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Respiratory System > Lower respiratory tract infection > Flashcards

Lower respiratory tract infection Flashcards

1
Q

What is the rough mortality in hospitalised patients with pneumonia?

A

5.7-12%

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2
Q

Symptoms of pneumonia

A
  • Malaise
  • Myalgia
  • Fever
  • Chest pain (pleuritic)
  • Cough
  • Purulent sputum
  • Dyspnoea
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3
Q

Signs of pneumonia

A
  • Pyrexia
  • Tachpnoea
  • Central cyanosis
  • Dullness on percussion of affected lobes(s)
  • Bronchial breath sounds
  • Inspiratory crepitations
  • Increased vocal resonance
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4
Q

Techniques used to investigate pneumonia

A
  • Serum biochemistry, CRP and full blood count
  • Chest X-ray (CXR)
  • Blood cultures
  • Throat swab (for atypical pathogens)
  • Urinary legionella antigen
  • Sputum microscopy and culture
  • HIV test
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5
Q

What severity scoring is used for pneumonia?

A 
- CURB 65
C - confusion
U - blood urea >7
R - respiratory rate >30
B - diastolic blood pressure <60
65 - age >65
and a score of 0, 1-2, 3-5
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6
Q

Treatment for pneumonia CURB 0-1

A

Amoxycillin or clarithromycin/ doxycycline

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7
Q

Treatment for pneumonia CURB 2

A

Amoxicillin and clarithromycin or levofloxacin

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8
Q

Treatment for pneumonia CURB 3-5

A

Co-amoxiclav and clarithromycin or levofloxacin (if penicillin allergic)

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9
Q

Specific situations in pneumonia

A
  • Aspiration pneumonia
  • Haematological malignancy/neutropenia
  • Legionnaires disease
  • Influenza
  • Staphylococal pneumonia including PVL toxin
  • MRSA
  • HIV
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10
Q

Supportive treatments for pneumonia

A
  • Oxygen
  • IV fluids
  • CPAP (continuous positive airway pressure)
  • Intubation and ventilation
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11
Q

Complications of Pneumonia

A
  • Septicaemia
  • Acute kidney injury
  • Empyema
  • Lung abscess
  • Metastatic infection
  • ARDS
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12
Q

Differential diagnoses that may be mistaken for pneumonia

A
  • Tuberculosis
  • Lung cancer
  • Pulmonary embolism
  • Pulmonary oedema
  • Pulmonary vasculitis (Wegners granulomatosis)
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13
Q

What is empyema?

A

Pus in the pleural space. It should be suspected if a patient with a resolving
pneumonia develops a recurrent fever.
- The aspirated fluid is typically yellow and turbid with a pH <7.2.

-Streptococcus (52%). Staph. Aureus (11%), Anaerobes (20%)

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14
Q

What are symptoms of Empyema?

A
  • Chest pain is a prominent feature
  • Absence of cough
  • Often high swinging fever
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15
Q

What techniques can be used to investigate empyema?

A
  • CT thorax and pleural ultrasound.
  • Diagnosed by diagnostic pleural aspiration (pH <7.20)
  • CXR indicates a pleural effusion.
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16
Q

How is empyema treated?

A
  • Chest drain and intravenous antibiotics
  • Antibiotic treatment may be prolonged e.g. 6 weeks.
  • Intrapleural t-PA/DNase sometimes required to break down fluid that is too thick.
17
Q

What is a lung abscess?

A

A cavitating area of localised, suppurative infection within the lung.

18
Q

Causes of lung abscess?

A
  • Inadequately treated pneumonia
  • Aspiration
  • Bronchial obstruction
  • Pulmonary infarction
19
Q

Symptoms of lung abscess

A

Symptoms may be non-specific

- e.g. Lethargy, weight loss, high swinging fever.

20
Q

Techniques to investigate lung abscess

A
  • Full blood count (anaemia, neutrophilia)
  • CXR: walled cavity, often with a fluid level.
  • Consider CT scan to exclude obstruction.
  • Sputum culture (including TB microscopy and culture).
21
Q

Treatment for lung abscess

A
  • Prolonged antibiotics

- Drainage is via bronchial tree, but occasionally percutaneous drainage may be necessary.

22
Q

What is Bronchiectasis?

A

Bronchiectasis is a long-term condition that affects the airways in your lungs.

  • If you have bronchiectasis, your airways are scarred and inflamed with thick mucus.
  • Your airways become widened and cannot clear themselves properly.
23
Q

Causes of Bronchiectasis

A
  • Idiopathic
  • Immotile cilia syndrome
  • Cystic fibrosis
  • Childhood infections e.g. measles
  • Hypogammaglobulinaemia
  • Allergic bronchopulmonary aspergillosis (ABPA)
24
Q

Symptoms of Bronchiectasis

A
  • Chronic cough
  • Daily sputum production (often copious)
  • Sometimes: Wheeze, dyspnoea, tiredness, flitting chest pains, haemoptysis.
25
Q

Signs of bronchiectasis

A
  • Finger clubbing

- Course inspiratory crepitations (auscultation)

26
Q

Techniques used to investigate Bronchiectasis

A
  • High resolution computed tomography (HRCT) thorax
  • Sputum culture: typically includes haemophilus influenzae, staph. aureus and pseudomonas aeruginosa
  • Serum immunoglobulins
  • Total IgE and Aspergillus precipitins
  • CF genotyping
27
Q

Treatment for Bronchiectasis

A
  • Chest physiotherapy
  • Immediate treatment of infection with appropriate antibiotics
  • May require inhaled therapy including beta2 agonist and inhaled corticosteroid.

Respiratory System (28 decks)

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