LRTI in Adults Flashcards
What is acute bronchitis
Inflammation of bronchi
<3weeks
Cough & sputum
Viral
What are the symptoms which would make a patient go to a GP for acute bronchitis
- Cough severe or > 3 weeks
- Fever for > 3 days
- Haemoptysis
- Increasing SOB
- Underlying heart/lung condition
- Recurrent bronchitis -> chronic bronchitis
What are the symptoms for COPD exacerbation
Change in colour of sputum
Fevers
Increased breathlessness
Wheeze
Cough
What infections can trigger a COPD exacerbation
Strep pneu
H’ Inf
Moraxella catarrhalis
Viral
HMV’S
What is the treatment for COPD exacerbation
- Corticosteroid (oral/IV) +/- Antibiotic
- Amoxycillin
- Doxycycline
- Co-trimoxazole
- Clarithromycin
+/- nebulizers
WHat is pneuomonia
Inflammation of lung parenchyma
Solidification due to cellular exudate in alveoli
What are the risk factors for pneumonia
- Smoking
- XS alcohol
- Extremes of age
- Preceding viral illness- disruption of mucociliary escalator
- Pre-existing lung disease (COPD, CF)
- Chronic illness
- Immunocompromised (HIV, cancer therapy)
- Hospitalisation *
- IV drug users
What are the symptoms of pneumonia
Fever, rigors, myalgia
Cough and sputum
Chest pain (pleuritic)
Dyspnoea
Haemoptysis
What are signs of pneumonia
Tachypnoea
Tachycardia
Reduced expansion
Dull percussion
Bronchial breathing
Crepitations
Vocal resonance incr.
What does rusty brown sputum mean
Strep pneumonia
Hospital
What are the investigations for pneuomonia
Bloods – serum biochemistry, FBC, CRP
Blood cultures
CXR
Sputum culture, viral throat swab
Legionella urinary antigen
What are the differential diagnosis for pneumonia
Tuberculosis
Lung cancer
Pulmonary embolism
Pulmonary oedema
Pulmonary vasculitis (Wegners granulomatosis
LOVE TB
What does an x-ray of pneumonia look like
Shows area of inflammation
Increased white spots on lungs
What are the different types of acquired pneumonia
Community acquired (typical/atypical)
Nosocomial >48hrs (hospital acquired)
What are the different causes of Community acquired pneumonia
Typical:
S. Pneumoniae
H. influenzae
Mycoplasma pneumoniae
In 4-5 year cycles
Atypical:
Legionella pneumophila
Chlamydia pneumoniae
Chlamydia psittaci
Coxiella burnetti
Moraxella catarrhalis
Influenza virus
What are the different causes of Nosocomial pneumonia
What is the severity scoring associated with pneumonia
CURB 65
* C confusion
* U blood urea> 7mmol/L
* R respiratory rate > 30/min
* B Systolic BP < 90mmHg, diastolic BP <60mmHg
* 65 age>65
Score
0-1 low risk- treated in community
2 moderate risk-hospital treatment
3-5 high risk of death/ITU
What is the treatment for pneumonia
What are some complications of pneumonia
Sepsis
Acute Kidney Injury
Adult Respiratory Distress Syndrome
Parapneumonic effusion
Empyema
Lung Abscess
Disseminated infection
PLEAD AS
How would you diagnose an Empyema/Parapneumonic Effusion
Chest X-ray
D shaped opacity
Consolidation on right lung
CDC
How would you diagnose a lung abscess
Foul smelling sputum
Haemoptysis
Send sputum for AFB
What are the causes of bronchiectasis
Idiopathic
Childhood infection
CF
Ciliary dyskinesia
Hypogammaglobulinaemia
ABPA (Allergic Broncho-Pulmonary Aspergillosis)
What is bronchiectasis
Abnormal dilatation of distal bronchi
Can be exacerbated by infection
- Staph aureus
- H. influenzae
- Pseudomonas aeruginosa
What are the symptoms & signs of bronchiectasis
Chronic productive cough
Breathlessness
Recurrent LRTI
Haemoptysis
Finger clubbing
Bilateral Crepitations (coarse)
Wheeze
Obstructive spirometry
What investigation would you use for bronchiactasis
Cxr- signet ring
Sputum culture
What is the management for Bronchiectasis
Mucolytics
Prolonged antibiotic course 10-14 days
Prophylactic abx
