lower resp tract infection Flashcards
whats the uuk incidence of pneumonia?
5-11 per 1000
whats the mortality rate of in hospitalised patients with pneumonia?
5.7-12%
what are symptoms of pneumonia?
malaise fever chest pain cough purulent sputum dyspnoea
what are signs of pneumonia?
pyrexia tachpnoea central cyanosis dullness on percussion of affected lobe bronchial breath sounds inspiratory crepitations increased vocal resonance
how do you investigate pneumonia?
Serum biochemistry and full blood count Chest X-Ray (CxR) Blood cultures Throat swab (for atypical pathogens) Urinary legionella antigen Sputum microscopy and culture
whats the most commen mycobacteria that contributes to pneumonia?
strep Pneumoniae
and H.influenzae
what is the pneumonic for severity if pneumonia?
CURB 65 confusion blood urea >7 Resp rate >30 Blood pressure <60 age >65
what is the scoring like for severity of pneumonia?
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
what would the treatment be for CURB 0-1 ?
amoxycillin or clarithromycin/ doxycycline
what would the treatment be for CURB 2?
Amoxycillin and clarithromycin or levofloxacin
what would the treatment be for CURB 3-5
Co-amoxiclav and clarithromycin or levofloxacin (if penicillin allergic)
what are other treatments for pneumonia that isnt antibiotics?
oxygen
i.v. fluids
CPAP
intubation and ventilation
what is pneumonia?
inflammatory condition of the lung affecting primarily the small air sacs known as alveoli
what are complications of pneumonia?
Septicaemia Acute Kidney Injury Empyema Lung Abscess Haemolytic anaemia (mycoplasma) ARDS
what other diseases or conditions have the same symptoms thus making it hard to differentiate between?
Tuberculosis Lung cancer Pulmonary embolism Cardiac failure Pulmonary vasculitis (Wegners granulomatosis)
what is empyema?
a collection of pus in the pleural cavity caused by microorganisms, usually bacteria. Often it happens in the context of a pneumonia, injury, or chest surgery. It is one of the various kinds of pleural effusion.
what would you use to investigate empyema?
CT thorax
pleural utlrasound
is empyema presented with a cough?
no
how is empyema diagnosed?
diagnostic pleural asspiration
whats the/ treatment for empyema
chest drain
intravenous antibiotics
what are lung abscess
a type of liquefactive necrosis of the lung tissue and formation of cavities (more than 2 cm)[1] containing necrotic debris or fluid caused by microbial infection.
what are the symptoms of lung abscess?
may be non specific
lethargy
weight loss
jigh swinging fever
how would you investigate lung abscesses?
Investigate with CT thorax and sputum culture (including TB microscopy and culture).
what are the causes of bronchiectasis?
Idiopathic Immotile Cilia Syndrome Cystic fibrosis Childhood infections such as measles Hypogammaglobulinaemia Allergic Bronchopulmonary Aspergillosis (ABPA)
what are symptoms of bronchiectasis?
chronic cough
daily sputum
sometimes: wheeze, dyspnoea, tiredness, flitting chest pains, haemoptysis
what are the signs of bronchiecstasis?
finger clubbing
course inspiratory crepitations
how would you investigate bronchiectasis?
HRCT Thorax Sputum culture microbiology typicall includes haemophilus influenzae, staph. aureus and pseudomonas aeruginosa Serum immunoglobulins Total IgE and Aspergillus precipitins CF genotyping
whats the treatment of bronchiectasis?
Chest physiotherapy
Prompt treatment of infections with appropriate antibiotics
May require inhaled therapy including beta2 agonist and inhaled corticosteroid.
whats acute bronchitis
inflammation of the trachea and bronchi
what is myalgia?
muscle aches
what would you give to a patient with pneumonia if they are allergic to penecillin (amoxycillin)?
clarithromycin or doxycycline
