Resp 7 - Lower RTI's + Pneumonia Flashcards
List the natural defences against infection in the respiratory tract:
- Nasal hairs
- Muco-cilliary clearance
- Cough/sneezing reflex
- Lymphoid follicles in pharynx and tonsils
- Alveolar macrophages
- Local IgA and IgG secretions
List some organisms which make up the normal flora of the upper respiratory tract:
Anaerobes (ie Bacteroides, Clostridium, Lactobacillus) Viridans streptococci Neisseria spp. Candida sp. Strep. pneumonia Strep. pyogenes Haem. influenzae Pseudosmonas spp E coli
List some bacteria which make up the normal flora of the lower respiratory tract:
Normally bacteria free
List the most common infections in the upper respiratory tract:
Rhinitis Pharyngitis Laryngitis Epiglottitis Tracheitis Sinusitis Otitis media
What type of organisms most commonly cause upper respiratory tract infections?
Viruses
List the most common infections in the lower respiratory tract:
Bronchitis
Bronchiolitis
Pneumonia
Define bronchiectasis:
Chronic widening of airways leading to mucous build-up = more vulnerable to infection
Define acute bronchitis:
Inflammation of medium-sized airways (mainly in smokers)
What are the symptoms of acute bronchitis?
Cough
Fever
Increased sputum
(worsened) Shortness of Breath
What organisms are associated with acute bronchitis?
- Viruses
- Strep. pneumonia
- Haem. influenzae
- Moraxella catarrhalis
What is the treatment for acute bronchitis?
- Physiotherapty
- Bronchodilation
+/- Antibiotics
Define pneumonia:
Inflammation of the respiratory portion of the lung, usually due to infection
= Cellular exudate in alveolar spaces
What is the normal presentation of pneumonia?
- Malaise
- Fever
- Productive cough (sputum may be purulent/rusty/bloody)
- Pleuritic chest pain
- Shortness of breath
- Nausea/vomiting
Define lobar pneumonia:
Inflammation of a particular lobe of the lung
Define bronchopneumonia:
Inflammation arising from the bronchi/bronchioles, often diffuse and patchy
How does interstitial pneumonia present?
- Sudden onset dyspnoea
- Rapid respiratory failure
IDIOPATHIC
Who is most at risk of developing aspiration pneumonia?
- Stroke patients
- Epileptics
- Alcoholics/drug users
What are the 4 main types of pneumonia?
1) Hospital-acquired
2) Community-acquired
3) Aspiration
4) Immuno-compromised patient
What organisms most commonly cause community-acquired pneumonia (85% cases)?
- S. pneumoniae
- H. influenzae
- K. pneumonia
- S. aureus
Define hospital-acquired pneumonia:
Infection of the lower respiratory tract, which was not incubating at time of admission.
Usually occurs ~ 2-3 days after admission, usually associated with impaired defenced.
What organism most commonly causes hospital-acquired pneumonia?
S. pneumoniae
What is often seen in examination of a patient with pneumonia?
- Pyrexia
- Tachycardia
- Tachypnoea
- Cyanosis
- Crackles
- Dullness-to-percussion
- Tactile-vocal-fremites
- Bronchial breathing
What scoring system would you use to assess the severity of pneumonia in a patient? Explain it:
CURB 65 score:
C = new mental confusion U = urea > 7mmol/L R = respiratory rate > 30/min B = systolic blood pressure < 90 mmHg 65+ = age over 65
If score = 2+ : Indicates need for hospital treatment
If score = 3+ : May need ICU treatment
Name 5 different ways to collect specimens for diagnosis of pneumonias:
1) Sputum
2) Broncholavage fluid
3) Blood
4) Urine
5) Nose/Throat swabs
Give the 3 opportunistic pathogens which often cause pneumonia in immunocompromised patients:
1) Pneumocystitis jiroveci
2) Aspergillus spp.
3) CMV (cytomegalovirus)
What is the management of pneumonia?
- Good fluid intake (IV if required)
- Anti-pyretics
- Analgesics for pleural pain
- O2 (if cyanotic with good respiratory drive)
Antibiotic: - Amoxicillin if community-acquired (Tetracyclin if allergic)
- Co-Amoxiclav + Clarithromycin if hospital-acquired
