W3: LRTI ADULTS

Question 1

ACUTE BRONCHITIS causative agents

Answer 1

rhinovirus
adenovirus
influenza A and B,
and parainfluenza virus

Question 2

ACUTE BRONCHITIS presentation and Tx

Answer 2

temporary. 3w+/recurrent = COPD
cough+sputum, SOB, ↑temp, HAEMOPTYSIS

=> supportive mgmt: hydration paracetamol

Question 3

COPD EXACERBATION causative

Answer 3

viral (most common)

• H influenzae
• rhinovirus
• influenza

strept.pneumon
Moraxella catarrhalis*

Question 4

COPD EXACERBATION pres. and Tx

Answer 4

change in sputum colour, ↑SOB, wheeze, fever, cough

=> STEROID, ANTIBIOTIC, +/- nebs

Question 5

PNEUMONIA pres.

Answer 5

INFLAMMATION OF LUNG PARENCHYMA

• fever, rigors, MYALGIA, cough, sputum (rusty brown - S. pneumon), PLEURITIC PAIN, HAEMOPTYSIS
• tachypnoea, tachycardia, ↓lung expansion, dull percussion, CREPITATIONS, vocal resonsance (consolidation)

Question 6

TYPICAL PNEUMONIA causative

Answer 6

Strept. pneumonia
H. influenz.
Myco. pneumonia

Question 7

PNEUMONIA VISUALISATION & diagnostics

Answer 7

-CXR: white exudate and consolidation

• bloods: fbc, crp
• cultures, sputum, throat
• LEGIONELLA URINARY ANTIGEN

Question 8

LEGIONNAIRE’S DISEASE

Answer 8

URINARY Ag. Legionella pneumophila. Atypical COMM. ACQUIRED. A/C.

• systemic
• DRY COUGH
• hyponatremia
• liver and renal dysfunction & failure

Question 9

Causes of recurrent Pneumonia

Answer 9

underlying lung disease (COPD), bronchiectasis, immunocompromised patients, local obstructive process such as a TUMOR

Question 10

ATYPICAL Comm.Aqc-PNEUMONIA (CAP)

Answer 10

• Legionnaire’s
• Chlamydia pneumoniae: CORONARY
• Coxiella burnetti: FARM ANIMALS
• Chlamydia psittaci: BIRDS
• pneumo jirovecci: HIV
• morax. catarrh.: COPD

Question 11

NONSOCOMIAL PNEUMONIAE

Answer 11

48hr+ onset of admission

• enterobacc
• s. aureus: IVDU
• pseudomonas aerigunosa: FOUL SPUTUM +. underlying COPD
• KLEBS pneumon.: aspiration; alcoholics
• TB

Question 12

CAVITATING PNEUMONIA

Answer 12

nonsocomial:

s. aureus, klebs pneumonia, TB

Question 13

ANATOMICAL PNEUMONIAE

Answer 13

1. BRONCHOPNEUMON. multifocal; lower zone; copd compl.? start at bronchioles, pus, exudate, neutro. polymorph
2. LOBAR solid lower lobe pleural involvement (pleurisy?)
3. HYPOSTATIC localised lower zones, oedema (+ cardiac)
4. aspiration (alsoaetiological pneumon.) VOMIT RISK FACTOR.

Question 14

PNEUMONIA COMPLICATIONS

Answer 14

• night sweats
• swinging fever
  1. SEPSIS

2. AKI
3. PARAPNEUMONIC EFFUSION (+empyema)
   - acidic pH
   - drain, thoracic USS, fibrinolytics
4. DISSEMINATED INFECTION
5. LUNG ABCESS
   - TB apex
   - ↑sputum, haemopt., ↑volume
   - CT scan, broncheoscopy
   - rule out Ca! smoker?

Question 15

CURB65 + Management Plans Based on Scoring

Answer 15

CONFUSION
UREA ≥7mmol/L
RR 30+
BP <90/60
65y/o+

0-1 LOW
=> AMOXICILLIN 5 DAYS
2 MODERATE
=> AMOX + CLARITH 5-7DAYS
3-5 HIGH
=> CO-AMOXICLAAV + CLARITH. 7-10DAYS

Question 16

BRONCHIECSTASIS: aetiology; pres.; typical mgmt

Answer 16

Dilated distaal bronchi at narrow lower level airways
- Idiopathic, recurrent LRTI

↑SPUTUM, haemoptysis, creps+wheeze
SIGNET RING, altered spirometry

=> chest physio; mucolytics; Abx 10-14d;

=> (+)vaccinations; Abx prophylaxis

Question 17

BRONCHIECSTASIS causative factors

Answer 17

Pseudomonas aeruginosa pneumonia (recurrent)
CF
Rheumatoid Arthritis
Childhood infection

Question 18

PREVALENCE v INCIDENCE

Answer 18

PREVALENCE: total w/ condition @ any given time

INCIDENCE: rate of diagn.