Resp 7 - Lower RTI's + Pneumonia

Question 1

List the natural defences against infection in the respiratory tract:

Answer 1

• Nasal hairs
• Muco-cilliary clearance
• Cough/sneezing reflex
• Lymphoid follicles in pharynx and tonsils
• Alveolar macrophages
• Local IgA and IgG secretions

Question 2

List some organisms which make up the normal flora of the upper respiratory tract:

Answer 2

Anaerobes (ie Bacteroides, Clostridium, Lactobacillus)
Viridans streptococci
Neisseria spp.
Candida sp.
Strep. pneumonia
Strep. pyogenes
Haem. influenzae
Pseudosmonas spp
E coli

Question 3

List some bacteria which make up the normal flora of the lower respiratory tract:

Answer 3

Normally bacteria free

Question 4

List the most common infections in the upper respiratory tract:

Answer 4

Rhinitis
Pharyngitis
Laryngitis
Epiglottitis
Tracheitis
Sinusitis
Otitis media

Question 5

What type of organisms most commonly cause upper respiratory tract infections?

Answer 5

Viruses

Question 6

List the most common infections in the lower respiratory tract:

Answer 6

Bronchitis
Bronchiolitis
Pneumonia

Question 7

Define bronchiectasis:

Answer 7

Chronic widening of airways leading to mucous build-up = more vulnerable to infection

Question 8

Define acute bronchitis:

Answer 8

Inflammation of medium-sized airways (mainly in smokers)

Question 9

What are the symptoms of acute bronchitis?

Answer 9

Cough
Fever
Increased sputum
(worsened) Shortness of Breath

Question 10

What organisms are associated with acute bronchitis?

Answer 10

• Viruses
• Strep. pneumonia
• Haem. influenzae
• Moraxella catarrhalis

Question 11

What is the treatment for acute bronchitis?

Answer 11

• Physiotherapty
• Bronchodilation
  +/- Antibiotics

Question 12

Define pneumonia:

Answer 12

Inflammation of the respiratory portion of the lung, usually due to infection
= Cellular exudate in alveolar spaces

Question 13

What is the normal presentation of pneumonia?

Answer 13

• Malaise
• Fever
• Productive cough (sputum may be purulent/rusty/bloody)
• Pleuritic chest pain
• Shortness of breath
• Nausea/vomiting

Question 14

Define lobar pneumonia:

Answer 14

Inflammation of a particular lobe of the lung

Question 15

Define bronchopneumonia:

Answer 15

Inflammation arising from the bronchi/bronchioles, often diffuse and patchy

Question 16

How does interstitial pneumonia present?

Answer 16

• Sudden onset dyspnoea
• Rapid respiratory failure

IDIOPATHIC

Question 17

Who is most at risk of developing aspiration pneumonia?

Answer 17

• Stroke patients
• Epileptics
• Alcoholics/drug users

Question 18

What are the 4 main types of pneumonia?

Answer 18

1) Hospital-acquired
2) Community-acquired
3) Aspiration
4) Immuno-compromised patient

Question 19

What organisms most commonly cause community-acquired pneumonia (85% cases)?

Answer 19

• S. pneumoniae
• H. influenzae
• K. pneumonia
• S. aureus

Question 20

Define hospital-acquired pneumonia:

Answer 20

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.

Question 21

What organism most commonly causes hospital-acquired pneumonia?

Answer 21

S. pneumoniae

Question 22

What is often seen in examination of a patient with pneumonia?

Answer 22

• Pyrexia
• Tachycardia
• Tachypnoea
• Cyanosis
• Crackles
• Dullness-to-percussion
• Tactile-vocal-fremites
• Bronchial breathing

Question 23

What scoring system would you use to assess the severity of pneumonia in a patient? Explain it:

Answer 23

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

Question 24

Name 5 different ways to collect specimens for diagnosis of pneumonias:

Answer 24

1) Sputum
2) Broncholavage fluid
3) Blood
4) Urine
5) Nose/Throat swabs

Question 25

Give the 3 opportunistic pathogens which often cause pneumonia in immunocompromised patients:

Answer 25

1) Pneumocystitis jiroveci
2) Aspergillus spp.
3) CMV (cytomegalovirus)

Question 26

What is the management of pneumonia?

Answer 26

• 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