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Respiratory system 2017 > Lower respiratory tract infections > Flashcards

Lower respiratory tract infections Flashcards

1
Q

List some lower respiratory tract infections

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

What are the symptoms of pneumonia?

A 
Malaise
fever
pleuritic chest pain
cough
purulent sputum - rusty
Dyspnoea 
headache
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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
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4
Q

What are the investigations for pneumonia?

A 
FBC
CXR - opacities
Blood cultures
Throat swab
Urinary legionella sample
Sputum culture
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5
Q

List some microbiological causes of pneumonia

A 
Strep pneumoniae
Haemophilus influenzae
Legionella
Staph aureus
Mycoplasma pneumoniae
Chlamydia psittaci
Viruses
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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

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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

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8
Q

How do you treat CURB 0-1 pneumonia?

A

Amoxycilin or clarithromycin or doxycycline

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9
Q

How do you treat CURB 2 pneumonia?

A

Amoxycillin and clarithromycin/levofloxacin

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10
Q

How do you treat CURB 3-5 pneumonia?

A

Co-amoxiclav and clarithromycin/levofloxacin

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11
Q

When is levofloxacin used?

A

In penicillin allergic individuals

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12
Q

What supportive treatments are given alongside antibiotics for pneumonia?

A

O2
Fluids
CPAP
Intubation and ventilation

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13
Q

What are some complications of pneumonia?

A 
Septicaemia and shock
Acute kidney injury
Empyema
Lung abscess
Haemolytic anaemia (mycoplasma)
ARDS
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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

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15
Q

What are some differential diagnoses of pneumonia?

A 
TB
Lung cancer
Pulmonary embolism
Cardiac failure
Pulmonary vasculitis
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16
Q

What is empyema?

A

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

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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
Q

What can cause bronchiectasis?

A 
Idiopathic
Immotile cilia syndrome
CF
Childhood infections e.g. measles
Hypogammaglobulinaemia
Allergic bronchopulmonary aspergillosis
26
Q

What can cause hypogammaglobulinaemia?

A 
Acquired
Drug related
GI or kidney related
haematological disorders
cancer
27
Q

What are the symptoms of bronchiectasis?

A 
Chronic cough
Daily sputum, half cup or more
Wheeze
Dyspnoea
Chronic fatigue
Fitting chest pain
Haemoptysis
28
Q

What are the signs of bronchiectasis?

A

Clubbing
Crepitations on auscultation
Signet ring appearance on CT
Positive sputum culture

29
Q

How do you treat bronchiectasis?

A

Chest physiotherapy
Long term antibiotics
Inhaled beta 2 agonists and corticosteroids

30
Q

What are some diagnostic techniques for LRTIs?

A

Microscopy and culture of sputum and blood
Antigen detection methods
Nucleic acid amplification - PCR
Serology (antibody measurement)

31
Q

What are the 3 major respiratory pathogens?

A

Strep pneumoniae
Haemophilis influenzae
Moraxella catarrhalis

32
Q

What staining technique is used only for TB?

A

ZN or auramine phenol stain

Appear as red bacilli that resist decolorisation by alcohol or acid (AAFB)

33
Q

How long do you have to culture mycobacterium in TB?

A

6-12 weeks

34
Q

What is broncho-alveolar lavage?

A

Lower airway sample collected during bronchoscopy - squirts fluid into the lungs then collects it for examination

35
Q

What organisms are not easily cultured?

A

Legionella pneumophilia
Mycoplasma pneumoniae
Chlamydia psittaci
Coxiella burnetti

36
Q

What are some techniques used for antigen detection?

A

Latex agglutination
EIA/ELISA
PCR
Immunofluorescence

37
Q

In what body fluid can you find legionella and pneumococcal antigens?

A

Urine

38
Q

Describe the PCR technique

A

Denaturation at 94-98C
Annealing of primers at 50-65C
Elongation at 75C

39
Q

What respiratory viruses are tested for on a multiplex assay?

A 
Influenza A and B
Adenovirus
RSV
Parainfluenza
Metapneumovirus
Coronavirus
Rhinovirus
40
Q

What is a marker of primary infection?

A

IgM

41
Q

What is a marker of secondary infections?

A

IgG

Respiratory system 2017 (31 decks)

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