Lower Respiratory Infections

Question 1

Common signs and symptoms of pneumonia and bronchitis,

Answer 1

• Bronchitis
Cough with purulent sputum, rhinorrhea, nasal congest, fever, myalgias, arthralgias, dyspnea/SOB, wheezing, sore throat
oPhysical exam=may have rhonchi, wheezing, coarse breath sounds

• Pneumonia
oSymptoms of acute infection (cough, sputum, fever, prodrome), abnormal lung function, infiltrate on cxray
oFever, tachycardia, tachypnea, decreased breath sounds, rigors/sweats, dyspnea, myalgias, pleuritic cp, hypoxic, tactile fremitus

Question 2

Comparisons and contrasts of pneumonia and bronchitis

Answer 2

• Comparisons=cough w/ sputum, fever, myalgias, dyspnea

* Contrasts=lung sounds in bronchitis, infiltrate in cxray of pneumonia, more pleuritic chest pain in pneumonia

Question 3

What are the most common bacterial agents for the development of bronchitis or pneumonia?

Answer 3

• Streptococcus pneumonia
• Mycoplasma pneumonia
• Chlamydophila pneumonia
• Haemophilus influenza
• Pneumocystis jirovecci

Question 4

What are the most common viral agents for the development of bronchitis or pneumonia?

Answer 4

• Rhinoviruses
• Coronaviruses
• Respiratory syncytial virus
• Parainfluenza viruses
• Adenoviruses
• Influenza A
• Influenza B
• Enteroviruses
• Herpes Simplex viruses

Question 5

indications for chest xray in adults?

Answer 5

temperature >100 F
heart rate > 100 bpm
ventilatory rate > 20 bpm
(one of the above or two of the following)
decreased breath sounds
crackles (rales)
absence of asthma

Question 6

imaging exam findings for pneumonia

Answer 6

CXR to help establish diagnosis and identify complications such as pleural effusion; may be negative, especially early in disease.
*consider CT scan for CXR (-) whose diagnosis is questionable

Question 7

laboratory exam for suspected pneumonia

Answer 7

WBC, blood cultures, sputum gram stain, urine antigens, PCR, antibody titers, cold agglutinins, CRP, procalctonin, BNP may be of some use

Question 8

what diagnostic labs/tests/images may be useful for diagnosing bronchiectasis?

Answer 8

high resolution CT
CXR should be obtained; occasionally it will be diagnostic, if it correlates with the appropriate clinical setting.
PFTs the most common abnormality is obstruction

Question 9

what diagnostic labs/tests/images may be useful for diagnosing lung abscess?

Answer 9

CXR- may see cavitary lesion with an air fluid level