Lower Respiratory Tract Infections

Question 1

Which age group are typically affected by bronchiolitis?

Answer 1

Young children and infants - often below 18 months.

Question 2

What factors may worsen bronchiolitis?

Answer 2

Younger age at onset
Smokers in home
Premature birth

Question 3

What virus is responsible for bronchiolitis?

Answer 3

respiratory syncytial virus (RSV).

Question 4

What are symptoms of bronchiolitis?

Answer 4

Tachypnoea
Irritating cough
Poor feeding
Apnoea (in smaller babies)

Question 5

How is bronchiolitis diagnosed?

Answer 5

PCR
History/Examination

Question 6

How is bronchiolitis treated?

Answer 6

Supportive only - keep child upright and plenty of fluids.

Question 7

What is the most common aetiology of acute bronchitis?

Answer 7

Around 90% are viral in origin.

Question 8

What is the pathology behind acute bronchitis?

Answer 8

Infection irritates and inflames the bronchi, resulting in increased mucus production - which leads to cough.

Question 9

What are symptoms of acute bronchitis?

Answer 9

Productive cough
Fever (only in some cases)
Chest exam normal

Question 10

How is acute bronchitis managed?

Answer 10

Supportive only.

Question 11

Which strain of influenza results in pandemics?

Answer 11

Influenza A.

Question 12

How is influenza treated?

Answer 12

Supportive management
Antivirals if necessary
Vaccination can be offered to at-risk groups

Question 13

What scoring system is used to assess severity of influenza infection?

Answer 13

CRB65 score.

Question 14

Is Haemophilus influenzae a bacteria or a virus?

Answer 14

A bacteria.

Question 15

What organism causes whooping cough (pertussis)?

Answer 15

Bordetella pertussis.

Question 16

How does whooping cough present?

Answer 16

The patient will have cold-like symptoms, followed by a paroxysmal cough. Vomiting is common.
May have residual cough for over a month.

Question 17

How is whooping cough treated?

Answer 17

If cough, <3 weeks, then antibiotics.
Vaccines are available to prevent disease.

Question 18

What is pneumonia?

Answer 18

A common lower respiratory tract infection, characterised by inflammation of lung tissue.

Question 19

What is the most common causative organism of community-acquired pneumonia?

Answer 19

Streptococcus pneumoniae.

Question 20

Which organism is typically responsible for pneumonia in elderly/COPD patients?

Answer 20

Haemophilus influenzae.

Question 21

What is the commonest cause of pneumonia in PWIDs?

Answer 21

Staphylococcus aureus.

Question 22

Which atypical pneumonia, often presents in immunocompromised patients (e.g. AIDS)?

Answer 22

Pneumocystis jiroveci.

Question 23

What atypical pneumonia often presents in alcoholics?

Answer 23

Klebsiella pneumoniae.

Question 24

What atypical pneumonia is associated with inhalation of contaminated water droplets?

Answer 24

Legionella pneumophila.

Question 25

What are the two forms of pneumonia that may develop?

Answer 25

Lobar pneumonia Bronchopneumonia

Question 26

What form of pneumonia is typically seen in young, healthy adults?

Answer 26

Lobar pneumonia.

Question 27

An elderly patient presents with dyspnoea, confusion, pleuritic chest pain, rigours and is tachypnoeic - what is the diagnosis?

Answer 27

Pneumonia.

Question 28

What is the CURB65 score used for?

Answer 28

Used in pneumonia to determine how likely it is that streptococcus is responsible?.

Question 29

What are the criteria of CURB65?

Answer 29

Confusion Urea>7mmol Respiratory rate >30 BP - systolic<90/diastolic<60 >65 years

Question 30

What organism produces rust-coloured sputum in cases of pneumonia?

Answer 30

Streptococcus pneumoniae.

Question 31

What organisms cause green sputum in cases of pneumonia?

Answer 31

Haemophilus influenzae, or pseudomonas aeruginosa.

Question 32

What organism is characterised by red-currant jelly sputum in pneumonia patients?

Answer 32

Klebsiella pneumoniae.

Question 33

What causes foul-smelling sputum in pneumonia patients?

Answer 33

Anaerobic organisms.

Question 34

How should a patient with a CURB65 score of 0-2 be treated?

Answer 34

Amoxicillin (if allergic, give doxycycline). Remember this depends on the setting.

Question 35

How should a patient with a CURB65 score of 3-5 be treated?

Answer 35

Co-amoxiclav and doxycycline. Remember this depends on the setting.

Question 36

What is the most common cause of hospital-acquired pneumonia?

Answer 36

Staphylococcus aureus

Question 37

Which patients are more susceptible to bronchopneumonia?

Answer 37

Those with a co-morbidity.

Question 38

Alongside antibiotic therapy, what other steps are involved in pneumonia treatment?

Answer 38

Give oxygen therapy (if hypoxic) Fluids Bed rest Smoking cessation

Question 39

What is typically the cause of intrapulmonary abscess?

Answer 39

Usually a preceding illness (e.g. pneumonia).

Question 40

How does an intrapulmonary abscess present?

Answer 40

Patient will have pneumonia symptoms, however they will deteriorate despite treatment.

Question 41

How is a intrapulmonary abscess investigated?

Answer 41

CXR - shows a walled cavity CT scan - will allow distinction between this and emphysema to be made

Question 42

How is an intrapulmonary abscess treated?

Answer 42

Broad spectrum antibiotics Some may require drainage/resection