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Respiratory Medicine > LRTI in Adults > Flashcards

LRTI in Adults Flashcards

1
Q

List the 5 different LRTI’s that can affect adults

A
  1. Acute bronchitis
  2. Pneumonia
  3. Bronchectasis
  4. Lung abscess
  5. Empyema
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2
Q

Where is the lower respiratory tract?

A

The lower respiratory tract is anything below the vocal chords

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3
Q

What is acute bronchitis?

A

inflammation of bronchi

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4
Q

What are the 2 main symptoms of acute bonchitis?

A

cough and sputum

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5
Q

What is the usual causative agent of acute bronchitis/

A

Viruses

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6
Q

How should acute bronchitis be managed/

A

Supportively- fluids, paracetamol etc

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7
Q

How long should acute bronchitis last?

A

<3 weeks

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8
Q

List 5 features that can characterise a COPD exacerbation

A
  1. Change in colour of sputum
  2. Fevers
  3. Increased breathlessness
  4. Worsening wheeze
  5. Worsening Cough
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9
Q

Are infective exacerbations of COPD usually caused by bacterial or viral infections?

A

Viral

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10
Q

Name the 3 bacteria that are most commonly responsible for bacterial exacerbations of COPD

A
  1. Streptococcus pneumoniae
  2. Haemophilus influenzae
  3. Moraxella catarrhalis
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11
Q

How are exacerbations of COPD treated?

A
  1. Steroids (to reduce inflammation)
  2. antibiotics (if appropriate)
  3. Nebulisers
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12
Q

What is the most common antibiotic given to treat COPD?

A

Amoxicillin

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13
Q

What is pneumonia?

A

an inflammation of the lung parenchyma

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14
Q

Name and describe the three different types of pneumonia

A

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)

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15
Q

List the 9 pneumonia risk factors

A
  1. Smoking
  2. Excessive alcohol consumption
  3. Extremes of age (Infants & Elderly)
  4. Preceding viral illness
  5. Pre-existing lung disease
  6. Chronic illness
  7. Immunocompromised
  8. Hospitalisation
  9. Intravenous drug abusers
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16
Q

What are the symptoms of pneumonia? (5)

A
  1. fever/rigors
  2. cough & sputum
  3. chest pain (pleuritic)
  4. Dyspnoea
  5. Haemoptysis
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17
Q

What are the clinical signs associated with pneumonia?

A 
Tachypnoea
Tachycardia 
Dull percussion 
Bronchial breathing
Crepitations
Increased vocal resonance
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18
Q

How would you investigate pneumonia in primary care?

A

often no investigations

CXR if the diagnosis is in doubt or if symptoms were persistent

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19
Q

How would pneumonia be investigated in hospital? (6)

A
  1. Bloods (serum biochemistry, full blood count, inflammatory marker c-reactive protein)
  2. Blood cultures (pneumonia is a sepsis risk!)
  3. Chest x-ray
  4. Sputum culture
  5. Viral throat swab
  6. Legionella urinary antigen
20
Q

Name the top 3 bacteria most commonly responsible for pneumonia

A
  1. Strep pneumoniae
  2. H. Influenzae
  3. Legionella pneumoniae
21
Q

What is the name of the scoring system that can be used to assess the severity of pneumonia?

A

CURB65

22
Q

What does each section of the CURB65 score stand for?

A 
C- Confusion 
U- Blood urea >7
R- Respiratory rate of 30 greater 
B- Systolic BP <90, diastolic <60
65- Aged 65 or over
23
Q

CURB65 Scores are split into;
0-1
2
3-5

Explain the risk and level of treatment required for each score

A

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

24
Q

Which antibiotic is used to treat a pneumonia scoring 0-1. How long should it be given for?

A

amoxicillin (clarithromycin or doxycycline if penicillin allergy) for 5 days

25
Q

Which antibiotic is used to treat a pneumonia scoring 2. How long should it be given for?

A

Amoxicillin + Clarithromycin (levofloxacin if penicillin allergic) for 5-7 days

26
Q

Which antibiotic is used to treat a pneumonia scoring 3-5. How long should it be given for?

A

Co-amoxiclav + clarithromycin (levoflopxican or co-trimoxazole if penicillin allergic) for 7-10 days

27
Q

In a pneumonia patient who has recently suffered an influenza infection, what is the likely causative bacteria?

A

S. Aureus

28
Q

What type of bacteria is most likely in aspiration pneumonia and what antibiotics should be given to treat it?

A

Anaerobes infections are the most likely causation

Amoxicillin + metronidazole

29
Q

What antibiotic is used to treat MRSA?

A

Vancomycin

30
Q

What are the three likely causative agents of pneumonia in an immunocompromised patient and what antibiotic can be used to treat?

A

Fungi
Viruses
Pneumocystis jiroveci pneumoniae (treat with high dose co-trimoxazole)

31
Q

What is parapneumonic effusion?

A

A pleural effusion secondary to pneumonia (bacterial or viral) or lung abscess

32
Q

What is empyema

A

pus in the pleural space.

33
Q

What findings would you expect in an x-ray of a patient suffering from parapneumonic effusion/ empyema?

A

consolidation, blunting of costophrenic angle and D-shaped areas

34
Q

What differentiates a simple effusion, complicated effusion and empyema?

A

Simple effusion = pH > 7.2
Complicated effusion = pH < 7.2
Empyema = pus/Culture +ve

35
Q

Which kind of bacteria are the most likely to cause lung abscesses? (3)

A

staph aureus, pseudomonas or anaerobes

36
Q

If a mass is seen on a CXR, what should the patient be screened for?

A

TB

37
Q

How do you rule out a tumour in a patient with a lung mass?

A

CT and/or bronchoscopy

38
Q

What should happen to patients over 50 years old 6 weeks after pneumonia treatment?

A

A follow up CXR to ensure the infection has fully resolved

39
Q

Which three things should be considered if a patient has recurrent pneumonia?

A
  1. Immunocompromised?
  2. Structural lung diseases
  3. Aspiration
40
Q

What is bronchiectasis?

A

dilated distal bronchi that produces high volumes of thickened sputum causing the airways to narrow

41
Q

What is the distinctive feature of bronchiectasis on CT?

A

Signet ring

42
Q

What is the characteristic feature of bronchiectasis?

A 
have chronic sputum production which is difficult to expectorate
Chronic cough 
Recurrent LRTI 
Haemoptysis 
Finger clubbing 
Crepitations 
Wheeze 
Obstructive spirometry
43
Q

List the 6 causes of bronchiectasis

A
  1. Idiopathic
  2. Childhood infection
  3. Cystic fibrosis
  4. Ciliary dyskinesia
  5. Hypogammaglobulinaemia
  6. Allergic Broncho-Pulmonary Aspergillosis (ABPA)
44
Q

Name the three infective agents most commonly responsible for exacerbations of bronchiectasis

A
  • Staph aureus
  • Haemophilus influenzae
  • Pseudomonas aerigunosa
45
Q

How is bronchiectasis managed and treated?

A

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

Respiratory Medicine (27 decks)

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