Cystic Fibrosis, TB, Bronchitis

Question 1

S+S of bronchitis

Answer 1

Cough with or without sputum

Resolves in 1-3 weeks

Question 2

Causes of bronchitis

Answer 2

Resp virus

Rarely bacteria - bordetella pertussis, mycoplasma pneumonia, chlamydia pneumonia

Question 3

Management of bronchitis

Answer 3

Supportive

Question 4

What are transudate pleural effusions caused by?

Answer 4

Imbalances in hydrostatic + oncotic pressures in the chest

Question 5

What causes exudative pleural effusions?

Answer 5

Infection
Malignancy 
Immunological responses 
Lymphatic abnormalities 
Noninfectious inflammation 
Trauma

Question 6

What are Lights criteria?

Answer 6

If 1 of 3 is present, fluid is exudate:
Pleural fluid protein
Pleural fluid LDH/ serum LDH ratio >0.6
Pleural fluid LDH >2/3 the upper limit of normal serum LDH

Question 7

What measurements can be done with pleural fluid?

Answer 7

Cholesterol 
Triglycerides 
Amylase
Creatinine 
pH

Question 8

What does pleural fluid cytology assess?

Answer 8

Malignancy

Question 9

Pathology of cystic fibrosis

Answer 9

Mutations in CFTR gene

Deranged chloride transport leads to thick, viscous secretions in lungs, liver, pancreas, intestine + reproductive tract

Question 10

Diagnosis of CF

Answer 10

Clinical + evidence of CFTR dysfunction (elevated sweat chloride, presence of 2 disease causing mutations, abnormal nasal potential difference)
Sweat chloride test is diagnostic

Question 11

What should be done following a positive sweat chloride test?

Answer 11

DNA analysis

Question 12

What pathogens are common in CF?

Answer 12

Staph aureus + pseudomonas aeruginosa

Question 13

Management of p. aeruginosa

Answer 13

Piperacillin-tazobactam 
Ceftazidime 
Imipenem-cilastatin 
Meropenem 
PLUS:
A fluoroquinolone

Question 14

What bacteria causes TB?

Answer 14

Mycobacterium tuberculosis

Question 15

What is active vs latent TB?

Answer 15

Active = symptomatic or progressive 
Latent = no clinically active TB

Question 16

RF for TB

Answer 16

Born in high prevalance areas
children
Immunosuppression

Question 17

S+S of TB

Answer 17

Weight loss, fever, night sweats, anorexia or malaise

Persistent productive cough, SOB, haemoptysis

Question 18

Investigations for ?TB + results of CXR

Answer 18

CXR + sputum sample + early morning urine, + biopsy

Shows upper lobe cavitation, pleural effusion + miliary appearance

Question 19

Management of TB

Answer 19

Rifampicin, isoniazid, pyrazinamide, ethambutol for 2 months
Rifampicin + isoniazid for 4 months

Question 20

SE of TB drugs

Answer 20

Hepato, neuro + opth toxicity

Question 21

S+S of CF

Answer 21

Nasal polyps 
Steatorrhea 
Infertility 
Osteoporosis 
Repeated pneumonia 
chronic sinusitis 
Bronchiectasis
Pancreatic insufficiency

Question 22

What is non classic CF?

Answer 22

Milder mutation that only causes impairment in 1 organ

Have some CFTR expression

Question 23

What happens to sperm in CF?

Answer 23

Obstructive azoospermia due to blocked vas deferens

Question 24

What is DIOS?

Answer 24

Distal infective obstruction syndrome
Unique to CF
Changes in gut lead to accumulation of mucus which form mucofaeculant impactions

Question 25

Management of DIOS

Answer 25

Surgical review 
1) Laxatives (lactulose + senna) 
2) Oral gastrograffin 
3) Klean-prep (surgical decompression 2nd line) 
Compliance with pancreatic enzymes 
Avoid opiates + loperamide

Question 26

Future of CF

Answer 26

Modulator therapy that targets mutations