Disease Flashcards
What bacteria is the most common cause of community acquired pneumonia?
Streptococcus pneumoniae
What pathogens tend to cause hospital acquired pneumonia?
gram negative enterobacteria or staphylococcus aureus
What patients are most likely to get aspiration pneumonia?
Patients with stroke etc. or decreased consciousness (alcoholics etc.)
Describe the symptoms of pneumonia.
Fever, rigor, malaise, anorexia, dyspnoea, cough, purulent sputum, haemoptysis, pleuritic pain
What features might you see on a CXR in a patient with pneumonia?
Lobar or multilobar infiltrates, cavitation or pleural effusion.
What antibiotics should be given to treat mild community acquired pneumonia?
OR amoxicillin or clarithromycin or doxycycline.
What antibiotics should be given to treat severe community acquired pneumonia?
Co-amoxiclav IV or cephalosporin IV and clarithromycin IV.
Add flucloxacillin and/or rifampicin if staph suspected, vancomycin if MRSA suspected.
What antibiotics would be used to treat atypical pneumonia caused by legionella pneumophilia?
Fluoroquinone with clarithromycin or rifampicin
What time of pneumonia is acquired from infected birds?
Chlamydophila psittaci
What complications can occur with pneumonia?
Respiratory failure Hypotension AF Pleural effusion Empyema Lung abscess Septicaemia Pericarditis Jaundice
What are the characteristic features of interstitial lung disease?
Inflammation and/or fibrosis of the interstitium and the bronchovascular and septal tissues.
Describe the clinical features of interstitial lung disease.
Insidious onset of dyspnoea Cough Bilateral airway crackles Finger clubbing Exercise induced desaturation
Hypoxaemia and right sided heart failure can occur in advanced disease.
What sort of disease pattern would you expect to see in pulmonary function tests carried out on a patient with interstitial lung disease?
Restrictive (with reduced total lung capacity and functional residual capacity)
Which ethnicities are more likely to be affected by sarcoidosis?
Afro-carribeans
Describe the respiratory symptoms of sarcoidosis.
Dry cough, progressive dyspnoea, decreased exercise tolerance and chest pain.
How is acute sarcoidosis treated?
Bed rest and NSAIDs
What are some of the non pulmonary signs of sarcoidosis?
Lymphadenopathy, hepatomegaly, splenomegaly, uveitis, conjunctivitis, erythema nodosum
What is a pneumothorax?
A collection of air between visceral and parietal pleura causing a real pleural space.
Describe the pathogenesis of a secondary pneumothorax.
Associated with underlying respiratory diseases that damage the lung architecture , most commonly obstructive, fibrotic or infective, and occasionally inherited disorders such as Marfan’s or cystic fibrosis.
How does a tension pneumothorax occur?
Air accumulates in the pleural cavity faster than it can be removed. Increasing intrathoracic pressure results in mediastinal shift, compression of the functioning lung, inhibition of venous return and shock due to reduced CO.
What is the treatment of a secondary pneumothorax?
Chest drain
Describe the clinical features of asthma.
Episodic dry cough
Wheeze
Chest tightness
Dyspnoea
These are often worse at night or early in the morning.
What is asthma?
Asthma is a chronic inflammatory disorder, characterised by increased responsiveness of the bronchi to stimuli, manifested by widespread and variable airway narrowing that varies in severity.
What are the main characteristics of asthma?
Narrowing of airways
Airway hyper-responsiveness
Inflammation
Hypersecretion of mucous
What factors can precipitate an asthma attack or worsen symptoms?
Tobacco smoke Specific antigens Exhaust fumes Exercise Cold air
Extrinsic asthma is dependent on which antibody?
IgE
Which antigens are common causes of extrinsic asthma?
Proteins in the faecal pellets of dust mites Grass Tree pole Dander Fungal spores
What features are characteristic of the late phase response in asthma?
Bronchoconstriction
Airway inflammation
Oedema
Hyper-responsiveness
The immediate response to stimulus in extrinsic asthma is an example of which type of hypersensitivity reaction?
Type I
Describe the inflammatory process that occurs during the immediate response to stimulus in allergic asthma.
Antigen/IgE mediated mast cell degranulation and the release of histamine, prostaglandin and leukotrienes. This causes bronchoconstriction, increased mucous production and vascular leak.
What inflammatory cell type is present in large numbers in asthmatic bronchi?
Eosinophils
Which class of drugs should not be prescribed to asthmatics?
Beta blockers
What disease pattern is apparent on the spirometry of a patient with asthma?
Obstructive
What is the first drug used in the treatment of asthma?
SABA
Which two disease pathways are encompassed in a diagnosis of COPD?
Chronic bronchitis and emphysema
What is the cause of emphysema?
Progressive destruction of alveolar septa and capillaries, leading to the development of enlarged airways and airspaces, decreased elastic recoil and increased airway collapsibility.
How does pursed lip breathing help to limit distal airway collapse in patients with emphysema?
Causes increased pressure in the upper airways
How is COPD diagnosed?
Obstructive spirometry, which is irreversible with bronchodilator or steroid therapy.
How does pulmonary rehab help in the management of patients with COPD?
Strengthens respiratory muscles and improves quality of life and exercise tolerance, whilst reducing hospitalisations. It has no effect on lung function.
When does heart failure occur?
When the heart is no longer able to generate sufficient cardiac output to meet the demands of the body.
What causes diastolic heart failure?
Impaired filling, due to reduced ventricular compliance e.g hypertrophy, fibrosis
What name is given to heart failure as a result of chronic lung disease?
Cor pulmonale
What are the signs and symptoms of congestive heart failure?
Reduced exercise tolerance, pulmonary congestion resulting in dyspnoea, pulmonary oedema resulting in orthopnoea and PND, peripheral oedema, hepatomegaly, ascites and cardiac dilatation with gallop rhythm.
What are the systolic murmurs?
Aortic stenosis
Mitral regurgitation
(Pulmonary stenosis and tricuspid regurgitation)
What murmurs are diastolic?
Aortic regurgitation
Mitral stenosis
(Pulmonary regurgitation and tricuspid stenosis)
What congenital heart defect can result in aortic stenosis?
Congenital bicuspid valve
What triad of symptoms are often associated with aortic stenosis?
Angina
SOB
Syncope
Where is aortic stenosis best heard?
Second intercostal space on the right, radiating to the carotids
Do mechanical valves require anticoagulation?
Yes, bioprosthetic valves do not
What patients are given TAVI over conventional valve replacement?
Patients with lots of comorbidities
Patients who have has a previous sternotomy
Where does mitral regurgitation radiate to?
Axilla
What drugs may be used to treat mitral regurgitation?
Diuretics
ACE inhibitors
What are the risk factors for intermittent claudication?
Male Increasing age Diabetes Smoking Hypertension Hyperlipidaemia
What non-invasive investigations can be done on a patient with suspected intermittent claudication?
Measurement of ABPI
Duplex ultrasound scanning
Why is it important for patients with intermittent claudication to walk?
Helps to develop collateral circulation.
What are the symptoms of critical leg ischaemia?
Pain at rest in the toes and forefoot that is worse at night and relieved by walking around
Ulcers/gangrene
Describe ventricular rhythm in atrial fibrillation.
Irregularly irregular
Why is the ventricular rate less than the atrial rate in atrial fibrillation?
The AV node is unable to conduct all of the impulses.
What are the three forms of atrial fibrillation?
Paroxysmal
Persistent
Permanent
Describe permanent atrial fibrillation
Pharmacological and non-pharmacological methods are unable to restore sinus rhythm.
What signs and symptoms are associated with atrial fibrillation?
Palpitations Pre-syncope/syncope Chest pain Dyspnoea Sweatiness Fatigue
What drugs used in the treatment of AF control rate by slowing down AV node conduction?
Digoxin
Beta blockers
Verapamil
What treatment used in the treatment of AF can restore sinus rhythm?
Amiodarone
DC cardioversion
How can normal sinus rhythm be maintained in a patient suffering from AF?
Anti-arrhythmic drugs
Catheter ablation of atrial focus
Surgery
What features would you see on an ECG of someone with AF?
Absent P waves
F waves
Irregularly irregular rhythm
Normal QRS
How does transposition of the great arteries usually present in babies?
Cyanosis
What feature keeps babies with transposition of the great arteries alive? How does it do this?
Foramen ovale
Allows mixing of oxygenated and deoxygenated blood
Which duct must be kept patent in babies with a duct dependent circulation?
Ductus arteriosus
Babies who present with cardiac failure tend to have which sort of congenital heart defect?
VSD
What four elements make up Tetralogy of Fallot?
VSD
Pulmonary stenosis
Overriding aorta
RVH
What is the most common cause of peptic ulcers?
H. pylori
Describe H. pylori
Gram negative microaerophilic flagellated bacillus
When/how is H. pylori acquired?
During infancy via oral-oral/faecal-oral spread
Infection of which part of the stomach with H. pylori results in ulceration?
Antrum
Infection of which part of the stomach by H. pylori results in non-cardia gastric adenocarcinoma?
Body
How is H. pylori infection diagnosed?
Gastric biopsy for urease testing, histology and C and S
Urease breath test
Faecal antigen test
Serology
What is the treatment for peptic ulcers caused by H. pylori?
PPI, metronidazole and clarithromycin
What drugs should be withdrawn from treatment in someone with peptic ulcer disease?
NSAIDs
What drug can be injected to stop bleeding from a peptic ulcer?
Adrenaline
What is the most common type of cancer found in the mouth?
Squamous cell carcinoma
What are the warning signs of oral cancer?
Red/white/red and white lesion Ulcers that won't go away Numbness in the lip/face Unexplained pain in the mouth or neck Change in voice Dysphagia
What is Barret’s oesophagus?
Metaplastic change due to persistent reflux of acid or bile. Stratified squamous epithelium is replaced by columnar epithelium
What is the name given to benign oesophageal tumours?
Squamous papilloma
What type of malignant tumour is most likely to be situated in the upper third of the oesophagus?
Squamous cell carcinoma
What type of malignant tumour is most likely to be situated in the lower third of the oesophagus?
Adenocarcinoma
What type of oesophageal cancer is most common in caucasians?
Adenocarcinoma
How many biopsies should be taken at endoscopy of a suspected oesophageal cancer?
At least 6
What mode of inheritance is involved in cystic fibrosis?
Autosomal recessive
What gene is mutated in cystic fibrosis?
CFTR gene
What does the CFTR gene code for?
a cAMP regulated chloride channel
What happens as a result of mutation in the CFTR gene in cystic fibrosis?
Decreased chloride secretion and increased sodium absorption across airway epithelium. This results in mucous being a lot thicker, predisposing the lungs to chronic infection and bronchiectasis.
What is the most common cause of bronchiectasis?
Cystic fibrosis
What is bronchiectasis?
Chronic infection of the bronchi and bronchioles leading to permanent dilation of the airways due to destruction of the elastic and muscular components of their walls by chronic inflammation.
What are the risk factors for lung cancer?
Smoking
Passive smoking
Asbestos exposure
Radon
What paraneoplastic syndrome is caused by high levels of cortisol and can result in moon face?
Cushing’s syndrome
Which paraneoplastic syndrome effects nerve fibres causing muscle weakness?
Lambert Eaton syndrome
Invasion of which nerve by a lung cancer could result in hoarseness?
Recurrent laryngeal nerve due to vocal cord paralysis
Are malignant pleural effusions usually transudative or exudative?
Exudative
Where are the most common sites of metastases for lung cancer?
Liver Brain Bone Adrenal glands Skin Other parts of the lung
How do small cell carcinomas of the lung present?
Central mass with lymph node enlargement.
Usually metastatic disease had already occurred.
Which type of lung cancer is most common in non-smokers?
Adenocarcinoma
Where in the lung does adenocarcinoma present?
Peripheries
How does squamous cell carcinoma of the lung present?
Central mass with tumour visible in the airway.
What is the most common cause of mesothelioma?
Asbestos exposure
How are lung cancers diagnosed?
Cytology of sputum and pleural fluid CXR CT for staging Bronchoscopy Radionuclide bone scan if bony metastases suspected
What are the three factors described in Virchow’s triad?
Hypercoagulable state
Stasis
Endothelial injury
What colour are venous thrombi?
red
What is a DVT?
Formation of a thrombi within the lumen of vessels that make up the deep venous system.
What veins are affected by distal DVT?
Anterior tibial, posterior tibial
What veins are affected by proximal DVT?
Popliteal, femoral
What is an embolus?
A dislodged thrombus
How do large PEs present?
CV shock
low BP
central cyanosis
sudden death
Are patients who present with PE likely to be in type 1 or type 2 respiratory failure?
Type 1 (low PaO2 and SaO2)
What type of imaging is sensitive for small pulmonary emboli?
V/Q scan
What imaging can be used to give a view of the pulmonary artery filling defect caused by PE to pick up larger clots in proximal vessels?
CT pulmonary angiogram
What are the characteristics of post-thrombotic syndrome?
Pain Oedema Hyperpigmentation Eczema Varicose collateral veins Venous ulceration
What is chronic thromboembolic pulmonary hypertension?
Original embolic material is replaced by fibrous tissue that is incorporated into the intima and media of the pulmonary arteries. This may occlude the pulmonary artery leading to increased resistance and RHF.
What drugs are used in the treatment of VTE?
Antigoagulants (VKAs, LMWH, NOACs)
Thrombolysis
Analgesia
What antibiotic should be given to a patient with klebsiella pneumonia?
Cefotaxime or impenem
What antibiotics should be given in staphylococcal pneumonia?
Flucloxacillin and/or rifampicin
What antibiotics should be given to treat infection with chlamydophila pneumoniae?
doxycycline and clarithromycin
What pathogen is the most common cause of viral pneumonia?
Influenza
What antibiotics should be given to a patient with pneumonia cause by pneumocystis jiroveci?
co-trimoxazole or pentimidine IV
What organism causes pneumonia in immunosuppressed patients?
Pneumocystis jiroveci
What is bacteraemia?
Bacteria in the bloodstream
What colour do positive blood cultures turn?
orange/yellow
What colour do negative blood cultures turn?
blue/purple
What is infective endocarditis?
Infection of the endothelium of the heart valves
What factors predispose a patient to endocarditis?
Heart valve abnormality
PWID
Intravascular lines
Tooth brushing/recent trip to the dentist
What side of the hear is usually infected in endocarditis?
left
What four organisms commonly cause infective endocarditis?
Staph aureus
Enterococcus
Staph epidemidis
What gram negative organisms may cause endocarditis?
HACEK organisms (E. coli and pseudomonas tend to be hospital acquired in the elderly with lots of comorbidities)
What is the relevance of staph epidermidis found in a blood culture of a patient with suspected endocarditis?
May be a skin contaminant. However, can infect prosthetic material such as prosthetic heart valves and intravascular lines.
What are the clinical signs of infective endocarditis?
Fever New or changing heart murmur Finger clubbing Splinter haemorrhage Splenomegaly Roth spots Janeway lesions Osler nodes Microscopic haematuria
What group of organisms are normal oral commensals that can cause infective endocarditis following dental treatment?
Viridans group streptococci
What antibiotics are given to a patient with native valve endocarditis?
Amoxicillin and gentamicin IV
What antibiotics are given to patients with prosthetic valve endocarditis?
Vancomycin, gentamicin and rifampicin
What heart valve is most commonly affected by endocarditis in PWID? What is usually the causative organism?
Tricuspid
Staph aureus
What treatment is given for infective endocarditis caused by staph aureus?
Flucloxacillin IV
What antibiotics are given for infective endocarditis caused by strep viridans?
benzylpenicillin and gentamicin IV
What antibiotics are given for infective endocarditis caused by enterococcus?
amoxicillin/vancomycin and gentamicin IV
How long are antibiotics usually given for in infective endocarditis?
4-6 weeks
What are the acute coronary syndromes?
Unstable angina
NSTEMI
STEMI
When does ACS occur?
Myocardial ischaemia results from sudden decrease in blood flow through a coronary vessel.
How do patients with ACS usually present?
Central crushing chest pain
Pain may radiate to the jaw, neck, arms, back or neck.
Pain lasts longer than 30 mins
Pain not relieved by GTN spray
Associated symptoms: nausea, sweating, vomiting, dyspnoea, palpitations
How can unstable angina be differentiated from an MI?
No ST elevation on ECG
No raised troponins
What is unstable angina?
Coronary occlusion of insufficient duration to cause cardiac necrosis.
What is an NSTEMI?
Incomplete or temporary occlusion of a coronary vessel causing a degree of infarction and necrosis.
What is the management for an NSTEMI?
MONAC
STEMI results in what characteristic ECG change?
ST elevation
What is the gold standard intervention for patients with STEMI?
PCI
What is the initial management of a STEMI?
MONAC
What is the name given to the complication of MI resulting in pericarditis, pericardial effusion and fever?
Dressler’s syndrome
