Cough Flashcards
Acute ddx of cough
Dry
=> asthma, ACEi drugs, heart failure, URTI (laryngitis, pharyngitis)
Productive
=> pneumonia (LRTI), TB
Chronic ddx of cough
Dry
=> asthma, lung cancer, GORD, mesothelioma
Productive
=> COPD, bronchiectasis, lung cancer, cystic fibrosis
Sx and signs of pneumonia
Typical
- fever, SOB, cough w/ green sputum, chest pain (pleuritic), confusion
Atypical
- hepatitis, myalgia, diarrhoea, headache, dry cough
Signs
- bronchial breathing, increased vocal resonance, course bibasal crackles, dull auscultation, decreased chest expansion
Ix for pneumonia
Basic obs Sputumb MCS Pleural fluid MCS Bloods: ABG, CRP, FBC CXR: lobar/bronchpneumonia/consolidation/air bronchograms
Complications of a pneumonia
Sepsis Empyema Pneumothorax Lung abscess Pleural effusion
How may a lung abcess present?
Swinging fevers, persistent pneumonia, foul-smelling sputum
Often Staph. aureus
How do you assess whether a pneumonia needs to be admitted?
CURB-65 C onfusion < 8 AMTS U rea > 7 mmol/L R R > 30 B P < 90/60 mmHg > 65 age
1 = outpatient, 2 = short stay, 3+ = inpatient; ITU
Acute mx of a pneumonia
Oxygen, sit pt up
IV fluids
CPAP if required (type I resp failure)
Surgical drainage (if abscess/empyema)
Which Abx are used for CAP organisms?
Strep. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis
=> Amoxicillin
=> Co-amoxicalv if severe
Which organisms form cavitating lesions?
Klebsiella
Staph. aureus
Which Abx are used for HAP organisms?
Klebsiella, Staph. aureus, Pseudomonas aeruginosa
=> Staph: flucloxacillin + gentamycin (aminoglycoside)
=>MRSA: vancomycin (glycopeptide)
Which Abx are used for atypical organisms?
Mycoplasma pneumoniae, Legionella pneumophila, Chlamydia psittaci
=> clarithromycin (macrolide)
Which atypical organism does the following point towards?
a) Owns pet birds
b) Transverse myelitis O/E
c) Came back from a long holiday and is hyponatraemic
a) Chlamydia psittaci
b) Mycoplasma pneumoniae
c) Legionella pneumophila (AC in hotels)
Which Abx are used for aspiration pneumoniaes?
Anaerobes from gut flora include Strep. pneumoniae, Staph. aureus
=> Metronidazole (nitroimidazole)
Signs + sx of TB
Fever, lethargy, wt loss, night sweats, cough w/ green sputum, haemoptysis, lympahdenopathy dissemination of TB
Ix for TB
Basic obs
Bloods
- increased WCC, CRP, blood cultures, ABG
Sputum MCS x3 samples
- Ziehl-Neelsen stain to enable visualisation of acid-fast bacili
Lymph node biopsy
- caseating granuloma
Mantoux/tuberculin shin test (TST) + IGRA
- cannot distinguish between active + latent TB, requires intact immune system
CXR
What might a TB CXR show?
Consolidation (patchy/heterogenous) Bihilar lymphadenopathy Upper lobe scarring Cavitating lesions Pleural effusions If miliary => nodular shadowing
RFs of TB
Smoking, travel, South Asians/Indian/Bangladesh, immunocompromised (HIV pts)
Causes of bronchiectasis
Congenital
- cystic fibrosis
- primary ciliary dyskinesia (sinusitis, PCD, situs inversus)
- Young’s syndrome (bronchiectasis, sinusitis, infertility)
Acquired
- TB, measles, pneumonia
- pertussis, immunocompromised
- allergic bronchopulmonary aspergillus
Signs and sx of bronchiectasis
Bibasal crackles, clubbing
Haemoptysis, wt loss, fever, chest pain, chronic green cough and sputum, SOB