lower respiratory tract infections-adults Flashcards
give some examples of LRTIs?
acute bronchitis AECOPD pneumonia empyema lung abscess bronchiestasis
what are the symptoms of pneumonia?
malaise and lethargy myalgia fever pleuritic chest pain cough purulent sputum dyspnoea
infection with which organism causes rusty sputum?
streptococcus pneumonia
what are the signs of pneumonia?
pyrexia tachypnoea central cyanosis dullness on percussion of affected lobe (if lobar) bronchial breath sounds inspiratory crepitations increased vocal resonance
what are the investigations for pneumonia?
serum biochemistry- U&Es, LFT CRP full blood count blood cultures throat swab (for atypical pathogens) urinary (for legionella) sputum microscopy and culture HIV test
what are the most common pathogens that cause pneumonia?
strep. pneumoniae H. influenzae legionella mycoplasma pneumoniae chlamydophila pneumoniae viruses
what is the CURB 65 scoring system for pneumonia?
C- confusion U- urea >7 R- respiratory rate >30 B- blood pressure, diastolic <60 65- age >65
the presence of one is a score of 1, presence of two is 2 etc.
what does a score of 0 on the curb 65 test mean?
low risk and could be treated in community
what does a score of 1-2 on curb 65 test mean?
hospital treatment usually required
what does a score of 3-5 on the curb 65 test mean?
high risk of death and need for ITU
what is the treatment of curb 0-1 pneumonia?
amoxycilline or clarithromycin/doxycycline if allergic to penicillin
what is the treatment of curb 2 pnemonia?
amoxycillin and clarithromycin or levofloxacin (if allergic to penicillin)
what is the treatment for curb 3-5 pneumonia?
co-amoxiclav and clarithromycin or levofloxacin (if penicillin allergy)
what sort if organisms cause apiration pneumonias?
anaerobes
what is the treatment for aspiration pneumonia?
metronidazole (for anaerobes) and amoxycillin
why is a combination of antibiotics given for pneumonia?
to cover atypical bacteria
what sort of anitbiotics are given to pneumonia patients with haemotological malignancy?
broad spectrum and possibly antifungals
who must be notified if legionnaires disease is diagnosed?
public health
what is used to treat pneumonia caused by MRSA?
vancomycin or linezolid
what are the general treatments for pneumonia?
oxygen
IV fluids
CPAP
intubation and vantilation
what are the possible complications of pneumonia?
sepricaemia acute kidney failure empyema lung abscess metastatic infaction ARDS
what conditions must be ruled out when pneumonia is suspected?
TB lung cancer pulmonary embolism pulmonary oedema pulmonary vasculitis
what may empyema follow on from?
pneumonia
what are the symptoms of empyema?
chest pain, absence of cough
what are the signs pf empyema?
swinging fever
what are the investigations for empyema?
CT thorax, pleural ultrasouns, diagnostic aspiration
what is the treatment of empyema?
chest drain and IV antibiotics
surgery for patients who do not respond to standard treatment.
which organisms are most most likely to cause cavitating pneumonia (lung abscess)?
staph. aureus, pseudomonas and anaerobes
what are the symptoms of a lung abscess?
non specific symptoms-lethargy, weight loss, high swinging fever
what are the investigations for a lung abscess?
CT of thorax and sputum culture (w/ TB microscopy and culture)
how is a lung abscess treated?
prolonged antibiotics
how are lung abscesses drained?
usually via the bronchial tree but occasionally via a chest drain
what are some causes of bronchiectasis?
most are idiopathic
- immotile cilia syndrome
- CF
- infections such as measles and croup
- hypogammglobulinaemia
- allergic bronchopulmonary aspergillosis
what are the symptoms of bronchiectasis?
chronic cough
copious daily sputum production
sometimes:
wheeze, dyspnoea, tiredness, flitting chest pains, haemoptysis
what are the signs of bronchiectasis?
finger clubbing
course inspiratory crepitations
what are the investigations for bronchiectasis?
HRCT thorax sputum culture serum immunoglobulins total IgE and aspergillus precipitins CF genotyping
what is the treatment of bronchiectasis?
chest physiotherapy
prompt treatment of infection with antibiotics
inhaled therapy eg. beta2 agonists and inhaled corticosteroids
