LRTIs in Adults Flashcards
What is acute bronchitis?
Inflammation of bronchi.
Temporary (<3 weeks).
Cough and sputum - usually viral.
Supportive management.
5% of acute bronchitis cases lead to pneumonia.
When should you see a GP for a review of acute bronchitis?
Cough - severe, >3 weeks.
Temperature - high, >3 days (flu / pneumonia).
Sputum - blood.
Underlying heart or lung conditions.
SOB - worsening.
Repeated episodes of bronchitis.
What is COPD exacerbation?
Change in colour of sputum.
Fever.
Increased SOB.
Wheeze.
Cough.
Caused by S. Pneumoniae, H. Influenzae, M. Catarrhalis, or a viral infection.
Treat with steroids, antibiotics, or nebulisers.
What can cause bronchiectasis?
Idiopathic.
Childhood infection.
CF.
Ciliary dyskinesia.
Hypogammaglobulinaemia.
Allergic bronchopulmonary aspergillosis (ABPA).
What are the symptoms of bronchiectasis?
Chronic productive cough.
SOB.
Recurrent LRTIs.
Haemoptysis.
Finger clubbing.
Creps (coarse).
Wheeze.
Obstructive spirometry.
What can cause infective exacerbations in bronchiectasis?
S. Aureus.
H. Influenzae.
Pseudomonas spp.
What are the tests and treatments for bronchiectasis?
Sputum Cx (essential) - has AAFBs.
Chest physiotherapy.
Mucolytics.
Prolonged abx (~2 weeks).
Consider prophylactics.
Vaccinations.
What are the risk factors for pneumonia?
Smoking and alcohol.
Extremes of age.
Viral illness.
Pre-existing lung disease.
Chronic illness.
Immunocompromised.
Hospitalisation.
IVDU.
What are the symptoms of pneumonia?
Fever, rigors, myalgia.
Cough and sputum.
(S. Pneumoniae causes rusty brown sputum).
Chest pain - pleuritic.
Dyspnoea.
Haemoptysis.
What are the signs of pneumonia?
Tachypnoea and tachycardia.
Reduced expansion.
Dull percussion.
Bronchial breathing.
Creps.
Increased vocal resonance.
Inflammation of lung parenchyma.
Consolidation - solidification due to cellular exudate in alveoli, impairs gas exchange.
What are the investigations of pneumonia?
CXR - if diagnosis doubt, or not improving.
Bloods - cultures, serum biochemistry, FBC, CRP.
Sputum cultures, viral throat swabs.
Legionella urinary antigen.
What are the differential diagnoses of pneumonia?
Tuberculosis.
Lung cancer.
Pulmonary embolism / oedema / vasculitis.
What are examples of typical community-acquired pneumonia?
S. Pneumoniae.
H. Influenzae.
M. Pneumoniae (5 year cycles, extrapulmonary complications).
What are examples of atypical community-acquired pneumonia?
L. Pneumophilia (from water / air abroad).
C. Pneumoniae (CAD).
C. Psittaci (birds).
C. Burnetti (farm animals).
M. Catarrhalis (COPD).
Viruses (influenza, RSV, SARS).
What are examples of nosocomial pneumonia?
Enterobacteria and clostridia spp.
S. Aureus (IVDU).
P. Aerigunosa (green sputum).
K. Pneumoniae and TB (cavitations).
Anaerobes.
How is severity scored in pneumonia?
CURB 65.
Confusion.
Urea > 7mmol/L.
RR > 30/min.
BP < 90mmHg (diastolic < 60mmHg).
65 < age.
Consider young people, the hypoxic, and multi-lobar consolidation.
What does a CURB 65 score of 0-1 in pneumonia represent?
Low risk of death (<3%). Treat in community.
Amoxicillin (clarithromycin or doxycycline if allergic to penicillin) for 5 days.
What does a CURB 65 score of 2 in pneumonia represent?
Moderate risk of death (9%).
Hospital treatment is usually required.
Amoxicillin (with clarithromycin for atypical; levofloxacin if allergic to penicillin) for 5-7 days.
What does a CURB 65 score of 5 in pneumonia represent?
High risk of death (25%). ITU needed.
Co-amoxiclav (with clarithromycin for atypical; levofloxacin or co-trimoxazole if allergic to penicillin) for 7-10 days.
What should be considered when managing pneumonia?
Route - IV or oral.
Supportive management - oxygen, fluids, antipyretics, NSAIDs, intubation, ventilation.
What are special circumstances with pneumonia?
Influenza - S. Aureus as a secondary infection.
Immunocompromised - caused by fungi, viruses, haematological malignancy, neutropenia, HIV, and PJP (treat PJP with co-trimoxazole).
MRSA - treat with vancomycin.
Describe recovery from pneumonia and recurrent pneumonia.
Takes weeks.
CXR is repeated after 6 weeks in >50yr old smokers (smoking cessation is encouraged).
Consider immunocompromised, underlying structural lung disease, or aspiration in recurrent pneumonia.
What is aspiration pneumonia?
Likely caused by anaerobes.
Caused by stroke, MS, myasthenia, sedation, or oesophageal disease.
Treat with amoxicillin and metronidazole.
What are the complications of pneumonia?
Sepsis.
AKI.
Adult Respiratory Distress Syndrome.
Parapneumonic effusion or empyema.
Lung abscess.
Disseminated infection.
How are empyema and lung abscesses treated?
Empyema:
Thoracic ultrasound +/- aspiration.
Simple - pH > 7.2.
Complicated - pH < 7.2.
Pus or positive culture.
May require drainage and prolonged abx.
Lung abscess:
Likely from S. Aureus or Pseudomonas spp.
Purulent sputum and haemoptysis.
Screen for TB.
CT scan +/- bronchoscopy.
Prolonged abx.
