lower respiratory Flashcards
acute bronchitis
preceded by common cold
cold which goes to the chest
acute bronchitis clinical features
productive cough fever normal CXR normal chest exam transient wheeze
acute bronchitis treatment
usually self limiting
antibiotics not indicated
can lead to significant morbidity in patients with chronic lung disease
infections in patients with COPD
variable disease chronic sputum production bronchoconstriction inflammation of the airways SOB chest pains exacerbation - infective, non-infective
acute exacerbation of COPD
may be preceded by upper respiratory infection - sputum, wheezy, SOB
examination - respiratory distress, wheeze, coarse crackles, cyanosed, ankle oedema
management of acute exacerbation of COPD primary care
antibiotic - doxycycline or amoxicillin
bronchodilator inhalers
short course of steroids
refer to hospital if evidence of respiratory failure, not coping at home
management of COPD exacerbation in hospital
arterial blood gases
CXR
oxygen if hypoxaemic
rest, then mobilise
red hpatisation
consolidation caused by pneumonia
named as looks more like liver tissue
pneumonia symptoms
malaise anorexia sweats rigors myalgia arthralgia headache confusion cough pleurisy haemoptysis dyspnoea preceding URTI abdominal pain diarrhoea
pneumonia signs
fever rigors herpes labialis tachypnoea crackles rub cyanosis hypotension
pneumonia investigation
blood culture serology arterial blood gases full blood count urea liver function CXR
CURB65
community required pneumonia Confusion Urea>7 Respiratory rate Blood pressure systolic <90 or diastolic <60 65 years or older
community acquired pneumonia management
antibiotics - amoxicillin, doxycycline oxygen fluids bed rest no smoking
pathogens
S. pneumoniae H. influenzae legionella sp staph aureus M. pneumoniae C. pneumonia Gm -ve enterobacteria viruses influenza A & B chlamydia psitacci coxiella burnetii
mycoplasma pneumonia
wide range of pathologies pneumonia hepatitis immune thrombocytopenic purpura autoimmune haemolytic anaemia arthritis no cell wall causes protracted paroxysmal cough common cause of community acquired pneumonia person to person spread
hospital acquired pneumonia
need extended gram negative cover
amoxicillin, gentamicin
apiration pneumonia
need anaerobic cover
amoxicillin, metronidazole
legionella
chest symptoms may be minimal
GI disturbance is common
confusion common
levofloxacin
IV antibiotics when
oral route not available
sensitivities
deep seated infections -abscesses, bone, endocarditis, meningitis
first dose
lifestyle
HIV - PCP PWID - staph aureus alcohol/homeless - TB, Klebsiella frequently hospitalised - pseudomonas returning traveller - legionella, TB indian sub-continent - TB eastern Europe - MDR TB
complications of pneumonia
respiratory failure
pleural effusion
empyema
death
influenza clinical presentation
fever - high, abrupt onset malaise myalgia headache cough prostration
classical flu
influenza A
influenza B
Flu like illnesses
parainfluenza viruses
haemophilus influenzae
bacterium
not a primary cause of flu
may be a secondary invader
flu transmission
by droplets, through direct contact with secretions of someone with the infection
flu complications
primary influenzal pneumonia secondary bacterial pneumonia bronchitis otitis media perinatal mortality, prematurity, smaller neonatal size, lower birth weight
flu therapy
symptomatic - bed rest, fluids, paracetamol
antivirals - oseltamivir (tamiflu), zanamivir
lab confirmation of influenza
direct detection of virus
PCR
nasopharyngeal swabs
throat swabs
coxiella burnetii
Q fever - pyrexia of unknown orign pneumonia uncommon, sporadic zoonosis sheeps and goats complication - culture negative endocarditis
chlamydophila psittaci
casues Psittacosis
uncommon, sporadic zoonosis
caught from pet birds
presents as pneumonia
bronchiolitis
lung infection and causes inflammation and congestion in bronchioles
1st or 2nd year of life
fever
coryza
cough
wheeze
severe cases - grunting, decrease PaO2, intercostal/sternal indrawing
bronchiolitis complications
respiratory and cardiac failure
chlamydia trachomatis
STI which can cause infantile pneumonia
diagnosed by PCR on urine of mother or pernasal/throat swabs of child
chlamydophila pneumoniae
person to person
mostly mild respiratory infection
may be picked up by test foe psittacosis
