9/2 Flashcards
1
Q
TB
- define
- patho
- RF
- types
- symptoms
- signs
- Ix
- Mx
- Med SE
- extra-pulmonary TB
A
define
- infection by myocplasma tuberculosis
patho
- inhalation of TB bacili»_space; alevoli infected»_space; macropage + alveoli»_space; ghon focus»_space; moves to hilar LN»_space; ghon complex»_space; calcified»_space; ranke complex
- primary - hilar, subbpleural, LL, pharyngeal
- secondary - apical
RF
- lower economic class
- certain parts of world
- alcoholoc
- asian/ african ethnicity
- contact of somone
- IVDU, HIV
- immunosuppressed
types
- primary
- latent - some primary cases remain latent
- secondary - reactivation of primary (can become miliary)
symptoms
- haemoptysis
- cough
- SOB
- tachycardia
- pleuritic chest pain
- fever, malaise, wt loss, anorexia, night sweats
signs
- apical creptitations
- clubbing
- late - consildation, pleural effusion
Ix
- obs
- resp exam
- latent - mantoux test (tuberculin inserted and greater >5mm wheel is positive), then IGRA
active:
- sputum - acid fast bacilli in zeihl-neelsen stain - red in 24hrs
– 3 samples inc morning
– takes 6W
- broncho-alveolar lavage
- CXR - cavitating (secondary), dissmeninated (miliary), hilar (primary)
Mx
- active - 6M - rifampicin, isoniazide, pyrazinamide, ethambutol for 2M and PE for another 4M
- latent - isoanizid for 6M or RI for 3M
- contact tracing
- public health
- neg pressure rooms, N95
- TB specialist witihn 2W
- test for MDR-TB
SE meds
- rifampicin - red and orange urine/ tears
- isonazide - peripheral neuropathy so give B6 (pyridoxine)
- pyrazinamide - gout
- ethambutol - optic neuritis
extra-pulmonary TB - miliary - spread via blood
- renal - sterile pyruai
- meningitis, focal neuro, decreased consciousness, headache
- msk - arthritis, osteomyelitis, psoas abscess, pott’s
- GI - obstruction, appendicitisl, ascites
- cardio - pericardial effusion, constrictive pericarditis
- lymphadenopathy
- skin - erythema nodosium and bazin’s
2
Q
Pneumonia
- define
- RF
- types
- causes
- symptoms
- signs
- Ix
- scoring system
- Mx
- complication
A
define
- infection»_space; inflam of lungs
RF
- HIV, immunosuppresed, DM
- COPD, bronchiectasis, CF
- elderly
- alcoholics
- smokers
types
- CAP
- HAP - within 10 days of hosp discharge or 48hrs after admission
- aspiration - stroke
causes
- CAP - strep pneumoniae, haem influenza (bronchiectasis), myocoplasma (young), legionella (air con), chlamydia pneumonia (URTI infants, elderly), chlamydia psticci, Q fevers, PCP (HIV), moraxella (COPD, immuno)
- HAP - klebsiella, e.coli, staph, pseudomonas (ventilator)
symptoms
- cough initially dry then 1/2D later»_space; rusty-coloured purulent sputum
- haemoptysis
- SOB
- pleuritic chest pain
- fever, wt loss, malaise
- elderly - oncfusion, more unwell
- mycoplasma - rash, pericarditis, HIV, D&V, meningoencephalitis
- legionella
- chlamydia psticci - bird flu
- Q fevers - farmers flu
signs
- crackles on auscultation
- bronchial breathing
- dull to percussion on affected
- IN vocal resonance
- tachypnoea
- decreased expansion on affected side
Ix
- obs - RR, BP, HR
- resp exam
- FBC, UE, CRP, LFT, blood cultures
- CXR - consolidation - lobar or broncho
- urine - legionella and pneumococcus
- sputum sample - legionella
- PCR - mycoplasma
CURB-65
- confusion AMT<8/10
- Urea>7
- RR>30
- BP<90 or <60
- age>65
Mx
- CAP - 0/1 - amoxicillin for 5D (macrolide if allergy)
- CAP>1 - amoxillcin + clarithromycin for 7D
- mycoplasma - erythromycin
- legionella - erythromycin, clarithromycin
- saureus - fluclox
- aspiration - metronidazole
- HAP - RF for MRSA and co-amoxiclav for 5-7D if mod, taz if severe
- pseudomonas - ciprofloxacin
- PCP - co-trimoxazole
- CXR 6weeks after infection
complications
- empyema
- pleural effusion
- bronchiectasis
- sepsis
- lung abscess
3
Q
Cystic fibrosis
- define
- patho
- symptoms
- signs
- Ix
- Mx
A
define
- auto recessive inheritance of mutations of the CFTR gene, commonly deltaF508 mutation
patho
- mutation affects Cl- transportation in mucus and causes thickened mucus
- affects transports in bile and pancreatic secretions causing them to thicken
symptoms
- meconium ileus - thick meconium that won’t pass at 24hrs
- recurrent URTIs, asthma, pneumothorax, fibrosis and cor pulmonale
- pancreatic - pancreatitis, pancreatic insufficiency, DM, vit ADEK deficiency, coagulopathy and bleeding disorder
- steatorrhoea
- gallstones, peptic ulcers, cirrhosis
signs
- clubbing
- crackles on ausculation
- male infertility and female subfertility
- DM
- rickets
Ix
- obs
- resp exam, abdo exam, chest exam
- glucose check
- FBC, UE, LFT, CRP
- sweat test - measure cl->60 positive
- sputum culture - pseudomonas, haem, s.aureus
- abdo uss - fatty liver, cirrhosis, chronic pancreatitis
- spirometry - obstructive deficit
Mx
- specialist
- physio
- creon - lipase supplement
- ADEK supplements
- prophlyactic abx - azithromycin
- carbocysteine
- bronchodialtors
- lung or liver transplant - failure
- genetic counselling, infertility and DM mx
