LRTI and Pneumonia

Question 1

Describe the normal flora of the LRT. (4)

Describe some less common flora. (5)

Answer 1

Viridans Streptococci
Neisseria
Anaerobes
Candida

Strep pneumoniae
Strep pyogenes
Haemophilus influenzae
Pseudomonas
E. coli.

Question 2

Describe the normal defenses of the LRT. (4)

Answer 2

Muco-ciliary clearance mechanism
Cough
Sneeze
Immunity (secretions of IgA and IgG).

Question 3

Describe things that compromise the natural defenses of the LRT. (4)

Answer 3

Poor swallowing - alcohol, muscle weakness
Abnormal cilia - smoking, infection
Abnormal mucus - CF
Host immunity defects - HIV

Question 4

Describe upper respiratory tract infections. (5)

Answer 4

Rhinitis
Pharyngitis
Laryngitis
Sinusitis 
Otitis media

Question 5

Describe lower respiratory tract infections. (6)

Answer 5

Bronchitis
Bronchiolitis 
Bronchiectasis
Empyema
Abscess
Pneumonia

Question 6

Describe acute bronchitis. 
Pathophysiology (2)
Causes (3)
Symptoms (4)
Treatments (2)

Answer 6

Inflammation of the medium sized airways often in smokers caused by S. pneumonia, H. Influenzae, m. Catarrhalis.
Cough, SoB, fever, sputum.
Bronchodilation, abx.

Question 7

What is the difference between pneumonia and pneumonitis? (1)

Answer 7

Pneumonia is infective, pneumonitis is not (physical / chemical).

Question 8

Describe causative organisms of community acquired pneumonia. (3)

Answer 8

Mostly strep pneumonia

May also be ‘atypical organisms’ eg chlamydia pneumonia, mycoplasma pneumonia.

Question 9

What are the 4 classifications of pneumonia?

Answer 9

Hospital acquired
Community acquired
Aspiration
Immunocompromised.

Question 10

Describe hospital acquired pneumonia. (4)

Answer 10

Pneumonia occurring over 48 hours after admission - often associated with impaired defenses or prosthetics eg ventilators
Staph aureus (inc MRSA) common, treat with co-amoxiclav or meropenem.

Question 11

Describe aspiration pneumonia (3)

Answer 11

Aspiration of food, drink, saliva, vomit often in pts with reduced consciousness, epilepsy, swallowing pathologies.
Oral flora + anaerobes > co-amoxiclav

Question 12

Describe causes of pneumonia in each state of immunocompromisation. (8)

Answer 12

HIV: PCP, TB
Neutropenia: fungi like aspergillus
Bone marrow transplant: CMV
Splenectomy: encapsulated organisms like strep pneumonia, malaria.

Question 13

Describe clinical features of pneumonia. (5)

Answer 13

Malaise, fever, productive cough with purulent or rust sputum, pleuritic chest pain, breathlessness.

Question 14

Describe the CURB65 system for assessing the dpseverity of pneumonia. (5)

Answer 14

C - new onset confusion
U - urea > 7 mmol/l
R - Resp rate > 30
B - blood pressure < 90/60
65 - over 65 years old.

Question 15

Describe the stages of pneumonia on a tissue level. (4)

Answer 15

Consolidation
Red hepatisation
Grey hepatisation
Resolution

Question 16

Describe the prognosis of pneumonia in a previously healthy individual. (1)
Describe what might change this. (5)

Answer 16

In a previously healthy person: 5% mortality

Worse in older patients, high CURB65 score, v high or v low WCC, absence of fever, lots of X Ray shadowing.

Question 17

Describe the management of pneumonia. (4)

Answer 17

Oral fluids
Anti-pyretics
If severe IV fluids and oxygen
Abx that are organisms specific.

Question 18

Describe complications of pneumonia. (3)

Answer 18

Pleural effusion
Empyema
Abscess formation

Question 19

Describe the preventative measures to avoid pneumonia. (3)

Answer 19

Immunisation - flu vaccine.
Chemoprophylaxis - oral penicillin or erythromycin
Smoking cessation.