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Lower Respiratory Tract Infections Notes

This is a sample of our (approximately) 3 page long Lower Respiratory Tract Infections notes, which we sell as part of the Respiratory Notes collection, a MBChB (hons) (1st) package written at University Of Leicester in 2014 that contains (approximately) 35 pages of notes across 13 different documents.

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Lower Respiratory Tract Infections Revision

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Lower Respiratory Tract Infections Pneumonia Infective respiratory tract infection causing radiological shadowing Classified according to setting in which it is acquired as this influences the likely pathogens and therefore determines best empirical treatment

Community-acquired pneumonia Pathophysiology
- Droplet spread
- Organisms multiply rapidly in lung
- Local defense mechanisms overcome
- = Pneumonia Clinical features
- Fever
- Cough
- Sputum production (yello/green)
- Chest pain
- Dyspnoea
- Systemic features (malaise, anorexia, fatigue) Likely organisms
- Strep. Pneumonia
- H. Influenzae Investigations Microbial
- Sputum MC+S
- Blood culture
- Urine (legionella antigen)
- Microscopy (gram, acid fast stain for TB)
- PCR - viral replication
- Nose and throat swabs
- NPAs (nasopharyngeal aspirates
- viral)

Defense mechanisms
- Muco-cilary escalator
- Cough reflex Tobacco suppresses ciliary function = impaired defense Signs
- Tachypnoea
- Hypotension Severe disease
- Cyanosis
- Confusion
- Crackles, bronchial breathing

Differential diagnosis
- Pulmonary infarction (but no fever)
- Pulmonary oedema (no fever, 3rd heart sound)
- Inflammatory diseases o Vasculitis, acute allergic alveolitis
- TB (cavitation on CXR, night sweats) Non-Microbial Imaging
- CXR Bloods
- Blood gas (saturation)
- FBC (WCC, platelets)
- U+E (Urea + hydration status)
- CRP

Management Assess severity
- CURB 65 General supportive measures
- Analgesia, O2, IV fluids Antibiotic therapy
- Mild cases (amoxicillin)
- Severe cases (IV macrolide - erythromycin) Treat complications
- Effusion, empyema, lobar collapse

CURB 65 Confusion Urea >7mmol/L Respiratory rate > 30/min Blood pressure 65 2 = severe pneumonia (admit) No criteria = non-severe pneumonia 1 criteria = use clinical judgment and age to decide whether to admit

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