Lower Respiratory Tract Infections in Adults

Question 1

What is acute bronchitis?

Answer 1

Inflammation of the bronchi

Question 2

How can acute bronchitis be differentiated?

Answer 2

Length of time patient has it for

Temp: < 3 weeks

Chronic: 3 months of the year for two years in a row - COPD

Question 3

How long can the post viral cough in acute bronchitis last?

Answer 3

8 weeks

Question 4

What are the symptoms of acute bronchitis?

Answer 4

Cough and sputum

Question 5

How is acute bronchitis managed?

Answer 5

Usually of viral origin - no antibiotics

Supportive management only - lots of fluids, paracetamol

Question 6

When should someone see a GP with acute bronchitis?

Answer 6

Cough for more than 3 weeks

High temp for more than three days - can be a sign of pneumonia

Coughing up blood

Underlying heart or lung condition

More breathless

Repeated episodes of bronchitis

Question 7

What is bronchiectasis?

Answer 7

Long-term condition where the airways of the lungs become abnormally widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection.

Question 8

What are the symptoms of bronchiectasis?

Answer 8

Chronic productive cough
Breathlessness
Recurrent LRTI
Finger clubbing
Crepitations (coarse)
Wheeze
Obstructive spirometry

Question 9

What are the causes of bronchiectasis?

Answer 9

Idiopathic
Childhood infection
Cystic fibrosis
ABPA

Question 10

Treatment for bronchiectasis

Answer 10

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

Question 11

What is a lung abscess?

Answer 11

Collections of pus within the lungs

Question 12

What causes lung abscesses?

Answer 12

Liquefactive necrosis of lung tissue

Causes can be primary or secondary

Question 13

What is a primary lung abscess?

Answer 13

Develops from primary infection of the lung. T

Commonly arise from aspiration, necrotising pneumonia or chronic pneumonia

e.g. in the setting of pulmonary tuberculosis or immunodeficiency

Question 14

What is a secondary lung abscess?

Answer 14

One that develops as a result of another condition.

Question 15

Treatment of lung abscess

Answer 15

Prolonged antibiotics and physiotherapy with postural drainage

Question 16

What is another name for pleural empyema?

Answer 16

Pyothorax

Question 17

What is empyema?

Answer 17

Pockets of pus that have collected inside a body cavity.

Question 18

What happens in empyema?

Answer 18

The lungs and inside of the chest cavity are lined with a smooth layer called the pleura.

These layers are almost in contact, but separated by a thin space (the pleural space) filled with a small amount of lubricant called pleural fluid.

The pleural fluid can sometimes build up and become infected, and a collection of pus forms.

This can thicken and cause areas of the pleura to stick together, creating pockets of pus.

Question 19

What are causes of empyema?

Answer 19

Failure of pneumonia to respond to treatment

Bronchiectasis

Blood clot

Surgery to chest

Endoscopy

Infection in bloodstream

Question 20

Who is at risk of developing emyema?

Answer 20

Those who:

have diabetes
have a weakened immune system
have acid reflux
drink too much alcohol or take a lot of recreational drugs

Question 21

Symptoms of empyema

Answer 21

a fever and night sweats
a lack of energy
difficulty breathing
weight loss
chest pain
a cough and coughing up mucus containing pus

Question 22

Diagnosis of empyema

Answer 22

If patient w pneumonia is not getting better and is producing mucus, a sample should be taken to identify bacteria and prescribe an antibiotic

CXR or US

Question 23

How is empyema treated?

Answer 23

Antibiotics
Chest drain
Surgery to remove lining of lung
Stoma if chest drain not possible

Question 24

Conservative management of lung abscess

Answer 24

Chest physiotherapy for postural drainage

Smoking cessation therapy if necessary

Question 25

Medical management of lung abscess

Answer 25

Supportive treatment: Oxygen; fluid Regime; analgesia

Antibiotic treatment: Intravenous therapy for 3 weeks followed by oral antibiotics for 1-2 months.