Lower Respiratory Tract Infections

Question 1

Common LRTIs

Answer 1

Acute bronchitis

exacerbation of COPD

pneumonia

empyema

lung abscess

bronchiectasis

Question 2

Pneumonia Symptoms

Answer 2

Malaise

Myalgia (muscle pain)

Over

Chest pain (pleuritic)

cough

purulent sputum

dyspnoea

Question 3

Pneumonia signs

Answer 3

pyrexia

tachpneoa

central cyanosis

dullness on percussion of affected lobes

bronchial breath sounds

inspiratory crepitations

increased goal resonance

Question 4

Pneumonia investigation

Answer 4

serum Biochemistry, CRP, FBC

CXR

blood culture

that swab

urinary legionalla antigen

sputum microbiology and culture

HIV test

Question 5

CRP

Answer 5

C-reactive protein

biomarker of inflammation

Question 6

Microbiology of pneumonia

Answer 6

strep pneumonia

h influenzae

lgeionella

staph aureus

Question 7

Pneumonia severity scoring

Answer 7

CURB65

Question 8

CURB65

Answer 8

confusion

blood urea >7

respiratory rate >30

diastolic blood pressure <60

age less than 65

Question 9

CRUB65 0, 1-2, 3-5

Answer 9

0 - low risk

1-2 - hospital treatment

3-5 - high risk of death

Question 10

Treatment of CRUB 0-1

Answer 10

amoxycillin or

clarithromycin

Question 11

Treatment of CRUB 2

Answer 11

amoxycillin AND clarithromycin

Question 12

Treatment of CRUB 3-5

Answer 12

co-aoxiclav and clarithromycin

or levofloxacin (if penicillin allergic)

Question 13

Pneumonia treatment

Answer 13

oxygen

IV fluids

CPAP (continuous positive airway pressure)

intubation and ventilation

Question 14

Pneumonia complications

Answer 14

septicaemia

acute kidney injury

empyema

lung abscess

metastatic infection

Question 15

Pneumonia differential diagnosis

Answer 15

TB

lung cancer

pulmonary embolism

pulmonary oedema

pulmonary vasculitis

Question 16

Empyema microbiology

Answer 16

streptococcus (52%)

Staph Aureus (11%)

Anaerobes (20%)

Question 17

Empyema symptoms

Answer 17

chest pain

absence of cough

high swimming fever

Question 18

Empyema investigations

Answer 18

CT thorax

pleural ultrasound

Question 19

diagnosing empyema

Answer 19

diagnostic pleural aspiration (pH <7.2)

Question 20

Empyema treatment

Answer 20

chest drain

intravenous antibiotics (6 weeks)

Question 21

Lung Abscess microbiology

Answer 21

staph aureus

pseudomonas

anaerobes

Question 22

Lung Abscess symptoms

Answer 22

lethargy

weight loss

high swinging fever

Question 23

Lung Abscess investigation

Answer 23

CT thorax

sputum culture

Question 24

Empyema treatment

Answer 24

prolonged antibiotics

drainage via the bronchial tree

Question 25

Bronchiectasis causes

Answer 25

idiopathic immotile cilia syndrome cystic fibrosis childhood infections (such as measles)

Question 26

Bronchiectasis symptoms

Answer 26

chronic cough daily sputum production sometime (wheeze, dyspnoea, tiredness, flitting chest pains, haemoptysis)

Question 27

Bronchiectasis signs

Answer 27

finger clubbing course Inspiratory crepitations (auscultation)

Question 28

Bronchiectasis investigation

Answer 28

HRCT thorax Sputum culture serum immunoglobulins total IgE

Question 29

Bronchiectasis microbiology

Answer 29

haemophilus influenza staph aureus pseudomonas aeruginosa

Question 30

Bronchiectasis treatment

Answer 30

chest physiotherapy prompt treatment of infections with appropriate antibiotics may require inhaled therapy including beta2 agonist and ICSs