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Block 31 CardioResp > CT 12 Pneumonia, TB, Bronchiectasis + CF > Flashcards

CT 12 Pneumonia, TB, Bronchiectasis + CF Flashcards

1
Q

Classifications of pneumonia

A
  • CAP
  • HAP
  • VAP (ventilator acquired pneumonia)
  • aspiration pneumonia
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2
Q

presentation of pneumonia

A

cough
sputum
SOB
fever
haemoptysis
pleuritic chest pain
delirium in elderly

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3
Q

Features of sepsis secondary to pneumonia

A

tachypnoea
tachycardia
hypoxia
hypotension
fever
confusion

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4
Q

what scoring system is used for pneumonia

A

CURB 65

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5
Q

What are the parameters of curb65

A

confusion
urea >7mmol
RR > 30
BP <90/60

age >65

predicts mortality

score of 0-1 = treat at home..
>2 - consider hospital admission
>3 = consider intensive care

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6
Q

most common causative agents of pneumonia

A

strep pneumoniae (gr+ve sensitive to penicillin)

haemophilus influenzae (gr-ve sensitive to amoxicillin) (COPD patients)

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7
Q

Moraxella causes pneumonia in which patients

A

immunocompromised patients

or COPD

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8
Q

Pseudomonas causes pneumonia in patients with what

A

CF
or bronchiectasis

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9
Q

staph aureus causes pneumonia in which patients

A

CF
also occurs in patients post-influenza virus

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10
Q

5 causative agents of atypical pneumonia (legions of psittaci MCQs)

A

legionella

psittaci

Mycoplasma (no cell wall)

chlamydophila pneumoniae

Qs - Q fever = coxiella burnetii

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11
Q

Legionella

A

typically caused by inhaling infected water from infected water systems, such as air conditioning units. It can cause a syndrome of inappropriate ADH (SIADH), resulting in hyponatraemia (low sodium). The typical exam patient has recently had a cheap hotel holiday and presents with pneumonia symptoms and hyponatraemia. A urine antigen test can be used as an initial screening test.

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12
Q

what electrolyte abnormality does legionalla pneumonia cause

A

hyponatremia secondary to SIADH

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13
Q

mycoplasma

A

milder pneumonia and a rash called erythema multiforme, characterised by varying-sized “target lesions” formed by pink rings with pale centres. It can cause neurological symptoms in young patients.

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14
Q

Coxiella

A

linked to exposure to the bodily fluids of animals. The typical exam patient is a farmer with a flu-like illness.

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15
Q

chlamydia psittaci

A

contracted from contact with infected birds

eg parrot owner

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16
Q

pneumocystis jirovecii occurs in which patients

A

fungal pneumonia in immunocompromised patients
eg
poorly controlled HIV and low CD4 count

presents with dry cough, SOB on exertion and night sweats

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17
Q

Treatment for PCP

A

Co trim
also given prophylactically

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18
Q

what drugs are used to treat atypical pneumonias

A
  • macrolides
  • fluoroquinolones
  • tetracyclines
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19
Q

Investigations for pneumonia

A

-Chest x-ray
-Full blood count (raised white cell
count)
-Renal profile (urea level for the —-
CURB-65 score and acute kidney
injury)
- C-reactive protein (raised in
inflammation and infection)

Sputum cultures
Blood cultures
Pneumococcal and Legionella urinary antigen tests

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20
Q

treatment of mild CAP

A

refer to local area guidelines

Amoxicillin
Doxycycline
Clarithromycin

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21
Q

complications of pneumonia

A
  • sepsis
  • ARDS
  • pleural effusion
  • empyema
  • lung abscess
  • death
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22
Q

examination findings in pneumonia

A
  • bronchial breath sounds
    -coarse crackles
  • dull to percussion due to consolidation
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23
Q

Most common causes of CAP

A
  • strep pneumoniae
  • H influenzae
  • moraxella
  • staph aureus
24
Q

most common causes of HAP

A
  • Pseudomonas (gr-ve rod, sensitive to piptaz)
  • MRSA (gr+ve) sensitive to vancomycin +linezolid
  • Klebsiella (gr-ve rod)
  • escherichia coli (gr-ve rod)
25
facts about mycobacterium tuberculosis
- gram positve acid fast bacilli (requires ziehl-neelsen stain) -mycolic acid present Is an intracellular pathogen infects macrophages Mycobacterium tuberculosis M. Bovis M. Africanum
26
how is TB spread
inhaling saliva droplets from infected people
27
disease course of TB
- immediate clearance of bacteria - primary active infection - latent TB ( bacteria is present but there are no symptoms) - secondary TB (reactivation of latent TB to active infection) -milliary TB (when cannot be controlled and TB disseminates from the lungs to other parts of body leading to extrapulmonary TB)
28
risk factors for developing TB
Close contact with active tuberculosis (e.g., a household member) Immigrants from areas with high tuberculosis prevalence ( central+ southern africa, south asia) People with relatives or close contacts from countries with a high rate of TB Immunocompromised (e.g., HIV or immunosuppressant medications) Malnutrition, homelessness, drug users, smokers and alcoholics
29
BCG vaccine - what type
live attenuated (weakened) not routinely given - only for those at high risk
30
mantoux test
tuberculin is injected into upper dermal layer and response is measured
31
symptoms of Tb
Cough Haemoptysis (coughing up blood) Lethargy Fever or night sweats Weight loss Lymphadenopathy Erythema nodosum (tender, red nodules on the shins caused by inflammation of the subcutaneous fat) Spinal pain in spinal tuberculosis (also known as Pott’s disease of the spine)
32
investigations for TB
- ziehl-neelsen stain - mantoux test (read after 72 hours) - interferon gamma release assay mixing a blood sample with antigens from the M. tuberculosis bacteria. After previous contact with M. tuberculosis, white blood cells become sensitised to the bacteria antigens and will release interferon-gamma on further contact. A positive result is when interferon-gamma is released during the test. - CXR (may show patchy consolidation, pleural effusions and hilar lymphadenopathy) cavitation in upper zones - PCR -sputum cultures or special mycobacterium blood cultures
33
what is the treatment for TB
RIPE rifampicin for 6 months Isoniazid for 6 months Pyrazinamide for 2 months Ethambutol for 2 months
34
which TB drug causes peripheral neuropathy and how is this prevented
isoniazid are prescribed pyridoxine B6 also hepatotoxic
35
SE associated with rifampicin
- orange/red discolouration of urine and tears - CYP450 inducer - hepatotoxic
36
SE associated with pyrazinamide
- hyperuricaemia so exacerbates gout and increases risk of renal stones - hepatotoxic
37
SE associated with ethambutol
vision loss or blurred color blindness
38
what is bronchiectasis
permanent dilation of the bronchi sputum collects and organisms grow resulting in a chronic cough, continuous sputum production and recurrent infections it is caused by damage to the airways
39
causes of bronchiectasis
idiopathic severe pneumonia pertussis TB Alpha 1 antitrypsin deficiency CF yellow nail syndrome primary ciliary dysfunction/kartegener's syndrome = anything that causes chronic inflammation and subsequent damage to the airways
40
what 3 conditions make up yellow nail syndrome
- yellow nails - lymphoedema - bronchiectasis
41
symptoms of bronchiectasis
- SOB - chronic productive cough - recurrent chest infections - weight loss
42
signs of bronchiectasis
Sputum pot by the bedside Oxygen therapy (if needed) Weight loss (cachexia) Finger clubbing Signs of cor pulmonale (e.g., raised JVP and peripheral oedema) Scattered crackles throughout the chest that change or clear with coughing Scattered wheezes and squeaks
43
Investigations for bronchiectasis
Sputum culture - most common organisms are H. influenzae and pseudomonas -CXR - high resolution CT is test of choice
44
how is bronchiectasis managed
- vaccines - resp physio - long term antibiotics - inhaled colistin for pseudomonas colonisation (for exacerbation cipro is choice of antibiotics) - LABA's for SOB - LTO - surgical lung resection - lung transplant
45
what are the key consequences of CF
Thick bile duct and pancreatic secretions Thick airway secretions Congenital bilateral absence of the vas deferens (males)
46
what are complications of CF
- liver disease - pancreatic insufficiency - pancreatitis - diabetes -infertility due to absence of vas deferens (surgical sperm retrieval is an option + then IVF)
47
what is the first sign of CF
meconium ileus not passing a stool within 24 hrs of birth, abdominal distension and vomiting
48
children with CF present with
Chronic cough Thick sputum production Recurrent respiratory tract infections Loose, greasy stools (steatorrhoea) due to a lack of fat-digesting lipase enzymes Abdominal pain and bloating Poor weight gain Reduced height sweat is salty
49
3 causes of clubbing in children
- CF - IBD - cyanotic heart disease
50
diagnosis + investigations
- CF is screened at birth with the newborn bloodspot test - sweat test (pilocarpine applied to skin, electrodes applied, sweating induced and then chloride levels are measured. higher in CF due to impaired CFTR genetic testing for CFTR gene
51
pseudomonas colonisation in CF may be treated with
oral cipro
52
management of CF
- IVACAFTOR (CFTR MODULATOR THERAPIES) - chest physio - CREON - prophylactic flucox to reduce risk of staph aureus colonisation - LT azithromycin for recurrent infections - bronchodilators - nebs hypertonic saline to make secretions less viscoud
53
Other end stage managements for CF
Home oxygen (if necessary) Insulin for cystic fibrosis diabetes Lung transplantation in end-stage respiratory failure Liver transplant in end-stage liver failure Fertility treatment involving testicular sperm extraction for infertile males Genetic counselling
54
approaches to preventing spread of TB
1) Early Diagnosis & Treatment Active case finding (screening high-risk groups) Rapid diagnosis (AFB smear, GeneXpert, culture) Directly Observed Therapy (DOT) to ensure treatment adherence 2) Infection Control in Healthcare & Community Settings Isolation of infectious TB patients (negative-pressure rooms) Use of N95 respirators for healthcare workers Improving ventilation and reducing overcrowding 3) Vaccination (BCG Vaccine) Routine neonatal vaccination in high-prevalence areas Targeted vaccination for high-risk individuals 4) Contact Tracing & Latent TB Treatment Screening close contacts of TB patients Treating latent TB with isoniazid or rifampicin 5) Addressing Drug-Resistant TB (MDR-TB & XDR-TB) Ensuring full treatment adherence to prevent resistance Using second-line drugs (e.g., fluoroquinolones, bedaquiline) 6 ) Public Health Education & Global Strategies Community awareness campaigns to reduce stigma Promoting early healthcare-seeking behavior WHO End TB Strategy (goal: 90% reduction in TB deaths by 2035)
55
what are respiratory causes of clubbing
- lung cancer (NSCC) - Bronchiectasis - PF - sarcoidosis - asbestosis - chronic TB - CF
56

Block 31 CardioResp (12 decks)

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