Lower respiratory tract

Question 1

what are common lower respiratory tract infections

Answer 1

• Bronchitis
• Bronchiolitis
• Pneumonia
• Influenzas

Question 2

what is the common pathogen in the LRTI

Answer 2

• Common pathogen is either a bacteria or a virus

Question 3

what is bronchitis

Answer 3

• Inflammation of the bronchioles,

Question 4

how many people have bronchitis

Answer 4

• Acute bronchitis; high incidence 30-50 people per 1000 people/yr

Question 5

what causes acute bronchitis

Answer 5

• Approximately 90% casue = virus and 10% cases = bacterial self-limiting

Question 6

what specific bacteria and viruses cause bronchitis

Answer 6

• Vrisues = adenovirus, coronavirus, parainfluenza, influenza and rhinovirus
• Bacteria; Bordetella pertussis and mycoplasma pneumonia
• Severe bronchiolitis (children <2yr); respiratory syncytial virus

Question 7

what are the symptoms of acute bronchitis

Answer 7

• Sore throat
• Fatigue
• Stuffy or runny nose
• Fever
• Body aches
• Vomiting
• Diarrhea
  Self-limiting – symptomatic up to 2 weeks
  Minority – severe illness and require hospital admission (ventilator support

Question 8

what is the pathophysiology of acute bronchitis

Answer 8

• Inflammation of the bronchi

- Inflammation equals swelling and narrowing of the bronchi

Question 9

who is acute bronchitis more of a problem in

Answer 9

• Especially in children under the age of 2 it is a problem

Question 10

describe how RSV can cause acute bronchitis

Answer 10

• Epithelial cells that line the airways that get infected and are picked up by pattern recognition receptors and then you get this recruitment of neutrophils, macrophages and natural killer cells this is part of the first line of defence
• Dendritic cells process these viruses and present it to the adaptive and acquired immune system
• T cells activate eosinophils what activate CD4+ T cell and CD8+ T cell

Question 11

how do you prevent the spread of acute bronchitis

Answer 11

• Avoid contact with viral particles
• Wash hands frequent
• Avoid touching your eyes with contaminated hands
• Use disposable tissue
• Use instant hand sanitizers to stop the spread of germs
• Avoid touching your nose
• Prevention goal – decrease infection risk

Question 12

describe how you come to the diagnosis of acute bronchitis

Answer 12

• cough less than or equal to 3 weeks or/or not sputum
• if you have sings of consolidation, airway obstruction, fever, increases RR and increases HR then you should consider asthma or other pulmonary diseases
• cough less than or equal to 3 weeks or/or not sputum
• if you don’t have signs of consolidation, airway obstruction, fever, increased RR and increased HR, then check to see if it is being documented during and outbreak of influenza
• if yes treat as appropriate e
• if no then they have acute bronchitis

Question 13

what is the treatment for acute bronchitis

Answer 13

• exepected 14 day duration of cough
• educate them on the fat that lack of evidence for antibiotics
• encourage increased fluid intake, humidity
• recommend antipyretics, analgesics, antitussives for symptom relief

Question 14

describe facts of pneumonia

Answer 14

• Leading cause of infection in children
• 6 out of 10 childhood pneumonia deaths are concentrated in 10 countries
• More deaths for children under 5 than any other disease

Question 15

describe the definition of pneumonia

Answer 15

• Inflammation of the alveoli in either one or both lungs

- Alveoli become inflamed and fill up with fluid

Question 16

what pathogen causes pneumonia

Answer 16

• bacteria or virus

Question 17

who is at risk from pneumonia

Answer 17

• elderly and the very young

Question 18

what vaccination can you use for pneumonia

Answer 18

• Pneumooccal vaccines used as a preventer

Question 19

what is the most frequent cause of pneumonia

Answer 19

• In the EU streptococcus pneumoniae is the most frequent causative agent across all severities and ages
• Antibiotic resistance S. pneumoniae: Penicillin (10%) & Macrolides (15%)

Question 20

what are the symptoms of pneumonia

Answer 20

• Commonly resolve spontaneously withint 4-7 days
• Headache
• Fever
• Weakenss
• Dry cough
• Nasal congestion
• Chills
• Sore throat
• Sweating
• Muscle aches
• Symptoms commonly last for 3-4 weeks
• Daily activities are impaired for a further 3 weeks on average

Question 21

describe the pathophysiology of pneumonia

Answer 21

Pneumonia (direct injury) → Inflammation → Innate immunity →Alveolar injury/dysfunction

Invasion & overgrowth of a pathogenic microorganism in the lung parenchyma → intra-alveolar exudates → Pneumonia

If there is enough repetitive injury to the alveoli then they cross into the systemic circulation, the neutrophils will then start to modulate this

Question 22

how do you diagnose pneumonia

Answer 22

• Physical exam
• Complete blood count
• Sputum culture
• Urine test
• PCR
• CT scan
• Chest radiograph to allow accurate diagnosis.- consolidation in the lower zones

Microbiological investigations

• Urea and electrolytes to inform severity assessment.
• C-reactive protein to aid diagnosis and as a baseline measure.
• Full blood count and Liver function tests

Question 23

what is community acquired pneumonia

Answer 23

• this is pneumonia that happens in the community

Question 24

how can you diagnose pneumonia in the community

Answer 24

= Symptoms + New focal chest signs on examination + At least one systemic feature (fevers, sweats, rigors and/or a temperature of ≥38oC)

Question 25

how can you diagnose pneumonia in the hospital

Answer 25

= clinical symptoms & signs of an lower respiratory tract infection + chest-X-ray (consolidation)

Question 26

describe the points in the CRB65 score

Answer 26

• 1 point for each feature present
• Confusion,
• Respiratory rate is greater than or equal to 30 l/min
• Blood pressure hypotensive
• Age greater than equal to 65 years
• if 0 - dutiable for home treatment and given antibiotics
• if 1-2 moderate severity should consider a hospital referral
• if 3-4 high severity - urgent hospital admission, empirical antibiotics if life threatening

Question 27

what does severe pneumonia and very severe pneumonia look like if your younger than 2 months

Answer 27

Severe pneumonia

• RR is greater or equal to 60l/min
• Lower chest wall in drawing
• But no signs of very severe pneumonia

Very severe pneumonia

• Central cyanosis
• Not able to drink
• Head nodding

Question 28

If you between 2-60 months what does

• pneumonia look like
• severe pneumonia
• very severe pneumonia look like

Answer 28

Pneumonia

• Respirator rate is greater than or equal to l/min (2-11 months of age)
• Respiratory rate greater than or equal to 40l/min (for 12-60 months of age
• But no signs of severe or very sever pneumonia

Severe pneumonia

• Low chest wall in drawing
• But no sings of very severe pneumonia

Very severe pneumonia

• Central cyanosis
• Unable to drink
• Head nodding

Question 29

if they have a CRB65 score of 0 how do you treat

Answer 29

- amoxicillin 500mg
or
- doxycycline 200mg loading then 100mg 
or
- clarithromycin 500mg BD
for 5-7 days

Question 30

if they have a CRB65 score of 1-2 how do you treat

Answer 30

• amoxicillin 500mg plus, clarithromycin 500mg dual therapy
  or
• doxycycline monotherapy 200mg loading then 100mg

Question 31

if they have a CRB65 score of 3 or more how do you treat

Answer 31

• bezylpencillin 1-2g IV or amoxicillin 1g

Question 32

describe treatment plan for children aged 2-59 months

Answer 32

• cough and cold means they have no pneumonia so home care advice
• fast breathing and or chestt undraping pneumonia - oral amoxicillin and home care advice
• general danger signs - severe pneumonia or very severe disease - first dose antibiotic and referral to facility for injectable antibiotic/supportive therapy