Lower Respiratory Tract Infection

Question 1

Give some examples of lower respiratory tract infections

Answer 1

• cute bronchitis
• pneumonia
• empyema
• lung abscess
• bronchiectasis

Question 2

What are the main symptoms of pneumonia

Answer 2

• malaise
• fever
• pleuritic chest pain (pain of inspiration)
• cough
• purulent sputum
• dyspnoea

Question 3

What are the main clinical signs of pneumonia

Answer 3

• pyrexia
• tachpnoea
• central cyanosis (due to hypoxia)
• dullness on percussion
• bronchial breath sounds
• increased vocal resonance

Question 4

Give some examples of investigations that may be carried out to diagnose pneumonia

Answer 4

• FBC (WBC, platelets, C-reactive protein)
• CXR
• blood cultures in fever (could indicate bacteraemia)
• throat swabs for atypical pathogens
• urinary legionella antigen
• sputum microscopy and culture

Question 5

Name the main pathogens that can cause pneumonia

Answer 5

• strep pneumoniae

- haemophilus influenzae

Question 6

Describe the pneumonia severity scoring system

Answer 6

CURB65

C - confusion
U - blood urea greater than 7
R - respiratory rate greater than 30
B - diastolic blood pressure less than 60
65 - over sixty five years of age

Question 7

Name the antibiotics used to treat pneumonia with a 0/1/2 CURB65 score

Answer 7

amoxicillin and/or clarithromycin/levofloxacin

Question 8

Name the antibiotics used to treat pneumonia with a CURB65 score of three or more

Answer 8

co-amoxiclav and clarithromycin/levofloxacin

Question 9

Give some examples of the supportive treatments used in pneumonia treatment

Answer 9

• oxygen (in hypoxia)
• IV fluids (in hypotension and shock)
• CPAP (continuous positive airway pressure)
• intubation and ventilation

Question 10

Name some complications that can arise from pneumonia

Answer 10

• septicaemia
• acute kidney injury
• empyema
• lung abscess
• haemolytic anaemia
• ARDS

Question 11

Name some conditions that can pneumonia can be mistaken for

Answer 11

• TB
• lung cancer
• PE
• cardiac failure

Question 12

What is a prominent feature of empyema

Answer 12

chest pain without a cough and a high swinging fever

Question 13

What are the main causative organisms of empyema

Answer 13

• streptococcus
• staph aureus
• anaerobes

Question 14

How is empyema diagnosed

Answer 14

pleural aspiration of pH less than 7.2

Question 15

What are the treatment options for an empyema patient

Answer 15

• chest drain and IV antibiotics

- surgery if unresolved

Question 16

What are the main causative organisms of lung abscess

Answer 16

• pseudomonas
• staph aureus
• anaerobes

Question 17

What are the main symptoms of lung abscess

Answer 17

• unspecific
• lethargy
• weight loss
• high swinging fever

Question 18

How is lung abscess investigated

Answer 18

• CT

- sputum culture

Question 19

What can cause bronchiectasis, other than idiopathy

Answer 19

• immotile cilia
• cystic fibrosis
• childhood infections e.g. measles
• hypogammaglobulinaemia
• allergic bronchopulmonary aspergillosis

Question 20

What are the symptoms of bronchiectasis

Answer 20

• chronic cough
• daily copious sputum production
• wheeze
• dyspnoea
• fatigue
• haemoptysis

Question 21

How can bronchiectasis be investigated

Answer 21

• high resolution CT
• sputum culture
• serum immunoglobulins
• CF genotyping
• total IgE/aspergillus preciptins

Question 22

How is brochiectasis treated

Answer 22

• chest physiotherapy
• treatment of all infections with antibiotics
• possible inhaled therapy (beta-2 agonists/inhaled corticosteroids)