Lower Respiratory Tract infections

Question 1

Symptoms of Pneumonia

Answer 1

Fever
Myalgia 
Fatigue 
Dyspnoea (severe)
Pleuritic pain
Cough (may or may not)

Question 2

Pneumonia may not present with what in the elderly?

Answer 2

Fever

Question 3

Rusty sputum is suggestive of what?

Answer 3

Pneumococcal pneumonia

Question 4

Signs of pneumonia

Answer 4

Pyrexia
Tachypnoea
Central cyanosis
Dullness on percussion
Bronchial breathing
Crepitations
Increased Vocal Resonance

Question 5

Investigations in pneumonia

Answer 5

Chest radiograph
Sputum for culture
Acute and convalescent serology	
Mycoplasma IgM      
Atypical serology         
Full blood count
ESR/CRP
Blood culture
Legionella urinary antigen             
Pneumococcal urinary antigen
HIV

Question 6

Common pathogens in pneumonia

Answer 6

Strep pneumoniae
(gram -ve coccus
chlamydia psittaci
mycoplasma pneumoniae
Staph. Aureus  
Haemophilus influenza

Question 7

Common cause of bacterial pneumonia in children

Answer 7

Mycoplasma pneumoniae

Question 8

What is the severity scoring system for pneumonia?

Answer 8

CURB 65
Confusion
Urea (blood, >7)
Respiratory rate>30
Blood pressure (diastolic<60)
65 (age >65)

Question 9

What treatment/drug does a CURB65 score of 0 recommend?

Answer 9

Low risk
Treat in community
Amoxycillin OR clarithromycin

Question 10

What treatment/drug does a CURB 65 score of 1-2 suggest?

Answer 10

Hospital treatment required
Amoxicillin AND Clarithromycin
(Beta lactam and macrolide)

Question 11

What treatment/drug does a CURB 65 score of >3 suggest?

Answer 11

High risk of death
Need for ITU
Co-amoxiclav AND clarithromycin

Question 12

Treatment for aspiration pneumonia?

Answer 12

(anaerobes)

Metronidazole and amoxycillin

Question 13

Haematological malignancy treatment?

Answer 13

Broad spec

?antifungals

Question 14

Influenza pneumonia increases the risk of what?

Answer 14

Staphylococcal pneumonia

Question 15

Treatment for MRSA involved pneumonia?

Answer 15

Vancomycin or Linezolid

Question 16

Pathogen often involved in pneumonia in the immunocompromised?

Answer 16

Pneumocystis jirovecii

fungus

Question 17

Full treatment plan for pneumonia?

Answer 17

Antibiotics
Oxygen
Analgesia
CPAP
Intubation and ventilation

Question 18

Complications of pneumonia

Answer 18

Scepticaemia 
Acute kidney injury
Empyema
Lung abscess
Metastatic infection 
ARDS

Question 19

Differential diagnosis for pneumonia?

Answer 19

Tuberculosis
Lung cancer
PE
Pulmonary oedema 
Pulmonary vasculitis

Question 20

Empyema may follow which bacterial pneumonias?

Answer 20

Streptococcus (50%)
Staph aureus
Anaerobes

Question 21

Symptoms of empyema

Answer 21

Chest pain
High swinging fever
Absence of cough

Question 22

Investigations for empyema?

Answer 22

CT thorax

pleural ultrasound

Question 23

Diagnosis for empyema?

Answer 23

Acidic pleural aspiration

Question 24

Treatment for empyema?

Answer 24

Chest drain
IV antibiotics
May need t-PA/DNase
Surgery if not improving

Question 25

Pathogens most likely to cause cavitating pneumonia?

Answer 25

Staph aureus Pseudomonas Anaerobes

Question 26

Investigations for lung abscess?

Answer 26

CT Thorax Sputum culture TB microscopy/culture

Question 27

Treatment for lung abscess

Answer 27

Prolonged antibiotics | Drainage

Question 28

Causes of Bronchiectasis

Answer 28

``` Idiopathic Immotile Cilia syndrome Cystic Fibrosis Childhood infections Hypogammaglobulinaemia ABPA (Aspergillosis) ```

Question 29

Symptoms of bronchiectasis

Answer 29

Chronic cough Copious sputum production ?wheeze, dyspnoea, tiredness, pain, haemoptysis

Question 30

Signs of bronchiectasis

Answer 30

Finger clubbing | Course inspiratory crepitations

Question 31

Investigations for bronchiectasis

Answer 31

``` HRCT Thorax Sputum culture Serum immunoglobulins IgE, Aspergillus precipitins CF genotyping ```

Question 32

Treatment for bronchiectasis

Answer 32

Chest physiotherapy Prompt treatment of infections May need inhaled therapy

Question 33

Common LRTI Viruses

Answer 33

RSV Influenza A/B Adenovirus

Question 34

Common LRTI bacteria

Answer 34

Strep pneumoniae Haemophyilius influenzae M. pneumoniae Chlamydia pneumoniae

Question 35

Tracheitis presents as what?

Answer 35

"croup which doesn't get better" Fever Stridor

Question 36

Treatment for Tracheitis

Answer 36

Augmentin

Question 37

Criteria for persistent bacterial bronchitis

Answer 37

Wet cough >1 month Remission with antibiotics

Question 38

Bronchiolitis cardinal signs

Answer 38

Stuffiness Tachypnoea Poor feeding Crackles

Question 39

Investigations for bronchiolitis

Answer 39

Nasopharyngeal aspiration | O2 saturation

Question 40

What does wheeze suggest in paediatrics LRTIs?

Answer 40

Bacterial cause unlikely

Question 41

When to diagnose an LRTI as pneumonia in a child?

Answer 41

Signs are focal Crepitations High fever

Question 42

Management of mild symptomatic pneumonia in a child

Answer 42

No Rx

Question 43

Management of symptomatic pneumonia in a child

Answer 43

Amoxicillin (then) Macrolide (IV if vomiting)