LRTI in Adults Flashcards
What are the clinical features of acute bronchitis? (5)
Inflammation of the bronchi
Cough and sputum
Wheeze
Chest discomfort
Usually viral
When to see a GP with bronchitis? (6)
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
What are the signs of a COPD exacerbation? (4)
Changes in sputum colour
Fevers
Increased breathlessness
Wheeze cough
What organisms may cause and exacerbation in COPD? (4)
Strep. pneumonia
Haemophilus influenza
Moraxella catarrhalis
Viral
What are the treatments for exacerbated COPD? (3)
Steroids
Antibiotics (amoxicillin, doxycycline, co-trimoxazole, clarithromycin)
+/- Nebulisers
What is consolidation of the lungs?
Solidification of the lungs due to cellular exudate which congregates in alveoli and leads to impaired gas exchange.
What are the symptoms of pneumonia? (6)
Dyspnoea (SOB)
Cough - purulent (yellow/green)
High temp
Rigors (shivering)
Myalgia (muscle pain)
Chest pain
What increases your risk for pneumonia?
Smoking & alcohol XS
Extremities of age
Preceding viral illness
Pre-existing lung disease
Chronic illness
Immunocompromised
Hospitalisation
IV drug users
What are some complications of pneumonia?
Sepsis
Acute kidney injury
Adult respiratory distress syndrome
Parapneumonic effusion
Empyema (pus in lungs)
Dissemination infection (spreading)
What is bronchiectasis?
Pathological dilation of the bronchi
What is bronchiectasis due to? (4)
Severe infective episode
Recurrent infections
Proximal bronchial obstruction
Lung parenchymal destruction
What causes bronchiectasis?
Idiopathic (no cause)
Childhood infection
CF
Ciliary dyskinesia
Hypogammaglobulinemia
Allergic broncho-pulmonary aspergillosis (ABPA)
What are the symptoms of bronchiectasis? (9)
Chronic productive cough
Breathlessness
Recurrent LRTI
Haemoptysis
Finger clubbing
Crepitations (stridor)
Wheeze
Clubbing
Obstructive spirometry
What is a lung abscess?
A hole in the lung filled with pus
What can cause a lung abscess?
Obstructed bronchus - tumour
Aspiration
Particular organisms
Metastatic in pyaemia (infection comes from blood - uncommon)
Necrotic lung (secondary infection - uncommon)
Describe bronchopneumonia?
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)
Describe lobar pneumonia?
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
What are some complications of LRTI?
Most resolve
Infection spreads to pleura
Organisation
Abscess
Bronchiectasis
Potentially fatal
Explain organisation as a complication of LRTI?
Mass lesion
COP - fibrous tissue in air space that used to contain pus - RARE
Constructive bronchiolitis
What are some common organisms leading to LRTI?
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
What causes recurrent pneumonia?
Obstruction - tumour
Damage - bronchiectasis
Lung disease - COPD, CF
Non-resp disease - immunocompromised, HIV
Aspiration
What are the typical organisms are responsible for CAP?
Strep pneumonia
Haemophilus influenza
Mycoplasma pneumonia
What are the atypical organisms responsible for CAP?
Legionella pneumophilia
Chlamydia pneumonia
Chlamydia psittaci
Coxiella burnetti
Moraxella catarrhalis
Viruses
What organisms cause HAP?
Enterobacteria
Staph. aureus
Pseudomonas aeigunosa
Klebsiella pneumoniae
When is it hospital acquired pneumonia?
After 48 hours of being in hospital
What does CURB-65 stand for and what does it show?
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
What do the CURB-65 scores show?
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)
What treatment is given for a CURB-65 score of 0-1?
Amoxicillin
(If penicillin allergy = clarithromycin or doxycycline)
5 days
What treatment is given for a CURB-65 score of 2?
Amoxicillin + clarithromycin (atypical)
(If penicillin allergy = levofloxacin)
5-7 days
What treatment is given for a CURB-65 score of 3-5?
Co-amoxiclav + clarithromycin (atypical)
(If penicillin allergy = levofloxacin or co-trimoxazole)
7-10 days
What are the supportive management for pneumonia?
Oxygen
Fluids (IV or oral)
Antipyretics, NSAIDS
Intubation and ventilation
