Lower Respiratory Tract Infections Flashcards
Symptoms of Pneumonia (7)
Malaise Myalgia Fever Chest pain (pleuritic) Purulent sputum Maybe be rusty sputum (haemoptysis) Dyspnoea
Signs of Pneumonia (7)
Pyrexia Tachypnoea Central cyanosis Dullness on percussion of affected lobe Bronchial breath sounds Inspiratory crepitations Increased vocal resonance
Investigations for Pneumonia (7)
Serum biochemistry, CRP (produced by liver in response to inflammation) and FBC CXR Blood cultures Throat swab (atypical pathogens) Urinary legionella antigen Sputum microscopy and culture HIV test
Microbiology of Pneumonia (9)
Strep. Pneumoniae- CAP H. influenzae Legionella S. Aureus- HAP (MRSA) Moraxella Catarrhalis Mycoplasma pneumoniae Chlamydophyla pneumoniae Chlamydophyla psittaci Coxiella burnetii
Pneumonia Severity Scoring
CURB 65
C (CURB)
Confusion
U (CURB)
Blood urea >7
R (CURB)
Respiratory rate >30
B (CURB)
diastolic blood pressure <60
65 (CURB)
age>65
A score of 0 (CURB)
low risk and could be treated in the community
A score or 1-2 (CURB)
hospital treatment usually required
A score of 3-5 (CURB)
High risk of death and need for ITU
Treatment for (CURB) 0-1
Amoxycillin or Clarithromycin/doxycycline
Treatment for (CURB) 2
Amoxycillin and Clarithromycin or levofloxacin
Treatment for (CURB) 3-5
Co-amoxiclav and Clarithromycin or Levofloxacin (if penicillin allergic)
Treatment for aspiration pneumonia and why
Anaerobes likely
Metronidazole and amoxycillin
Haematological malignancy/neutropenia treatment
Broad spectrum antibiotics, consider anti-fungals if immunosuppressed
Legionnaires disease treatment
Consider involvement with public health to check water systems
MRSA pneumonia treatment
Vancomycin or linezolid
What type of pneumonia would be seen in HIV (immunosuppressed)
Pneumocystis jiroveci pneumonia
General treatment for pneumonia (4)
Oxygen- hypoxic
IV fluids- AKI/ dehydration
Continuous positive airway pressure- for type 1 respiratory failure
Intubation and ventilation
Complications of pneumonia (6)
Septicaemia AKI- dehydration Empyema Lung abscess Metastatic infection Acute Respiratory Distress Disorder
Differential diagnosis for pneumonia (5)
TB Lung cancer Pulmonary embolism Pulmonary Oedema Pulmonary vasculitis (Wegner's granulomatosis)
Cause of Empyema (3)
Streptococcus
S. aureus
Anaerobes
Investigation of Empyema
High swinging fever
CT thorax
Pleural ultrasound
Pleural aspiration (pH<7.2)
Treatment of Empyema (2)
Chest drain and IV antibiotics
Intrapleural t-PA/DNase required to breakdown thick fluid if it wont drain
Features of Lung Abscess (3)
Similar to empyema
May or may not follow pneumonia
S.aures, Pseudomonas may lead to cavitating pneumonia
Symptoms of Lung Abscess (3)
Lethargy
Weight loss
High swinging fever
Investigation for lung abscess (3)
CT thorax
Sputum culture
CXR
Treatment of Lung abscess (2)
Prolonged antibiotics
Drainage via bronchial tree
What is Bronchiectasis
Widening of bronchi which leads to accumulation of mucous
Causes of Bronchiectasis (6)
Idiopathic Immotile Cilia Syndrome Cystic fibrosis Childhood infections (measles, whooping cough) Hypogammaglobulinemia Allergic bronchopulmonary aspergillosis
Symptoms of Bronchiectasis (7)
Chronic cough Daily sputum Wheeze Dyspnoea Tiredness Fitting chest pains Haemoptysis
Signs of Bronchiectasis (2)
Finger clubbing
Coarse inspiratory crepitations
Investigations for Bronchiectasis (5)
High resonance CT of the thorax Sputum culture: S. aureus, P. aeruginosa, H. Influenzae Serum immunoglobulins Total IgE and aspergillus precipitins CF genotyping
Treatment for Bronchiectasis
Chest physiotherapy to clear the sputum
Appropriate antibiotics
Inhaled beta 2 agonists and inhaled corticosteroids
