Vaccination schedule and signs of infection.

What should be included in the treatment plan for severe pneumonia cases?

Intensive monitoring and possible hospitalization.

How does stress affect respiratory health in pneumonia patients?

It can worsen symptoms and hinder recovery.

What role do diagnostic imaging tests play in pneumonia management?

To confirm diagnosis and evaluate treatment response.

How does chronic alcohol use relate to pneumonia risk?

It increases the likelihood of aspiration and suppression of immunity.

What's the role of chest physiotherapy in patients with pneumonia?

It aids in mucus clearance and lung function improvement.

What is a patient’s responsibility in preventing pneumonia after a diagnosis?

Adhere to medication schedules and follow-up appointments.

How does antibiotic resistance affect pneumonia treatment?

It complicates treatment choices and may require stronger drugs.

What are common viral pathogens that may lead to pneumonia cases?

Influenza, RSV, and adenoviruses.

What are the upward trends in pneumonia-related mortality generally attributed to?

Increased antimicrobial resistance and aging population.

What should healthcare providers educate patients about flu vaccinations?

Benefits, availability timing, and common misconceptions.

How do environmental factors impact pneumonia risk?

Pollution and allergen exposure can exacerbate respiratory conditions.

In what demographic is the risk of pneumonia remarkably higher?

Immunocompromised individuals and the elderly.

How does the presence of comorbidities complicate pneumonia management in patients?

It increases treatment complexity and risk for complications.

What role does hand hygiene play in preventing respiratory infections?

It significantly reduces the spread of pathogens.