Lower respiratory tract infections Flashcards

1
Q

List some lower respiratory tract infections

A
Acute bronchitis
Exacerbation of COPD
Pneumonia
Empyema
Lung abscess
Bronchiectasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the symptoms of pneumonia?

A
Malaise
fever
pleuritic chest pain
cough
purulent sputum - rusty
Dyspnoea 
headache
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the signs of pneumonia?

A
pyrexia
tachypnoea
central cyanosis
dullness on percussion of affected lobe
bronchial breathing
inspiratory crepitations
increased vocal resonance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the investigations for pneumonia?

A
FBC
CXR - opacities
Blood cultures
Throat swab
Urinary legionella sample
Sputum culture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List some microbiological causes of pneumonia

A
Strep pneumoniae
Haemophilus influenzae
Legionella
Staph aureus
Mycoplasma pneumoniae
Chlamydia psittaci
Viruses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What organism is mostly associated in pneumonia in younger people with a sub-acute course with non-respiratory complications such as haemolytic anaemia?

A

Mycoplasma pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do you score severity of pneumonia?

A
CURB 65
C - confusion 
U - blood urea >7
R - resp rate >30
B - diastolic pressure <60
65 - age >65yo

CURB score 0-1: home care
CURB score 2: hospital care
CURB score 3-5: ITU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do you treat CURB 0-1 pneumonia?

A

Amoxycilin or clarithromycin or doxycycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you treat CURB 2 pneumonia?

A

Amoxycillin and clarithromycin/levofloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do you treat CURB 3-5 pneumonia?

A

Co-amoxiclav and clarithromycin/levofloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When is levofloxacin used?

A

In penicillin allergic individuals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What supportive treatments are given alongside antibiotics for pneumonia?

A

O2
Fluids
CPAP
Intubation and ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some complications of pneumonia?

A
Septicaemia and shock
Acute kidney injury
Empyema
Lung abscess
Haemolytic anaemia (mycoplasma)
ARDS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How can you distinguish TB from pneumonia?

A

TB often in upper lobes of the lungs and often has a much more chronic course

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some differential diagnoses of pneumonia?

A
TB
Lung cancer
Pulmonary embolism
Cardiac failure
Pulmonary vasculitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is empyema?

A

Collection of pus in a cavity of the body, particularly in pleural cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What often causes empyema?

A

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

18
Q

What are the symptoms and signs of empyema?

A

Chest pain
Cloudy pus
Absence of cough
High swinging fever

19
Q

How do you diagnose empyema?

A

Pleural aspiration
CT
Pleural ultrasound

20
Q

How do you treat empyema?

A
Chest drain
IV antibiotics
Intrapleural t-PA to degrade clots
DNase
Surgery if they don't improve
21
Q

Describe a lung abscess

A

Type of liquefactive necrosis of lung tissue and formation of cavities >2cm containing necrotic debris or fluid, caused by microbial infections

22
Q

What organisms usually cause lung abscesses?

A

Staph Aureus
Pseudomonas
Anaerobes

23
Q

What are the symptoms of lung abscess?

A

lethargy
weight loss
swinging fever

24
Q

How do you treat lung abscesses?

A

Prolonged antibiotics

Must check its not TB

25
What can cause bronchiectasis?
``` Idiopathic Immotile cilia syndrome CF Childhood infections e.g. measles Hypogammaglobulinaemia Allergic bronchopulmonary aspergillosis ```
26
What can cause hypogammaglobulinaemia?
``` Acquired Drug related GI or kidney related haematological disorders cancer ```
27
What are the symptoms of bronchiectasis?
``` Chronic cough Daily sputum, half cup or more Wheeze Dyspnoea Chronic fatigue Fitting chest pain Haemoptysis ```
28
What are the signs of bronchiectasis?
Clubbing Crepitations on auscultation Signet ring appearance on CT Positive sputum culture
29
How do you treat bronchiectasis?
Chest physiotherapy Long term antibiotics Inhaled beta 2 agonists and corticosteroids
30
What are some diagnostic techniques for LRTIs?
Microscopy and culture of sputum and blood Antigen detection methods Nucleic acid amplification - PCR Serology (antibody measurement)
31
What are the 3 major respiratory pathogens?
Strep pneumoniae Haemophilis influenzae Moraxella catarrhalis
32
What staining technique is used only for TB?
ZN or auramine phenol stain Appear as red bacilli that resist decolorisation by alcohol or acid (AAFB)
33
How long do you have to culture mycobacterium in TB?
6-12 weeks
34
What is broncho-alveolar lavage?
Lower airway sample collected during bronchoscopy - squirts fluid into the lungs then collects it for examination
35
What organisms are not easily cultured?
Legionella pneumophilia Mycoplasma pneumoniae Chlamydia psittaci Coxiella burnetti
36
What are some techniques used for antigen detection?
Latex agglutination EIA/ELISA PCR Immunofluorescence
37
In what body fluid can you find legionella and pneumococcal antigens?
Urine
38
Describe the PCR technique
Denaturation at 94-98C Annealing of primers at 50-65C Elongation at 75C
39
What respiratory viruses are tested for on a multiplex assay?
``` Influenza A and B Adenovirus RSV Parainfluenza Metapneumovirus Coronavirus Rhinovirus ```
40
What is a marker of primary infection?
IgM
41
What is a marker of secondary infections?
IgG