18 LRTI's

Question 1

Who gets acute bronchitis?
Symptoms? (3)
Treatment?

Answer 1

Winter, children
Dry cough, dyspnoea, tachypnoea.
Supportive.

Question 2

Causes of acute bronchitis?

4 viral 3 bacterial

Answer 2

Rhinovirus, coronavirus, adenovirus, influenza.
Bacterial = less common
Haemophilus influenzae, Mycoplasma pneumoniae, Bordetella pertussis.

Question 3

What is chronic bronchitis?

Answer 3

Productive cough on most days for 3 months of 2 successive years. Exogenous irritants.
Acute infective exacerbations (same organisms as acute bronchitis).

Question 4

Symptoms of bronchiolitis? (4)
Epidemiology?
Cause?

Answer 4

Wheeze, cough, nasal discharge, respiratory distress.
Winter, 2-10months old.
RSV:75%. Also parainfluenza/ adenovirus/ influenza.

Question 5

How is bronchiolitis diagnosed? (3)

Treatment?

Answer 5

CXR, FBC, nasal aspirate for viral PCR.

Supportive: O2, feeding assistance.

Question 6

What are the typical patterns of acute bacterial pneumonia?

Answer 6

Bronchopneumonia - bronchioles with spread to alveoli.

Lobar pneumonia - most of lobe, 90% Strep pneumoniae.

Question 7

What are the four types of pneumonia?

Answer 7

Community acquired.
Hospital acquired: >48hrs after admission.
Ventilator acquired: >48hrs after intubation/ventilation.
Aspiration.

Question 8

What is the epidemiology of community acquired pneumonia (CAP)?
Causative organisms? (4)

Answer 8

50-70yo. Midwinter to spring.
Strep pneumoniae, Haem influenzae (person to person).
Legionella pneumophilia (environment).
Chlamydophilia psittaci (from animals).

Question 9

Why are atypical pneumonias named as such?

Answer 9

Traditionally because cases fail to respond to penicillin or sulpha drugs/ no organism could be identified.
Now: different presentation + Rx.

Question 10

What is the presentation of bacterial CAP? (11)

Answer 10

Rapid onset fever/chills, productive cough, pleuritic chest pain, fatigue, anorexia.
Tachypnoea, tachycardia, hypotension.
Dull to percuss, reduced air entry, bronchial breathing.

Question 11

What is the presentation of pneumonia caused by mycoplasma pneumoniae?
Complications? (4)

Answer 11

Epidemics every 4-8yrs.
Children. Cough.
Dx: serology.
Complications: pericarditis, arthritis, Guillan-Barre, peripheral neuropathy.

Question 12

What is the presentation of pneumonia caused by legionella pneumophilia?
6 symptoms, 2 signs

Answer 12

Colonises water piping.
High fever, rigors, dyspnoea, cough, D+V, confusion.
Deranged LFTs, low sodium.

Question 13

What is the presentation of pneumonia caused by chlamoydophila psittaci?
6 features

Answer 13

Bird exposure.
Pneumonia and splenomegaly.
Rash, hepatitis, haemolytic anaemia, reactive arthritis.

Question 14

How does viral influenza present?

2o organsims? (3)

Answer 14

Fever, headache, myalgia, dry cough + sore throat.
1o viral pneumonia if cardiac/lung problems.
2o bacterial pneumonia: S.pneumoniae, Haemophilus influenzae, Staphaureus.

Question 15

What are the recommended microbiological investigations for moderate-severe CAP? (5)

Answer 15

Sputum + gram stain.
Blood culture.
Pneumococcal urinary antigen.
Legionella urinary antigen.
PCR/serolgy: viral, mycoplasma pneumoniae, chlamydophilia sp.

Question 16

What is the CURB65 score and what is it used for.

Answer 16

CAP severity assessment. 2:mod. 3-5:high.
Confusion.
Urea >7mmol.
Resp rate >30.
BP sys less 90. dias less 60
Age >65.

Question 17

How are LRTIs prevented? (2)

Answer 17

Pneumococcal vaccination if heart/lung/kidney disease, splenectomy.
Influenza vacc f >65, chronic disease or multiple morbidities.

Question 18

Which organisms cause hospital acquired pneumonia? (2)

Answer 18

Enterobacteriacae

Pseudomonas