at 4 - Respiratory Infections

Question 1

What is the difference between acute and chronic bronchitis?

Answer 1

Acute
- previously well people
- cough with or without sputum
- usually viral
- may be complicated be secondary bacterial 
Recurrent
- cough with sputum over 2 months
- more likely bacterial 
- look for underlying sinus infection, post nasal drip and bronciectasis

Question 2

What are the features of an exacerbation of COPD?

Answer 2

increased breathless
increased sputum production
green sputum
(may also get fever, wheeze, cough, increased HR and RR, sore throat with nasal discharge

Question 3

What is the treatment of COPD exacerbation?

Answer 3

antibiotics and steroids

Question 4

What predicts mortality of COPD?

Answer 4

DECAF score
D = MRC dyspnoea score
E = low eosinophils
C = consolidation
A = acidosis
F = atrial fibrillation

Question 5

What is the course of action if admitted to hospital with a COPD exacerbation/

Answer 5

CXR
ECG
Blood gases, if low sats —> resp failure?
DECAF score

Question 6

What are the two common types of asthma exacerbations?

Answer 6

viral or allergic but can be bacterial

They are managed similarly to COPD

Question 7

What are the typical features of community acquired pneumonia?

Answer 7

pre-existing disease
abrupt onset
purulent sputum
pleuritic pain
marked systemic upset
localised signs
responds to beta-lactums

Question 8

What are the atypical features of community acquired pneumonia?

Answer 8

previously well
insidious onset
dry cough, SOB, wheeze
mild systemic upset
no response to beta-lactams

Question 9

What are the most common bacterial causes of CAP?

Answer 9

mycoplasma e.g. in winter

regionally e.g. sept/oct, travel, clusters

Question 10

What is the management of CAP in sever and non-severe cases?

Answer 10

Non-severe
- oral antibiotics
Severe
- iv antibiotics

Question 11

How is the severity of CAP assessed? What are the implications of this score?

Answer 11

CURB 65
Confusion
Urea
Respiratory Rate
BP
65 age greater than 65

1-2 safe for oral treatment
more than 2 = iv treatment
more than 4 = intensive care/

Question 12

What are the complications of CAP?

Answer 12

respiratory failure
lung abcess
parapneumoinc effusion (simple or complex, empyema

Question 13

What is the management of empyema?

Answer 13

antibiotics
drainage
surgery to break adhesion, decortication, open drainage

Question 14

What are the symptoms of TB?

Answer 14

night sweats, fever
weight loss
productive cough
haemoptysis 
may be latent or act

Question 15

How is TB diagnosed?

Answer 15

acid fast bacilli sputum test
aspirate involved lymph nodes
bronchoscopy if not making sputum
vitamin D levels?

Question 16

What are the most common spread sites for TB?

Answer 16

meninges and musculoskeletoal

Question 17

What is the most common complication of antibiotics used to treat TB?

Answer 17

hepatitis

Question 18

How can TB be controlled in the community?

Answer 18

housing/overcrowding
nutrition, child health
immunisation?
chemoprophylaxis for family members

Question 19

What is bronchiectasis?

Answer 19

chronic bronchial dilation, poor mucus clearance, recurrent infection

Question 20

What is the aetiology of bronchiectasis?

Answer 20

post infective
aspiration
mechanical obstruction
immune deficiency
RA, IBD
poor mucociliary clearance, CF or PCD

Question 21

What are the investigations for bronchiectasis?

Answer 21

CXR - tramline, cystic change
sputum culture
think about causes
CT - bronchial wall thickening, signet ring

Question 22

What is the management of bronchiectasis?

Answer 22

physiotherapy and postural drainage
bronchodilators as airways tend to collapse
antibiotics