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Respiratory BJ > Lower Respiratory Tract Infections 2 > Flashcards

Lower Respiratory Tract Infections 2 Flashcards

1
Q

what are the main problems associated with LRTIs?

A 
Acute Bronchitis
COPD Exacerbations
Pneumonia
Empyema
Lung Abscess
Bronchiectasis
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2
Q

What is acute bronchitis?

A

A viral infection causing inflammation of trachea & main airways

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3
Q

How does bronchiectasis relate to LRTIs?

A

It dilates the airways making patients more prone to infection

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4
Q

How common/severe is pneumonia?

A

5-11 per 1000 people
22-42% requires hospitalisation
5.7-12% mortality in the hospitalised patients

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5
Q

Symptoms of Pneumonia?

A 
Malaise
Fever
Pleuritic Chest Pain (sharp)
Cough
Purulent (infected) Sputum
Dyspnoea
Headache
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6
Q

Why is it difficult to diagnose pneumonia?

A

Its initial symptoms are very vague and fit other LRTIs.

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7
Q

What are the signs of pneumonia?

A
  • Pyrexia
  • Tachypnoea
  • Central Cyanosis
  • Dullness on Percussion of the affected Lobes
  • Bronchial Breath Sounds
  • Inspiratory Crackles
  • Increased Vocal Resonance
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8
Q

How does increased vocal resonance occur in pneumonia?

A

Consolidation of the lobe leads to increased vocal resonance.

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9
Q

How do we investigate Pneumonia?

A

Serum Biochem, FBC (Infection)
CRP (shows inflammation)
CXR (shows degree of consolidation)
Blood Culture (picking out specific pathogen in feverish patients)
Sputum Microscopy/Culture (picking out pathogen)
Throat Swab (for Atypical Pathogens e.g. Viruses)
Urinary Legionella Antigen (To check for Legionnaires disease)

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10
Q

What is legionnaires?

A

A serious lung infection caused by legionella bacteria.

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11
Q

What are the most common causes of Penumonia?

A 
Strep. Pneumoniae (Gram +ve, Pneumococcus) [36%]
H. Influenzae [10.2%]
Legionella [0.4%]
Staph. Aureus [0.8%]
Viruses [13.1%]
Mycoplasma Pneumoniae [1.3%]
Chlamydia Psittaci [1.3%]
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12
Q

Why dont the common causes of pneumonia add up to near 100%?

A

In the majority of cases the causative microorganism isnt found.

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13
Q

Which pneumonia causing organisms are atypical?

A

Chlamydia Psittaci

Mycoplasma Pneumoniae

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14
Q

How would strep Pneumoniae appear under gram staining & Microscopy?

A

Purple

Balls (cocci) forming chains

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15
Q

What scale do we use to score the severity of penumonia?

A

The CURB 65 scale. Each letter + 65 stands for a criteria. The number they score determines how to respond.

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16
Q

What are the criteria of the CURB 65 scale?

A 
C - Confusion
U - Blood Urea>7
R - Respiratory Rate>30
B - Diastolic BP<60
65 - Age>65 yrs
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17
Q

Do we hospitalize a 0 CURB65 score?

A

Assume low risk and treat in the community

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18
Q

Do we hospitalise a curb65 score of 1-2?

A

Usually need hospital level treatment

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19
Q

Do we hospitalise a CURB65 score of 3-5?

A

Assume a high risk of death and admit to ITU

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20
Q

How do we treat a CURB65 score of 0-1?

A

Amoxycillin or Clarithromycin/Doxycycline

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21
Q

How do we treat a CURB65 score of 2?

A

Amoxicillin AND Clarithromycin (or Levofloxacin)

22
Q

How do we treat a CURB 65 score > 2?

A

Co-Amoxiclav & Clarithromycin. (Or levofloxacin if penicillin allergic)

23
Q

Why do we use co-amoxiclav over standard amoxicillin in severe pneumonia cases?

A

It has a broader spectrum.

24
Q

Why non-drug treatments do we sometimes give severe pneumonia patients?

A

Oxygen or if necessary CPAP
I.V. Fluids
In Very severe cases intubation & Ventilation

25
Q

What are the common complications of Pneumonia?

A 
Septicaemia
Acute Kidney Injury
Empyema
Lung Abscess
Haemolytic Anemia (Mycoplasma)
ARDS
26
Q

When do pneumonia patients generally get an Acute Kidney Injury?

A

When theyre elderly and/or suffer from co-morbidities.

27
Q

How does Haemolytic Anaemia occur in pneumonia?

A

In Mycoplasma caused pneumonia an immune phenomenon can cause RBCs to be destroyed.

28
Q

What do we do if a pneumonia patient develops ARDS?

A

Transfer to the ICU

29
Q

What are other conditions that can appear to be Pneumonia?

A 
TB
Lung Cancer
Pulmonary Embolism
Cardiac Failure
Pulmonary Vasculitis (Wagners Granulomatosis)
30
Q

How do we tell TB from pneumonia?

A

TB tends to infect the upper lobes and generally occurs following something else so the patient will have been unwell for at least several weeks.

31
Q

How is a pulmonary embolism mistaken for pneumonia?

A

It can produce infarcts that look like pneumonia, particularly in the elderly

32
Q

What is Pulmonary Vasculitis?

A

A term used to describe conditions involving destruction of blood vessels in the lungs.

33
Q

What is empyema?

A

Infection in the pleural cavity

34
Q

What microorganisms tend to cause empyema?

A

Streptococcus [52%]
Staph. Aureus [11%]
Anaerobes [20%]

35
Q

How do we tell an empyema apart from other LRTIs?

A

Chest pain, the lack of a cough and often a high swinging fever.

36
Q

How do we investigate an Empyema?

A

A CT of the Thorax

Pleural Ultrasound

37
Q

How do we diagnose/treat Empyema?

A

Diagnostic Pleural Aspiration (check if pH is <7.2), then culture.
Then treat with a chest drain & relevant IV Antibiotics

38
Q

What can we do if an empyema patient doesn’t respond to antibiotics?

A

The Antibiotics can be extended for longer or surgery is available.

39
Q

What are the symptoms of a lung abscess?

A

Pretty non-specific

Lethary, Weight Loss, high swinging fever

40
Q

How do we investigate a lung abscess?

A

With a CT Thorax and a sputum culture (including TB culture)

41
Q

What organisms are likely to cause abscesses?

A

Staph Aureus
Pseudomonas
Anaerobes

42
Q

How do we treat a Lung Abscess?

A

Drain via the bronchial tree (or percutaneously) Then treat with prolonged antibiotics.

43
Q

What are the most common potential causes of bronchiectasis?

A 
Idiopathic (mainly)
Immotile Cilia Syndrome
Cystic Fibrosis
Childhood infection
Hypogammaglobulinaemia
Allergic Bronchopulmonary Aspergillosis (ABPA)
44
Q

How does Cystic fibrosis relate to bronchiectasis?

A

CF patients often have a severe case of bronchiectasis at a young age.

45
Q

How do childhood infections relate to Bronchiectasis?

A

Theres a correlation between childhood infections like measles & whooping cough and bronchiectasis

46
Q

How does hypogammaglobinaemia lead to bronchiectasis?

A

Immunoglobulin G isn’t produced so infections are very common.

47
Q

What does ABPA look like?

A

ABPA can present like asthma and if chronic lead to bronchiectasis.

48
Q

What are the symptoms of bronchiectasis?

A

Chronic Cough
Daily (often large) sputum production

And not always but sometimes:

  • Wheeze
  • Dyspnoea
  • Chronic Tiredness
  • Flitting chest pain
  • Haemoptysis
49
Q

What signs are there of bronchiectasis?

A 
Finger Clubbing (generally only in V. Severe cases)
Course inspiratory Crepitations
50
Q

What do we do to investigate Bronchiectasis?

A

A High Resolution Thorax CT.
Sputum Culture
Serum immunoglobulins (looking for Immunoglobulin G deficiency)
Total IgE & Aspergillus precipitins (Looking for ABPA)
CF genotyping

51
Q

How does bronchiectasis appear on a HRCT?

A

Some of the airways will be unusually dilated. Can often compare the two sides

52
Q

What can we do to treat Bronchiectasis?

A

Inhaled Beta2 agonists & corticosteroids. (like Asthma)
Chest Physiotherapy.
Promptly treat infections with antibiotics.

Respiratory BJ (31 decks)

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