... Flashcards by Ben Johnston

What test can be done ona suspected case of lung cancer?

FBC + Clotting Screen
Serum Calcium
Bone Profile
LFT + RFT
CXR
Biopsy
Bronchoscopy + bronchoalveolar lavage
Aspirate any pleural effusion
PET Scan + Bone Scan

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How does Lung Cancer present?

Dyspnoea
Chest Pain
Chronic cough +/- Haemoptysis
Recurrent Chest Infections
Weight Loss
Wheezing - Dysphagia - Bone Pain - Shoulder Pain - Horners Syndrome - Swollen neck/face - Hoarseness

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What are the most common causative organisms in pneumonia>

Strep Pneumoniae
Mycoplasma Pneumoniae
Haemophilus Influenzae
Viral
Pseudomonas Aeruginosa
Staph Aureus
Legionella

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Explain the Curb 65 Score for severity and treatemnt of Pneumonia?

C - Confusion
U - Urea>7mmol/L
R - Resp. rate > 30/m
B - BP <60 or 90
65 - >65yrs

o = community treated
1-2 = Hospital Treated
3-5 = ITU

o-1 = Clarithromycin (macrolide) or Amoxicillin (B-lactam) or Doxycyclin
2 = Clarithromycin and Amoxicillin (or Levofloxacin - Fluroquinolone)
3-5 = Clarithromycin &amp; Co-Amoxiclav (Or Levofloxacin)

Add Vancomycin for MRSA
Add Flucloxacillin for Staph
Can also add rifampicin in severe cases

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What are the complications of Pneumonia?

Lung abscess
Pleural Effusion
Empyema
Bronchiectasis

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What tests are done on suspected pneumoina?

FBC - CRP - ABG - U&amp;E - LFT
CXR
Bronchoscopy + Bronchoalveolar Lavage
Sputum &amp; Blood Cultures
Urinary Legionella
Throat Swab for atypical Pathogens

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What none antibiotic treatments are there for pneumonia?

Analgesia
Anti-pyretics
Fluids (IV if necessary)
O2 - CPAP - Intubate
CCS~ help with inflammation

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What are the common organisms behind a lung abscess?

Pseudomonas Aeruginosa Or Staph Aureus

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What treatments are there for lung abscess?

Postural Drainage
Percutaneous Drainage
Long course of antibiotics
Surgical Excision

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How do we test for a mesothelioma and how does it present?

Dyspnoea - Chest Wall Pain - Pleural effusions/pneumothorax - Haemoptysis - Weight loss - Fatigue - Fever - Night Sweats - Clubbing - Cough

CXR - Diffuse or localised pleural thickening (unilateral)
Biopsy
Aspirate Effusion

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What could make sinusitis chronic and what would we do?

Nasal Polyps - Immunocompromised - Allergy - Asthma - Smoking

CT/MRI/XR - Nasal Endoscopy

Amoxicillin - Nasal Irrigation - Surgical Intervention

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How do we treat Otitis Media and what are the common organisms?

Analgesia and ~antibiotics

Haemophilus Influenzae or Strep Pneumoniae

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What causes Croup vs epiglottitis?

Croup: Parainfluenza Virus Type 1
Epiglottitis: Haemophilus Influenzae B

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Compare Croup and Epiglottitis presentation?

Croup:
Hoarse - Barking Cough - Dyspnoea worse at night - Stridor - Look relatively well - Slow onset

Epiglottitis:
Little Cough - Drools - Dyspnoea better when leaning forward - Stridor - Dysphagia - Look very Sick - Rapid onset

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How do we treat croup vs epiglottis?

Croup;
Oral CCS (Add O2 an Adrenaline if dyspnoea severe)

Epiglottitis:
Secure Airway with O2 and intubation 
Throat Swab for culture and viral smears
Blood culture for bacteraemia
FBC - Raised WCC
ANTIBIOTICS

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How do we diagnose TB?

With 3 postive sputum cultures on consecutive days

How do we treat TB and what are the drug interactions of rifampicin?

Rifampicin + Isoniazid (6 months)
Ethambutol + Pyrazinamide (just 2 months)

Rifampicin:
Induces cytochrome P-450 enzymes rendering various drugs useless:
The Pill - Anti-convulsants - Prednisalone

What are the smyptoms of TB?

Night Sweats
Weight Loss (Consumption)
Fever
Pleuritic Pain
Clubbing 
Crackles/Bronchial Breating
Dyspnoea
Cough + Purulent Sputum + Haemoptysis

How id CF inherited?

Autosomal Recessive

What are the isngs of CF?

Clubbing

Coarse Crackles

How do we monitor the severity of CF in small kids?

Record and chart thier growth

How do we treat CF?

Azithromycin to suppress bacterial load
Treat infective exacerbations
Bronchodilator
Ivacaftor
Mucolytics
Drainage
NSAIDS / CCS

What are the common infections caught in CF?

Pseudomonas Aeruginosa
Staph Aureus
Haemophilus Influenzae
Burkolderia Cepacchi (BAD)

How does cerebral palsy affect kids sleep and what do we do for it?

Causing fragmented and delayed sleep

We give them melatonin

How does Duchennes muscular dystrophy affect kids sleep and what do we do?

Leads to nocturnal desaturation eventually leading to resp failure and death We give them BiPAP

What are most secondary Pneumothoraxes caused by?

COPD

What are the signs of a tension pneumothorax?

``` Progressing Dyspnoea Tracheal DEviation away from affected side Mediastinal Shift Raised JVP Haemodynamic Instability ```

What is surgical emphysema?

Bubble wrap like air tracking in the subcutaneous fat, quite common in severe or tension pneumonthorax

What are the symptoms/signs of a pleural effusion?

Symptoms: Dull Ache - malaise/fever - Night sweats - Weight loss - Dyspnoea - Pleuritic Pain - Dry Cough Signs: Bronchial breathing - Decreased Vocal Resonance - Decreased Expansion - Stony Dullness Cause related: Tar Staingin - Raised JVP - Clubbing - Lymphadenopathy - Tracheal Deviation - Peripheral Oedema - Orthopnea/PND

What commonly causes Transudate vs exudate oedemas?

Transudate: LVF - Liver Cirrhosis - PE - Hypoalbuminaemia - Mitral Stenosis - Constrictive Pericarditis Exudate: Pneumonia - Bronchiectasis - lung Abscess - Malignancy - PE - Post MI - Rheumatoid Arthritis - Autoimmune - Pancreatitis

What test can you do on the fluid from a pleural effusion?

``` Cytology - Malignant cells etc M,c & S Total Protein LDH Amylase - Pancreatitis Glucose ```

What are the risk factors for a PE?

``` The pill or HRT Pregnancy Inherited Thrombophilia Bed or chair bound or travel Previous PE or DVT Recent Surgery or Trauma Hypertension Cardiopulmonary Disease e.g. MI ```

How do we investigate a suspected PE?

``` Clincial probability assessment e.g. Wells Score D dimer ECG Chest XR CT Pulmonary Angiogram Echo FBC + ABG V/Q scan Thrombophilia testing ```

How does a PE present?

Dyspnoea Pleuritic Pain Cough +/- Haemoptysis Fever - pleural Rub - Tachypnoea/tachycardia - cyanosis - Maybe pleural effusion Massive PE: Syncope & Collapse + Hypotension

How do you treat a pulmonary embolism?

Symptoms - O2 Break up clot - Anticoagulants (DOAC - Rivaroxaban/LMWH for 5 days/Warfarin 3-6 months) Remove Clot - Embolectomy In an acute massive PE you might do thrombolysis with alteplase

Describe adenocarcinoma?

Tends to be peripheral Tends to grow more slowly Most common tumour in the young and non-smokers

White Asbestos

White asbestos - Chrysotile Brown - Amosite Blue - Crocidolite Asbestos and smoking have a synergistic effect on lung cancer risk

treat croup/epiglottitis?

``` Croup; Oral CCS (Add O2 an Adrenaline if dyspnoea severe) ``` ``` Epiglottitis: Secure Airway with O2 and intubation Throat Swab for culture and viral smears Blood culture for bacteraemia FBC - Raised WCC ANTIBIOTICS ```

What is the most common organism in pneumonia, CF and Lung abscess following pneumonia?

Pneumonia - Strep pneumoniae CF - Pseudomonas Abscess - pseudomonas/Staph. aureus