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A2. Respiratory system > Lower Respiratory Tract Infection > Flashcards

Lower Respiratory Tract Infection Flashcards

1
Q

What are the possible lower respiratory tract infections?

A 
Acute bronchitis
Exacerbation of COPD
Pneumonia
Empyema
Lung abscess
Bronchiectasis
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2
Q

What are the symptoms of pneumonia?

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

What is rusty sputum usually associated with?

A

Pneumococcal pneumonia

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4
Q

What are the signs of pneumonia?

A 
Pyrexia
Tachpnoea
Central cyanosis
Dullness of percussion of affected lobes
Bronchial breath sounds
Inspiratory crepitations
Increased vocal resonance
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5
Q

What are the relevant investigations for patients with pneumonia?

A 
Serum biochemistry and full blood count
Chest X-Ray
Blood cultures
Throat swabs
Urinary legionella antigen
Sputum microscopy and culture
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6
Q

What are the most likely causes of pneumonia?

A 
Strep pneumoniae
H.Influenzae
Legionella
Staph Aureus
Mycoplasma pneumoniae - Chlamydia psittaci
All viruses
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7
Q

What is the scoring method for pneumonia?

A

CURB65

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8
Q

How does the CURB 65 score work?

A 
Confusion
Blood urea above 7
Respiratory rate above 30
Diastolic blood pressure less than 60
Age older than 65

A score of:
0 - indicates low risk
1/2 - Hospitalization
3/5 - High risk of death and need for ITU

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9
Q

How do you treat CURB 0-1?

A

Amoxycillin or clarithromycin / doxycycline

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10
Q

How do you treat CURB 2?

A

Amoxycillin and clarithromycin or levoflaxin

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11
Q

How do you treat CURB 3-5?

A

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

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12
Q

What other treatment besides antibiotics is advisable?

A

Oxygen
i.v. fluids
Continuous positive airway pressure
Intubation and ventilation

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13
Q

What are the complications associated with pneumonia?

A 
Septicaemia (typically develop shock)
Acute kidney injury
Empyema
Lung abscess
Haemolytic anaemia
ARDS
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14
Q

What might pneumonia get confused with?

A 
TB
Lung cancer
Pulmonary embolism
Cardiac failure
Pulmonary Vasculitis (Wegners granulomatosis)
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15
Q

Where does TB infect the lung?

A

Upper lobes because TB is aerophilic and the upper lobes tend to have more air

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16
Q

Why can pulmonary embolism look like pneumonia on a scan?

A

Because of the pulmonary infarcts they cause

17
Q

What are the most common causes of empyema?

A

Streptococcus
Staph aureus
Anaerobes

18
Q

What are the signs/symptoms of empyema?

A

Chest pain
Absence of cough
High fever

19
Q

How do you investigate empyema?

A

CT and ultrasound

20
Q

How do you diagnose empyema?

A

pH is less than 7.2 after pleural aspiration

21
Q

What is the treatment of empyema?

A

Chest drain and intravenous antibiotics (prolonged - 6 weeks)
Intrapleural tissue plasminogen activator and DNase sometimes required (these break down adhesions in pleural space and allow tissue to flow out)

Surgery for patients who do not improve with the above management

22
Q

What can lung abscesses follow from?

A

Pneumonia

23
Q

What are the symptoms of a lung abscess?

A

Non-specific
Lethargy
Weight loss
High Swinging fever

24
Q

What are the relevant investigations for lung abscess?

A

CT thorax
Sputum culture
TB microscopy and culture as TB can be cavitating

25
Q

Which bacteria are more likely to cause lung cavitation?

A

Staph. Aureus, pseudomonas

26
Q

What is treatment for lung abscess?

A

Prolonged antibiotics

Drainage via the bronchial tree or pericutaneous

27
Q

What is bronchiectasis defined as?

A

Abnormal widening of the bronchi or their branches, causing a risk of infection

28
Q

What are the causes of bronchiectasis?

A 
Idiopathic
Immotile cilia syndrome
Cystic fibrosis
Childhood infection (measles)
Hypogammaglobulinaemia
Allergic bronchopulmonary Aspergillosis
29
Q

What is hypogammaglobulinaemia?

A

(body does not produce immunoglobulin G)

30
Q

What is allergic bronchopulmonary aspergillosis?

A

Presents like asthma (wheezing and cough)

Allergy to aspergillus

31
Q

What are the symptoms of bronchiectasis?

A 
Chronic cough
Daily sputum production
Sometimes -
Dyspnoea
Tiredness
Flitting chest pains
Haemoptysis
32
Q

How do you describe the flitting chest pains in bronchiectasis?

A

Short lived, vary between the left and the right hand side

33
Q

What are the signs for bronchiectasis?

A 
Finger clubbing (in severe cases)
Course inspiratory crepitations
34
Q

What are the relevant investigations for bronchiectasis?

A

HRCT thorax
Sputum culture - will typically include haemophilus influenzae which can be resistant to amoxicillin
Serum immunoglobulins (searching for Hypogammaglobulinaemia)
Total IgE aspergillus precipitations
CF genotyping

35
Q

What is the treatment of bronchiectasis?

A 
Chest physiotherapy since massive sputum production
High dose antibiotics
Inhaled therapy (corticosteroids and beta 2 agonists)

A2. Respiratory system (77 decks)

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