LRTI in Adults Flashcards
List the 5 different LRTI’s that can affect adults
- Acute bronchitis
- Pneumonia
- Bronchectasis
- Lung abscess
- Empyema
Where is the lower respiratory tract?
The lower respiratory tract is anything below the vocal chords
What is acute bronchitis?
inflammation of bronchi
What are the 2 main symptoms of acute bonchitis?
cough and sputum
What is the usual causative agent of acute bronchitis/
Viruses
How should acute bronchitis be managed/
Supportively- fluids, paracetamol etc
How long should acute bronchitis last?
<3 weeks
List 5 features that can characterise a COPD exacerbation
- Change in colour of sputum
- Fevers
- Increased breathlessness
- Worsening wheeze
- Worsening Cough
Are infective exacerbations of COPD usually caused by bacterial or viral infections?
Viral
Name the 3 bacteria that are most commonly responsible for bacterial exacerbations of COPD
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
How are exacerbations of COPD treated?
- Steroids (to reduce inflammation)
- antibiotics (if appropriate)
- Nebulisers
What is the most common antibiotic given to treat COPD?
Amoxicillin
What is pneumonia?
an inflammation of the lung parenchyma
Name and describe the three different types of pneumonia
a) Bronchopneumonia (patchy infiltrate throughout the lungs)
b) Lobar Pneumonia (causes consolidation in an entire lobe)
c) Interstitial pneumonia (usually inflammatory rather than infective. Can be caused by viruses)
List the 9 pneumonia risk factors
- Smoking
- Excessive alcohol consumption
- Extremes of age (Infants & Elderly)
- Preceding viral illness
- Pre-existing lung disease
- Chronic illness
- Immunocompromised
- Hospitalisation
- Intravenous drug abusers
What are the symptoms of pneumonia? (5)
- fever/rigors
- cough & sputum
- chest pain (pleuritic)
- Dyspnoea
- Haemoptysis
What are the clinical signs associated with pneumonia?
Tachypnoea Tachycardia Dull percussion Bronchial breathing Crepitations Increased vocal resonance
How would you investigate pneumonia in primary care?
often no investigations
CXR if the diagnosis is in doubt or if symptoms were persistent
How would pneumonia be investigated in hospital? (6)
- Bloods (serum biochemistry, full blood count, inflammatory marker c-reactive protein)
- Blood cultures (pneumonia is a sepsis risk!)
- Chest x-ray
- Sputum culture
- Viral throat swab
- Legionella urinary antigen
Name the top 3 bacteria most commonly responsible for pneumonia
- Strep pneumoniae
- H. Influenzae
- Legionella pneumoniae
What is the name of the scoring system that can be used to assess the severity of pneumonia?
CURB65
What does each section of the CURB65 score stand for?
C- Confusion U- Blood urea >7 R- Respiratory rate of 30 greater B- Systolic BP <90, diastolic <60 65- Aged 65 or over
CURB65 Scores are split into;
0-1
2
3-5
Explain the risk and level of treatment required for each score
0-1= Low risk, could be treated in the community
2= Moderate risk, hospital treatment usually required
3-5= High risk of death- ITU intervention is needed
Which antibiotic is used to treat a pneumonia scoring 0-1. How long should it be given for?
amoxicillin (clarithromycin or doxycycline if penicillin allergy) for 5 days
Which antibiotic is used to treat a pneumonia scoring 2. How long should it be given for?
Amoxicillin + Clarithromycin (levofloxacin if penicillin allergic) for 5-7 days
Which antibiotic is used to treat a pneumonia scoring 3-5. How long should it be given for?
Co-amoxiclav + clarithromycin (levoflopxican or co-trimoxazole if penicillin allergic) for 7-10 days
In a pneumonia patient who has recently suffered an influenza infection, what is the likely causative bacteria?
S. Aureus
What type of bacteria is most likely in aspiration pneumonia and what antibiotics should be given to treat it?
Anaerobes infections are the most likely causation
Amoxicillin + metronidazole
What antibiotic is used to treat MRSA?
Vancomycin
What are the three likely causative agents of pneumonia in an immunocompromised patient and what antibiotic can be used to treat?
Fungi
Viruses
Pneumocystis jiroveci pneumoniae (treat with high dose co-trimoxazole)
What is parapneumonic effusion?
A pleural effusion secondary to pneumonia (bacterial or viral) or lung abscess
What is empyema
pus in the pleural space.
What findings would you expect in an x-ray of a patient suffering from parapneumonic effusion/ empyema?
consolidation, blunting of costophrenic angle and D-shaped areas
What differentiates a simple effusion, complicated effusion and empyema?
Simple effusion = pH > 7.2
Complicated effusion = pH < 7.2
Empyema = pus/Culture +ve
Which kind of bacteria are the most likely to cause lung abscesses? (3)
staph aureus, pseudomonas or anaerobes
If a mass is seen on a CXR, what should the patient be screened for?
TB
How do you rule out a tumour in a patient with a lung mass?
CT and/or bronchoscopy
What should happen to patients over 50 years old 6 weeks after pneumonia treatment?
A follow up CXR to ensure the infection has fully resolved
Which three things should be considered if a patient has recurrent pneumonia?
- Immunocompromised?
- Structural lung diseases
- Aspiration
What is bronchiectasis?
dilated distal bronchi that produces high volumes of thickened sputum causing the airways to narrow
What is the distinctive feature of bronchiectasis on CT?
Signet ring
What is the characteristic feature of bronchiectasis?
have chronic sputum production which is difficult to expectorate Chronic cough Recurrent LRTI Haemoptysis Finger clubbing Crepitations Wheeze Obstructive spirometry
List the 6 causes of bronchiectasis
- Idiopathic
- Childhood infection
- Cystic fibrosis
- Ciliary dyskinesia
- Hypogammaglobulinaemia
- Allergic Broncho-Pulmonary Aspergillosis (ABPA)
Name the three infective agents most commonly responsible for exacerbations of bronchiectasis
- Staph aureus
- Haemophilus influenzae
- Pseudomonas aerigunosa
How is bronchiectasis managed and treated?
Sputum cultures are essential (including mycobacterium) to identify the causative agent!
Chest physio
Mucolytics (to thin out mucous)
Prolonged antibiotic course 10-14 days (the infections are deep seated!)
Vaccinations (flu and pneumococcal)
Consider prophylactic antibiotics
