Lower respiratory tract infection - adults

Question 1

What is acute bronchitis?

Answer 1

Inflammation of the bronchi
Is temporary so lasts less than 3 weeks
Usually viral
Symptoms - cough and sputum

Question 2

What is the treatment for acute bronchitis?

Answer 2

Supportive management - drinking lots of fluid and taking paracetamol

Question 3

What is chronic bronchitis defined as?

Answer 3

Cough lasting 3 months of the year for at least 2 years in a row

Question 4

When would you go see the GP with bronchitis?

Answer 4

Cough lasts more than 3 weeks, high temp. for more than 3 days, sputum is streaked with blood, have underlying heart or lung condition, if becoming more breathless and have had repeated episodes of bronchitis

Question 5

What are the symptoms of a COPD exacerbation?

Answer 5

Change in colour and amount of sputum
Fever
Increased breathless
Wheeze
Cough

Question 6

What are common bacterial and virial causes of COPD exacerbations?

Answer 6

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Many viral causes

Question 7

What is the treatment for COPD exacerbations?

Answer 7

Steroids to reduce inflammation
Antibiotics for infection - amoxicillin, doxycycline, co-trimoxazole and clarithromycin
Maybe nebulisers if severe

Question 8

What is pneumonia?

Answer 8

Inflammation of lung parenchyma - comprises of thin walled alveoli

Question 9

What is bronchopneumonia?

Answer 9

It is the acute inflammation of the bronchi, accompanied by inflamed patches in the nearby lobules of the lungs
Is patchy and usually only one lung affected

Question 10

What is lobar pneumonia?

Answer 10

Lobar pneumonia is a form of pneumonia characterized by inflammatory exudate within the intra-alveolar space resulting in consolidation that affects a large and continuous area of the lobe of a lung

Question 11

What is interstitial pneumonia?

Answer 11

Is an inflammatory process and is usually viral

Question 12

What are some of the risk factors for pneumonia?

Answer 12

Smoking and alcohol excess
Extremes of age
Preceding viral illness, Pre-existing lung diseases, chronic illness, immunocompromised, hospitalisation and IV drug abusers

Question 13

What are the symptoms of pneumonia?

Answer 13

Fever, rigors and myalgia - pain in muscles
Cough and sputum
Chest pain that is increased on deep inspiration
Dyspnoea - SOB

Question 14

What are some clinical signs of pneumonia?

Answer 14

Tachypnoea, tachycardia, reduced expansion, dull percussion, bronchial breathing, crepitations and vocal resonance as lung is more solid

Question 15

What does rusty brown sputum in a patient show?

Answer 15

They have strep. pneumoniae

Question 16

What community investigations would be made in pneumonia?

Answer 16

Maybe non
CXR if diagnosis in doubt or not improving

Question 17

What investigations could be made in the hospital for pneumonia?

Answer 17

Bloods - serum biochemistry, FBC and CRP
Blood cultures
CXR
Sputum culture, viral throat swab
Legionella urinary antigen

Question 18

What are differential diagnosis to a patient with pneumonia symptoms?

Answer 18

Tuberculosis, Lung cancer, Pulmonary embolism, Pulmonary oedema, Pulmonary vasculitis

Question 19

What typical bacteria causes community acquired pneumonia?

Answer 19

Streptococcus pneumoniae
Haemophilus influenzae
Mycoplasma pneumoniae

Question 20

What atypical bacteria causes community acquired pneumonia?

Answer 20

Legionella pneumophilia
Chlamydia pneumoniae
Chlamydia psittaci
Coxiella burnetti
Moraxella catarrhalis
Viruses - influenza, RSV, SARS..

Question 21

What the bacteria found in hospital acquired pneumonia?

Answer 21

Enterobacteria
Staphylococcus aureus
Pseudomonas aeruginosa
Klebsiella pneumoniae

Question 22

Describe CURB65 and pneumonia severity

Answer 22

C - confusion
U - blood urea > 7 mmol/L
R - respiratory rate > 30/min
B - systolic BP < 90 mmHg, diastolic blood pressure < 60 mmHg
65 - age > 65

Question 23

What is the score system for CURB 65?

Answer 23

0-1 low risk - treat in community
2 moderate risk - hospital treatment required
3-5 high risk of death and need for intensive care

Question 24

What things do you need to consider in the CURB65 severity scale?

Answer 24

People who are hypoxic, young people and multi-lobar consolidations

Question 25

What is the treatment for low risk pneumonia?

Answer 25

Amoxicillin Clarithromycin or doxycycline if penicillin allergy Duration is 5 days

Question 26

What is treatment for moderate risk pneumonia?

Answer 26

Amoxicillin and clarithromycin Levofloxacin if penicillin allergy Duration is 5-7 days

Question 27

What treatment is for high risk pneumonia?

Answer 27

Co-amoxiclav and clarithromycin Levofloxacin or co-trimoxazole if penicillin allergy Duration is 7-10 days

Question 28

When would patients with pneumonia take antibiotics with IV?

Answer 28

If signs of sepsis

Question 29

What supportive management is needed for pneumonia?

Answer 29

O2, fluids, antipyretics, NSAIDs Intubation and ventilation

Question 30

Explain aspiration pneumonia?

Answer 30

Inhalational acute lung injury that occurs after aspiration of sterile gastric contents Happens in patients who have had a stroke, MS, myasthenia, sedation, oesophageal disease Anaerobes likely - amoxicillin and metronidazole

Question 31

What is used to treat MRSA?

Answer 31

Vancomycin

Question 32

What are some complications of pneumonia?

Answer 32

Sepsis, acute kidney injury, adult respiratory distress syndrome, parapneumonic effusion, empyema, lung abscess and disseminated infection

Question 33

What are signs of complicated pneumonia?

Answer 33

Swinging fever Sweats Persistently high WCC/ CRP Weight loss Failure to improve

Question 34

What is empyema?

Answer 34

The collection of pus in a cavity in the body, especially in the pleural cavity

Question 35

What is parapneumonic effusion

Answer 35

Parapneumonic effusion (PPE) is a type of pleural effusion - Pleural effusion is a build up of fluid in the pleural cavity. Having too much fluid in the pleural space can prevent your lungs from fully expanding and make it hard to breathe

Question 36

What is the treatment for empyema/ parapneumonic effusion?

Answer 36

May need to drain and prolonged antibiotics Surgery may be needed and drugs through chest drains

Question 37

What is a lung abcess?

Answer 37

Also called a pulmonary abscess, is a pus-filled cavity in the lungs caused by an infection More likely staph aureus, pseudomonas, anaerobes... Purulent sputum and haemoptisis

Question 38

What is the treatment for a lung abscess?

Answer 38

Screen for TB CT scan and maybe bronchoscopy Prolonged antibiotics

Question 39

What is the recovery for pneumonia?

Answer 39

Takes weeks Repeat CXR 6 weeks if over 50 years and smoker Smocking cessation should be encouraged and helped

Question 40

What could recurrent pneumonia suggest?

Answer 40

Person may be immunocompromised, have underlying structural lung disease, cancer or aspiration

Question 41

What is bronchiectasis?

Answer 41

Bronchiectasis is a long-term condition where the airways of the lungs become widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection

Question 42

What are some causes of bronchiectasis?

Answer 42

Idiopathic Childhood infection, CF, Ciliary dyskinesia, hypogammaglobulinemia, allergic Broncho-pulmonary aspergillosis

Question 43

What are the symptoms and clinical examination signs for bronchiectasis?

Answer 43

Symptoms - chronic productive cough, breathlessness, recurrent LRTI and haemoptysis Examination - finger clubbing, crepitations, wheeze and obstructive spirometry

Question 44

What bacteria can cause infective exacerbations of bronchiectasis?

Answer 44

Staph. aureus Haemophilus influenza Pseudomonas aerigunosa

Question 45

What treatment would be given to patients with infective exacerbations of bronchiectasis?

Answer 45

Mucolytic, prolonged antibiotic course and vaccines Consider prophylactic antibiotics if frequent