Lower respiratory tract infections

Question 1

define lower respiratory tract infection.

Answer 1

respiratory tract infections below the larynx

Question 2

what are the common predisposing factors that lead to a Lower respiratory tract infection occurring.

Answer 2

loss or suppression of cough reflex (pathogen is not removed).
Cillary defects
mucus disorders
pulmonary odema
immunodeficency
macrophage function inhibitiom
aspiration of food.

Question 3

common bacterial organism which cause lower respiratory tract infections

Answer 3

streptococcus pnemonia
haemophilus influenz
staphylococcus aureus
klebisella pneumona
Mcyoplaasma pneumonaie
Legionella pneumophila
Mycobacterium tuberculosis.

Question 4

common viral organisms which cause lower respiratory tract infections

Answer 4

Influenza
Parainfluenza
Respiratory syncytial virus- RSV
Adenovirus

Question 5

common fungal infections which cause lower respiratory infections

Answer 5

aspergillus, candida, pneumocytisis jiroveci.

Question 6

define acute bronchitis

Answer 6

• Inflammation and oedema of trachea and the bronchi

Question 7

clinical signs of acute bronchitis

Answer 7

cough (dry), dysponea, tachyponea, retrosternal pain

Question 8

common pathogens which cause acute bronchitis and chronic bronchitis.

Answer 8

viral- common
rhinovirus, coranavirus, adenovirus and influenza
bacteria- rare
H. infleunza, M. pneumonia, B, pertussis.

Question 9

diagnosis of acute bronchitis

Answer 9

vaccination history and previous exposure- to eliminate organisms
culture of respiratory secretions to isolate cause

Question 10

treatment for acute bronchitis

Answer 10

supportotive
oxygen therapy-immuneocompromised
antibiotics is bacterial

Question 11

define chronic bronchitis

Answer 11

cough productive of sputum on most days during atleast 3 months of 2 successive years (which cannot be attributed to alternative cause)

Question 12

what factors contribute to developing chronic bronchitis

Answer 12

sex- men
age- over 40
smoking
pollution
allergens- in particular.

Question 13

In what age group is bronchioloitis common

Answer 13

children- narrow bronchioles

Question 14

define bronchiolitis

Answer 14

• Inflammation and oedema of the bronchioles

Question 15

clinical signs of bronchiolitis

Answer 15

acute onset wheeze, cough, nasal discharge, respiratory distress (grunting, retractions, and nasal flaring.

Question 16

most common pathogen which causes bronchiolitis

Answer 16

RSV

Question 17

diagnosis of bronchiolitis

Answer 17

chest X-ray
FBC
Microbiology
nasopharyngeal aspirate

Question 18

Treatment for bronchiolitis

Answer 18

supportive- oxygen

antibiotic is bacterial

Question 19

define pneumonia

Answer 19

• Infection of distal airway and alveoli- form inflammatory exudate

Question 20

2 anatomical patterns of pneumonia

Answer 20

– Bronchopneumonia- patchy distributed around bronchioles and spread to alveoli.
– Lobar pneumonia-90% due to s. pneumniae, affects large part of the lung, line demarcation and consolidation.

Question 21

4 ways in which pneumonia can be caused

Answer 21

community acquired-most common
hospital acquired
Ventilator acquired pneumonia
Aspiration pneumonia

Question 22

what defines hospital acquired pneumonia

Answer 22

• Pneumonia developing >48hrs after hospital admission

Question 23

what defines hospital ventilator pneumonia

Answer 23

• Subgroup of HAP
• Pneumonia developing >48hrs after ET intubation & ventilation
common when not breathing well

Question 24

what defines aspiration pneumonia

Answer 24

subgroup HAP or CAP.
• Pneumonia resulting for the abnormal entry of fluids e.g. food, drinks, stomach contents, etc. into the lower respiratory tract
• Common is patients unconscious

Question 25

how is CAP pneumonia transmitted

Answer 25

Person-to-person or from a person from environment from animals

Question 26

what organism cause CAP pneumonia

Answer 26

``` Atypical • Mycoplasma pneumoniae • Legionella pneumophilia • Chlamydophila pneumoniae • Chlamydophila psittaci • Coxiella burnetii Typical • Streptococcus pneumoniae • Haemophilus influenzae • Moraxella catarrhalis • Staphylococcus aureus • Klebsiella pneumoniae ```

Question 27

clinical signs and symptoms of pneumonia

Answer 27

``` • Rapid onset • Fever/chills-rigors • Productive cough- blood or purulent. • Mucopurulent sputum • Pleurtitic pain- lung parenchyma is infected and inflamed, and on deep inspiration it rubs against the pleura • General malaise-fatigue and anxiety. tachypnoea, tachycardia, hypotension ```

Question 28

what is found upon examination of a patient with pneumonia

Answer 28

dull to percuss (consolidation) and reduced air entry, bronchial breathing.

Question 29

main symptom of mycoplasma pneumonia

Answer 29

cough

Question 30

rare complications of mycoplasma pneumonia

Answer 30

guillian- barre, peripheral neuropathy

Question 31

mycoplasma pneumonia is common in which age group

Answer 31

children

Question 32

Chlamydophila pneumoniae is common in which age group

Answer 32

elderly

Question 33

what are outbreaks of legionella pneumophilla associated with

Answer 33

 Colonises water piping systems |  Outbreaks associated with showers, air conditioning units, humidifiers

Question 34

signs of legionella pneumophilla

Answer 34

 High fevers, rigors, cough: dry initially becoming productive, dyspnoea, vomiting, diarrhoea, confusion- low GCS.  Bloods: deranged LFTs, SIADH (low sodium)

Question 35

what animal exposure is Chlamydophila psittaci associated with

Answer 35

birds

Question 36

signs of Chlamydophila psittaci

Answer 36

rash, hepatitis, haemolytic anaemia, reactive arthritis, spleenomegaly.

Question 37

what is the recover time from influenza

Answer 37

2-3 weeks

Question 38

symptoms of influenza

Answer 38

– Fever, headache, myalgia (pain in muscles) and sore throat

Question 39

primary viral pneumonia occurs most commonly in what types of people

Answer 39

people with pre-existing cardiac or lung problems (heart failure of COPD)

Question 40

What the of infections commonly occurs after a primary viral pneumonia

Answer 40

– Secondary bacterial pneumonia then may develop after initial period of improvement:- COMMON as viral infection damages the lung so it is an opportunity for bacteria to colonise.

Question 41

3 most common pathogens which cause secondary bacterial pneumonia

Answer 41

– S.pneumoniae, H.influenzae, S.aureus

Question 42

diagnosis of influenza

Answer 42

viral antigen detection in respiratory samples using PCR.

Question 43

treatment for influenza

Answer 43

no treatment

Question 44

non microbiological investigations for CAP

Answer 44

routine observations- BP/Pulse/Oximetry Blood: FBC/U and E, CRP, LFT Chest X-ray.

Question 45

Microbiological invesitagtions for inpatients for CAP

Answer 45

– Sputum gram stain and culture- see what the organism is. – Blood culture- if serious as the pathogens has multiplied in the lung and then reached the blood supply. – Pneumococcal urinary antigen – Legionella urinary antigen PCR for viral pathogen, mycoplasma pneumoniae, chlamydophilia

Question 46

what assessment is used to determine the disease severity of CAP

Answer 46

``` CURB65 Confusion Urea Respiratory rate Blood pressure Age> 65 years ```

Question 47

which 2 vaccine prevent lower respiratory tract infections

Answer 47

* Pneumococcal vaccination (S. pneumoniae) | * Influenza vaccination for vulnerable groups (annually)

Question 48

Management of CAP

Answer 48

A- airway- open and patent B-breathing- reap rate, oxygen saturation C-circulation- BP and heart rate, urinary catheter to measure output. antibiotics given depends on CURB65 score.

Question 49

which groups of patients are given the pneumococcal vaccination

Answer 49

– Patients with chronic heart, lung and kidney disease | – Patients with splenectomy

Question 50

which groups of patients are given the influenza vaccine

Answer 50

– Over 65s | – Chronic disease, multiple co-morbidities e.g. diabetes.