Flashcards in this deck (40)

• COVID-19 is an infection caused by SARS‑CoV‑2, which is a positive-sense RNA coronavirus and causes respiratory and systemic disease ranging from asymptomatic to critical illness.
  covid virology pathogenesis
• Key steps in COVID-19 pathogenesis: - Virus binds ACE2 receptor via the spike protein and enters respiratory epithelium - Replication triggers immune response - Severe disease: cytokine storm causing ARDS, multiorgan injury and coagulopathy
  pathogenesis covid
• ARDS in COVID-19 is hypoxaemic respiratory failure from a "cytokine storm" within 1 week of COVID, often with bilateral opacities on CXR.
  complications ards covid
• Symptoms of COVID-19 by severity: - Mild: fever, cough, fatigue, anosmia, myalgia, sore throat - Moderate: SOB and O2 sat 90–94% - Severe: hypoxia <90%, ARDS, multi-organ failure
  presentation symptoms covid
• Extra-respiratory manifestations of COVID-19 include GI (diarrhoea/nausea), neuro (headache, confusion, anosmia), cardiac (myocarditis), and skin (rashes/COVID toes).
  manifestations covid systems
• Major risk factors for severe COVID-19 include age >65, male sex, comorbidities (DM, CKD, COPD, CVD, obesity), immunosuppression, third trimester pregnancy, and unvaccinated status.
  riskfactors covid
• Investigations commonly show lymphopenia, raised CRP and D-dimer, possible mild thrombocytopenia, raised ferritin/LDH, and troponin in severe disease; diagnostic test: RT-PCR nasopharyngeal swab.
  investigations covid labs
• Oxygen therapy target for most COVID-19 patients is SpO2 92–96%, with stepwise escalation: nasal cannula → face mask → high-flow nasal O2 → CPAP → mechanical ventilation.
  management oxygen covid
• First-line treatments: dexamethasone for those needing oxygen; IV remdesivir for hospitalised patients on O2 if symptom onset is <7 days. Second-line: tocilizumab for systemic inflammation and prophylactic LMWH/UFH in hospitalised patients. Prevention: vaccine.

  
  treatment covid pharmacology
• Influenza is an acute viral respiratory infection caused by influenza A or influenza B viruses.
  infectiousdisease influenza overview
• Key steps in influenza pathogenesis: - Virus binds respiratory epithelial cells via Hemagglutinin (HA) - Viral replication → cell death and airway inflammation - Host immune response causes systemic symptoms
  pathogenesis influenza virology
• Common systemic symptoms of influenza include fever, chills, myalgia, headache and malaise.
  symptoms influenza clinical
• Respiratory and less common GI symptoms of influenza: - Respiratory: cough, sore throat, nasal congestion - GI (less common): nausea, vomiting, diarrhea
  symptoms influenza clinical
• Major complications of influenza include viral or secondary pneumonia, COPD/asthma exacerbation, myocarditis, encephalitis and multi organ failure.
  complications influenza clinical
• Key risk groups for severe influenza are people over 65 years, pregnant, with chronic heart, lung, liver, or renal disease, immunocompromised and residents of long-term care facilities.
  riskfactors influenza publichealth
• Investigations for suspected influenza: clinical diagnosis in mild cases; for confirmation use RT-PCR from nasopharyngeal swab. In severe cases consider FBC, CRP and CXR if pneumonia is suspected.
  investigations diagnosis influenza
• Treatment and prevention: First-line is supportive care and paracetamol for fever. If severe/hospitalised or immunocompromised, aim within 48 hours to give oseltamivir (oral) or zanamivir (inhaled). Prevention: annual influenza vaccine (live attenuated in children, inactivated in adults).
  treatment prevention influenza
• Influenza classification includes Types, Subtypes/Lineages, Clades and Sub-clades. The provided diagram illustrates these groupings: Which hierarchical groups are shown in the diagram? Types, Subtypes/Lineages, Clades, Sub-clades
  classification influenza virology
• Upper respiratory tract infections (URTIs) are acute infections affecting structures above the vocal cords: nose, pharynx, larynx or sinuses.
  ent urti
• Common clinical types of URTIs include: - Common cold - Pharyngitis/Tonsillitis - Laryngitis - Sinusitis/rhinosinusitis - Otitis media/eustachian tube dysfunction - Epiglottitis
  types urti
• Typical URTI symptoms include: nasal congestion, rhinorrhoea, sore throat, cough and sometimes low-grade fever.
  symptoms urti
• Red-flag URTI signs requiring urgent attention: stridor, drooling, severe pain, high fever, neck stiffness, immunosuppression.
  redflag safety
• URTI risk factors include being young, immunosuppressed, having asthma/COPD, seasonal peaks (winter viruses), smoking and close contact.
  risk epidemiology
• Investigations for mild URTI are clinical; if severe/atypical consider throat swab (strep culture/rapid antigen) and nasopharyngeal swab (viral PCR for COVID/influenza).
  investigations diagnosis
• First-line supportive URTI treatment: rest, hydration, saline nasal spray or steam inhalation plus analgesics/antipyretics (paracetamol, ibuprofen).
  treatment management
• Recommended antibiotics for specific bacterial URTIs: Phenoxymethylpenicillin for strep throat (Group A), Amoxicillin for bacterial sinusitis and Amoxicillin for otitis media.
  antibiotics treatment
• Antiviral guidance: Oseltamivir is indicated for influenza in high-risk patients.
  antivirals treatment
• Lower respiratory tract infections (LRTIs) are infections below the larynx involving: - trachea - bronchi/bronchioles - lung parenchyma (alveoli)
  lrti definition respiratory
• Common types of LRTIs include: - Acute bronchitis - Bronchiolitis - Community-acquired pneumonia (CAP) - Healthcare-associated pneumonia (HAP) - Ventilator-associated pneumonia (VAP) - Exacerbation of COPD - COVID-19 / Influenza pneumonia
  types lrti
• Typical viral causes listed for acute bronchitis and bronchiolitis include: influenza A/B, RSV, COVID, adenovirus, parainfluenza
  etiology viral bronchitis
• Common bacterial pathogens causing community-acquired pneumonia (CAP) are Streptococcus pneumoniae and Haemophilus influenzae.
  etiology bacterial cap
• Key symptoms of LRTIs include: - Cough - Fever / chills - Dyspnoea - Wheeze - Pleuritic chest pain - Fatigue / malaise
  symptoms presentation
• Risk factors for LRTIs include: Smoking, age <5 or >65, chronic lung disease (COPD & Asthma), bronchiectasis, diabetes mellitus, immunosuppression, and recent hospital stay.
  risk epidemiology
• Investigations for suspected LRTI include blood tests: FBC, CRP, U&E, LFT, plus sputum culture and blood culture if severe and viral PCR for influenza/COVID, and CXR for imaging.
  investigations diagnosis
• A chest X-ray showing consolidation suggests pneumonia.
  investigations cxr
• First-line antibiotic for uncomplicated acute bronchitis given here is Amoxicillin.
  treatment bronchitis antibiotics
• Empirical treatment for CAP in moderate disease is co-amoxiclav + doxycycline/clarithromycin and for severe CAP is benzylpenicillin + clarithromycin.
  treatment cap antibiotics
• HAP treatment: early (<5 days) options include co-amoxiclav OR doxycycline; late-onset or high-risk HAP uses piperacillin-tazobactam (Tazocin).
  treatment hap
• VAP recommended empirical therapy is piperacillin-tazobactam (Tazocin), adding vancomycin if there is MRSA risk.
  treatment vap antibiotics
• For COPD exacerbation, antibiotics are recommended only if there is increased sputum purulence, sputum volume and dyspnoea; first-line is doxycycline and second-line amoxicillin.
  treatment copd antibiotics