18 - LRTI Flashcards Preview

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Flashcards in 18 - LRTI Deck (27):
1

Risk factors for LRTI

loss or suppression of cough reflex / swallow

ciliary defects
mucus disorders
pulm. oedema
immunodeficiency
macrophage function inhibition

2

Acute bronchitis - what is it

inflammation & oedema of trachea and bronchi

3

Acute bronchitis - clinical presentation

cough (dry), dyspnoea, tachypnoea

4

Acute bronchitis - who?

winter
children

5

Acute bronchitis - causative agents

usually viral - rhinovirus, coronavirus, adenovirus, influenza

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

6

Acute bronchitis - diagnosis

tests not indicated in mild presentations

if needed culture may be helpful

7

Acute bronchitis - treatment

supportive treatment for healthy patients

those with severe may require oxygen therapy or resp. support

antibiotics only if bacterial

8

Chronic bronchitis - definition

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

9

Chronic bronchitis - who?

10-25% adult population

most common in men and >40yrs

Smoking, pollution, allergens

10

Bronchiolitis - who?

children

11

Bronchiolitis - what is it?

inflammation and oedema of bronchioles

12

Bronchiolitis - clinical presentation

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

13

Bronchiolitis - when?

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

14

Bronchiolitis - most common cause

RSV (75% of cases)

others: parainfluenza, adenovirus, influenza

15

Bronchiolitis - diagnosis

CXR
FBC
Microbiological diagnosis

16

Bronchiolitis - treatment

supportive: O2, feeding assistance

No clear evidence to support steroids, bronchodilators, ribavirin

Antibiotics only if complicated by bacterial infection

17

Pneumonia - what is it

infection affecting distal airways and alveoli forming inflammatory exudate

18

Pneumonia - anatomical patterns

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)

19

Pneumonia - types

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

20

Aspiration pneumonia

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

21

CAP - epidemiology

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

22

CAP - clinical presentation - bacterial

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

23

CAP - clinical presentation - viral

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

24

CAP - investigations

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

25

Assessement of disease severity

CURB65

26

CURB stands for

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

27

LRTI prevention

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

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

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