LRTI 1

Question 1

bronchitis/bronchiolitis

Answer 1

inflammation of the bronchi chest infection

usually develops during URTI

Question 2

pertussis

Answer 2

bordetella pertussis
gram negative bacilli
vaccine preventable - rates increasing in Australia
80-100% infection rate in unimmunised
attaches to nasopharynx, produces toxins, damage to trachea/bronchi

Question 3

phases of pertussis

Answer 3

catarrhal phase - fever, coryza, mild cough
paroxysmal phase - after 1-2 weeks - frequent repetitive bursts of coughing then single expiratory whoop
convalescent phase - after 2-4 weeks, lasts for months, diminishing cough

Question 4

pertussis complications

Answer 4

subconjunctival haemorrhage, pneumothorax, rib fractures, hernias

Question 5

peruses diagnosis

Answer 5

PCR of throat swab or NP aspirate
culture
serology

Question 6

bronchopneumonia

Answer 6

infection of the lung parenchyma

5% fatality rate

Question 7

pathogenesis of bronchopneumonia

Answer 7

microbes access lower respiratory tract
- aspiration from oropharynx e.g. sleep, elderly
- inhalation of contaminated droplets
- blood stream
proliferate within the alveoli
- macrophages and surfactant normally clear
- mucociliary elevator eliminates

Question 8

four phases of bronchopneumonia

Answer 8

• oedema
• red hepatization
• grey hepatization
• resolution

Question 9

pneumococcal pneumonia

Answer 9

strep pneumoniae
gram positive diplococci
commonest cause of pneumonia, severe illness and death
lasts weeks to months
vaccination has reduced severity and frequency

Question 10

staphylococcal pneumonia

Answer 10

classically complicates flu
increasingly reported as a primary cause
including MRSA
may be associated with PVL

Question 11

atypical pneumonia

Answer 11

caused by atypical organisms - difficult to culture in laboritory

• mycoplasma pneumonia
• chlamoydophila pneumonia
• legionella pneumophila
• chlamoydophila psittaci

Question 12

legionnaires disease

Answer 12

• legionella pneumophila
  hot water tanks, air conditioning, cooling towers, inhalation of aerosol
  in. WA longbeachae is a bigger issue that pneumophila

Question 13

chlamoydophila psittaci

Answer 13

• intracellular bacteria
• transmitted via inhalation, contact or ingestion
• feral bird and domesticated poultry
• headache predominant
• can cause severe pneumonia

Question 14

coxiella burnetii

Answer 14

the cause of Q-fever
- Query fever
dust contaminated with birthing products, milk, meat
- vets, farmers, shearers at risk

Question 15

pneumonia typical features

Answer 15

fever 
chills/rigors 
cough 
shortness of breath 
chest pain

Question 16

atypical symptoms

Answer 16

In 20%

myalgia, arthralgia, headache, gastrointestinal symptoms - diarrhoea, vomiting

Question 17

pneumonia upon physician examination

Answer 17

tachycardia, low blood pressure 
elevated respiratory rate 
reduced O2 saturation 
reduced air entry over affected lung 
added sounds 
- crepitations or crackles 
bronchial breathing

Question 18

diagnosis of pneumonia

Answer 18

blood tests - full blood count

radiology - chest x ray, computerised tomography or CT scan

Question 19

blood test to detect pneumonia

Answer 19

inflammatory markers e.g. c reactive protein

blood culture

Question 20

microbiological diagnosis of pneumonia

Answer 20

microbiological - sputum gram stain and culture - 40% yield
serological tests - detection of antibodies, four fold rise in IgM, used for atypical pneumonia, includes urinary antigen

Question 21

mild CAP

Answer 21

• pneumonia that doesn’t warrant admission
  no confusion, hypoxia, low BP, should be reviewed after 24-48 hours
  oral amoxycillin or oral doxycycline
  atypical organisms to not respond to beta lactams

Question 22

moderate CAP

Answer 22

requiring admission
intravenous antibiotics
doxycycline to cover atypical organisms plus penicillin

Question 23

severe CAP

Answer 23

high risk of death or needing admission to ICU
IV therapy can be changed to orals after significant improvement
IV ceftriaxone or penecillin
plus iv azithromycin

Question 24

aspiration pneumonia

Answer 24

aspiration risk 
reduced consciousness, impaired swallow 
includes oral organisms 
treatment requires addition or anaerobe cover 
tazocin covers all

Question 25

additional treatment

Answer 25

oxygen 
IV fluids and electrolytes 
analgesia 
bronchodilators 
physiotherapy

Question 26

complications

Answer 26

respiratory or multi organ failure
DIC
fever resolve and inflammatory markers improves 2-4 days