LRTI in Adults

Question 1

What are the clinical features of acute bronchitis? (5)

Answer 1

Inflammation of the bronchi
Cough and sputum
Wheeze
Chest discomfort
Usually viral

Question 2

When to see a GP with bronchitis? (6)

Answer 2

Cough lasts more than 3 weeks
Have a high temp for more than 3 days
Mucous streaked with blood
Underlying heart/lung condition
More breathless
Repeated episodes of bronchitis

Question 3

What are the signs of a COPD exacerbation? (4)

Answer 3

Changes in sputum colour
Fevers
Increased breathlessness
Wheeze cough

Question 4

What organisms may cause and exacerbation in COPD? (4)

Answer 4

Strep. pneumonia
Haemophilus influenza
Moraxella catarrhalis
Viral

Question 5

What are the treatments for exacerbated COPD? (3)

Answer 5

Steroids
Antibiotics (amoxicillin, doxycycline, co-trimoxazole, clarithromycin)
+/- Nebulisers

Question 6

What is consolidation of the lungs?

Answer 6

Solidification of the lungs due to cellular exudate which congregates in alveoli and leads to impaired gas exchange.

Question 7

What are the symptoms of pneumonia? (6)

Answer 7

Dyspnoea (SOB)
Cough - purulent (yellow/green)
High temp
Rigors (shivering)
Myalgia (muscle pain)
Chest pain

Question 8

What increases your risk for pneumonia?

Answer 8

Smoking & alcohol XS
Extremities of age
Preceding viral illness
Pre-existing lung disease
Chronic illness
Immunocompromised
Hospitalisation
IV drug users

Question 9

What are some complications of pneumonia?

Answer 9

Sepsis
Acute kidney injury
Adult respiratory distress syndrome
Parapneumonic effusion
Empyema (pus in lungs)
Dissemination infection (spreading)

Question 10

What is bronchiectasis?

Answer 10

Pathological dilation of the bronchi

Question 11

What is bronchiectasis due to? (4)

Answer 11

Severe infective episode
Recurrent infections
Proximal bronchial obstruction
Lung parenchymal destruction

Question 12

What causes bronchiectasis?

Answer 12

Idiopathic (no cause)
Childhood infection
CF
Ciliary dyskinesia
Hypogammaglobulinemia
Allergic broncho-pulmonary aspergillosis (ABPA)

Question 13

What are the symptoms of bronchiectasis? (9)

Answer 13

Chronic productive cough
Breathlessness
Recurrent LRTI
Haemoptysis
Finger clubbing
Crepitations (stridor)
Wheeze
Clubbing
Obstructive spirometry

Question 14

What is a lung abscess?

Answer 14

A hole in the lung filled with pus

Question 15

What can cause a lung abscess?

Answer 15

Obstructed bronchus - tumour
Aspiration
Particular organisms
Metastatic in pyaemia (infection comes from blood - uncommon)
Necrotic lung (secondary infection - uncommon)

Question 16

Describe bronchopneumonia?

Answer 16

Bacterial infection leasing to acute inflammation (pus and neutrophils fill alveoli)
located in central acinus area
Tends to occur in lower lobes
Focal/patchy areas of consolidation (white fluffy shadows and bilateral basal)

Question 17

Describe lobar pneumonia?

Answer 17

Infection involves the whole lobe
Solid consolidation of the lung (whole lobe)
Complete white out on chest X-ray
Hyper response, creates lots of fluid and spreads this around the whole lobe

Question 18

What are some complications of LRTI?

Answer 18

Most resolve
Infection spreads to pleura
Organisation
Abscess
Bronchiectasis
Potentially fatal

Question 19

Explain organisation as a complication of LRTI?

Answer 19

Mass lesion
COP - fibrous tissue in air space that used to contain pus - RARE
Constructive bronchiolitis

Question 20

What are some common organisms leading to LRTI?

Answer 20

Strep pneumoniae - 39%
Chlamydophila pneumonia - 13.1%
Mycoplasma pneumonia - 10.8%
H.Influenza - 5.2%
Legionella - 3.6%
Staph aureus
Moxarella catarrhalis
Chlamydophila psittaci
Coxiella burnetii

Question 21

What causes recurrent pneumonia?

Answer 21

Obstruction - tumour
Damage - bronchiectasis
Lung disease - COPD, CF
Non-resp disease - immunocompromised, HIV
Aspiration

Question 22

What are the typical organisms are responsible for CAP?

Answer 22

Strep pneumonia
Haemophilus influenza
Mycoplasma pneumonia

Question 23

What are the atypical organisms responsible for CAP?

Answer 23

Legionella pneumophilia
Chlamydia pneumonia
Chlamydia psittaci
Coxiella burnetti
Moraxella catarrhalis
Viruses

Question 24

What organisms cause HAP?

Answer 24

Enterobacteria
Staph. aureus
Pseudomonas aeigunosa
Klebsiella pneumoniae

Question 25

When is it hospital acquired pneumonia?

Answer 25

After 48 hours of being in hospital

Question 26

What does CURB-65 stand for and what does it show?

Answer 26

C = confusion
U = Blood urea > 7mmol/L
R = Respiratory rate > 30/min
B = BP, systolic < 90mmHg, diastolic <60 mmHg
65 = Age > 65

Shows severity of pneumonia and indicated level of treatment and intervention

Question 27

What do the CURB-65 scores show?

Answer 27

0-1 = Low risk, could be treated in community (<3& risk of death)
2 = Moderate risk, hospital treatment usually required (9% risk of death)
3-5 = High risk, need for ITU (15-40% risk of death)

Question 28

What treatment is given for a CURB-65 score of 0-1?

Answer 28

Amoxicillin
(If penicillin allergy = clarithromycin or doxycycline)
5 days

Question 29

What treatment is given for a CURB-65 score of 2?

Answer 29

Amoxicillin + clarithromycin (atypical)
(If penicillin allergy = levofloxacin)
5-7 days

Question 30

What treatment is given for a CURB-65 score of 3-5?

Answer 30

Co-amoxiclav + clarithromycin (atypical)
(If penicillin allergy = levofloxacin or co-trimoxazole)
7-10 days

Question 31

What are the supportive management for pneumonia?

Answer 31

Oxygen
Fluids (IV or oral)
Antipyretics, NSAIDS
Intubation and ventilation