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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
Which preceding viral illness can lead to pneumonia?
Flu
26
List some of the clinical symptoms of pneumonia.
*Fever, rigors, myalgia * Cough and sputum * Chest pain (pleuritic) * Dyspnoea * Haemoptysis- rare but red flag
27
List some of the clinical signs of pneumonia.
* Tachypnoea * Tachycardia * Reduced expansion * Dull percussion * Bronchial breathing * Crepitations * Vocal resonance increase
28
What is the normal body temp range?
37 degrees +/- 0.6 degree
29
Define rigors
Shivers
30
Define myalgia
Muscle pain
31
What is meant by pleuritic chest pain?
Pain upon deep inspiration
32
What bacteria can cause brown, rusty looking sputum?
Streptococcus pneumoniae
33
Define Tachypnoea
Rapid breathing
34
Define Tachycardia
HR > 90bpm
35
Define Crepitations
Rattling sounds
36
What investigations could be done in someone w suspected pneumonia in a community setting?
Nothing really Chest x-ray sometimes used
37
What investigations could be done in someone w suspected pneumonia in a hospital setting?
Bloods – serum biochemistry, FBC, CRP Blood cultures Chest x-ray Sputum culture, viral throat swab Legionella urinary antigen
38
List some of the differential diagnoses of pneumonia
* TB * Lung cancer * Pulmonary embolism * Pulmonary oedema * Pulmonary vasculitis
39
Which bacteria is the most common cause of pneumonia?
Strep Pneumoniae
40
Name some typical community acquired organisms which cause pneumonia
* Streptococcus pneumoniae * Haemophilus influenzae * Mycoplasma pneumoniae
41
Name some atypical community acquired organisms which cause pneumonia
* Legionella pneumophilia * Chlamydia pneumoniae * Chlamydia psittaci * Coxiella burnetti * Moraxella catarrhalis * Viruses im sorry, write them out a few times
42
Which bacteria causes pneumonia and brings about extrapulmonary complication?
Mycoplasma pneumoniae
43
Name some of the symptoms you would get with pneumonia from an atypical community acquired organism
Dry cough Less sputum General fatigue Headache Muscle aches
44
Where does Legionella pneumophilia tend to accumulate?
Fresh water Around air conditioning
45
Chlamydia pneumoniae is more common in patients with what?
Coronary artery disease
46
What is Chlamydia psittaci associated with?
Birds
47
What is Coxiella burnetti associated with?
Farm animals
48
What is Moraxella catarrhalis associated with?
Can infect people w COPD
49
Name some viruses which can cause pneumonia.
Influenza, RSV, SARS, varicella
50
Name some of the bacteria which can cause hospital acquired pneumonia.
* Enterobacteria * Staphylococcus aureus * Pseudomonas aerigunosa * Klebsiella pneumoniae
51
Which bacteria (causing hospital acquired pneumonia) can cause the patient to produce very green sputum?
Pseudomonas aerigunosa
52
Pseudomonas aerigunosa usually affects people with what underlying condition?
Lung disease
53
Which organisms can cause cavitation pneumonia?
* Staphylococcus aureus * Klebsiella pneumoniae *TB
54
What scoring system is used in those with pneumonia?
CURB 65
55
Discuss CURB 65
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
What does a score 0-1 of CURB 65 tell us?
Low risk - could be treated in community
57
What does a score 2 of CURB 65 tell us?
Moderate risk - hospital treatment usually required
58
What does a score 3-5 of CURB 65 tell us?
High risk of death and need for ITU
59
Why should we be wary in using CURB 65 in young people?
Symptoms may be missed out and they could still have pneumonia- - Hypoxia - Multi-lobar consolidation
60
What is the risk of death % for those who score 0-1 on CURB 65?
<3%
61
What is the risk of death % for those who score 2 on CURB 65?
9%
62
What is the risk of death % for those who score 3-5 on CURB 65?
15-40%
63
Describe the treatment for those with a 0-1 CURB 65 score.
-Amoxicillin -Clarithromycin or doxycycline if penicillin allergy -5 days duration
64
Describe the treatment for those with a 2 CURB 65 score.
-Amoxicillin and clarithromycin (atypical) -Levofloxacin if penicillin allergy -5-7 days duration
65
Describe the treatment for those with a 3-5 CURB 65 score.
-Co-amoxiclav + clarithromycin (atypicals) -Levofloxacin or co-trimoxazole if penicillin allergy -7-10 days duration
66
Name some supportive management options for those with pneumonia.
Oxygen, fluids (IV or oral) Antipyretics, NSAIDs Intubation and ventilation
67
What bacterial infection can influenza lead to?
Staphylococcus aureus secondary infection
68
Aspiration pneumonia tends to occur in conditions where people cannot swallow properly. Give some examples of conditions in which aspiration pneumonia will also occur.
Stroke, MS, myasthenia, sedation, oesophageal disease
69
What treatment would you five for those w aspiration pneumonia and why?
Amoxicillin + metronidazole as likely to be anaerobic infections
70
Immunocompromised patients with pneumonia are may also develop which organisms?
-Fungi – aspergillus fumigatus, candida… -` Viruses – CMV, HSV, VZV…
71
What is MRSA and how can you treat it?
Methicillin-resistant Staphylococcus Aureus Usually found is hospitals Vancomycin
72
List some complications of pneumonia.
* Sepsis * Acute Kidney Injury * Adult Respiratory Distress Syndrome * Parapneumonic effusion * Empyema * Lung Abscess * Disseminated infection
73
Define empyema.
Pockets of pus (lungs in this case)
74
What are some signs that somebody could have complications with their pneumonia?
- Swinging fever - Sweats - Persistently high WCC / CRP - Weight loss -Failure to improve
75
What investigation would be carried out to diagnose Parapneumonic Effusion / Empyema?
Chest x-ray Thoracic ultrasound +/- aspirate (needle to draw out fluid)
76
Describe how we can tell if it is a simple effusion.
pH>7.2
77
Describe how we can tell if it is a complicated effusion.
pH <7.2
78
Describe how we can tell if it is a empyema.
Pus Culture positive
79
What are some of the treatments/ managements for those with Parapneumonic Effusion / Empyema?
May need drain + prolonged antibiotics May need surgery
80
Lung abscesses are more likely to occur with which bacteria?
Staph aureus, pseudomonas, anaerobes
81
What are some presenting symptoms for those w a lung abscess?
Purulent sputum Haemoptysis
82
Which investigations may be carried out in someone w a lung abscess?
CT scan +/- bronchoscopy
83
What is the treatment for a lung abscess?
Prolonged antibiotics.
84
How long does recovery from pneumonia take?
Weeks
85
What recommendations can be made to those with pneumonia?
Stop smoking
86
If a patient w pneumonia is a smoker and over 50, what should you do?
Repeat chest x-ray after six weeks
87
What happens in Bronchiectasis?
Dilated distal bronchi which produce a lot of sputum
88
What are some causes of bronchiectasis?
Usually no cause- idiopathic Childhood infection Cystic fibrosis
89
What are the main symptoms of bronchiectasis?
Chronic productive cough * Breathlessness * Recurrent LRTI * Haemoptysis
90
In those with bronchiectasis, what might you see upon examination?
*Finger clubbing * Crepitations (coarse) * Wheeze * Obstructive spirometry
91
Which bacteria may cause an infective exacerbation of bronchiectasis?
o Staph aureus o Haemophilus influenzae o Pseudomonas aerigunosa
92
What treatments can be given to those with an infective exacerbation of bronchiectasis?
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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