Lower Respiratory Tract Infections

Question 1

What does the lower respiratory tract contain?

Answer 1

Trachea, primary bronchi and lungs

Question 2

What are the main causes of respiratory tract infections?

Answer 2

Bacteria
Viruses
Fungi
Protozoa

Question 3

What are the 2 main types of pneumonia?

Answer 3

Community acquired pneumonia

Hospital Acquired pneumonia

Question 4

What are the features of community acquired pneumonia?

Answer 4

Mainly in young and old
many cases idiopathic
gram negative
secondary to another RT infection

Question 5

What are the symptoms of pneumonia?

Answer 5

sudden onset of chills, followed by fever/chest pain/productive cough
raised WBC count
thick sputum, rusty colour, purulent

Question 6

How do you treat pneumonia?

Answer 6

Community acquired - beta lactam agent and macrolide
CURB score assessment - 5 point score (confusion, urea high, high resp rate, low blood pressure) and if more than 3 high death risk

Question 7

What is atypical pneumonia?

Answer 7

not due to strep pneumonia
doesn’t respond to beta lactam
insidious onset, normal CXR, subclinical infection

Question 8

Which forms of pneumonia are typical and which are atypical?

Answer 8

Typical - S. pneumoniae, H.influenza, group A strep

Atypical - C pneumoniae, L pneumophilia, M.tuberculosis, Myocplasma

Question 9

What is streptococcus pneumoniae?

Answer 9

Typical
more and more prevalent
AKA pneumococcus
colonises upper respiratory tract
identifiable features: gram stain of sputum negative alpha haemolytic, bile soluble sputum

Question 10

What is mycoplasma pneumoniae?

Answer 10

atypical
droplet transmission
neurological
diagnosis - CXR patchy bilateral bronchopneumonia
difficult to culture
antibodies produced against patients own RBCs
IgM test
serology
PCR

Question 11

What is legionella penumophilia?

Answer 11

atypical
small gram negative bacteria
distinctive orange/yellow 
slow growth
clinical signs - confusion, muscle ache, pneumonia, renal failure

Question 12

What is chlamydia pneumoniae?

Answer 12

person to person spread
atypical
co-pathogen in coronary artery disease

Question 13

What is pneumocystis pneumonia?

Answer 13

important cause of pneumonia in severely immunocompromised

Question 14

How is pneumonia diagnosed?

Answer 14

history and clinical exam
chest x ray, blood count, blood cultures
sputum

Question 15

What are some pneumonia complications?

Answer 15

pleural effusion
emphysema
lung abscess

Question 16

What is fever?

Answer 16

caused by coxiella burnetiid
transmitted through infected animals
causes atypical pneumona

Question 17

What is tuberculosis?

Answer 17

chronic
respiratory but can affect any organ almost
primary infection = may inhale infected droplets from cough or sneeze
mycobacteria caused - aerobic, non-motile, straight/curved, fatty acid cell wall

Question 18

What is clinically important about TB mycobacteria?

Answer 18

Resistant to drying, antibiotics, alcohol and alkalis, hydrophobic, impermeable to standard stains

Question 19

What are some common LRTIs?

Answer 19

bronchitis
bronchiolitis
pneumonia
influenza

Question 20

What are some symptoms of acute bronchitis?

Answer 20

sore throat, fatigue, stuffy/runny nose, fever, body aches, vomiting, diarrhea

Question 21

How is acute bronchitis managed?

Answer 21

educate about lack of antibiotic use
encourage fluid intake and humidity
recommend analgesics, antitussives and antipyretics

Question 22

Define pneumonia

Answer 22

Inflammation of the alveoli in either one or both lungs
Alveoli become inflamed & fill up with fluid
Common pathogen: Bacteria or virus
Elderly & the very young: Greatest risk

Question 23

What are the symptoms of pneumonia?

Answer 23

headache, fever, weakness, dry cough, nasal congestion, chills, sore throat, sweating, muscle aches

Question 24

What is the pathophysiology of pneumonia?

Answer 24

injury-> inflammation -> innate immunity -> alveolar injury

Question 25

How is pneumonia diagnosed?

Answer 25

sputum culture
urine test
PCR
CT scan
complete blood count

Question 26

How is pneumonia prevented?

Answer 26

• improve indoor air quality
• drink safe water, good sanitation, frequent hand washing with soap
• good nutrition
• recognise danger signs and seek help quickly
• routine immunisations (pertussis, measles)
• exclusive breastfeeding for first 6 months

Question 27

How is pneumonia treated?

Answer 27

home care advice
oral amoxicillin
first dose antibiotic and referral to facility for injectable antibiotic
supportive therapy