... Flashcards
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
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
What are the most common causative organisms in pneumonia>
Strep Pneumoniae Mycoplasma Pneumoniae Haemophilus Influenzae Viral Pseudomonas Aeruginosa Staph Aureus Legionella
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 & Co-Amoxiclav (Or Levofloxacin)
Add Vancomycin for MRSA
Add Flucloxacillin for Staph
Can also add rifampicin in severe cases
What are the complications of Pneumonia?
Lung abscess
Pleural Effusion
Empyema
Bronchiectasis
What tests are done on suspected pneumoina?
FBC - CRP - ABG - U&E - LFT CXR Bronchoscopy + Bronchoalveolar Lavage Sputum & Blood Cultures Urinary Legionella Throat Swab for atypical Pathogens
What none antibiotic treatments are there for pneumonia?
Analgesia Anti-pyretics Fluids (IV if necessary) O2 - CPAP - Intubate CCS~ help with inflammation
What are the common organisms behind a lung abscess?
Pseudomonas Aeruginosa Or Staph Aureus
What treatments are there for lung abscess?
Postural Drainage
Percutaneous Drainage
Long course of antibiotics
Surgical Excision
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
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
How do we treat Otitis Media and what are the common organisms?
Analgesia and ~antibiotics
Haemophilus Influenzae or Strep Pneumoniae
What causes Croup vs epiglottitis?
Croup: Parainfluenza Virus Type 1
Epiglottitis: Haemophilus Influenzae B
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
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
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
