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Respiratory system SA > Lower respiratory tract infections > Flashcards

Lower respiratory tract infections Flashcards

1
Q

What is examples of lower respiratory tract infections

A 
Acute bronchitis
Exacerbation of COPD
Pneumonia
Empyema
Lung Abscess
Bronchiectasis
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2
Q

What is the symptoms of pneumonia

A 
Malaise - tirdness 
Fever
Chest pain (pleuritic) - painful when breath 
Cough
Purulent sputum
Dyspnoea - breathlessness
Headache
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3
Q

What is the sputum produced in pneumonia caused by Streptococcus pneumoniae and Klebsiella pneumoniae called

A

rusty sputum

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4
Q

What is the signs of pneumonia

A 
Pyrexia
Tachpnoea - fast respiratory rate 
Central cyanosis (blue tongue)
Dullness on percussion of affected lobe(s)
Bronchial breath sounds - harsh 
Inspiratory crepitations (rattes)
Increased vocal resonance
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5
Q

What does the sign of central cyanosis indicate on a patient with pneumonia

A

Patient has become hypoxic

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6
Q

What is the different investigations used for pneumonia

A 
Serum biochemistry and full blood count
Chest X-Ray (CxR)
Blood cultures
Throat swab (for atypical pathogens)
Urinary legionella antigen
Sputum microscopy and culture
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7
Q

Why does a chest X-ray look white for a patient with pneumonia

A

looks white as alveoli filled with bacterial cells and inflammatory substances

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8
Q

Why are blood tests and sputum culture important in investigation of pneumonia

A

used to confirm an infection and to try to identify the type of organism causing the infection

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9
Q

What is the purpose of the Urinary legionella antigen investigation

A

To test for Legionnaires’ disease which is a form of atypical pneumonia caused by any type of Legionella bacteria

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10
Q

What is the greatest causing pathogens of pneumonia

A 
Strep Pneumoniae				36%
H. Influenzae					10.2%
Legionella					0.4%
Staph aureus					0.8%
Mycoplasma pneumoniae		1.3%
Chlamydia psittaci				1.3%
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11
Q

What are the risk factos affect the scoring on your severity of pneumonia

A 
The CURB 65 
C		confusion
U	        blood urea>7
R		respiratory rate>30
B		diastolic blood pressure<60
65	         age>65
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12
Q

If you have 0 of the CURB 65 risk factors what is your severity and antibiotic treatment

A

low risk and could be treated in community with Amoxycillin or clarithromycin / doxycycline

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13
Q

If you have 1-2 of the CURB 65 risk factors what is your severity
if you have CURB2 how many antibiotics must you take and what are there names

A

hospital treatment usually required

2 -Amoxycillin and clarithromycin

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14
Q

If you have 3-5 of the CURB 65 risk factors what is your severity and antibiotic treatment

A

high risk of death and need for ITU

Co-amoxiclav and clarithromycin

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15
Q

When would levofloxacin be given in the treatment of pneumonia

A

CURB2 and above if patient is allergic to penicillin

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16
Q

What is the non antibiotic treatment for pneumonia

A

Oxygen
i.v. fluids
CPAP - continued positive airway pressure
Intubation and ventilation - if severe

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17
Q

What is continued positive airway pressure

A

a form of positive airway pressure ventilator, which applies mild air pressure on a continuous basis to keep the airways continuously open in people who aren’t able to breathe spontaneously on their own

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18
Q

What is the complications of pneumonia

A 
Septicaemia - infection in blood 
Acute Kidney Injury
Empyema
Lung Abscess
Haemolytic anaemia (breakdown of RBC)
Acute respiratory distress syndrome
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19
Q

What different diagnosis can be made instead of pneumonia

A 
Tuberculosis
Lung cancer
Pulmonary embolism
Cardiac failure
Pulmonary vasculitis (Wegners granulomatosis)
20
Q

If the symptoms carry on for a long time is it more likely to be pneumonia or TB

A

TB

21
Q

What could be mistaken as pneumonia on an X-ray

A

pulmonary embolism

pulmonary vasculitis

22
Q

What further condtions could follow pneumonia

A

Lung abscess
empyema
(bronchiectasis)

23
Q

What pathogens are responsible for empyema

A

Streptococcus (52%),
Staph. Aureus (11%),
Anaerobes (20%)

24
Q

What is empyema

A

collection of pus (infection) in the pleural cavity

25
Q

What is the symptoms of empyema

A

Chest pain
High swimming fever
(no cough)

26
Q

What is used to investigate and diagnose a empyema

A

investigate - CT thorax and pleural ultrasound

Diagnose - pleural aspiration

27
Q

What pH of the pleural aspiration of a patient with empyema

A

< pH 7.2

28
Q

What is the treatment for empyema

A

Treatment is chest drain and intravenous antibiotics
(antibiotics up to 6 weeks)

surgery if don’t respond

29
Q

Define lung absces

A

necrosis of the lung tissue and formation of cavities containing necrotic debris or fluid caused by microbial infection

30
Q

What organisms are more likely to cause a lung abscess

A

Staph. Aureus, pseudomonas and anaerobes

31
Q

What are the symptoms of a lung abscess

A

usually non specific i.e. weight loss, high swimming fever, lethargic

32
Q

How is a lung abscess investigated

A

Investigate with CT thorax and sputum culture

33
Q

What is the treatment of lung abscess

A

prolonged antibiotics

34
Q

Where is drainage usually taken from,

A

bronchial tree

occasionally percutaneous drainage necessary

35
Q

What is the pathology of bronchiectasis

A

damaged dilated airways, due to thickened airway wall and mucus production

36
Q

What is the aetiology of bronchiectasis

A

Idiopathic

Immotile Cilia Syndrome

Cystic fibrosis

Childhood infections such as measles

Hypogammaglobulinaemia
- reduction in all types of gamma globulins, including antibodies that help fight infection

Allergic Bronchopulmonary Aspergillosis (ABPA)
- exaggerated response of the immune systemto the fungus Aspergillus

37
Q

What is the symptoms of bronchiectasis

A 
Chronic cough
Daily sputum production (often copious)
Sometimes,
Wheeze
Dyspnoea
Tiredness
Flitting chest pains
Haemoptysis
38
Q

What is the signs of bronchiectasis

A

Usually no signs
Finger clubbing
Course inspiratory crepitations - crackely noise
(only heard on auscultation)

39
Q

What investigations take place for bronchiectasis

A 
High resolution CT Thorax
Sputum culture
Serum immunoglobulins
Total IgE and Aspergillus precipitins
CF genotyping

(investigations look for underlying cause)

40
Q

What is the potentially microbiology of bronchiectasis

A

haemophilus influenzae,
staph. aureus
pseudomonas aeruginosa

41
Q

What is the treatment for bronchiectasis

A

Chest physiotherapy
Prompt treatment of infections with appropriate antibiotics
inhaled therapy including beta2 agonist and inhaled corticosteroid.

42
Q

When would chest physiotherapy be useful

A

when you have a lot of mucus

43
Q

When would inhaled therapy be needed in the treatment of bronchiectasis

A

when wheezing becomes present

44
Q

What is the pathology of acute bronchitis

A

inflammation of trachea and main airways

45
Q

What is the usual cause of acute bronchitis

A

viral infection

Respiratory system SA (37 decks)

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