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Respiratory > Chronic pulmonary infection > Flashcards

Chronic pulmonary infection Flashcards

1
Q

Commonest cause of immunodeficiency

A

CVID

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2
Q

Organism which might cause empyema/abscess after flu?

A

Staph (CAVITATES!)

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3
Q

When does an effusion need drained?

A

pH 1000

glucose

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4
Q

Strep milleri

A

Gram positive

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5
Q

Staph aureus

A

Usually psot op, or nosocmial

Immunocompromised

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6
Q

D sign

A

Empyema!

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7
Q

Treatment for empyema (Abx)

A

IV

Amoxicillin and metronidazole!!

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8
Q

Treatment for bronchiectasis

A 
Stop smoking
Pneumococcal vaccine
When colonised with persistent bacteria
– Prophylactic antibiotics
– Nebulised colomycin
– Pulsed IV abx
– Alternating oral antibiotics
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9
Q

Anti-inflammatory treatment for bronchiectasis

A

Low dose macrolide antibiotics have been shown to reduce exacerbation rates in bronchiectasis
– Clarithromycin 250 mg OD
– Azithromycin 250mg Three Times a Week
• Particularly effective in pseudomonas colonised individuals

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10
Q

CF carrier rate

A

1/25

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11
Q

CF incidence rate

A

1/2500

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12
Q

Bronchial challenge testing

A

Methacholine/histamine

-look to see what concentration produces a 20% decrease in FEV1

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13
Q

↓FEV1 or ↓PEF post exercise

A

Asthma

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14
Q

How to check lung volume

A

Helium dilution / N2 washout : functional residual capacity

↑TLC in hyperinflation(Emphysema) ↓TLC in restrictive lung disease

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15
Q

Exhaled breath nitric oxide

A

Non invasive marker of eosinophilic airway inflammation in asthma

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16
Q

Asthma triad

A

Reversible airflow obstruction
Airway hyperresponsiveness
Airway inflammation

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17
Q

Hallmarks of remodelling is asthma?

A

Thickening of BM
Collagen deposition in submucosa
Hypertrophy of smooth muscle

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18
Q

Asthma histology

A

Desquamation
Eosinophils
Mucus plugging
Epithelial shedding

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19
Q

Cells in COPD

A

CD8+
Alveolar macrophage
Neutrophil

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20
Q

Cells in bronchitis?

A

Chronic neutrophil inflammation

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21
Q

How to assess risk of exacerbations in COPD?

A

Two exacerbations or more within the last year or an FEV1

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22
Q

Diagnosing asthma

A 
•  History and examination
•  Diurinal variation of peak flow rate
•  Reduced forced expiratory ratio
(FEV1/FVC 15%)
•  Provocationtesting→bronchospasm
- exercise
- histamine/allergen inhalation
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23
Q

Ipratropium

A

Short acting SAMA

24
Q

Tiotropium

A

LAMA

25
Q

Salbutamol

A

SABA

26
Q

Actions of a spacer divider

A

Avoids coordination problems with pMDI
• Reduces oropharyngeal and laryngeal side effects
• Reduces systemic absorption from swallowed fraction
• Acts a holding chamber for aerosol
• Reduces particle size and velocity
• Improves lung deposition

27
Q

LTD4

A 
Increased mucus secretion
Edema
Decreased mucus transport
Epithelial cell damage
Contraction and proliferation of airway smooth muscle
28
Q

Montelukast

A

LTRA, oral

29
Q

How do you give Omalizumab?

A

Anti-IgE monoclonal antibody

Injection every 2-4 weeks

30
Q

M1

A

enhance cholinergic reflex

31
Q

M2

A

Inhibit Ach release

32
Q

M3

A

Mediate bronchoconstriction and mucus secretion

33
Q

When are high doses of nebulised ipratropium given?

A

Acute COPD, acute asthma

34
Q

When is IV aminophylline given?

A

Acute attacks

35
Q

Name a drug theophylline could react with?

A

erythromycin (P450 drug interactions)

36
Q

Rofumilast

A

PDE4 inhibitor

might add it in COPD as addition to LABA/LAMA instead of ICS

37
Q

Side effect of PDE4 inhibitors

A

Nausea, diarrhoea, headache, weight loss

38
Q

Abx for COPD exacerbation

A

Amoxicillin

39
Q

Treatment of acute asthma

A

TREATMENT OF ACUTE ASTHMA
• Oral prednisolone (or iv hydrocortisone )
• Nebulised high dose salbutamol, ± Neb ipratropium, ± iv aminophylline/magnesium
• 60% O2
• ITU Assisted mecahnical intubated ventilation if falling PaO2 and rising PaCO2
- never use respiratory stimulant

40
Q

Treatment for pulmonary hypertension?

A

Pharmacologic Treatment

  • prophylactic anticoagulation [warfarin]
  • O2 if hypoxic
  • Po Vasodilators :Endothelin antagonist (Oral Bosentan) , PDE5-inhibitor (Oral Sildenafil), iv Epoprostenol
41
Q

Peumothorax risk factors in babies

A

IPPV, CPAP and ventilation

RDS (stiff lungs)

42
Q

Treatment for surfactant deficiency

A

Steroids

43
Q

Raised immunoreactive trypsin

A

CF (also F508 deletion etc)

44
Q

Which virus causes bronchiolitis?

A

RSV

45
Q

How to remember bronchiolitis? FACT

A

Fast breathing:shallow not taking in a lot of air
Appetite: poor/can’t feed normally
Cough: distinctive rasping cough
Temperature

46
Q

Organism which usually causes epiglottitis?

A

Haemophilus influenza

47
Q

Steeple sign on x-ray

A

Epiglottitis

48
Q

Viral laryngotracheobronchitis

A

Croup

49
Q

Treatment for croup

A

Steroid

50
Q

Drug treatment for TB in children?

A

2 mths- Isoniazid, Rifampicin,
Pyrazinamide
4 mths- Isoniazid, Rifampicin

51
Q

Recurrent laryngeal nerve palsy

A

Hoarse voice

52
Q

Pancoast tumour

A

Brachial plexus invasion

53
Q

Eaton lambert syndrome

A

Weakness that can develop from tumour (lung cancer)

Mimics myasthenia gravis, resolves when tumour is resected

54
Q

Treatment for laryngeal obstruction

A

Treat underlying cause eg foreign body removal, anaphylaxis
Mask bag ventilation with high flow O2
Cricothyroidotomy
Tracheostomy

55
Q

Treatment of anaphlyaxis

A 
IM Epinephrine (adrenaline)
IV antihistamine
IV corticosteroid
High flow O2
Nebulised bronchodilators
Endotracheal intubation if necessary
56
Q

Treatment for obstructive sleep apnoea

A

Remove underlying cause

CPAP

Respiratory (10 decks)

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