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Year 1- Respiratory > Lower Respiratory Tract Infections in Adults > Flashcards

Lower Respiratory Tract Infections in Adults Flashcards

1
Q

Upper respiratory tract infections are infections which occur above what?

A

Vocal cords

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2
Q

What is the inflammation of the trachea called?

A

Tracheitis

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3
Q

Which part of the lungs does pneumonia involve?

A

Parenchyma of the lungs
->alveoli and base units of the lungs

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4
Q

Define acute bronchitis.

A

Inflammation of the lungs

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5
Q

How long does acute bronchitis last?

A

Temporary so <3 weeks

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6
Q

What are some of the presenting symptoms of acute bronchitis?

A

Cough and sputum

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7
Q

What is the difference between acute and chronic bronchitis?

A

Acute- cough is temporary, <3 weeks
Chronic- often seen in those with COPD, having a cough for three months of the year for at least two years in a row.

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8
Q

What type of infection of acute bronchitis usually?

A

Viral

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9
Q

Describe the management of acute bronchitis.

A

Supportive management
->lots of fluids
->paracetamol

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10
Q

List some unusual symptoms which would require the individual to see their GP.

A
  • cough is severe or lasts longer than 3 weeks
  • high temperature for more than 3 days
    –may be a sign of flu or a more serious condition, like pneumonia
  • cough up mucus streaked with blood
  • underlying heart or lung condition, such as asthma, heart failure or emphysema
  • more breathless
  • repeated episodes of bronchitis
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11
Q

Name some presenting symptoms of someone with an exacerbation of COPD.

A
  • Change in colour of sputum
  • Fevers
  • Increased breathlessness
  • Wheeze (worse)
  • Cough (worse)
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12
Q

Name the three common bacteria which cause COPD exacerbation.

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Moraxella catarrhalis
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13
Q

Name some antibiotics which can treat an exacerbation of COPD.

A

-amoxicillin
- doxycycline
- co-trimoxazole
- clarithromycin

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14
Q

Other than antibiotics, what treatment can be given for an exacerbation of COPD?

A

Steroids
Nebulisers

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15
Q

Define pneumonnia.

A

Inflammation of lung parenchyma

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16
Q

How many people with acute bronchitis then go on to develop pneumonia?

A

1 in 20

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17
Q

What are some of the risk factors for developing pneumonia?

A

*Smoking, alcohol in excess
* Extremes of age (very young and very old)
* Preceding viral illness
* Pre-existing lung disease
* Chronic illness
* Immunocompromised
* Hospitalisation
* IVDU (IV drug abusers)

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18
Q

Name three types of pneumonia.

A

Bronchopneumonia
Lobar pneumonia
Interstitial pneumonia

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19
Q

Define bronchopneumonia.

A

Inflammation of the alveoli

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20
Q

Define lobar pneumonia

A

Infection in which the air sacs fill with pus and other liquid.

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21
Q

Define interstitial pneumonia.

A

Rare disorder that affects the tissue that surrounds and separates the tiny air sacs of the lungs.

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22
Q

Describe how bronchopneumonia affects the lung.

A

Usually affects one lung in patches

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23
Q

Describe how lobar pneumonia affects the lung.

A

Causes consolidation of an entire lobe of the lung.

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24
Q

Define consolidation.

A

Solidification due to cellular exudate in alveoli leads to impaired gas exchange

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25
Q

Which preceding viral illness can lead to pneumonia?

A

Flu

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26
Q

List some of the clinical symptoms of pneumonia.

A

*Fever, rigors, myalgia
* Cough and sputum
* Chest pain (pleuritic)
* Dyspnoea
* Haemoptysis- rare but red flag

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27
Q

List some of the clinical signs of pneumonia.

A
  • Tachypnoea
  • Tachycardia
  • Reduced expansion
  • Dull percussion
  • Bronchial breathing
  • Crepitations
  • Vocal resonance increase
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28
Q

What is the normal body temp range?

A

37 degrees +/- 0.6 degree

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29
Q

Define rigors

A

Shivers

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30
Q

Define myalgia

A

Muscle pain

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31
Q

What is meant by pleuritic chest pain?

A

Pain upon deep inspiration

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32
Q

What bacteria can cause brown, rusty looking sputum?

A

Streptococcus pneumoniae

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33
Q

Define Tachypnoea

A

Rapid breathing

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34
Q

Define Tachycardia

A

HR > 90bpm

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35
Q

Define Crepitations

A

Rattling sounds

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36
Q

What investigations could be done in someone w suspected pneumonia in a community setting?

A

Nothing really
Chest x-ray sometimes used

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37
Q

What investigations could be done in someone w suspected pneumonia in a hospital setting?

A

Bloods – serum biochemistry, FBC, CRP
Blood cultures
Chest x-ray
Sputum culture, viral throat swab
Legionella urinary antigen

38
Q

List some of the differential diagnoses of pneumonia

A
  • TB
  • Lung cancer
  • Pulmonary embolism
  • Pulmonary oedema
  • Pulmonary vasculitis
39
Q

Which bacteria is the most common cause of pneumonia?

A

Strep Pneumoniae

40
Q

Name some typical community acquired organisms which cause pneumonia

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Mycoplasma pneumoniae
41
Q

Name some atypical community acquired organisms which cause pneumonia

A
  • Legionella pneumophilia
  • Chlamydia pneumoniae
  • Chlamydia psittaci
  • Coxiella burnetti
  • Moraxella catarrhalis
  • Viruses

im sorry, write them out a few times

42
Q

Which bacteria causes pneumonia and brings about extrapulmonary complication?

A

Mycoplasma pneumoniae

43
Q

Name some of the symptoms you would get with pneumonia from an atypical community acquired organism

A

Dry cough
Less sputum
General fatigue
Headache
Muscle aches

44
Q

Where does Legionella pneumophilia tend to accumulate?

A

Fresh water
Around air conditioning

45
Q

Chlamydia pneumoniae is more common in patients with what?

A

Coronary artery disease

46
Q

What is Chlamydia psittaci associated with?

A

Birds

47
Q

What is Coxiella burnetti associated with?

A

Farm animals

48
Q

What is Moraxella catarrhalis associated with?

A

Can infect people w COPD

49
Q

Name some viruses which can cause pneumonia.

A

Influenza, RSV, SARS, varicella

50
Q

Name some of the bacteria which can cause hospital acquired pneumonia.

A
  • Enterobacteria
  • Staphylococcus aureus
  • Pseudomonas aerigunosa
  • Klebsiella pneumoniae
51
Q

Which bacteria (causing hospital acquired pneumonia) can cause the patient to produce very green sputum?

A

Pseudomonas aerigunosa

52
Q

Pseudomonas aerigunosa usually affects people with what underlying condition?

A

Lung disease

53
Q

Which organisms can cause cavitation pneumonia?

A
  • Staphylococcus aureus
  • Klebsiella pneumoniae
    *TB
54
Q

What scoring system is used in those with pneumonia?

A

CURB 65

55
Q

Discuss CURB 65

A

C =confusion
U =blood urea >7mmol/l
R = RR> 30bpm
B = systolic BP < 90 mmHg, diastolic blood pressure < 60mmHg
65= aged 65 or above

56
Q

What does a score 0-1 of CURB 65 tell us?

A

Low risk - could be treated in community

57
Q

What does a score 2 of CURB 65 tell us?

A

Moderate risk - hospital treatment usually required

58
Q

What does a score 3-5 of CURB 65 tell us?

A

High risk of death and need for ITU

59
Q

Why should we be wary in using CURB 65 in young people?

A

Symptoms may be missed out and they could still have pneumonia-
- Hypoxia
- Multi-lobar consolidation

60
Q

What is the risk of death % for those who score 0-1 on CURB 65?

A

<3%

61
Q

What is the risk of death % for those who score 2 on CURB 65?

A

9%

62
Q

What is the risk of death % for those who score 3-5 on CURB 65?

A

15-40%

63
Q

Describe the treatment for those with a 0-1 CURB 65 score.

A

-Amoxicillin
-Clarithromycin or doxycycline if penicillin allergy
-5 days duration

64
Q

Describe the treatment for those with a 2 CURB 65 score.

A

-Amoxicillin and clarithromycin (atypical)
-Levofloxacin if penicillin allergy
-5-7 days duration

65
Q

Describe the treatment for those with a 3-5 CURB 65 score.

A

-Co-amoxiclav + clarithromycin (atypicals)
-Levofloxacin or co-trimoxazole if penicillin allergy
-7-10 days duration

66
Q

Name some supportive management options for those with pneumonia.

A

Oxygen, fluids (IV or oral)
Antipyretics, NSAIDs
Intubation and ventilation

67
Q

What bacterial infection can influenza lead to?

A

Staphylococcus aureus secondary infection

68
Q

Aspiration pneumonia tends to occur in conditions where people cannot swallow properly.
Give some examples of conditions in which aspiration pneumonia will also occur.

A

Stroke, MS, myasthenia, sedation, oesophageal disease

69
Q

What treatment would you five for those w aspiration pneumonia and why?

A

Amoxicillin + metronidazole as likely to be anaerobic infections

70
Q

Immunocompromised patients with pneumonia are may also develop which organisms?

A

-Fungi – aspergillus fumigatus, candida…
-` Viruses – CMV, HSV, VZV…

71
Q

What is MRSA and how can you treat it?

A

Methicillin-resistant Staphylococcus Aureus
Usually found is hospitals
Vancomycin

72
Q

List some complications of pneumonia.

A
  • Sepsis
  • Acute Kidney Injury
  • Adult Respiratory Distress Syndrome
  • Parapneumonic effusion
  • Empyema
  • Lung Abscess
  • Disseminated infection
73
Q

Define empyema.

A

Pockets of pus (lungs in this case)

74
Q

What are some signs that somebody could have complications with their pneumonia?

A
  • Swinging fever
  • Sweats
  • Persistently high WCC / CRP
  • Weight loss
    -Failure to improve
75
Q

What investigation would be carried out to diagnose Parapneumonic Effusion / Empyema?

A

Chest x-ray
Thoracic ultrasound +/- aspirate (needle to draw out fluid)

76
Q

Describe how we can tell if it is a simple effusion.

A

pH>7.2

77
Q

Describe how we can tell if it is a complicated effusion.

A

pH <7.2

78
Q

Describe how we can tell if it is a empyema.

A

Pus
Culture positive

79
Q

What are some of the treatments/ managements for those with Parapneumonic Effusion / Empyema?

A

May need drain + prolonged antibiotics
May need surgery

80
Q

Lung abscesses are more likely to occur with which bacteria?

A

Staph aureus, pseudomonas, anaerobes

81
Q

What are some presenting symptoms for those w a lung abscess?

A

Purulent sputum
Haemoptysis

82
Q

Which investigations may be carried out in someone w a lung abscess?

A

CT scan +/- bronchoscopy

83
Q

What is the treatment for a lung abscess?

A

Prolonged antibiotics.

84
Q

How long does recovery from pneumonia take?

A

Weeks

85
Q

What recommendations can be made to those with pneumonia?

A

Stop smoking

86
Q

If a patient w pneumonia is a smoker and over 50, what should you do?

A

Repeat chest x-ray after six weeks

87
Q

What happens in Bronchiectasis?

A

Dilated distal bronchi which produce a lot of sputum

88
Q

What are some causes of bronchiectasis?

A

Usually no cause- idiopathic
Childhood infection
Cystic fibrosis

89
Q

What are the main symptoms of bronchiectasis?

A

Chronic productive cough
* Breathlessness
* Recurrent LRTI
* Haemoptysis

90
Q

In those with bronchiectasis, what might you see upon examination?

A

*Finger clubbing
* Crepitations (coarse)
* Wheeze
* Obstructive spirometry

91
Q

Which bacteria may cause an infective exacerbation of bronchiectasis?

A

o Staph aureus
o Haemophilus influenzae
o Pseudomonas aerigunosa

92
Q

What treatments can be given to those with an infective exacerbation of bronchiectasis?

A

o Sputum Cx essential (including AAFB)
o Chest physio
o Mucolytics
o Prolonged antibiotic course 10-14 days
o Vaccinations

Year 1- Respiratory (36 decks)

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