Flashcards in 18 LRTI's Deck (18)
Who gets acute bronchitis?
Dry cough, dyspnoea, tachypnoea.
Causes of acute bronchitis?
4 viral 3 bacterial
Rhinovirus, coronavirus, adenovirus, influenza.
Bacterial = less common
Haemophilus influenzae, Mycoplasma pneumoniae, Bordetella pertussis.
What is chronic bronchitis?
Productive cough on most days for 3 months of 2 successive years. Exogenous irritants.
Acute infective exacerbations (same organisms as acute bronchitis).
Symptoms of bronchiolitis? (4)
Wheeze, cough, nasal discharge, respiratory distress.
Winter, 2-10months old.
RSV:75%. Also parainfluenza/ adenovirus/ influenza.
How is bronchiolitis diagnosed? (3)
CXR, FBC, nasal aspirate for viral PCR.
Supportive: O2, feeding assistance.
What are the typical patterns of acute bacterial pneumonia?
Bronchopneumonia - bronchioles with spread to alveoli.
Lobar pneumonia - most of lobe, 90% Strep pneumoniae.
What are the four types of pneumonia?
Hospital acquired: >48hrs after admission.
Ventilator acquired: >48hrs after intubation/ventilation.
What is the epidemiology of community acquired pneumonia (CAP)?
Causative organisms? (4)
50-70yo. Midwinter to spring.
Strep pneumoniae, Haem influenzae (person to person).
Legionella pneumophilia (environment).
Chlamydophilia psittaci (from animals).
Why are atypical pneumonias named as such?
Traditionally because cases fail to respond to penicillin or sulpha drugs/ no organism could be identified.
Now: different presentation + Rx.
What is the presentation of bacterial CAP? (11)
Rapid onset fever/chills, productive cough, pleuritic chest pain, fatigue, anorexia.
Tachypnoea, tachycardia, hypotension.
Dull to percuss, reduced air entry, bronchial breathing.
What is the presentation of pneumonia caused by mycoplasma pneumoniae?
Epidemics every 4-8yrs.
Complications: pericarditis, arthritis, Guillan-Barre, peripheral neuropathy.
What is the presentation of pneumonia caused by legionella pneumophilia?
6 symptoms, 2 signs
Colonises water piping.
High fever, rigors, dyspnoea, cough, D+V, confusion.
Deranged LFTs, low sodium.
What is the presentation of pneumonia caused by chlamoydophila psittaci?
Pneumonia and splenomegaly.
Rash, hepatitis, haemolytic anaemia, reactive arthritis.
How does viral influenza present?
2o organsims? (3)
Fever, headache, myalgia, dry cough + sore throat.
1o viral pneumonia if cardiac/lung problems.
2o bacterial pneumonia: S.pneumoniae, Haemophilus influenzae, Staphaureus.
What are the recommended microbiological investigations for moderate-severe CAP? (5)
Sputum + gram stain.
Pneumococcal urinary antigen.
Legionella urinary antigen.
PCR/serolgy: viral, mycoplasma pneumoniae, chlamydophilia sp.
What is the CURB65 score and what is it used for.
CAP severity assessment. 2:mod. 3-5:high.
Resp rate >30.
BP sys less 90. dias less 60
How are LRTIs prevented? (2)
Pneumococcal vaccination if heart/lung/kidney disease, splenectomy.
Influenza vacc f >65, chronic disease or multiple morbidities.