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Respiratory > Lower respiratory tract infection - adults > Flashcards

Lower respiratory tract infection - adults Flashcards

1
Q

What is acute bronchitis?

A

Inflammation of the bronchi
Is temporary so lasts less than 3 weeks
Usually viral
Symptoms - cough and sputum

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2
Q

What is the treatment for acute bronchitis?

A

Supportive management - drinking lots of fluid and taking paracetamol

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3
Q

What is chronic bronchitis defined as?

A

Cough lasting 3 months of the year for at least 2 years in a row

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4
Q

When would you go see the GP with bronchitis?

A

Cough lasts more than 3 weeks, high temp. for more than 3 days, sputum is streaked with blood, have underlying heart or lung condition, if becoming more breathless and have had repeated episodes of bronchitis

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5
Q

What are the symptoms of a COPD exacerbation?

A

Change in colour and amount of sputum
Fever
Increased breathless
Wheeze
Cough

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6
Q

What are common bacterial and virial causes of COPD exacerbations?

A

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Many viral causes

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7
Q

What is the treatment for COPD exacerbations?

A

Steroids to reduce inflammation
Antibiotics for infection - amoxicillin, doxycycline, co-trimoxazole and clarithromycin
Maybe nebulisers if severe

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8
Q

What is pneumonia?

A

Inflammation of lung parenchyma - comprises of thin walled alveoli

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9
Q

What is bronchopneumonia?

A

It is the acute inflammation of the bronchi, accompanied by inflamed patches in the nearby lobules of the lungs
Is patchy and usually only one lung affected

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10
Q

What is lobar pneumonia?

A

Lobar pneumonia is a form of pneumonia characterized by inflammatory exudate within the intra-alveolar space resulting in consolidation that affects a large and continuous area of the lobe of a lung

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11
Q

What is interstitial pneumonia?

A

Is an inflammatory process and is usually viral

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12
Q

What are some of the risk factors for pneumonia?

A

Smoking and alcohol excess
Extremes of age
Preceding viral illness, Pre-existing lung diseases, chronic illness, immunocompromised, hospitalisation and IV drug abusers

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13
Q

What are the symptoms of pneumonia?

A

Fever, rigors and myalgia - pain in muscles
Cough and sputum
Chest pain that is increased on deep inspiration
Dyspnoea - SOB

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14
Q

What are some clinical signs of pneumonia?

A

Tachypnoea, tachycardia, reduced expansion, dull percussion, bronchial breathing, crepitations and vocal resonance as lung is more solid

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15
Q

What does rusty brown sputum in a patient show?

A

They have strep. pneumoniae

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16
Q

What community investigations would be made in pneumonia?

A

Maybe non
CXR if diagnosis in doubt or not improving

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17
Q

What investigations could be made in the hospital for pneumonia?

A

Bloods - serum biochemistry, FBC and CRP
Blood cultures
CXR
Sputum culture, viral throat swab
Legionella urinary antigen

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18
Q

What are differential diagnosis to a patient with pneumonia symptoms?

A

Tuberculosis, Lung cancer, Pulmonary embolism, Pulmonary oedema, Pulmonary vasculitis

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19
Q

What typical bacteria causes community acquired pneumonia?

A

Streptococcus pneumoniae
Haemophilus influenzae
Mycoplasma pneumoniae

20
Q

What atypical bacteria causes community acquired pneumonia?

A

Legionella pneumophilia
Chlamydia pneumoniae
Chlamydia psittaci
Coxiella burnetti
Moraxella catarrhalis
Viruses - influenza, RSV, SARS..

21
Q

What the bacteria found in hospital acquired pneumonia?

A

Enterobacteria
Staphylococcus aureus
Pseudomonas aeruginosa
Klebsiella pneumoniae

22
Q

Describe CURB65 and pneumonia severity

A

C - confusion
U - blood urea > 7 mmol/L
R - respiratory rate > 30/min
B - systolic BP < 90 mmHg, diastolic blood pressure < 60 mmHg
65 - age > 65

23
Q

What is the score system for CURB 65?

A

0-1 low risk - treat in community
2 moderate risk - hospital treatment required
3-5 high risk of death and need for intensive care

24
Q

What things do you need to consider in the CURB65 severity scale?

A

People who are hypoxic, young people and multi-lobar consolidations

25
Q

What is the treatment for low risk pneumonia?

A

Amoxicillin
Clarithromycin or doxycycline if penicillin allergy
Duration is 5 days

26
Q

What is treatment for moderate risk pneumonia?

A

Amoxicillin and clarithromycin
Levofloxacin if penicillin allergy
Duration is 5-7 days

27
Q

What treatment is for high risk pneumonia?

A

Co-amoxiclav and clarithromycin
Levofloxacin or co-trimoxazole if penicillin allergy
Duration is 7-10 days

28
Q

When would patients with pneumonia take antibiotics with IV?

A

If signs of sepsis

29
Q

What supportive management is needed for pneumonia?

A

O2, fluids, antipyretics, NSAIDs
Intubation and ventilation

30
Q

Explain aspiration pneumonia?

A

Inhalational acute lung injury that occurs after aspiration of sterile gastric contents
Happens in patients who have had a stroke, MS, myasthenia, sedation, oesophageal disease
Anaerobes likely - amoxicillin and metronidazole

31
Q

What is used to treat MRSA?

A

Vancomycin

32
Q

What are some complications of pneumonia?

A

Sepsis, acute kidney injury, adult respiratory distress syndrome, parapneumonic effusion, empyema, lung abscess and disseminated infection

33
Q

What are signs of complicated pneumonia?

A

Swinging fever
Sweats
Persistently high WCC/ CRP
Weight loss
Failure to improve

34
Q

What is empyema?

A

The collection of pus in a cavity in the body, especially in the pleural cavity

35
Q

What is parapneumonic effusion

A

Parapneumonic effusion (PPE) is a type of pleural effusion - Pleural effusion is a build up of fluid in the pleural cavity. Having too much fluid in the pleural space can prevent your lungs from fully expanding and make it hard to breathe

36
Q

What is the treatment for empyema/ parapneumonic effusion?

A

May need to drain and prolonged antibiotics
Surgery may be needed and drugs through chest drains

37
Q

What is a lung abcess?

A

Also called a pulmonary abscess, is a pus-filled cavity in the lungs caused by an infection
More likely staph aureus, pseudomonas, anaerobes…
Purulent sputum and haemoptisis

38
Q

What is the treatment for a lung abscess?

A

Screen for TB
CT scan and maybe bronchoscopy
Prolonged antibiotics

39
Q

What is the recovery for pneumonia?

A

Takes weeks
Repeat CXR 6 weeks if over 50 years and smoker
Smocking cessation should be encouraged and helped

40
Q

What could recurrent pneumonia suggest?

A

Person may be immunocompromised, have underlying structural lung disease, cancer or aspiration

41
Q

What is bronchiectasis?

A

Bronchiectasis is a long-term condition where the airways of the lungs become widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection

42
Q

What are some causes of bronchiectasis?

A

Idiopathic
Childhood infection, CF, Ciliary dyskinesia, hypogammaglobulinemia, allergic Broncho-pulmonary aspergillosis

43
Q

What are the symptoms and clinical examination signs for bronchiectasis?

A

Symptoms - chronic productive cough, breathlessness, recurrent LRTI and haemoptysis
Examination - finger clubbing, crepitations, wheeze and obstructive spirometry

44
Q

What bacteria can cause infective exacerbations of bronchiectasis?

A

Staph. aureus
Haemophilus influenza
Pseudomonas aerigunosa

45
Q

What treatment would be given to patients with infective exacerbations of bronchiectasis?

A

Mucolytic, prolonged antibiotic course and vaccines
Consider prophylactic antibiotics if frequent

Respiratory (24 decks)

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