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Y4 Respiratory Medicine > 5. Lower Respiratory Tract Infections > Flashcards

5. Lower Respiratory Tract Infections Flashcards

1
Q

Sx of CAP

A

Cough and breathlessnnes, pleuritic pain , new sputum production (54%), haemoptysis(15%)

Confusion, abd pain, GI upset, myalgia and headache

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2
Q

Signs of CAP

A

Pyrexia, rigors, tachyc, hypoT, tachypneoa
COARSE inspiratory crackles, reduced expansion, bronchial breathing, pleural rub on pneum side, abd tenderness

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3
Q

Def of CAP

A

Sx and signs consistent with LRTI, new CXR shadowing (eg. may have loss of definition of heart border), and no other explanation

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4
Q

How to differentiate between Middle and Lower lobe pneumonia

A

If lower lobe, hemidiaphragm will not be clear

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5
Q

What bacteria can cause lung abscess commonly

A

Staph aureus

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6
Q

How to assess pneumonia severity

A

CURB65
Confusion
Urea>7
SBP <90 or DBP<60
Age >65
1 or less is low severity

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7
Q

If CURB =2, how to treat

A

Usually only oral antibiotics

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8
Q

Ix for Moderate vs severe pneumonia

A

Blood cultures and sputum, pneumococcal urine antigen test for both (consider ONLY for moderate )

Ix for legionella only is suspected in mod pneumonia ( urine antigen and sputum ) vs Ix for legionella and atypical and viral pathogens

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9
Q

Common source of mild CAP and how to treat

A

Strep pneumoniae, just treat with oral amox

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10
Q

Mod severity CAP Tx

A

Oral amox + clarithromycin

(IV benzyl may be fiven instead of amox if oral not possible)

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11
Q

What is the use of clarithromycin in CAP

A

For atypical organisms

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12
Q

High severity CAP Tx

A

IV co amox + clarithro, add levofloxacin if legionella

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13
Q

How to treat parapneumonic effusion

A

With abx

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14
Q

What is empyema

A

Infxn and pockets in pleural space

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15
Q

When would chest drain be considered for Empyema

A

Pleural fluid acidosis
+ve bacteriology from pleural space
frank pus

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16
Q

Empyema charcteristics

A

High protein (>30) and LDH (>1000),usually have loculations, high neurophil, low glucose (<2.2) and ph <7.2

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17
Q

Org in pri vs sec empyema

A

Strep, anaerobes, staph aureus, gram -ve aerobes
vs
MRSA, Gram -ve aerobes like e coli, pseudomonas, kleb more common, s aureus and anaerobes

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18
Q

Mx of empyema

A

Fluids, LMWH, ICD if meets criteria, Abx mainly coamox, but may use metro and cephs.

If failure to respond then decorticate and put abx, or if too frail then rib resection + permanent ICD

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19
Q

If flu like Sx and then CAP, what org is likely

A

Staph aureus

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20
Q

What is PCP assoc with

A

Immunocompromised

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21
Q

What is legionella assoc with

A

Water, travel overseas

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22
Q

What is bronchiectasis

A

Permanently dilated airways– chronic cough and sputum production, recurrent chest infections

23
Q

Sx of bronchiectasis

A

Fatigue, chest pain, cough

24
Q

Most common causes (2) of bronchiectasis

A

No cause, then past infection

25
Q

Possible causes of bronchiectasis that should be investigated

A

Allergic bronchopulmonary aspergillosis, common variable immunodefeciency and CF

26
Q

Most common pathogen in bronchiectasis and what other causes

A

H influenzae, then pseudomonas

27
Q

Ix for bronchiectasis and observation on imaging

A

Chest CT
Sputum culture, once a year and at exac start
Dense opacification of lung fields due to chronic bronchietastic change on CXR

28
Q

what does signnet ring sign suuggest

A

Bronchiectasis- bronchus bigger than vessel

29
Q

What variables are considered in bronchiectasis severity index scoring

A

Age, low BMI (< 18.5), >3 lobes involved or cystic bronchiectasis, FEV1

30
Q

What is bronchiectasis a risk factor for

A

Coronary heart disease and stroke, independent of past smoking

31
Q

Tx for bronchiectasis exacerbation, and what the requirements for tx

A

Abx - - acute detioration, worsening local sx, and or systemic upset

32
Q

Non-medical treatment for bronchiectasis

A

physiotherapy

33
Q

What disease is DNAse used for

A

CF

34
Q

long term treatment for bronchiectasis

A

SAB2 agonist if airways obstruction , anti cholinergic also possible
LABA if significant breathlessness and response to SA
similar to COPD

35
Q

Macrolides side effect and when is it used

A

GI, CV, hearing impairment
To reduce exac in high risk pts

36
Q

What are the high risk groups to target abx

A

BSI or >= 3 Exac per year

37
Q

Target froup for LT inhaled ABXs and which Abx are these

A

Chrminic PA or R, intolerance or lack of effect with macrolides

Gent or colomycin

38
Q

What resp condition is a risk factor for TB

A

Silicosis

39
Q

Sx of TB

A

Progressive Sx ( weeks/ months)
Weigh loss + night sweats
Cough
Possibly productive + haemoptysis
Anorexia
General malaise

40
Q

Which lobe predominance does TB have

A

Upper Lobe

41
Q

Features of active TB on chest radiograph

A

Soft nodular shadowing, consolidation, infiltration, cavitation, miliary modules, pleural effusion, tuberculoma

42
Q

First Ix for TB

A

Tuberculin skin test

43
Q

What are the TB specific antigens, are they present in BCH

A

ESAT 6 and CFP 10.

44
Q

When should INFg assay be performed

A

If Mantoux is +ve

45
Q

What samples should be done for pulmonary Tb and what test are done, what stain is used

A

Sputum x 3, induced sputum x3, BAL +- TBB
smear, culture (TB+ routine)and histopatholgy
Ziehl neelsen stain used

46
Q

should pulm tb pts be isolated in -ve pressure room

A

yes

47
Q

tx for TB and when shpuld it be extended

A

Rifampicin (R) 6mo
Isoniazaid (H) 6mo + pyridoxine
Pyrazinamide 2mo
ethambutol 2mo

extend if TB meningitis, extensive TB, miliary TB

48
Q

when should oral steroids be used in TB

A

extensive tb, meningitis, pericarditis, ureteric, and Pleural effusion

49
Q

Treatment for latent TB

A

6mo R/H or 3mo R+H

50
Q

Contact tracing for TB and precautions

A

Household and close contacts >8h
Should screen all close contacts- TST, CXR, med assessment of concerns

51
Q

What is considered HAP

A

Over 48 hrs in hospital

52
Q

What are the common causes of HAP

A

Pseudomonas and MRSA

53
Q

Should Gram-ve or Gram+ve be done for HAP first

A

Gram -ve then Gram +ve

54
Q
A

Y4 Respiratory Medicine (6 decks)

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