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Respiratory System > LRTI > Flashcards

LRTI Flashcards

1
Q

all types of LRTI we need to know

A
  • acute bronchitis
  • COPD exacerbations
  • pneumonia (major one) + its complications
  • bronchiectasis
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2
Q

Major LRTI in children

A
  • laryngotracheobronchitis (croup)
  • bacterial tracheitis/epiglottis
  • bronchiolitis
  • bordetella pertussi (whooping cough)
  • bronchitis
  • LRTI/pneumonia in children
  • empyema
  • viral induced wheeze
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3
Q

acute bronchitis

A
  • inflammation of bronchi lasting around 2-3 weeks
  • cold symptoms (cough+sputum)
  • usually viral causes
  • only need treatment if persistent, changes in sputum color, or have underlying conditions
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4
Q

COPD exacerbations

A
  • change in sputum color
  • fevers
  • increased SOB
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5
Q

organisms associated with COPD exacerbations

A
  • strep penumoniae
  • H. influenza
  • moraxella catarrhalis
  • viral
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6
Q

treatment of COPD exacerbations

A
  • steroids
  • nebs
  • antibiotics (amoxicillin, doxycycline, co-trimoazole, clarithromycin)
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7
Q

pneumonia characteristics

A
  • inflammation of lung parenchyma (gas exchange structures)
  • consolidation seen in CCX *this is the main way of confirming that it is pneumonia
  • fever, malaise
  • cough + sputum + haemoptysis
  • pleuritic chest pain
  • dyspnoea
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8
Q

risk factors of pneumonia

A
  • smoking
  • drinking (alcohol increases chances of exacerbations)
  • extremes of age (not mobile –> aspirations, and immunocompromised)
  • preceding viral illness/lung disease
  • chronic illness
  • IVDU (introduces pathogens to the body)
  • prior hospitalizations
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9
Q

signs of pneumonia

A
  • tachypnoea/tachycardia
  • reduced expansion
  • dull percussion
  • increased vocal resonances (because sound is louder while going through solid structure)
  • bronchial breathing where it should be vesicular (discontinuous)
  • crepetations
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10
Q

investigations carried out for pneumonia

A
  • CXR (main diagnosis)
  • blood cultures (CRP, FBC, serum biochem)
  • sputum culture + microbiology
  • viral throat swab
  • legionella urine antigen (bacterial antigen in urine)
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11
Q

differential diagnosis for pneumonia

A
  • TB
  • lung cancer
  • pulmonary embolism
  • pulmonary edema
  • pulmonary vasculitis (inflammation of the lung vessels)
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12
Q

top 5 microbes that causes pneumonia

A
  1. pneumococcal pneumoniae
  2. chlamydia penumoniae (CAD)
  3. (tied with CAD) viral cause
  4. mycoplasma pneumoniae
  5. H influenza
  6. legionalle pneumophillia
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13
Q

CURB65

A

severity scoring of pnuemonia (0-5 points)
C-confusion
U- blood urea>7mmol/L
R- RR>30/min
B- systolic BP<90mmHg, diastolic <60mmHg
65- age >65
* be careful because in younger ppl, the numbers that we should start worrying about is much less than this

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14
Q

causes of bronchiectasis

A
  • idiopathic
  • childhood infection or CF
  • ciliary dyskinesia (poorly functioning cilia –> retention of secretions and easily infected)
  • hypogammaglobulinaemia: impaire immune system from not having enough gamma globulins produced in the blood
  • allergic broncho-pulmonary asperillosis (ABPA): hypersensitivity to fungus.

mainly, the causes is anything that results in: dilatation of the bronchi, loss of mucous, LRTI

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15
Q

secondary causes of pneumonia

A
  • influenza (staph aureus)
  • aspiration pneumonia (in stroke, MS, oesophageal disease)
  • immunocompromised people (HIV, fungi, viruses)
  • MRSA
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16
Q

treatments of pneumonia (based on CURB65 scores)

A

0-1: amoxcillin, (clarithromycin or doxycycline in penicillin allergic patients), duration 5 days
2: amoxicillin + clarithromycin, (levofloxacin), 5-7 days
3-5: co-amoxiclav + clarithromycin, (levofloxacin or co-trimoxazole), 7-10 days

also consider supportive treatments like O2, ventilation, intubation, atipyretics, NSAIDS, fluids

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17
Q

pneumonia complications/exacerbations

A
  • sepsis
  • acute kidney injury (less perfusion to the kidneys because the blood is directed to other infected body parts)
  • parapnuemonic effusion
  • empyema
  • lung abscesses
  • swinging fever
  • weight loss
  • disseminated infection
  • failure to improve or persistently high WCC/CRP
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18
Q

3 types of pneumonia based on spread of disease

A
  1. bronchopneumonia (patches across the lungs)
  2. lobar pneumonia (the whole lobe affected)
  3. interstitial pneumonia (wipes out the whole lung, less about infection, more about inflammation)
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19
Q

typical microbes that causes pneumonia

A

pneumococcal pneumoniae
Haemophilus influenzae
mycoplasma pneumoniae (diarrhoea, stomach pain, etc)

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20
Q

atypical microbes that causes pneumonia

A 
legionella pneumophilia
chlamydia pneumoniae(CAD), chlamydia psittaci (birds)
coxiella burnetti (livestock)
moraxella catorrhalis 
virus
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21
Q

hospital acquired microbes that cause pneumonia

A 
enterobacteria
staph aureus 
pseudominas aerugionosa
klebsiella pneumoniae
clostridia 
anaerobes
TB
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22
Q

what antibiotic to give in aspiration pneumonia?

A

amoxicillin + metronidazole

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23
Q

what is the name of the virus that is associated with HIV and immunocompromise as a secondary cause of pneumonia, and what is the drug used against it?

A

pneumocystis jiroveci pneumoniae

co-trimoxazole

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24
Q

what is the drug used against MRSA

A

vancomycin

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25
Q

empyema as complications of pneumonia

A
  • pus in the pleural cavity
  • detected by thoracic ultrasound
  • the lower the pH of the pus, the more metabolic activity, meaning more infection. Low pH may need draining, but otherwise would go away by itself
  • prolonged antibiotics or surgery in severe cases
26
Q

lung abscesses in pneumonia

A
  • appears rounded in CXR
  • do bronchoscopy to make sure that it is not lung cancer
  • haemoptysis + foul smelling sputum
27
Q

differences btw LRTI in children and adults

A
  • fever pretty common and not concerning unless persistent
  • deteriorate quickly
  • LRTI common in children 3/10 will have it, and 9/10 kids will face viral infections –> weakened immunity –> opportunistic bacterial infection
  • red flag feature is persistent fever in children < 6 months
28
Q

common infective bacteria in children

A
  • strep pneumoniae
  • HI
  • moraxella catarrhalis
  • klebsiella pneumoniae
  • myocplasmia pneumoniae
  • chlamydia pneumoniae
29
Q

common infective virus in children

A
  • RSV
  • parainfluenze III
  • influenza A/B
  • human metapneumovirus
30
Q

common LTRI in children

A
  • bronchitis
  • bronchiolitis
  • laryngoltracheobronchitis (croup)
  • tracheitis
  • epiglottis
  • bordetella pertussis (whooping cough)
  • empyema
  • LRTI/pneumonia
  • viral induced wheeze
31
Q

symptoms of croup + key feature

A
  • viral infection of large airways –> narrowing
  • common (6 months - 6 yrs)
  • persistent cough that sounds like barking seal
  • inspiratory stridor
  • hoarseness of voice
  • respiratory distress
  • KEY FEATURE: worse at night (9 pm)
32
Q

symptoms that indicate moderate and severe croup

A

moderate: barking seal cough + inspiratory stridor
severe: barking seal cough + inspiratory stridor + lethargy/agitation

33
Q

management of croup

A
  • supportive care, safe netting, advice
  • oral once off dose of dexamethasone (steroid) 0.15ml/kg
  • admission for moderate and severe symptoms
  • oxygenation + a little steroid
  • nebulized adrenaline
34
Q

epiglottis symptoms

A
  • swollen epiglottis that blocks off airway
  • rare, medical emergency
  • can be vaccinated against, which is why it is rare
  • high fever
  • hypoxic
  • drooling, sore throat, leaning forward
35
Q

can we examine child with epiglottis?

A

NO

sticking something down a completely blocked off throat can make it worse

36
Q

trancheitis symptoms

A
  • swollen tracheal wall and narrow tracheal lumen
  • croup like symptoms, except it does not get better
  • fever
37
Q

causative organism for epiglottis and treatment

A
  • H. influenzae

- this can be vaccinated against, which is why it is rare

38
Q

causative organism for tracheitis and treatment

A
  • staph or strep infection

- co-amoxiclav

39
Q

corisal define

A

watery eyes and runny nose

40
Q

describe seesaw breathing

A

when the airway is mostly blocked and the child breathes by lifting the chest and sucking in abdomen

41
Q

when to admit a child?

A
  • severe resp symptoms/distress
  • child has other associated symptoms/underlying conditions, other risk factors
  • subcostal recession, seesaw breathing, tripod position (signs of severe resp distress)
  • child is systemically unwell, lethargy, agitation
  • O2 sat < 95%
  • tachypnoea (RR>50/min)
  • cathode ray tube > 2secs
  • less than 6 months old
  • pleuritic chest pain (empyema?)
  • bad social circumstances
42
Q

what is NPA

A

nasopharyngeal airway/nasal trumpet/nose hose - tube inserted into nasal passageway to secure open airway

43
Q

brodetella pertussi (whooping cough) symptoms and diagnosis

A
  • common in 2-5 years cycle
  • vaccination reduces risk and severity
  • coughing fit that goes on and on
  • vomiting due to cough
  • inspiratory whooping sound
44
Q

cause of whooping cough

A

bacterial infection

45
Q

treatments for whooping cough (3 antibiotics)

A

can be treated in 3 weeks with marcolides
1. erythromycin (usually this one)
2. clarythromycin
3. azithromycin
pregnant women in their 16-32 weeks and children <3 weeks old should be immunized for this

46
Q

bronchitis symptoms and characteristic

A
  • very common
  • loose, rattly cough
  • is actually a UTRI
  • vomiting
  • examination of the chest will turn out fine, no wheeze or crepetations
  • the child is usually well, condition self limiting, no need to treat the infection in normal cases.
47
Q

causative organism of bronchitis

A

haemophilus/pneumococcus

48
Q

mechanism of infection of bronchitis

A

stage 1. mucociliary clearance in minor airways has problems –> minor airway malacia/tracheomalacia (collapse of airway when exhaling), caused by RSV/adenovirus –> hard to breathe + coughing

stage 2. this collapse of the mucociliary clearance opens for opportunistic secondary bacterial infections

49
Q

differences and similarities btw empyema in children vs adults

A
  • offer antibiotics and drainage if needed in both cases

- children have better prognosis and more likely to recover in contrast to adults

50
Q

steps in treating LRTI in children

A
  1. oxygen, nutrition, hydration (this is normally enough, if it doesn’t work then think about step 2)
  2. antibiotics
  3. review treatment if needed
51
Q

which LRTI in children needs antibiotics?

A
  • bacterial tracheitis: co-amoxiclav
  • bordetella pertussis: marcolides (mainly erythromycin)
  • empyema: IV antibiotics
  • pneumonia: oral amoxicillin
52
Q

which LRTI in children does not need antibiotcis? (are mostly self-limiting)

A
  • laryngealtracheobronchitis(croup)
  • bronchitis
  • broncholitis
  • viral induced wheeze
53
Q

bronchiolitis symptoms

A
  • very common in < 2yrs
  • inflammation
  • congestion in bronchioles
  • cold symptoms (corisal)
  • mild fever
  • followed by coughing, wheezing, tachypnnoea
  • easily spread and reinfected
  • long symptoms (days and weeks)
54
Q

causative organism of bronchiolitis

A

RSV (respiratory syncytial virus)

55
Q

management of bronchiolitis

A
  • supportive care
  • admission
  • oxygenation and NPA as needed
  • NO CXR needed, clinical diagnosis
56
Q

LRTI/pneumonia symptoms in preschool, infants, and neonates

A

preschool: COUGH, fever pain
infants: COUGH, tachypnoea, irritable, lethargy, poor feeding, preceding UTRI, grunting
neonates: grunting, tachypnoea, resp distress, poor feeding, lethargy, coughing (unlike the other 2, coughing is not the main symptom)

57
Q

how to tell that is a LTRI

A
  • preceded with UTRI
  • fever >39 Celsius
  • chest recession and raised RR (tachypnoea) in resp distresses
  • wheeze is less common in children and adults
58
Q

treatment of pneumonia in children

A
  • if symptoms are mild, leave them alone, but safe net
  • oral amoxicillin is the first choice
  • oral macrolide is the second choice
  • use IV if there is vomiting, but otherwise, always go for oral
59
Q

empyema in children

A

children has good prognosis for this compared to adutls

60
Q

viral induced wheeze in children

A
  • if child between 6 months - 5 yrs have a wheeze, think of viral induced wheeze before asthma (it could actually be asthma, but the child is too young to know for sure anyway, only when it keeps happening over 5 years would you call it asthma )
  • use bronchodilators

Respiratory System (13 decks)

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