LTRI in Adults Flashcards
What does itis mean?
Inflammation
What is an abscess?
When bacteria in the lung form a pocket of infected fluid
What is acute bronchitis?
Inflammation of the bronchi
How does acute bronchitis last for?
It lasts less than 3 weeks
What are the main symptoms of acute bronchitis?
Cough and sputum
What is the definition of chronic bronchitis (COPD)?
A cough that lasts 3 months of the year for at least 2 years in a row.
What are the supportive ways to manage acute bronchitis?
Drinking lotrs of fluid and taking paracetamol.
What are the main symptoms of a COPD exacerbation?
Changes in the color and amount of sputum, fever, increased breathlessness, Wheeze and cough
What are the organisms that cause COPD exacerbations?
Streptococcus pneumonia, Haemophilus influenzae, moraxella catarrhalis,
What are the main treatments of COPD exacerbations?
- Steroids ( to reduce the inflammation)
- Antibiotics (depending on whether or not it is infectious) - Amoxycillin, doxycycline, co-trimoxazole, clarithromycin
- +/- nebulisers
What is pneumonia?
Inflammation of the lung parenchyma (functional tissue of the lung)
What are the three types of pneumonia?
Lobar, intersitial and bronchopneumonia
What does consolidation mean?
Solidification due to cellular exudate in alveoli leads to impaired gas exchange
What are 8 risk factors of pneumonia?
- Smoking
- Alcohol in excess
- Extremes of age
- Preceeding viral illnesses (flu)
- preexisting lung disease (COPD)
- Chronic illness
- Immunocompromised (HIV, CHEMOTHERAPY)
- Hospitalisation
- IV drug abusers
What are 7 symptoms of pneumonia?
- Fever
- Rigors (shivers)
- Myalgia (pain in the muscles)
- cough and sputum
- Chest pain
- Dysponea (breathlessness)
- Haemoptysis
What does rusty brown sputum mean?
Streptococci pneumoniae
What are 7 signs that you expect to find on examination of someone with pneumoniae?
- Tachypnea - raised RR
- Tachycardia - increased HR > 90 bpm
- Reduced lung expansion
- Dull percussion note
- Bronchial breathing
- Crepitations (/snapping open of the alveoli)
- Vocal resonance increases
What are the investigations to be carried out on community pneumoniae?
None but CXR if in doubt.
What are 6 investigations to carry out in hospital pneumonia?
- Blood chemistry for the blood count, Full blood count, and an inflammatory marker called C reactive protein
- Blood cultures
- CXR
- Throat swab
- Sputum culture
- Legionella urinary antigen
What are the differential diagnoses for pneumonia?
- TB
- Lung cancer
- Pulmonary embolism
- Pulmonary edema
- Pulmonary vasculitis
What organisms cause typical community acquired pneumonia?
Strep pneumonia, H.influenzae, Mycoplasma pneumonia
What kind of organism is strep pneumonia?
Purple streptococci, gram-positive and spherical organisms that tend to form spheres.
what is the second commonest cause of death in the UK?
Pneumonia
Is a CXR abnormal in pneumonia?
Always abnormal
What is seen in a CXR of someone with pneumonia?
Pulmonary shadowing/consolidation
What does the added sound of crackling usually indicate?
Infection
What is bronchiectasis?
The dilation of bronchi producing sepsis in the chest
What are 8 symptoms of bronchiectasis?
Daily cough Daily copious purulent (yellow, green or opaque sputum indicating the presence of neutrophils) Occasional haemoptysis Frequent chest infections Wheezing Dyspnoea Tiredness Flitting chest pains
What are the signs of bronchiectasis?
Finger clubbing
Lung crackles on inspiration and expiratoin
Can bronchiectasis be cured?
No
How is empyema distinguished from a simple effusion?
The fluid can be collected and sampled and is found to be pus
Why does the infected fluid need to be drained and not treated with antibiotics?
Because antibiotics do not penetrate well into the pleural cavity
What investigations are done for bronchiectasis?
Sputum culture
Spirometry
CXR
High resolution CXR are the main diagnostic tests
What infects the fluid in empyema?
Micro-organism
How is an abscess in the lung removed?
Long-term antibiotics, Sometimes the abscess must be drained by a surgeon or radiologist
What are some of the common micro-organisms causes of LRTIs?
Streptococcus pneumonia (50%), staphylococcus aureus
What are features of streptococcus pneumonia?
Abrupt onset High pyrexia/rigors Pleuritic chest pain Cough with purulent (green) sputum Hypotension and cyanosis Septicaemia
What is shown in CXR of streptococcus pneumonia?
Classically lobar and often patchy shadowing
What is the treatment for streptococcus pneumonia?
IV benzyl penicillin, amoxicillin, oral ampicillin
If the person is allergic to penicillin what antibiotics should be used?
Macrolide and Clarithromycin
What is the treatment for empyema?
Chest drain, IV antibiotics
What organisms are more likely to result in cavitating pneumonia?
Staph. aureus, Pseudomonas, Anaerobes
What are the causes of Bronchiectasis?
Idiopathic Immotile Cilia Syndrome CF Childhood infections such as measles ABPA
What is the treatment for bronchiectasis?
Chest physiotherapy
Prompt treatment of infections with appropriate antibiotics ,
May require inhaled therapy including beta2 agonist and inhaled corticosteroid
What does CURB65 stand for?
C = confusion U= blood urea>7
Respiratory rate >30
B = diastolic blood pressure <60
65 = age>6
What are the main features of bronchiectasis?
Dilated and damaged bronchi
What are the signs of pneumonia?
Pyrexia Tachpnoea Central cyanosis Dullness on percussion of affected lobe(s) Bronchial breath sounds Inspiratory crepitations Increased vocal resonance
What bacteria can cause pneumonia?
Strep pneumoniae H. Influenzae Legionella Staph aureus Mycoplasma pneumoniae Chlamydia psittac
What treatment is given to pneumonia patients?
Oxygen
I.V fluids
CPAP
Intubation and ventilation
What are the potential complications of pneumonia?
Septicaemia Acute kidney injury Empyema Lung abscess Haemolytic anaemia ARDS
