Lower respiratory tract infections

Question 1

What is classed as lower respiratory tract

Answer 1

Anything below the trachea (including the trachea)

Question 2

Name the lower respiratory tract infections

Answer 2

Acute bronchitis
Acute exacerbation of COPD
Pneumonia
Tuberculosis

Question 3

What causes acute bronchitis

Answer 3

Usually a virus

Question 4

What are presenting symptoms of acute bronchitis

Answer 4

wet cough

Question 5

When should you see GP with acute bronchitis

Answer 5

If symptoms are severe or have been going on for more than 3 weeks.

Question 6

What is the main indication of an acute exacerbation of COPD

Answer 6

Change in the colour of sputum (yellow or brown)

Question 7

What is the usual cause of acute exacerbation of COPD

Answer 7

viral Infection (most common)

Bacterial infection

• —-Streptococcus pneumoniae
• —-Moraxella cararrhalis

Question 8

What is Pneumonia

Answer 8

Inflammation of the lung parenchyma and consolidation due to cellular exudate which impairs gas exchange

Question 9

What are the three types on pneumonia

Answer 9

Bronchopneumonia - inflammation of tubes
Lobar pneumonia - inflammatory exudate in alveoli
Interstitial pneumonia - rare and doesnt arise from infection

Question 10

What are the presenting symptoms for Pneumonia

Answer 10

Fever, rigors and myalgia
Cough and Sputum
Sharp pleuritic chest pain
S.O.B

Question 11

What are the clinical signs of pneumonia

Answer 11

Dull percussion 
Reduced expansion 
increased vocal resonance
Coarse breathing sounds  (brochial breath sounds)
Visible consolidation on CXR
Fine Coarse Crackles

Question 12

What other illness increases your chance of getting pneumonia

Answer 12

FLU

Question 13

What investigations should be done if suspect pneumonia

Answer 13

Chest X-ray 
FBC (FBC and CRP) 
Sputum culture 
Viral throat swab 
Blood cultures

Question 14

What are the differentials to pneumonia

Answer 14

Tuberculosis 
Lung cancer
Pulmonary Vasculitis (destruction of blood vessels) 
PE
Pulmonary oedema

Question 15

What is used to score the severity of Pneumonia

Answer 15

CURB65

Question 16

What is curb 65

Answer 16

C- confusion 
U - Blood urea >7mmol
R- respiratory rate >30
B - Systolic BP <90 and diastolic <60
65 - >65? 

Get score out of 5.

0-1 - low risk
2 - moderate risk
3-5 - severe risk

Question 17

What is the treatment for pneumonia if Curb 0 or 1

Answer 17

Amoxacillin or clarythromycin (If allergic) - 5 days

Question 18

What is the treatment for pneumonia if Curb 2

Answer 18

Amoxacillin and clarythromycin or Levofloxacin (if allergic)

- 5-7 days

Question 19

What is the treatment for pneumonia if Curb 3-5

Answer 19

Co-amoxiclav + clarithromycin or Levofloxacin/

co-trimoxazole (if allergic) - 7-10 days

Question 20

What can happen in pneumonia is left untreated

Answer 20

Sepsis
Kidney injury
ARDS
Parapneumonic effusion

Question 21

What TYPICAL pathogens cause pneumonia

Answer 21

Pneumococcal pneumonia

Haemophilus influenzae

Question 22

What ATYPICAL pathogens cause pneumonia

Answer 22

Legionella pneumophilia
Chlamydia pneumonia
Viruses

Question 23

In the hospital, what pathogens can cause cavatating pneumonia

Answer 23

Staph Aureus and Klebsiella pneumoniae

Question 24

What does the CURB65 scale not take into consideration

Answer 24

young people
Hypoxia
Multi-lobal consolidation

Question 25

What is bronchiectasis

Answer 25

Long term consolodation where the airways of the lung become abnormally widened, building up mucous and increasing the chances of infection.

Question 26

What does the patient present with in bronchiectasis

Answer 26

Chronic wet cough
S.O.B
Frequent Lower respiratory tract infections
HAEMOPTOSIS

Question 27

What are the clinical signs of bronchiectasis

Answer 27

Finger clubbing
coarse voice
wheeze
Obstructive spirometry (reduced ratio)