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Respiratory block > Lower respiratory tract infection in adults > Flashcards

Lower respiratory tract infection in adults 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 is acute bronchitis ?

A

Temporary inflammation of the bronchi

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3
Q

How long does acute bronchitis last for ?

A

<3 weeks

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4
Q

What are the signs of acute bronchitis ?

A

Cough

Sputum

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5
Q

What is usually the cause of acute bronchitis ?

A

Viral

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6
Q

What is COPD exacerbation ?

A

Worsening of symptoms
Change in colour of sputum
Increased SOB, wheeze, cough

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7
Q

What is a likely caustitive agent of AECOPD ?

A

Strep pneumoniae
H.Influenzae
Moraxella catarrhalis
Viral

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8
Q

What is the treatment of COPD exacerbation ?

A 
Steroids
Antibiotics
    - amoxycillin
    - doxycycline
    - co-trimoxazole
    - clarithromycin
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9
Q

What is pneumonia ?

A

Inflammation of the lung parenchyma

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10
Q

How many cases of acute bronchitis develop into pneumonia ?

A

1 in 10

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11
Q

What is consolidation ?

A

Solidification due to cellular exudate in alveoli leads to impaired gas exchange

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12
Q

What are risk factors for pneumonia ?

A 
Smoking, alcohol
Extremes of age
Preceding viral illness
Pre-existing lung disease
Chronic illness
Immunocompromised
Hospitalisation
IDVU
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13
Q

What are the symptoms of pneumonia ?

A 
Malaise
Fever
Chest pain (pleuritic)
Cough
Purulent sputum
Dyspnoea
Haemoptysis
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14
Q

What is rusty sputum usually associated with ?

A

Strep pneumoniae

Pneumococcal pneumonia

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15
Q

What are the signs of pneumonia ?

A 
Pyrexia
Tachycardia 
Tachypnoea
Central cyanosis
Dullness of percussion of affected lobes
Bronchial breath sounds
Inspiratory crepitations
Increased vocal resonance
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16
Q

What are the investigations for pneumonia in community ?

A

Maybe none

CXR if in doubt

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17
Q

What are the investigations of pneumonia in hospital ?

A 
Bloods- serum biochemistry, FBC, CRP
Blood cultures
CXR
Sputum culture
Viral throat swab
Legionella urinary antigen
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18
Q

What are the most likely causes of pneumonia ?

A

Strep pneumonia
H.Influenzae

Legionella
Staph aureus 
Moraxella catarrhalis
Mycoplasma pneumoniae
Chlamydophilia pneumoniae 
Chlamydophilia psittaci 
Coxiella burnetti
All viruses
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19
Q

What are the differential diagnosis of pneumonia ?

A 
TB
Lung cancer 
Pulmonary embolism
Pulmonary oedema
Pulmonary vasculitis (wegners granulomatosis)
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20
Q

What are typical community acquired microorganisms ?

A

Streptococcus pneumoniae
Haemophilus influenzae
Mycoplasma pneumoniae

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21
Q

What are atypical community acquired microorganisms ?

A 
Legionella pneumophilia
Chlamydia pneumoniae
Chlamydia psittaci
Coxiella burnetti
Moraxella catarrhalis
Viruses
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22
Q

What is nosocomial infection ?

A

healthcare-associated infections (HAI)

Infections acquired during the process of receiving health care that was not present during the time of admission

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23
Q

When does nosocomial (HAI) occur ?

A

> 48hrs after admission

24
Q

What are nosocomial microorganisms ?

A

Enterobacteria
Staphylococcus aureus
Pseudomonas aeruginosa
Klebsiella pneumoniae

25
Q

How is the severity of pneumoia scored ?

A

CURB65

26
Q

What does CURB65 mean ?

A 
C- confusion
U- blood urea >7mmol/L
R- RR >/= 30/min
B- systolic BP <90mmHg, diastolic BP <60mmHG
65- age >/= 65
27
Q

What does a CURB score of 0-1 mean ?

A

Low risk- could be treated in community

28
Q

What does a CURB score of 2 mean ?

A

Moderate risk- hospital treatment usually required

29
Q

What does a CURB score of 3-5 mean ?

A

High risk of death and need for ITU

30
Q

What is the treatment for a CURB score of 0-1 ?

A

Amoxycillin
Clarithromycin/ doxycycline (if penicillin allergy)
for 5 days

31
Q

What is the treatment for a CURB score of 2 ?

A

Amoxycillin + clarithromycin
Levofloxacin (if penicillin allergy)
5-7 days

32
Q

What is the treatment for a CURB score of 3-5 ?

A

Co-amoxiclav + clarithromycin
Levofloxacin or co-trimoxazole (if penicillin allergy)
7-10 days

33
Q

What other treatment besides antibiotics is advisable ?

A

Oxygen
IV fluids
Continuous positive airway pressure
Intubation and ventilation

34
Q

What are the complications of pneumonia ?

A 
Sepsis 
Acute kidney injury 
Adult resp distress syndrome 
Parapneumonic effusion
Empyema
Lung abscess
Disseminated infection
35
Q

Why can pulmonary embolism look like pneumonia on a scan ?

A

Because of the pulmonary infarcts they cause

36
Q

What are the most common causes of empyema ?

A

Streptococcus
Staph aureus
Anaerobes

37
Q

What are the signs/symptoms of empyema ?

A

Chest pain
Absence of cough
High fever

38
Q

How do you investigate empyema ?

A

CT and ultrasound

39
Q

How do you diagnose empyema ?

A

pH is less than 7.2 after pleural aspiration

40
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

41
Q

What can lung abscesses follow from ?

A

Pneumonia

42
Q

What are the symptoms of a lung abscess ?

A

Non-specific
Lethargy
Weight loss
High Swinging fever

43
Q

What are the relevant investigations for lung abscess ?

A

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

44
Q

Which bacteria are more likely to cause lung cavitation ?

A

Staph. Aureus

Pseudomonas

45
Q

What is treatment for lung abscess ?

A

Prolonged antibiotics

Drainage via the bronchial tree or percutaneous

46
Q

What are the risk factors for recurrent pneumonia ?

A

Immunocompromised
Underlying structural lung disease
Aspiration

47
Q

What is bronchiectasis defined as ?

A

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

48
Q

What are the causes of bronchiectasis ?

A 
Idiopathic 
Childhood infection
CF
Ciliary dyskinesia 
Hypogammaglobulinemia
Allergic bronchi-pulmonary aspergillosis (ABPA)
49
Q

What is hypogammaglobulinemia ?

A

Body does not produce immunoglobulin G

50
Q

What is allergic bronchopulmonary aspergillosis ?

A

Presents like asthma (wheezing and cough)

Allergy to aspergillus

51
Q

What are the symptoms of bronchiectasis ?

A 
Chronic productive cough 
Daily sputum production
Breathlessness
Recurrent LRTI
Haemoptysis
52
Q

What are the signs of bronchiectasis ?

A

Finger clubbing
Coarse creps
Wheeze
Obstructive spirometry

53
Q

How do you describe the flitting chest pains in bronchiectasis ?

A

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

54
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 Hypogammaglobulinemia)
Total IgE aspergillus precipitations
CF genotyping

55
Q

What is the treatment of bronchiectasis ?

A

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

Respiratory block (38 decks)

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