Lower Respiratory Tract Infections Flashcards
Which age group are typically affected by bronchiolitis?
Young children and infants - often below 18 months.
What factors may worsen bronchiolitis?
Younger age at onset
Smokers in home
Premature birth
What virus is responsible for bronchiolitis?
respiratory syncytial virus (RSV).
What are symptoms of bronchiolitis?
Tachypnoea
Irritating cough
Poor feeding
Apnoea (in smaller babies)
How is bronchiolitis diagnosed?
PCR
History/Examination
How is bronchiolitis treated?
Supportive only - keep child upright and plenty of fluids.
What is the most common aetiology of acute bronchitis?
Around 90% are viral in origin.
What is the pathology behind acute bronchitis?
Infection irritates and inflames the bronchi, resulting in increased mucus production - which leads to cough.
What are symptoms of acute bronchitis?
Productive cough
Fever (only in some cases)
Chest exam normal
How is acute bronchitis managed?
Supportive only.
Which strain of influenza results in pandemics?
Influenza A.
How is influenza treated?
Supportive management
Antivirals if necessary
Vaccination can be offered to at-risk groups
What scoring system is used to assess severity of influenza infection?
CRB65 score.
Is Haemophilus influenzae a bacteria or a virus?
A bacteria.
What organism causes whooping cough (pertussis)?
Bordetella pertussis.
How does whooping cough present?
The patient will have cold-like symptoms, followed by a paroxysmal cough. Vomiting is common.
May have residual cough for over a month.
How is whooping cough treated?
If cough, <3 weeks, then antibiotics.
Vaccines are available to prevent disease.
What is pneumonia?
A common lower respiratory tract infection, characterised by inflammation of lung tissue.
What is the most common causative organism of community-acquired pneumonia?
Streptococcus pneumoniae.
Which organism is typically responsible for pneumonia in elderly/COPD patients?
Haemophilus influenzae.
What is the commonest cause of pneumonia in PWIDs?
Staphylococcus aureus.
Which atypical pneumonia, often presents in immunocompromised patients (e.g. AIDS)?
Pneumocystis jiroveci.
What atypical pneumonia often presents in alcoholics?
Klebsiella pneumoniae.
What atypical pneumonia is associated with inhalation of contaminated water droplets?
Legionella pneumophila.
What are the two forms of pneumonia that may develop?
Lobar pneumonia
Bronchopneumonia
What form of pneumonia is typically seen in young, healthy adults?
Lobar pneumonia.
An elderly patient presents with dyspnoea, confusion, pleuritic chest pain, rigours and is tachypnoeic - what is the diagnosis?
Pneumonia.
What is the CURB65 score used for?
Used in pneumonia to determine how likely it is that streptococcus is responsible?.
What are the criteria of CURB65?
Confusion
Urea>7mmol
Respiratory rate >30
BP - systolic<90/diastolic<60
>65 years
What organism produces rust-coloured sputum in cases of pneumonia?
Streptococcus pneumoniae.
What organisms cause green sputum in cases of pneumonia?
Haemophilus influenzae, or pseudomonas aeruginosa.
What organism is characterised by red-currant jelly sputum in pneumonia patients?
Klebsiella pneumoniae.
What causes foul-smelling sputum in pneumonia patients?
Anaerobic organisms.
How should a patient with a CURB65 score of 0-2 be treated?
Amoxicillin (if allergic, give doxycycline).
Remember this depends on the setting.
How should a patient with a CURB65 score of 3-5 be treated?
Co-amoxiclav and doxycycline.
Remember this depends on the setting.
What is the most common cause of hospital-acquired pneumonia?
Staphylococcus aureus
Which patients are more susceptible to bronchopneumonia?
Those with a co-morbidity.
Alongside antibiotic therapy, what other steps are involved in pneumonia treatment?
Give oxygen therapy (if hypoxic)
Fluids
Bed rest
Smoking cessation
What is typically the cause of intrapulmonary abscess?
Usually a preceding illness (e.g. pneumonia).
How does an intrapulmonary abscess present?
Patient will have pneumonia symptoms, however they will deteriorate despite treatment.
How is a intrapulmonary abscess investigated?
CXR - shows a walled cavity
CT scan - will allow distinction between this and emphysema to be made
How is an intrapulmonary abscess treated?
Broad spectrum antibiotics
Some may require drainage/resection
