Lower Respiratory tract infection

Question 1

What are factors that predispose someone to LRTIs?

Answer 1

• loss/suppression of cough reflex/swallow
• ciliary defects
• mucus disorders
• pulmonary oedema
• immunodeficiency
• macrophage function inhibition

Question 2

What is acute bronchitis?

Answer 2

inflammation and oedema of trachea and bronchi

Question 3

How does acute bronchitis present?

Answer 3

cough (typically dry), dyspnoea and tachypnoea

Question 4

What are the usual cause of acute bronchitis?

Answer 4

viruses (rhinovirus, coranovirus, adenovirus, influenza)

Question 5

How would you treat acute bronchitis?

Answer 5

-supportive treatment for healthy patients
-severe disease may require oxygen therapy
(-antibiotics in bacterial infection)

Question 6

Define chronic bronchitis

Answer 6

cough productive of sputum on most days during at least 3 months of 2 successive years

Question 7

What mediated the inflammation and oedema in chronic bronchitis?

Answer 7

exogenous irritants

Question 8

What is bronchiolitis?

Answer 8

inflammation and oedema of bronchioles

Question 9

How does bronchiolitis present?

Answer 9

acute onset wheeze, cough, nasal discharge, respiratory distress

Question 10

What is the most common cause of bronchiolitis?

Answer 10

RSV

Question 11

Which age group is most at risk of bronchiolitis?

Answer 11

infants (2-10 months)

Question 12

What tests would you require to diagnose bronchiolitis?

Answer 12

chest x-ray and full blood count and microbiological diagnosis

Question 13

How would you treat bronchiolitis?

Answer 13

-supportive: oxygen, feeding assistance

Question 14

What is pneumonia?

Answer 14

infection affecting the most distal airway and alveoli (with formation of inflammatory exudate)

Question 15

What are the characteristics of bronchopneumonia?

Answer 15

patchy distribution centred on inflamed bronchioles and bronchi then subsequent spread to alveoli

Question 16

What is the main cause of lobar pneumonia?

Answer 16

> S. pneumoniae

Question 17

Define hospital acquired pneumonia

Answer 17

pneumonia developing >48hrs after hospital admission

Question 18

Define ventilator acquired pneumonia

Answer 18

pneumonia developing >48hrs after ET incubation and ventilation

Question 19

Define aspiration pneumonia

Answer 19

pneumonia resulting for the abnormal entry of fluids into the lower respiratory tract

Question 20

What are the symptoms of bacterial community acquired pneumonia?

Answer 20

• rapid onset
• fever/chills
• productive cough
• mucopurulent sputum
• pleuritic chest pain
• malaise

Question 21

What are the signs of bacterial community acquired pneumonia?

Answer 21

tachypnoea, tachycardia, hypotension, dull to percuss, bronchial breathing

Question 22

What is the clinical presentation of mycoplasma pneumoniae?

Answer 22

• autumn epidemics
• commonest in children and young adults
• main symptom is cough
• complications include: pericarditis, peripheral neuropathy

Question 23

What is the clinical presentation of legionella pneumophilia?

Answer 23

• colonises water piping systems
• outbreaks associated with showers
• high fevers, rigors, cough (dry then become productive)

Question 24

What is the clinical presentation of chlamydophila pneumonia?

Answer 24

• incidence highest in elderly

- causes mild pneumonia or bronchitis

Question 25

What is the clinical presentation of chlamyophila psittaci?

Answer 25

- associated with exposure to birds | - may also have rash, hepatitis, haemolytic anaemia, reactive arthritis

Question 26

What is the clinical presentation of viral influenza?

Answer 26

fever, headache, myalgia, dry cough, sore throat

Question 27

How would primary viral pneumonia present?

Answer 27

cough, breathlessness, cyanosis

Question 28

Which patients are offered a pneumococcal vaccination?

Answer 28

- patients with chronic heart, lung and kidney disease | - patients with splenectomy