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Systems: Resp. WK > 23. LRTIs: Pathology, Management and Clinical Features > Flashcards

23. LRTIs: Pathology, Management and Clinical Features Flashcards

1
Q

What are the main infections of the lower respiratory tract? (6)

A
  1. acute bronchitis
  2. exacerbation of COPD
  3. pneumonia
  4. empyema
  5. lung abscess
  6. bronchiectasis
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2
Q

What is acute bronchitis?

A
  • short-term inflammation of large airways e.g. bronchi
  • self-limiting illness which lasts a couple of weeks
  • often caused by viral infection
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3
Q

What is empyema?

A
  • pus in pleural space
  • suspected if patient with resolving pneumonia develops a recurrent fever
  • may or may not follow a documented episode of pneumonia
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4
Q

What is the UK incidence for pneumonia?

A

between 5-11 per 1000 adult population

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5
Q

What percentage of community diagnosed pneumonia require hospitalisation in UK?

A

between 22-42%

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6
Q

What is the mortality percentage of hospitalised patients with pneumonia?

A

5.7-12%

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7
Q

Why is pneumonia difficult to diagnose initially?

A

Symptoms in the early start are very vague and fit other respiratory infections

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8
Q

What are the symptoms of pneumonia? (8)

A
  1. malaise
  2. fever
  3. chest pain (pleuritic)- very sharp
  4. cough
  5. purulent sputum (rusty colour)
  6. dyspnoea
  7. headache
  8. haemoptysis
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9
Q

What are signs of pneumonia?

A
  1. pyrexia
  2. tachpnoea
  3. central cyanosis
  4. dulness of percussion of affected lobe
  5. bronchial breath sounds
  6. inspiratory crepitations/crackles
  7. increased vocal resonance
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10
Q

What are bronchial breath sounds indicators of in terms of lungs? (6)

A
  • lung consolidation
  • cavitation
  • mass interposed between chest wall and large airways
  • tension pneumothorax
  • complete alveolar atelectasis/ collapse with patent airways
  • pleural effusion with atelectasis
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11
Q

What is bronchial breathing like?

A
  • louder and higher pitched than vesicular breath sounds

- no ventilation to alveoli and sound that is heard originates from bronchi and is transmitted through the chest wall

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12
Q

Bronchial breathing where is an abnormal sign?

A

Anywhere other than over trachea, right clavicle or right interscapular space is abnormal

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13
Q

What is a consolidated lung?

A
  • Region of lung that has filled with liquid, marked by induration (swelling or hardening of normal lung tissue) of a normally aerated lung
  • increase in fibrous elements, loss of elasticity
  • hardened mass
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14
Q

What investigations are done for pneumonia patients?

A
  1. Serum biochemistry and full blood count
  2. Chest X Ray
  3. Blood cultures
  4. Throat swab (for atypical pathogens)
  5. Urinary legionella antigen
  6. Sputum microscopy and culture
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15
Q

What investigation is mandatory in feverish patients?

A

Blood culture

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16
Q

What disease is a form of atypical pneumonia caused by any form of Legionella bacteria?

A

Legionnaires’ Disease (caused by Legionella)

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17
Q

What diagnostic technique is commonly used in pneumonia patients?

A

Air bronchograms: tubular outline of airways made visible by filling surrounding alveoli by fluid or inflammatory exudates.

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18
Q

What are the most common pathogens causing pneumonia as identified by microbiology? (from most to least common) (7)

A
  1. strep pneumoniae
  2. All other viruses
  3. H. influenzae
  4. Mycoplasma pneumoniae
  5. Chlamydia psittaci
  6. S. aureus
  7. Legionella
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19
Q

Where does Legionella bacteria usually live?

A

Grows in water systems, in stagnant and unclean water

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20
Q

What are 2 atypical pathogens?

A
  1. mycoplasma pneumoniae

2. chlamydia psittaci

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21
Q

Pneumonia patients are assessed to determine what?

A
  • their treatment

- whether patient should be admitted not not

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22
Q

What is the criteria for severity scoring in pneumonia patients? (CURB 65)

A 
C: confusion
U: blood urea >7 
R: respiratory rate>30 
B: diastolic blood pressure<60 
6:5: age>65
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23
Q

What is the scoring system for pnuemonia patients? (0-5)

A

0= low risk and could be treated in community
1-2: hospital treatment usually required
3-5: high risk of death and need for ITU (intensive therapy unit)

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24
Q

What is the treatment for CURB 0-1 patient score?

A

Amoxycillin or clarithromycin/ doxycycline

25
Q

What is the treatment for CURB 2 patient score?

A

Amoxycillin and clarithromycin or levofloxacin

26
Q

What is the treatment for CURB 3-5 patient score?

A

Co-amoxiclav (broader spectrum so used in more severe cases) and clarithromycin or levofloxacin (if penicillin allergic)

27
Q

What are 4 main additional treatments for pneumonia?

A
  1. Oxygen
  2. IV fluids
  3. CPAP; continuous positive airway pressure
  4. Intubation
28
Q

When is CPAP given to pneumonia patients?

A

If not able to oxygenate patient (in severe cases intubation and ventilation may be required)

29
Q

What are complications of pneumonia? (SLAP HER)

A

S: septicaemia
L: lung abscess
A: atrial fibrillations + ARDS (acute resp. distress syndrome)
P: pericarditis/ myocarditis
H: haemolytic anaemia (mycoplasma) and hypotension
E: empyema
R: respiratory failure, type 1 common

30
Q

What is septicaemia? (sepsis)

A
  • If immune system is weak and infection in body severe, it causes immune system to go into overdrive and inflammation affects the entire body.
  • Widespread inflammation can cause tissue and organ damage and interferes with blood flow
  • Most common sites of infection leading to sepsis are: lungs, urinary tract infection, abdomen and pelvis
31
Q

Acute kidney injury as a pneumonia complication affects which group of people?

A

Particularly the elderly with co-morbidities

32
Q

What is haemolytic anaemia as a pneumonia complication?

A

Immune phenomenon where RBCs are destroyed

33
Q

What is ARDS? (Acute respiratory distress syndrome)

A
  • occurs due to lung injury or secondary to sever systemic illness
  • inflammatory mediators as a result of lung damage are released causing increased capillary permeability and non-cardiogenic pulmonary oedema
  • often accompanied by multiorgan failure
34
Q

What are conditions which need to undergo differential diagnosis when diagnosing pneumonia?

A
  1. TB
  2. lung cancer
  3. pulmonary embolism
  4. cardiac failure
  5. pulmonary vasculitis (Wegners granulomatosis )
35
Q

How to distinguish between TV and pneumonia?

A
  • TB is infection of mainly upper lobes (likes airated lung tissue), has sub-acute or chronic cause and patient usually unwell for several weeks
  • Pneumonia has a short history of symptoms of around a week
36
Q

What are the main 3 groups of pathogens which cause empyema?

A
  1. streptococcus (52%)
  2. staph. aureus (11%)
  3. anaerobes (20%)
37
Q

What are symptoms of empyema?

A
  1. chest pain
  2. absence of cough (or dry)
  3. high and swinging fever and night sweats
  4. lack of energy/malaise
38
Q

What diagnostic techniques are used to investigate empyema? (3)

A
  1. CT of thorax
  2. pleural ultrasound
  3. diagnostic pleural aspiration (pH<7.2)
39
Q

What are the treatment options for empyema? (2)

A
  • chest drain
    -antibiotics
    (t-PA/DNase sometimes required)
40
Q

How long could the antibiotic treatment last for while treating empyema?

A

up to 6 weeks (depending on clinical response)

41
Q

If none of the treatments for empyema work, what option is left?

A

surgery for patients who are not improving

42
Q

What is a lung abscess?

A
  • Cavitating area of localised and suppurative infection within the lung
  • Necrosis of lung tissue forming cavities of more than 2cm which are filled with necrotic debris and fluid
43
Q

What 3 organisms are more likely to result in cavitating pneumonia? (3)

A
  1. staph aureus
  2. pseudomonas
  3. anaerobes
44
Q

What are symptoms for a lung abscess?

A 
not very specific: 
- Lethargy/ lack of energy 
- weight loss
-high swinging fever 
- foul-smelling sputum 
-pleuritic chest pain 
(empyema develops in 20-30% patients)
45
Q

What investigations should be done for a lung abscess?

A
  1. CT of thorax

2. sputum culture (including TB microscopy and culture)

46
Q

What is the treatment for a lung abscess?

A

prolonged antibiotic treatment

47
Q

What is the drainage via in a lung abscess?

A

Drainage via bronchial tree but occasionally percutaneous drainage may be necessary

48
Q

Is bronchiectasis a chronic or acute infection?

A

Chronic

49
Q

What is bronchiectasis?

A

Chronic infection of the bronchi and bronchioles leading to permanent dilation of these airways

50
Q

What are main organisms which cause bronchiectasis?

A
  1. H influenzae
  2. Strep pneumoniae
  3. Staph aureus
  4. Pseudonomas aeruginosa
51
Q

What are the main causes of bronchiectasis? (most of the time causes not found but these are potential)

A
  1. idiopathic
  2. immotile cillia syndrome
  3. cystic fibrosis (at early age)
  4. childhood infections such as measles or whooping cough
  5. hypogammaglobulinaemia
  6. . Allergic Bronchopulmonary Aspergillosis (ABPA)
52
Q

What is hypogammaglobulinaemia?

A
  • genetic and can be acquired (secondary)
  • not enough immunoglobulin gamma globulin is produced in the blood
  • therefore infections can’t be fought
53
Q

What is ABPA? (allergic bronchopulmonary aspergillosis)

A
  • exaggerated response of the immune system to fungus Aspergillus
  • occurs most commonly in CF and asthma patients
54
Q

What are symptoms of bronchiectasis?

A
  1. chronic cough
  2. daily sputum production (often copious/large amounts)
    Sometimes:
    -wheeze
    - dyspnoea
    -tiredness (chronic)
    - flitting chest pains (between both lungs)
    -haemoptysis
55
Q

What are common signs of bronchiectasis? (3)

A
  1. finger clubbing
  2. course inspiratory crepitations/crackles (auscultation)
  3. wheeze (asthma, COPD, ABPA)
56
Q

What is the investigation for bronchiectasis? (5)

A
  1. High resolution CT thorax
  2. Sputum culture
  3. Serum immunoglobulins
  4. Total IgE and Aspergillus precipitins (when antibody reacts with antigen it produces a precipitate)
  5. CF genotyping
57
Q

What antibiotic can haemophilus influenzae be resistant to for treatment of bronchiectasis?

A

amoxicillin

58
Q

What is the treatment for bronchiectasis? (3); similar to asthma treatment

A
  1. chest physiotherapy
  2. prompt treatment of infections with antibiotics
  3. may require inhaled therapy including beta 2 agonist and inhaled corticosteroids

Systems: Resp. WK (40 decks)

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