lower resp tract infection- adults Flashcards
(43 cards)
What is defined as part of the lower respiratory tract?
below the vocal cords
what does pneumonia involve?
parenchyma of the lungs
what is empyema?
pus
what is a lung abscess?
walled off cavity of infection and usually contains pus as well but in smaller area - develops thick skin around it.
what is bronchiectasis?
bronchi become dilated and inflamed- chronic condition.
Give characteristics of acute bronchitis?
inflammation of bronchi
temporary <3 weeks
cough and sputum
usually viral
main management - fluids, paracetamol
How long is chronic bronchitis present for>
cough lasting 3 months of the year for at least 2 years in a row
Give characteristics of a COPD exacerbation?
change in colour and amount of sputum
fevers
increased breathlessness
wheeze
cough
streptococcus pneumoniae
haemophilus influenzae
moraxella catarrhalis
viral
treatment for COPD exacerbation?
steroids - reduce inflammation antibiotics - effective or non effective
maybe nebulisers if severe
What are the different types of pneumonia?
bronchopneumonia
lobar pneumonia
interstitial pneumonia - viral usually
What does consolidation lead to?
solidification due to cellular exudate in alveoli leads to impaired gas exchange
what are risk factors for pneumonia?
smoking
alcohol to excess
extremes of age
preceding viral illness
pre-existing lung disease
chronic illness
immunocompromised
hospitalisation
IVDU
What are the symptoms of pneumonia?
fever (normal is 37 +/- 0.6 )
rigors (shivers)
myalgia (pain in muscles)
cough and sputum (rusty brown sputum= streptococcus pneumoniae)
chest pain (pleuritic)
dyspnoea
haemoptysis
Signs of pneumonia?
tachypnoea
tachycardia
reduced expansion
dull percussion
bronchial breathing
crepitations (snapping open of alveoli)
vocal resonance (goes up over areas of consolidation)
Investigations for pneumonia in the community?
may be none
CXR if in doubt or not improving
Investigations in hospital for pneumonia?
blood count , look for inflammatory marker called C reactive protein
blood cultures are helpful esp if febrile
sputum culture to try and identify the underlying bacteria
viral throat swab to see if viral cause or viral preceding infection- led to bacterial
legionella urinary antigen is also helpful to test for atypical organisms
Differential diagnosis for pneumonia?
tuberculosis
lung cancer
pulmonary embolism
pulmonary oedema
pulmonary vasculitis
What is the most common bug that causes pneumonia?
streptococcus pneumonia
What are the typical community acquired pneumoniae?
streptococcus pneumoniae
haemophilus influenzae
mycoplasma pneumoniae (4-5 year cycles, extra pulmonary complications)
What are the A-typical community acquired pneumoniae?
more systemic, more dry cough, less sputum production and general malaise , headaches , confusion, muscles aches , sometimes diarrhea and vomiting
legionella pneumophilia (air con, fresh water)
chlamydia pneumoniae (CAD)
chlamydia psittaci (birds)
coxiella burnetti (farm animals)
moraxella cattarhalis (COPD)
viruses (influenza, RSV , SARS, varicella)
What are the types of bacteria that cause nosocomial (hospital acquired pneumonia?
enterobacteria (aspiration)
staphylococcus aureus (after flu infection)
pseudomonas aerigunosa
klebsiella pneumoniae (aspiration and more common in alcoholics)
clostridia
anaerobes
TB
What is the common scoring system used for pneumonia?
CURB 65
What does CURB 65 stand for?
C- confusion
U- blood urea > 7mmol/L
R- Respiratory rate more or 30/ min
B- systolic BP< 90 mmHg, diastolic <60mmHg
65 - age 65 or older
score -1 point for each of these features
A score using CURB 65 indicates what?
0-1- low risk and could be treated in community
2- moderate risk- hospital treatment usually required
3-5 - high risk of death and need for ITU
