lower resp tract infection in adults Flashcards
what are examples of lower respiratory tract infections in adults
acute brinchitis exacerbation of COPD pneumonia - empyema - lung abscesss - bronchiectasis
what is acute bronchitis
inflammation of bronchi temporary <3 months cough and coutum usuallt viral supportive management
what is COPD exacerbation
change in colour of sputum fevers increased breathlessness wheeze cough - strep pneum - haem flu - moraxella cat viral
what is pneumonia and what are the risk factors
inflammation of lung parenchyma
- smoking and alcohol
- extremes of age
- preceding viral illness
- pre existing lung disease
- chronic illness
- immunocompromised
- howpitalisation
- IVDU
what are the clinical features of pneumonia
symptoms - fever, rugir, myalgia, cough and sputum, chest pain, dyspnoea and haemoptysis
signs - tachypnoea, tachycardia, rescued expansion. full percussion, bronchial breathing crépitations and vocal reasonable
what are the investigations for pneumonia
community - maybe none, CXR if in doubt
hospital / bloods - serum biochemistry, FBC, CRP and blood cultures
CXR
sputum culture, viral throat swab legionella urinary antigen
what are the classifications of pneumonia
community: typical (step pneum) and atypical chlamydia pneum)
nosocomial (entérobactéria)
what is the severity scoring for pneumonia
CURB 65
C - confusion
U - blood urea >7mmol/L
R - respiratory rate more than or equal to 30/min
B - systolic BO < 90mmhg, diastolic blood pressure < 60mmhg
65 - age more than or equal to 65
scores mean
0-1 - low risk - community treatment
2 - modersate - usuallt need hospital treatment
3-5 - high risk of death
what antibiotic would normally be used for pneumonia
amoxicillin or co-amoxiclav with clarithromysin
what are special circumstances in patients w pneumonia
influenza
aspiration pneumonia
immunocompromised
MRSA - vancomycin
what are the complications of pneumonia
sepsis acute kidney injury adult respiratory distress syndrome parapneumonic effusion empyema lung abscess disseminated infection
parapneumonic effusion/ empyema characteristics
thoracic ultrasound +/- aspirate fluid parameters - simple ph>7.2 complicated pH<7.2 empyema pus/culture postive may need drain + prolonged abx surgery/intrappeural tpA + DNAse
lung abscess characteristic
more likely with staph aureus, pseudomonas and anaerobes purulent sputum, haemoptysis screen for tb CT scan +/- bronchoscope prolonged antibiotics
describe the reconvert of pneumonia
takes weeks
repeat CXR 6 weeks of >50yrs, smokers
smoking cessation
when does recurrent pneumonia occur
in the immunocompromised
underlying structural lung disease
aspiration
what are the causes of bronchiectasis
idiopathic childhood infection cf ciliary dyskinesia hypogammaglobulinaemia allergic broncho- pulmonary aspergillosis
what is bronchiectasis
chronic productive cough breathlessness récurrent LRTI haemoptysis finger clubbing crépitations wheeze obstructive spirometry
