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Respiratory > Lower respiratory tract infections > Flashcards

Lower respiratory tract infections Flashcards

1
Q

Should the lower airway be colonised with bacteria?

A

No

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2
Q

What is acute bronchitis?

A

Inflammation of the bronchi usually caused by infection

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3
Q

What pathogens usually cause acute bronchitis?

A

Viruses usually

Bacteria:
H. influenzae
Strep. pneumonia
Many more

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4
Q

What are the symptoms of acute bronchitis?

A

Cough: productive or non
SOB
Wheeze
Fever

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5
Q

Do you get systemic involvement in bronchitis?

A

No, but you do get a fever

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6
Q

What would you find on a CXR with acute bronchitis?

A

Not a lot

No focal consolidation like there would be with pneumonia

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7
Q

Investigations for acute bronchitis.

A

ABG: if O2 levels are low and CO2 levels high then consider admission

CXR: no consolidations signs of pneumonia

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8
Q

Treatment of acute bronchitis.

A

If viral, just supportive care: pain relief, fluids, rest.

If bacterial: antibiotics

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9
Q

What problems can occur if you have COPD or asthma and you get acute bronchitis?

How would you manage this?

A

Exacerbation

Manage with inhalers + steroids

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10
Q

What is augmentin?

A

An antibiotic containing amoxicillin and clavulanate

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11
Q

What is pneumonia?

A

Inflammation of lung parenchyma

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12
Q

Who is at risk of getting pneumonia?

A

Extremes of age

COPD and other chronic lung diseases

Immunocompromised

Nursing home residents

Impaired swallowing

Diabetes

Congestive heart failure

Alcoholics + drug users

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13
Q

How is pneumonia classified?

A

Anatomically:

  • lobar
  • bronchopneumonia

Aetiologically: by the pathogen causing it

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14
Q

What are the causes of pneumonia?

A

Infection:

  • usually bacteria
  • sometimes virus

Unknown

Chemical
- aspiration of vomit

Radiotherapy

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15
Q

Which pathogens most commonly cause pneumonia?

A

Bacteria

  • S. pneumonia
  • Mycoplasma species
  • Chlamydophila pneumonia
  • Legionella
  • H. influenzae
  • Mycobacterium tuberculosis
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16
Q

Where do people come across Legionella?

A

Water tanks
Stagnant water
Travel

17
Q

What is consolidation?

A

Alveolar space that contains liquid instead of gas

It appears as white on an X-ray
It is a sign of pneumonia

18
Q

How does consolidation occur?

A

When an infection occurs in the distal airways, an inflammatory response occurs

So neutrophils and inflammatory exudate fill the alveolar space

Fluid accumulates = consolidation

19
Q

What are symptoms of pneumonia?

A 
Fever
Cough
Sputum sometimes
SOB
Pleuritic chest pain
Systemic features: fever, night sweats
Extra-pulmonary features: neurological
20
Q

What can sputum tell you about pneumonia?

A

Rusty sputum is suggestive of S. pneumonia

Non-productive suggests Mycoplasma, Chlamydophila, Legionella

21
Q

What are the signs of pneumonia?

A

Abnormal vital signs:

  • fever
  • raised HR
  • raised resp rate
  • low BP

Signs of lung consolidation on percussion and auscultation

Hypoxia, signs of respiratory failure

22
Q

What are the signs of lung consolidation you can hear?

A 
Dull to percussion
Decreased air entry
Bronchial breath sounds
Crackles plus wheeze
Aegophony
23
Q

What is aegophony and how do you test for it?

A

Ask the patient to say ‘e’ and listen to the lungs with a stethoscope

If they show aegophony the ‘e’ sound they are making will sound like an ‘a’

24
Q

Investigations for pneumonia?

A

CXR: show areas of consolidation
Also look for cavities (TB) and signs of cancer

Sputum

Bloods:

  • WBCs - marker for severity
  • U&E
  • LFT
  • CRP - marker for severity

Pulse oximetry

ABG: low O2 and high CO2 means it is severe

Microbiological tests

Urinalysis

25
Q

On an X-ray what would multi-lobar consolidation suggest the pathogen is?

A

S. pneumonia
S. aureus
Legionella

26
Q

On an X-ray what would multiple abscesses or pneumoatoceles suggest the pathogen is?

A

S. aureus

27
Q

What are pneumatoceles?

A

Cavities filled with air

28
Q

On an X-ray what would an upper lobe cavity suggest the pathogen is?

A

Klebsiella pneumoniae

29
Q

Management of pneumonia?

A

Antimicrobials depending on the pathogen

Analgesia

Oxygen if hypoxic

Admit to ITU/HDU if necessary

30
Q

What is CAP?

A

Community acquired pneumonia

31
Q

Which micro-organisms are usually responsible for hospital acquired pneumonias?

A

Gram negative bacilli

Staph. aureus

32
Q

What is a CURB-65 score?

A

C - Confusion: use the abbreviated mental test (score ≤8)
U - Urea >7mmol/L
R - Respiratory rate ≥30/min
B - Blood Pressure 65 years

1 point for each

A score ≥3 is severe pneumonia
≥2 requires hospitalisation

33
Q

What’s the difference between an empyema and an abscess?

A

Empyema: a collection of pus in an already existing cavity

Abscess: collection of pus in a newly formed cavity

34
Q

What is a pleural empyema?

A

Collection of pus in the pleural cavity

35
Q

What causes pleural empyema?

A

When bacteria invade the pleural space

36
Q

What are the clinical features of pleural empyema?

A

Fever + inflammation markers that don’t settle with antibiotics

Pain on deep inspiration

Signs of pleural collection: stony dull to percussion, reduced air entry

37
Q

What is the treatment for pleural empyema?

Why do you have to be quick?

A

Drain the pus

If it is left for too long it will become gelatinous, and will have to be removed surgically

38
Q

How can you prevent pneumonia?

A

Polysaccharide pneumococcal vaccination

Influenza vaccine

Smoking cessation

39
Q

Who is the Polysaccharide pneumococcal vaccination offered to?

A

Those over age 65
Splenic dysfunction
Immunocompromised
Chronic medical conditions

Respiratory (17 decks)

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