18 - LRTI

Question 1

Risk factors for LRTI

Answer 1

loss or suppression of cough reflex / swallow

ciliary defects
mucus disorders
pulm. oedema
immunodeficiency
macrophage function inhibition

Question 2

Acute bronchitis - what is it

Answer 2

inflammation & oedema of trachea and bronchi

Question 3

Acute bronchitis - clinical presentation

Answer 3

cough (dry), dyspnoea, tachypnoea

Question 4

Acute bronchitis - who?

Answer 4

winter

children

Question 5

Acute bronchitis - causative agents

Answer 5

usually viral - rhinovirus, coronavirus, adenovirus, influenza

bacterial - h.influenzae, m.pneumoniae, b.pertussis

Question 6

Acute bronchitis - diagnosis

Answer 6

tests not indicated in mild presentations

if needed culture may be helpful

Question 7

Acute bronchitis - treatment

Answer 7

supportive treatment for healthy patients

those with severe may require oxygen therapy or resp. support

antibiotics only if bacterial

Question 8

Chronic bronchitis - definition

Answer 8

cough productive of sputum on most days during at least 3 months of 2 successive years

Question 9

Chronic bronchitis - who?

Answer 9

10-25% adult population

most common in men and >40yrs

Smoking, pollution, allergens

Question 10

Bronchiolitis - who?

Answer 10

children

Question 11

Bronchiolitis - what is it?

Answer 11

inflammation and oedema of bronchioles

Question 12

Bronchiolitis - clinical presentation

Answer 12

wheeze, cough, nasal discharge, resp. distress (grunting, retractions, nasal flaring)

Question 13

Bronchiolitis - when?

Answer 13

peaks in winter and early spring in infants 2-10 months

Question 14

Bronchiolitis - most common cause

Answer 14

RSV (75% of cases)

others: parainfluenza, adenovirus, influenza

Question 15

Bronchiolitis - diagnosis

Answer 15

CXR
FBC
Microbiological diagnosis

Question 16

Bronchiolitis - treatment

Answer 16

supportive: O2, feeding assistance

No clear evidence to support steroids, bronchodilators, ribavirin

Antibiotics only if complicated by bacterial infection

Question 17

Pneumonia - what is it

Answer 17

infection affecting distal airways and alveoli forming inflammatory exudate

Question 18

Pneumonia - anatomical patterns

Answer 18

bronchopneumonia - patchy distribution centred on inflamed bronchioles and bronchi which spread to alveoli

lobar - affects a large part or whole lobe (90% due to S. pneumoniae)

Question 19

Pneumonia - types

Answer 19

community acquired (CAP)
hospital acquired (HAP)
Ventilator acquired (VAP)
Aspiration pneumonia

Question 20

Aspiration pneumonia

Answer 20

resulting from abnormal entry of fluids e.g. food, drinks, stomach contents into the lower resp. tract

Question 21

CAP - epidemiology

Answer 21

1 per 100 people per year
20-40% require hospital admission
50-70 yo
Midwinter

Question 22

CAP - clinical presentation - bacterial

Answer 22

rapid
fever/chills
productive cough
mucopurulent sputum
pleuritic chest pain
general malaise - fatigue, anorexia

signs: tachypnoea, tachycardia, hypotension.
examination: dull to percuss, reduced air entry w/ bronchial breathing

Question 23

CAP - clinical presentation - viral

Answer 23

influenza

uncomplicated: fever, headache, myalgia, dry cough, sore throat

Question 24

CAP - investigations

Answer 24

BP, pulse, oximetry
Bloods: FBC/U&E/CRP/LFTs
CXR
Sputum gram stain & culture; bloods; pneumococcal urinary antigen; legionella urinary antigen; PCR or serology

Question 25

Assessement of disease severity

Answer 25

CURB65

Question 26

CURB stands for

Answer 26

confusion
urea >7mmol/l
resp rate >30
blood pressure 65

Question 27

LRTI prevention

Answer 27

pneumococcal vaccinations - patients with chronic heart, lung, kidney disease/splenectomy

influenza - over 65s, chronic, multiple co-morbidities