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Flashcards in Lower respiratory tract infections Deck (50):
1

define lower respiratory tract infection.

respiratory tract infections below the larynx

2

what are the common predisposing factors that lead to a Lower respiratory tract infection occurring.

loss or suppression of cough reflex (pathogen is not removed).
Cillary defects
mucus disorders
pulmonary odema
immunodeficency
macrophage function inhibitiom
aspiration of food.

3

common bacterial organism which cause lower respiratory tract infections

streptococcus pnemonia
haemophilus influenz
staphylococcus aureus
klebisella pneumona
Mcyoplaasma pneumonaie
Legionella pneumophila
Mycobacterium tuberculosis.

4

common viral organisms which cause lower respiratory tract infections

Influenza
Parainfluenza
Respiratory syncytial virus- RSV
Adenovirus

5

common fungal infections which cause lower respiratory infections

aspergillus, candida, pneumocytisis jiroveci.

6

define acute bronchitis

• Inflammation and oedema of trachea and the bronchi

7

clinical signs of acute bronchitis

cough (dry), dysponea, tachyponea, retrosternal pain

8

common pathogens which cause acute bronchitis and chronic bronchitis.

viral- common
rhinovirus, coranavirus, adenovirus and influenza
bacteria- rare
H. infleunza, M. pneumonia, B, pertussis.

9

diagnosis of acute bronchitis

vaccination history and previous exposure- to eliminate organisms
culture of respiratory secretions to isolate cause

10

treatment for acute bronchitis

supportotive
oxygen therapy-immuneocompromised
antibiotics is bacterial

11

define chronic bronchitis

cough productive of sputum on most days during atleast 3 months of 2 successive years (which cannot be attributed to alternative cause)

12

what factors contribute to developing chronic bronchitis

sex- men
age- over 40
smoking
pollution
allergens- in particular.

13

In what age group is bronchioloitis common

children- narrow bronchioles

14

define bronchiolitis

• Inflammation and oedema of the bronchioles

15

clinical signs of bronchiolitis

acute onset wheeze, cough, nasal discharge, respiratory distress (grunting, retractions, and nasal flaring.

16

most common pathogen which causes bronchiolitis

RSV

17

diagnosis of bronchiolitis

chest X-ray
FBC
Microbiology
nasopharyngeal aspirate

18

Treatment for bronchiolitis

supportive- oxygen
antibiotic is bacterial

19

define pneumonia

• Infection of distal airway and alveoli- form inflammatory exudate

20

2 anatomical patterns of pneumonia

– Bronchopneumonia- patchy distributed around bronchioles and spread to alveoli.
– Lobar pneumonia-90% due to s. pneumniae, affects large part of the lung, line demarcation and consolidation.

21

4 ways in which pneumonia can be caused

community acquired-most common
hospital acquired
Ventilator acquired pneumonia
Aspiration pneumonia

22

what defines hospital acquired pneumonia

• Pneumonia developing >48hrs after hospital admission

23

what defines hospital ventilator pneumonia

• Subgroup of HAP
• Pneumonia developing >48hrs after ET intubation & ventilation
common when not breathing well

24

what defines aspiration pneumonia

subgroup HAP or CAP.
• Pneumonia resulting for the abnormal entry of fluids e.g. food, drinks, stomach contents, etc. into the lower respiratory tract
• Common is patients unconscious

25

how is CAP pneumonia transmitted

Person-to-person or from a person
from environment
from animals

26

what organism cause CAP pneumonia

Atypical
• Mycoplasma pneumoniae
• Legionella pneumophilia
• Chlamydophila pneumoniae
• Chlamydophila psittaci
• Coxiella burnetii
Typical
• Streptococcus pneumoniae
• Haemophilus influenzae
• Moraxella catarrhalis
• Staphylococcus aureus
• Klebsiella pneumoniae

27

clinical signs and symptoms of pneumonia

• Rapid onset
• Fever/chills-rigors
• Productive cough- blood or purulent.
• Mucopurulent sputum
• Pleurtitic pain- lung parenchyma is infected and inflamed, and on deep inspiration it rubs against the pleura
• General malaise-fatigue and anxiety.
tachypnoea, tachycardia, hypotension

28

what is found upon examination of a patient with pneumonia

dull to percuss (consolidation) and reduced air entry, bronchial breathing.

29

main symptom of mycoplasma pneumonia

cough

30

rare complications of mycoplasma pneumonia

guillian- barre, peripheral neuropathy

31

mycoplasma pneumonia is common in which age group

children

32

Chlamydophila pneumoniae is common in which age group

elderly

33

what are outbreaks of legionella pneumophilla associated with

 Colonises water piping systems
 Outbreaks associated with showers, air conditioning units, humidifiers

34

signs of legionella pneumophilla

 High fevers, rigors, cough: dry initially becoming productive, dyspnoea, vomiting, diarrhoea, confusion- low GCS.
 Bloods: deranged LFTs, SIADH (low sodium)

35

what animal exposure is Chlamydophila psittaci associated with

birds

36

signs of Chlamydophila psittaci

rash, hepatitis, haemolytic anaemia, reactive arthritis, spleenomegaly.

37

what is the recover time from influenza

2-3 weeks

38

symptoms of influenza

– Fever, headache, myalgia (pain in muscles) and sore throat

39

primary viral pneumonia occurs most commonly in what types of people

people with pre-existing cardiac or lung problems (heart failure of COPD)

40

What the of infections commonly occurs after a primary viral pneumonia

– Secondary bacterial pneumonia then may develop after initial period of improvement:- COMMON as viral infection damages the lung so it is an opportunity for bacteria to colonise.

41

3 most common pathogens which cause secondary bacterial pneumonia

– S.pneumoniae, H.influenzae, S.aureus

42

diagnosis of influenza

viral antigen detection in respiratory samples using PCR.

43

treatment for influenza

no treatment

44

non microbiological investigations for CAP

routine observations- BP/Pulse/Oximetry
Blood: FBC/U and E, CRP, LFT
Chest X-ray.

45

Microbiological invesitagtions for inpatients for CAP

– Sputum gram stain and culture- see what the organism is.
– Blood culture- if serious as the pathogens has multiplied in the lung and then reached the blood supply.
– Pneumococcal urinary antigen
– Legionella urinary antigen
PCR for viral pathogen, mycoplasma pneumoniae, chlamydophilia

46

what assessment is used to determine the disease severity of CAP

CURB65
Confusion
Urea
Respiratory rate
Blood pressure
Age> 65 years

47

which 2 vaccine prevent lower respiratory tract infections

• Pneumococcal vaccination (S. pneumoniae)
• Influenza vaccination for vulnerable groups (annually)

48

Management of CAP

A- airway- open and patent
B-breathing- reap rate, oxygen saturation
C-circulation- BP and heart rate, urinary catheter to measure output.
antibiotics given depends on CURB65 score.

49

which groups of patients are given the pneumococcal vaccination

– Patients with chronic heart, lung and kidney disease
– Patients with splenectomy

50

which groups of patients are given the influenza vaccine

– Over 65s
– Chronic disease, multiple co-morbidities e.g. diabetes.