Lower Resiratory Tract Infections (LRTI)

Question 1

What are the SIGNS of Pneumonia?

Answer 1

Pyrexia
Tachypnoea
Central Cyanosis
Dullness on Percussion [of affected lobe(s)]
Bronchial breathing
Inspiratory Crepitations
Increased Vocal Resonance

Question 2

What are the SYMPTOMS of Pneumonia?

Answer 2

Malaise
Fever
Chest Pain (Pleuritic)
Cough
Purulent Sputum
Dyspnoea

Question 3

What INVESTIGATIONS would be carried out to delineate a Pneumonia?

Answer 3

1) Serum Biochemistry & Full Blood Count
2) CXR
3) Blood Cultures
4) Throat Swab (for atypical pathogens)
5) Sputum Microscopy & Cultures
6) Urinary Legionella Antigen

Question 4

What are the most common PATHOGENS involved in Community-Acquired Pneumonia (CAP)?

Answer 4

1) Streptococcus Pneumoniae
2) Haemophilus Influenzae
3) Mycoplasma Pneumoniae
4) Chlamydia Psittaci

Question 5

What are the most common PATHOGENS involved in Hospital-Acquired (Nosocomial) Pneumonia?

Answer 5

1) MRSA
2) Pseudomonas
3) Enterobacter
4) Serratia

Question 6

What severity scoring system is used to ASSESS Pneumonia?

Answer 6

CURB 65
C - Confusion
U - blood Urea >7
R - Resp Rate > 30
B - diastolic BP <60
65 - age >65

Question 7

What is considered a LOW RISK of acquiring Pneumonia?

Answer 7

A CURB 65 score of 0.

The individual can be treated in the community.

Question 8

A CURB 65 score of 1-2 necessitates?

Answer 8

Hospital treatment.

Question 9

What is considered a HIGH RISK of acquiring Pneumonia?

Answer 9

A CURB 65 score of 3-5.

High risk of death and must be admitted to ITU.

Question 10

What is the CLINICAL MANAGEMENT for patients with a CURB score of 0-1?

Answer 10

Amoxycillin
OR
Clarithromycin/Doxycycline

Question 11

What is the CLINICAL MANAGEMENT for patients with a CURB score of 2?

Answer 11

Amoxycillin
AND
Clarithromycin or Levofloxacin (if penicillin allergic)

Question 12

What is the CLINICAL MANAGEMENT for patients with a CURB score of 3-5?

Answer 12

Co-amoxiclav
AND
Clarithromycin or Levofloxacin (if penicillin allergic)

Question 13

What further CLINICAL MANAGEMENT would be adopted for Pneumonia, if necessary?

Answer 13

O2
I.V. Fluids
Continuous Positive Airway Pressure (CPAP)
Intubation and Ventilation

Question 14

What are some of the COMPLICATIONS of Pneumonia?

Answer 14

Empyema
Lung Abscess
Septicaemia
Acute Renal Injury
Haemolytic Anaemia (mycoplasma)
Adult Respiratory Distress Syndrome (ARDS)

Question 15

What is the DIFFERENTIAL DIAGNOSIS for Pneumonia?

Answer 15

TB
Pulmonary Embolism
Lung Cancer
Pulmonary Vasculits (Wegners Granulomatosis)
Cardiac Failure

Question 16

What are the common CAUSES of Recurrent Pneumonia?

Answer 16

Idiopathic
Asthma
COPD
Immunological Disorders (WBC's/B-lymphocytes)
Immotile Cilia Syndrome
Cystic Fibrosis

Question 17

What are the COMMON ORGANISMS leading to LRTI?

Answer 17

1) Strep Pneumoniae
2) Haemophilus Influenzae
3) Moraxella Catarrhalis
4) Staph Aureus
5) ‘Atypical’ pathogens: Mycoplasma Pneumoniae, Chlamydia Psittaci, Coxiella Burnetti; Legionella Pneumophila.

Question 18

What are the CAUSES of Bronchiectasis?

Answer 18

Idiopathic
Immotile Cilia Syndrome
Cystic Fibrosis
Childhood Infections, i.e. Measles
Hypogammablobulinaemia
Allergic Bronchopulmonary Aspergillosis (ABPA)

Question 19

What are the SYMPTOMS of Bronchiectasis?

Answer 19

Chronic Cough
Daily Sputum production

Occasional:
Wheeze
Dyspnoea
Fatigue
Intermittent Chest Pain
Haemoptysis

Question 20

What are the SIGNS of Bronchiectasis?

Answer 20

Finger Clubbing

Course Inspiratory Crepitations

Question 21

What INVESTIGATIONS should be carried out if Bronchiectasis is suspected?

Answer 21

CT Thorax
Sputum Culture
CF Genotyping
Serum Immunoglobulins

Question 22

What are the TREATMENTS for Bronchiectasis?

Answer 22

Chest Physiotherapy (attempting to get rid of excess mucous)

Antibiotics

Inhaled Therapy (Beta-2 Agonist & inhaled Corticosteroid)