LRTI

Question 1

Discuss the aetiology and pathophysiology of pneumonia

Answer 1

Acute resp symptoms with consolidation on the CXR

Infection of the alveolar space

Thickening of the basal membranes

Leaking of vessels

Newborn = GBS
Younger children = viral common (RSV)
Older children = bacterial common (mycoplasma pneumonia, s.pneumonia)

Question 2

What are the symptoms and signs of pneumonia?

Answer 2

Fever
Anorexia
Dyspnoea
Cough
Purulent sputum
Haemoptysis
Pleuritic pain
Tachypnoea
Hypotension
Signs of consolidation = diminished expansion, dull percussion, bronchial breathing
End-inspiratory coarse crackles 
Increased vocal resonance

Question 3

What investigations should be performed for suspected pneumonia?

Answer 3

CXR = consolidation, air bronchogram

Nasopharyngeal aspirates

Bloods = FBC, U+Es, LFTs, CRP, cultures

Pleural fluid aspiration = C+S Immunocompromised or
ITU = bronchoscopy or bronchoalveolar lavage

Question 4

How is pneumonia managed?

Answer 4

Neonates = IV broad-spec
Older infants = amoxicillin
>5 = amoxicillin, erythromycin

Oxygen = sats >94%

IV fluids

Analgesia if pleurisy – paracetamol 1g/6h

Chest physiotherapy = if unable to clear secretions (prevent lobe collapse)

Follow up CXR at 6 weeks

Question 5

What complications can arise from pneumonia?

Answer 5

Early

• T1 resp failure
• Sepsis

Late

• Pleural effusion
• Empyema
• Lung abscess
• Bronchiectasis
• Bronchopleural fistula

Question 6

What is the aetiology of pneumonia?

Answer 6

Neonatal = GBHS, E.coli, Klebsiella

CAP = strep pneumonia, H. influenza. Staph aureus

HAP = >48h after admission, Enterobacter, staph aureus

Aspiration = stroke, myasthenia, reduced consciousness

VAP = ventilator acquired (loss of cough, defence mechanism)

Question 7

What are the common causes of cough that should be investigated further?

Answer 7

Infection
Asthma
COPD
GORD
Bronchiectasis

Question 8

How do the antibiotic treatments differ for community acquired pneumonia and hospital-acquired pneumonia?

Answer 8

CAP = oral amoxicillin and clarithromycin

HA = IV aminoglycoside and IV penicillin

Question 9

What are the causes of a viral wheeze?

Answer 9

• non-atpoic disorder
• rhinovirus (commonest MO)
• respiratory syncytial virus
• haemophilus
• coronaviruses
• human metapneumovirus
• human bocovirus

Question 10

How should a suspected viral wheeze be Ix?

Answer 10

Exam = hyperinflated, wheeze, no creps

• sweat test to rule out CF (especially if failure to thrive)
• nasal samples virology
• chronic: rule out TB, spirometry to rule out asthma

Question 11

Outline the Mx of a viral wheeze

Answer 11

• exclude inhaled foreign object
• avoid passive smoking (spead recovery)
• some need no Tx
• beta2-agonists via spacer (salbutamol )
• +/- inhaled ipratropium (anticholinergic)
• O2 needed/feeding diff = admit