Lower Respiratory Tract Infection in Adults

Question 1

What is the UK incidence of pneumonia?

Answer 1

5-11/1000 adult population

Question 2

What percentage of community acquired pneumonia requires hospitalisation?

Answer 2

Between 22 and 42%

Question 3

What is the mortality of hospitalised patients with pneumonia?

Answer 3

6-12%

Question 4

What are some symptoms of pneumonia?

Answer 4

Malaise

Myalgia

Fever

Chest pain

Cough

Purulent sputum

Dyspnoea

Question 5

What are some signs of pneumonia?

Answer 5

Pyrexia

Tachypnoea

Central cyanosis

Dullness on percussion of affected lobe

Bronchial breath sounds

Inspiratory crepitations

Increased vocal resonance

Question 6

What investigations are done for pneumonia?

Answer 6

Serum biochemistry, full blood count and C-reactive protein (CRP) test

Chest X-ray

Blood cultures

Throat swab

Urinary legionella antigen

Sputum microscopy and culture

HIV test

Question 7

What microrganisms are the 3 three for causing pneumonia?

Answer 7

1) Strep pneumoniae (39%)
2) Chlamydophilia pneumoniae (13.1%)
3) All viruses (13.1%)

Question 8

What is the severity of pneumonia measured by?

Answer 8

CURB 65

Question 9

What does CURB 65 stand up for?

Answer 9

C confusion

U blood urea > 7

R respiratory rate > 30

B diastolic blood pressure < 60

Question 10

What is each aspect of CURB 65 given a score of?

Answer 10

0 (low risk and could be treated in the community)

1-2 (hospital treatment usually required)

3 (high risk of death and need for ITU)

Question 11

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

Answer 11

Amoxycillin or clarithromycin/deoxycycline

Question 12

What is the treatment for a CURB 65 score of 2?

Answer 12

Amoxycillin and clarithromycin or levoflaxacin

Question 13

What is the treatment for a CURB 65 score of 3-5?

Answer 13

Co-amoxiclav and clarithromycin or levoflaxacin (if penicillin alergic)

Question 14

What are some things that come before pneumonia?

Answer 14

Aspiration pneumonia

Haematological malignancy

Legionnaires disease

Influenza

Staph pneumonia including PVL toxin

MRSA

HIV

Question 15

What treatment should be used for pneumonia caused by MRSA?

Answer 15

Vancomycin or linezolid

Question 16

What are treatment for pneumonia other than antibiotics?

Answer 16

Oxygen

IV fluids

CPAP (continuous positive airway pressure, keeps airways open)

Intubation and ventilation

Question 17

What does CPAP stand up for?

Answer 17

Continuous positive airway pressure

Question 18

What are some possible complications of pneumonia treatment?

Answer 18

Septicaemia

Acute kidney injury

Empyema

Lung abscess

Metastatic infection

ARDS (acute respiratory distress syndrome)

Question 19

What does ARDS stand up for?

Answer 19

Acute respiratory distress syndrome

Question 20

What is acute respiratory distress syndrome?

Answer 20

Widespread inflammation of the lungs

Question 21

What is differential diagnosis?

Answer 21

Process of differentiation between two or more conditions which share similar signs or symptoms

Question 22

What is the process of differentiating between two or more conditions that share similar symptoms called?

Answer 22

Differential diagnosis

Question 23

What does differential diagnosis of pneumonia exclude?

Answer 23

TB

Lung cancer

Pulmonary embolism

Pulmonary oedema

Pulmonary vasculitis

Question 24

What is empyema?

Answer 24

Collection of pus in the pleural cavity caused by microorganisms

Question 25

What is a collection of pus in the pleura cavity caused by microorganisms called?

Answer 25

Empyema

Question 26

What may follow pneumonia?

Answer 26

Empyema Lung abscess Bronchiestasis

Question 27

What are the top 3 organisms that cause empyema?

Answer 27

Steptococcus (52%) Anarobes (20%) Staph aureus (11%)

Question 28

What is the prominant feature of empyema?

Answer 28

Chest pain

Question 29

What symptoms is absent with empyema?

Answer 29

Cough

Question 30

What is used to investigate empyema?

Answer 30

CT thorax and ultrasound

Question 31

What is empyema diagnosed by?

Answer 31

Pleural aspiration (pH \< 7.2)

Question 32

What is the treatment for empyema?

Answer 32

Chest drain and IV antibiotics Surgery for patients who do not improve

Question 33

What is a lung abscess?

Answer 33

Necrosis of lung tissue leading to the formation of cavities containing necrotic debris or fluid caused by microbial infection

Question 34

What is necrosis of lung tissue leading to the formation of cavities containing necrotic debris called?

Answer 34

Lung abscess

Question 35

What are organisms that are more likely to cause lung abscess than others?

Answer 35

Staph aureus Pseudonomas Anaerobes

Question 36

What can the symptoms of lung abscess be?

Answer 36

Nonspecific such as lethargy, weight loss and high swing fever

Question 37

What is lethargy?

Answer 37

Lack of energy

Question 38

What is a lack of energy called?

Answer 38

Lathargy

Question 39

What is lung abscess investigated by?

Answer 39

CT thorax Sputum culture

Question 40

What is the treatment of lung abscess?

Answer 40

Prolonged antibiotics

Question 41

How is drainage for a lung abscess done?

Answer 41

Via the bronchial tree, occasionally percutaneous draining

Question 42

What is bronchiectasis?

Answer 42

Airways of the lung become abnormally widened, leading to excessive build up of mucus that can make the lungs more vulnerable to infection

Question 43

What does bronchiectasis cause in the lungs?

Answer 43

Build up of mucus making them more vulnerable to infection

Question 44

What is it called when the airways of the lungs become abnormally widened?

Answer 44

Bronchiectasis

Question 45

What are some of the causes of bronchiectasis?

Answer 45

Idiopathic Immotile cilia syndrome Cystic fibrosis Childhood infections such as measles Hypogammaglobulinemia Allergic bronchopulmonary aspergillus

Question 46

What is immotile cilia syndrome?

Answer 46

Genetic disorder that causes defects in cilia

Question 47

What is a genetic disorder that causes defects in cilia?

Answer 47

Immotile cilia syndrome

Question 48

What is hypogammaglobulinemia?

Answer 48

Reduction in all types of gamma globulins

Question 49

What is a reduction in all types of gamma globulins called?

Answer 49

Hypogammaglobulinemia

Question 50

What does ABPA stand up for?

Answer 50

Allergic bronchopulmonary aspergillosis

Question 51

What are the symptoms of bronchiectasis?

Answer 51

Chronic cough Daily sputum production Sometimes: Wheeze Dyspnoea Tiredness Flitting chest pains Haemoptysis

Question 52

What are signs of bronchiectasis?

Answer 52

Finger clubbing Course onspiratory crepitation (auscultation)

Question 53

What investigations are done for bronchiectasis?

Answer 53

High resolution CT thorax Sputum culture Serum immunoglobulins Total IgE and aspergillus precipitins CF genotyping

Question 54

What is the treatment for bronchiectasis?

Answer 54

Chest physiotherapy Prompt treatment of infections with antibiotics May require inhaled therapy including B₂ agonist and corticosteroid