Lower Respiratory Tract Infections

Question 1

What are examples of loss/suppressed cough reflex/swallowing?

Answer 1

Coma, Stroke or artificial ventilation.

Question 2

Why does pulmonary oedema pre-dispose to LRTI?

Answer 2

Collection of fluid in alveoli.

Question 3

What is Acute Bronchitis?

Answer 3

Inflammation and oedema of the bronchi.

Question 4

What are the usual causes of Acute Bronchitis?

Answer 4

Viruses (Rhino, adeno, coronavirus and influenza)

Question 5

What is the less common cause of Acute Bronchitis?

Answer 5

Bacteria.

Question 6

Whom does Acute Bronchitis usually affect?

Answer 6

Children

Question 7

What disease are cough (dry), tachypnoea and dyspnoea associated with?

Answer 7

Acute Bronchitis

Question 8

What would help with diagnosis in severe Acute Bronchitis?

Answer 8

Culture of resp secretions - not routine.

Question 9

What treatment is used for severe Acute Bronchitis?

Answer 9

Oxygen therapy

Question 10

Who is affected most in Chronic bronchitis?

Answer 10

Men over 40.

Question 11

What one exposure is Chronic Bronchitis exposed with?

Answer 11

Smoking

Question 12

What mediates airway oedema and irritation?

Answer 12

Exogenous (not infective) irritants.

Question 13

What causes 75% of Bronchiolitis cases?

Answer 13

Respiratory Syncytial Virus

Question 14

What other viruses cause Bronchiolitis?

Answer 14

> Parainfluenza
Adenovirus
Influenza

Question 15

Who does Bronchiolitis most commonly affect?

Answer 15

Young babies

Question 16

What symptoms would occur in Bronchiolitis?

Answer 16

> Nasal discharge
Acute onset of wheeze
Cough
Resp distress (flaring, grunting, intercostal retractions)

Question 17

How would Bronchiolitis be diagnosed?

Answer 17

> Chest x-ray and FBC

> Nasopharyngeal aspirate - viral PCR

Question 18

What are the types of pneumonia?

Answer 18

> Community acquired Pneumonia

> Hospital Acquired Pneumonia

Question 19

What infectious agents cause Hospital Acquired Pneumonia?

Answer 19

> Enterobacteriacae

> Pseudomonas Spp

Question 20

What are the sub-types of Hospital Acquired Pneumonia ?

Answer 20

> Ventilator Acquired Pneumonia.

> Aspiration Pneumonia - abnormal entry into LRTI.

Question 21

Who is affected by community acquired pneumonia?

Answer 21

50-70 year old’s peak age.

Question 22

What pneumonia causing organisms come from a persons existing commensals?

Answer 22

> S.Pneumoniae

> H. Influenzae

Question 23

What pneumonia causing organism comes from the environment?

Answer 23

L.Pneumophilia

Question 24

What pneumonia causing organism comes from animals?

Answer 24

C.pstittaci

Question 25

What are the atypical organisms that cause pneumonia? | (Hint: My legs burn, they smell of tacky clams"

Answer 25

``` > Mycoplasma Pneumoniae > Legionella Pneumoniae > Coxiella burnetii > Chlamydophila psittaci > Chlamydophilia pneumoniae. ```

Question 26

What disease does fever, malaise, anorexia, productive sputum, pleuritic chest pain and fever belong to?

Answer 26

Bacterial community acquired Pneumonia.

Question 27

What are the clinical signs of bacterial community acquired pneumonia?

Answer 27

> Tachypnoea > Tachycardia > Hypotension > Consolidation - dull percussion.

Question 28

A cough is the main symptom of what pneumoniae?

Answer 28

Mycoplasma Pneumoniae

Question 29

Who does Mycoplasma Pneumoniae affect?

Answer 29

Young adults/children

Question 30

What are the rare complications of Mycoplasma Pneumoniae?

Answer 30

> Guillan-Barre syndrome > Peripheral Neuropathy > Pericarditis > Arthritis

Question 31

What disease (type of pneumonia) is found in showers?

Answer 31

Legionella Pneumonia

Question 32

What are the main symptoms of Legionella Pneumonia?

Answer 32

``` > High fever > Vomiting > Diarrhoea > Confusion > Cough : dry --> productive ```

Question 33

Low sodium (SIADH) and deranged LFT's are found with what disease?

Answer 33

Legionella Pneumonia

Question 34

What pneumonia can go on to cause mild pneumonia or bronchitis?

Answer 34

Chlamydophila Pneuminae

Question 35

What disease is characterised by exposure to birds?

Answer 35

Chlamydophila psittaci

Question 36

What should you consider in pt's exposed to Chlamydophila Psittaci?

Answer 36

> Bird expsosure > Splenomegaly > Pneumonia

Question 37

What symptoms may pt's with Chlamydophila Psittaci have?

Answer 37

> Reactive arthritis > Haemolytic Anaemia > Rash > Hepatitis

Question 38

What disease does sore throat, dry cough, fever, headache, myalgia?

Answer 38

Influenza (viral)

Question 39

What is primary viral pneumonia common in?

Answer 39

Those with pre-existing lung and cardiac conditions.

Question 40

What symptoms are common in Primary Viral Pneumonia?

Answer 40

Cough, cyanosis, breathlessness.

Question 41

What may develop after initial primary viral pneumonia ?

Answer 41

Secondary bacterial Pneumonia

Question 42

How is influenza diagnosed?

Answer 42

Viral antigen in PCR.

Question 43

What are the mycobacterial investigations of Influenza?

Answer 43

``` > Sputum culture > Blood culture > Legionella urinary antigen > Pneumococcal urinary antigen > PCR/Serology ```

Question 44

What method are viral pathogens and mycoplasma pneumoniae discovered using in Influenza?

Answer 44

PCR of respiratory sample

Question 45

What method is used to find Chlamydophilia Pneumonia?

Answer 45

Complement fixed blood test

Question 46

What tool is used to assess CAP disease severity?

Answer 46

``` CURB Confusion Urea >7mmol/l Respiratory Rate >30 Blood pressure (systolic ```

Question 47

What is the Pneumococcal vaccination against?

Answer 47

S. Pneumoniae

Question 48

Who is the pneumococcal vaccination for?

Answer 48

Pt's with chronic heart, lung, kidney disease and splenectomy.