Lower respiratory tract infection - acute bronchitis & pneumonia (covered separately)

Question 1

What is acute bronchitis?

Answer 1

Acute bronchitis is a type of chest infection that is usually self-limiting, resulting from inflammation of the trachea and major bronchi.

Question 2

What are the common symptoms of acute bronchitis?

Answer 2

Patients typically present with an acute onset of cough (may or may not be productive), sore throat, rhinorrhoea, and wheeze.

Question 3

What percentage of patients may still have a cough after 3 weeks?

Answer 3

25% of patients will still have a cough beyond 3 weeks.

Question 4

What is the leading cause of acute bronchitis?

Answer 4

Viral infection is accepted as the leading cause of acute bronchitis.

Question 5

When do most episodes of acute bronchitis occur?

Answer 5

Around 80% of episodes occur in autumn or winter.

Question 6

What are some abnormal findings in patients with acute bronchitis?

Answer 6

Some patients may present with low-grade fever and wheeze.

Question 7

How can acute bronchitis be differentiated from pneumonia?

Answer 7

In acute bronchitis, sputum, wheeze, and breathlessness may be absent, while at least one is present in pneumonia. No other focal chest signs are present in acute bronchitis.

Question 8

What is the typical approach to diagnosing acute bronchitis?

Answer 8

Acute bronchitis is typically a clinical diagnosis.

Question 9

What role does CRP testing play in managing acute bronchitis?

Answer 9

CRP testing may guide whether antibiotic therapy is indicated.

Question 10

What are the management strategies for acute bronchitis?

Answer 10

Management includes analgesia, good fluid intake, and considering antibiotic therapy for certain patients.

Question 11

When should antibiotic therapy be considered for acute bronchitis?

Answer 11

Antibiotic therapy should be considered if patients are systemically very unwell, have pre-existing co-morbidities, or have a CRP of 20-100mg/L (offer delayed prescription) or a CRP >100mg/L (offer antibiotics immediately).

Question 12

What is the first-line antibiotic recommended for acute bronchitis?

Answer 12

The BNF currently recommends doxycycline as the first-line antibiotic.

Question 13

Who cannot use doxycycline?

Answer 13

Doxycycline cannot be used in children or pregnant women.

Question 14

What are alternatives to doxycycline for treating acute bronchitis?

Answer 14

Alternatives include amoxicillin.

Question 15

What is pneumonia?

Answer 15

Pneumonia is a common inflammatory condition affecting the alveoli in the lungs due to pathogens entering the lower respiratory tract.

Question 16

What are common causative pathogens of pneumonia?

Answer 16

Bacteria (e.g. Streptococcus pneumoniae), virus, and fungus (e.g. Pneumocystis jiroveci).

Question 17

What occurs in the pathophysiology of pneumonia?

Answer 17

An inflammatory cascade begins, neutrophils migrate to infected alveoli, releasing cytokines that activate an immune response and induce fever.

Question 18

What are the risk factors for pneumonia?

Answer 18

Aged under 5 or over 65, smoking, recent viral respiratory infection, chronic respiratory diseases, immunosuppression, aspiration risk, IV drug use, and other non-respiratory co-morbidities.

Question 19

What are common symptoms of pneumonia?

Answer 19

Cough with purulent sputum, dyspnoea, chest pain, fever, and malaise.

Question 20

What are common signs of pneumonia?

Answer 20

High temperature, tachycardia, hypotension, confusion, tachypnoea, low oxygen saturation, reduced breath sounds, bronchial breathing, crepitations, and dullness on percussion.

Question 21

What is the CRB65 criteria for assessing pneumonia risk in primary care?

Answer 21

C: Confusion, R: Respiration rate >= 30/min, B: Blood pressure systolic <= 90 mmHg or diastolic <= 60 mmHg, 65: Aged >= 65 years.

Question 22

What does a CRB65 score of 0 indicate?

Answer 22

Low risk (less than 1% mortality risk) and home-based care is recommended.

Question 23

What CRP levels indicate antibiotic therapy recommendations?

Answer 23

CRP < 20 mg/L: do not offer antibiotics; CRP 20 - 100 mg/L: consider delayed prescription; CRP > 100 mg/L: offer antibiotics.

Question 24

What is the CURB65 criteria used in secondary care?

Answer 24

C: Confusion, U: Urea > 7 mmol/L, R: Respiration rate >= 30/min, B: Blood pressure systolic <= 90 mmHg or diastolic <= 60 mmHg, 65: Aged >= 65 years.

Question 25

What does a CURB65 score of 0 or 1 indicate?

Answer 25

Low risk (less than 3% mortality risk) and home-based care may be considered.

Question 26

What is typically shown on a chest X-ray for pneumonia?

Answer 26

Consolidation (opacity) in the area of infection, and may also show effusion.