Lower Respiratory Tract Infection Flashcards by Ellen Meehan

name some symptoms of LRTI

> malaise
> fever
> chest pain (pleuritic)
> cough
> purulent sputum
> dyspnoea
> headache

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name some symptoms of LTRI

> pyrexia
> tachpnoea
> central cyanosis
> dullness on percussion
> bronchial breath sounds
> inspiratory crepitations
> increased vocal reasonance

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what investigations should be carried out if a LRTI is suspected?

> serum biochemistry
> full blood count
> blood cultures
> throat swab
> sputum microscopy and cuture

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what is the most common organism to cause pneumonia?

strep. pneumonia

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what two species that cause pneumonia affect young people and are associated with no respiratory complications?

> mycoplasma

> chlamydia

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what other organisms cause pneumonia?

> h. influenza
legionella
staph aureus

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explain the CURB 65 severity scoring

Confusion
U blood urea >7
Respiratory rate >30
B diastolic blood pressure <60
65, if the are older than 65

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how would you treat a patient with a CURB score of 0/1?

amoxicillin or clarithromycin/doxycyciline

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how would you treat a patient with a curb score of 2?

amoxicillin and clarithromycin or levofloxacin

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how would you treat a patient with a curb score of 3/4/5?

co-amoxiclav and clarithromycin or levofloxacin

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what supportive treatment could you give to someone with pneumonia?

> oxygen if they are hypoxic
i.v. fluids if they are shocked
continuous positive airway pressure
intubation and ventilation

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what complications can arise from pneumonia?

> septicaemia 
> acute kidney injury
> empyema (infection in the pleural space)
> lung abscess
> haemolytic anaemia
> ARDS

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what is the differential diagnosis for pneumonia?

> tuberculosis
> lung cancer
> pulmonary embolism
> cardiac failure
> pulmonary vasculitis

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what is an empyema?

this is an infection of the pleural space that can often follow pneumonia. there is diffuse ossification of the thorax and along the pleura causing it to thicken.

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what are the signs and symptoms of empyema?

> chest pain

> high swinging fever

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what in investigations are carried out in an empyema?

chest CT scan and a pleural ultrasound

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how is an empyema treated?

with a chest drain and intravenous antibiotics that may be prolonged to 6 weeks

what organisms are more likely to result in a cavitating pneumonia?

staph. aureus
pseudomonas
anaerobes

what is bronchiectasis?

this is a chronic condition where airways become full of mucous and dilate

name some causes of bronchiectasis?

> idiopathic
immotile cilia syndrome (cilia don’t work properly)
cystic fibrosis
childhood infections such as measles
hypogammaglobulinaemia (immunoglobulin G isn’t produced so infection cannot be fought as well)
allergic bronchopulmonary aspergillosis

what are the symptoms of bronchiectasis?

> chronic cough

> daily sputum production

what are the signs of bronchiectasis?

> finger clubbing

> course inspiratory crepitations

what investigations should be carried out in bronchiectasis?

> CT of the thorax
> sputum culture
> serum immunoglobulins
> total IgE and aspergillus precipitins
> CF genotyping

what is the treatment for bronchiectasis?

> chest physiotherapy
treatment of infection with antibiotics
maybe inhaled therapy with beta 2 agonists and inhaled corticosteriods

what are some viral infectious agents that cause LTRI in children?

> RSV > parainfluenza 3 > influenza A and B > adenovirus

what is tracheitis?

this is croup (barking cough and stridor) that does not get better. the tracheal wall is swollen and there are luminal debris which cause the narrowing of the tracheal debris. the child is very sick and feverish. It is caused by staph and strep.

what are the symptoms of bronchitis?

> loose rattily cough > post-tussive vomit > child well (parents worried)

what is bacterial bronchitis caused by?

the disturbed mucociliary clearance by minor airway malacia or RSV/adenovirus.

what would you expect to hear in a child with bronchitis in auscultation?

no wheeze or creps

describe the natural history of bronchitis

it is usually following an URTI and lasts around 4 weeks. the first week is the worst then each winter it gets less severe.

what is the criteria for persistent bacterial bronchitis?

> wet cough > more than 1 month > remission with antibiotics

what species is the cause of bronchiolitis?

RSV, para flu 3 and HMPV

what are the signs and symptoms of bronchiolitis?

> nasal stuffiness > tachypnoea > poor feeding > crackles

bronchiolitis is caused by a respiratory sinsitium virus. what does this virus do to cells?

it creates multinucleated cells by breaking down the walls between the cells until the huge cell breaks off.

how would you manage bronchiolitis?

maximum observation and minimal intervention

what investigations would you carry out for bronchiolitis?

> NPA cohorting | > oxygen saturation (severity)

describe the signs in childhood pneumonia?

> focal signs > presence of creps > fever

what is the management for childhood pneumonia?

> nothing if it is mild > first line oral amoxicillin > oral macrolide (second choice) > only iv antibiotics if they are vomiting

what are the signs and symptoms of pertussis?

> coughing fits (more than 2 weeks) > vomiting > colour change

how is empyema in children managed?

intravenous antibiotics