LTRI in Adults Flashcards
Symptoms of Pneumonia
Malaise Myalgia (muscle pain) Fever Chest pain (pleuritic) Cough Purulent sputum Dyspnoea
Signs of Pneumonia
Pyrexia
Tachypnoea (rapid breathing)
Central cyanosis (hypoxia)
Dullness to percuss on affected lobes
Bronchial breath sounds (due to consolidation)
Inspiratory crepitations
Increased vocal resonance (consolidation)
Pneumonia investigations
CXR (consolidation) U+Es LFT CRP (raised in pneumonia) FBC (raised WBC, especially neutrophils) Blood or sputum culture Urinary legionella antigen Throat swab (for atypical pathogens) HIV test
When a patient produces rusty coloured sputum what could this indicate?
Pneumonia caused by streptococcus pneumonia
5 bacterias that cause Pneumonia
Strep Pneumonia (commonest) Haem. Influenzae Legionella Staph aureus Mycoplasma pneumoniae
What can be used to score the severity of pneumonia?
CURB 65
C - confusion U - blood urea > 7 R - Respiratory rate > 30 B - diastolic BP < 60 65 - age > 65yrs
If a patient scores a CURB 65 of 0-1 what antibiotics should they be treated with?
Low risk and could be treated in community
Amoxycillin or clarithromycin / doxycycline
If a patient scores a CURB 65 of 2 what antibiotics should they be treated with?
Hospital treatment usually required (1-2)
Amoxycillin and clarithromycin or levofloxacin
If a patient scores a CURB 65 of 3-5 what antibiotics should they be treated with?
High risk of death and need for ITU
Co-amoxyclav and clarithromycin or levofloxacin (if penicillin allergic)
Other treatments for Pneumonia other than antibiotics?
Oxygen
IV fluids
CPAP (continuous positive airflow pressure)
Intubation and ventilation
Complications with Pneumonia
Septicaemia - if bacteria enters blood Acute kidney injury Empyema (pus in pleural cavity) Lung abscess Metastatic infection ARDS
Differential diagnosis
TB Lung cancer Pul embolism Pul oedema Pul vasculitis
Aetiology of Empyema
Secondary to Pneumonia
Streptococcus
Staph. aureus
Anaerobes
Symptom and sign of empyema
Chest pain (pleuritic) and swinging pyrexia
Investigation and diagnosis for empyema
CT thorax and pleural ultrasound (shows fluid) to investigate and diagnosed by pleural aspiration (pH < 7.2)
Treatment of empyema
Chest drain and IV antibiotics
Sometime intrapleural t-PA/DNase
Surgery if no improvement
Aetiology of lung abscesses
Secondary to pneumonia - certain organisms more likely to result in caveatting pneumonia; staph aureus, pseudomonas, anaerobes
Symptoms of lung abscess
Non-specific - lethargy, weigh loss, high swinging pyrexia
Lung abscess investigation
CT thorax Sputum culture (including TB microscopy and culture)
What is bronchiectasis?
Dilation of the bronchi due to scarring and thickened airway wall (mucus build up)
Aetiology of bronchiectasis
Idiopathic
Immotile cilia syndrome (mucus build up)
Cystic fibrosis
Childhood infection - measles
Hypogammaglobulinaemia (less antibodies to fight infection)
Allergic bronchopulmonary aspergillosis (ABPA) - hypersensitivity to aspergillosis
Symptoms of bronchiectasis
Chronic cough
Sputum production
Sometimes - wheeze, dyspnoea, fatigue, flitting chest pain, haemoptysis (vessel dilation causes rupture)
Signs of Bronchiectasis
Finger clubbing
Course inspiratory crepitations (auscultation)
Investigation on bronchiectasis
HRCT thorax (CT)
Sputum culture (for H influence, staph aureus, pseudomonas aeruginosa)
Serum immunoglobulins
Total IgE (for ABPA) and aspergillum precipitins
CF genotyping
Treatment of bronchiectasis
Chest physiotherapy
Antibiotics
May require inhaled therapy including beta 2 agonist and inhaled corticosteroid (for those SOB and wheezy)
Aetiological classifications of pneumonia
Community acquired Hospital acquired (nosocomial) In the immunocompromised Atypical Aspiration Recurrent
Patterns of pneumonia
Bornchopneumonia
Segemental
Lobar
Hypostatic
Aspiration
Obstructive, retention, endogenous lipid
What is the basis of anatomical classification of pneumonia: bronchi vs lobar?
Pneumonia is alveolar inflammation caused by infection. It can affect alveoli uniformly from one or more lobes of the lung (lobar) or spread from the terminal bronchioles to the alveoli in a more patchy distribution (bronchopneumonia)
What are the causative organisms of Pneumonia in the Immunocompromised and what drugs do you give?
Viruses
Legionella- Clarithromycin (tetracycline or macrolide)
Staphylococcus - Flucloxacillin
Streptococcus pneumoniae - Amoxicillin
What are the causative organisms of Pneumonia in the Community and what drugs do you give?
Streptococcus pneumoniae - Amoxicillin
Mycoplasma pneumoniae- Clarithromycin (tetracycline or macrolide)
Chlamydophila pneumoniae- Clarithromycin (tetracycline or macrolide)
Haemophilus influenzae - Amoxicillin/Co-amoxiclav
What are the causative organisms of Pneumonia in the Hospital and what drugs do you give?
Gram negative bacteria - Amoxicillin
MRSA - Vancomycin + Rifampin
Streptococcus pneumoniae - Amoxicillin
What are the causative organisms of Atypical Pneumonia and what drugs do you give?
Mycoplasma pneumoniae- Clarithromycin/Tetracycline
Legionella- Clarithromycin/Tetracycline
Chlamydia- Clarithromycin/Tetracycline
Coxiella burnetii - Clarithromycin/Tetracycline
