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Respiratory finals > Infection, bronchiectasis + CF > Flashcards

Infection, bronchiectasis + CF Flashcards

1
Q

Describe the common pathogens causing pneumonia and their associations

A

CAPs:

  • Strep pneumonia
  • S aureus
  • Haemophilus influenzae
  • Viruses: influenzae, coronavirus
  • Klebsiella: alcoholics
  • Pseudomonas: bronchiectasis, COPD

Atypicals:

  • Mycoplasma pneumonia
  • Legionella pneumoniae: air-conditioners, water sources

HAPs:

  • Gram -ve enterobacter
  • S aureus

Immunocompromised:

  • PCP
  • TB
  • Fungi
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2
Q

Describe the presentation of pneumonia

A

Commonly:

  • Productive cough
  • Fever
  • CP, SOB
  • Severe: sepsis

Atypicals: dry cough, confusion, hepatitis, headache, flu-like symptoms etc

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3
Q

Describe the signs of pneumonia on examination

A

General: tachycardia, tachypnoea, generally unwell, pyrexial, sweaty, rigors
Chest:
-Dullness to percussion
-Crackles on auscultation

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4
Q

Describe the investigations for pneumonia

A

History + examination

  • ECG if CP
  • Urine sample (rapid Ag test), sputum sample (MCS)
  • Bloods: FBC, CRP, U+Es, consider LFTs/cultures as needed
  • CXR
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5
Q

Describe how the severity of pneumonia is assessed

A 
If 2+: severe pneumonia. Admit
CURB 65
Confusion
Urea >7
RR >30
BP low
Age >65
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6
Q

Describe the antibiotic management of pneumonia

A

CAP:

  • Mild (CURB65 0-1): amox 500mg TDS 5 days OR doxy/clari/erythro
  • Mod (CURB65 2): amox + clari (500mg BD)
  • Sever (CURB65 3+): coamox (500/125 PO or 1.2g IV) + clari

HAP:
-Co-amox 500/125 TDS 5 days

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7
Q

Name some complications of pneumonia

A 
Respiratory failure
Sepsis
Empyema
Bronchiectasis
Pleural effusion
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8
Q

Define type I and type II respiratory failure

A

Type I: PaO2 < 8 kPa

Type II: PaO2 < 8 kPa and PaCO2 >6.5 kPa

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9
Q

Describe the aetiology of respiratory failure

A

V/Q mismatch:

  • Vascular causes: PE, PHTN
  • Pneumothorax
  • Atelectasis

Alveolar hypoventilation:

  • Obstructive causes: asthma, COPD, bronchiectasis
  • Restrictive causes: ILDs, CNS sedation, neuromuscular disease (GBS, MG), fluid
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10
Q

Describe the management of respiratory failure

A

Treat cause
Type I: high flow O2 to keep sats 94-98%, consider ventilation
Type II: Venturi mask 24% O2 to keep sats 88-92%, consider NIV

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11
Q

Describe the ways of administering oxygen therapy and when they are used

A

Nasal cannulae: 2-6L/min, 24-40% FiO2 (very variable FiO2 achieved). Most pts needing O2 who are not critically unwell
Face mask: alternative to nasal cannulae, not as well tolerated.
Venturi mask: 2-4L/min, very specific FiO2 achieved- 24-60% FiO2 (usually start with blue, 24%). For pts with chronic hypercapnia
Non-rebreathing mask: 15L/min, 60-80% FiO2. For critically ill pts

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12
Q

Define bronchiectasis

A

Bronchiectasis is permanent dilatation of the bronchi due to destruction of the elastic and muscular components of the bronchial wall

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13
Q

Describe the aetiology of bronchiectasis

A
  1. Typically due to severe/recurrent infections
  2. Congenital disorders: CF, Kartagener’s/PCD
  3. Immunodeficiency: HIV, SCIDs, etc
  4. Connective tissue disease
  5. COPD and asthma
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14
Q

Describe the pathophysiology of bronchiectasis

A

Inflammation -> destruction of bronchial wall components -> dilatation and predisposition to infection -> recurrent infections etc

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15
Q

Describe the presentation of bronchiectasis

A

Typically:

  • Persistent productive cough
  • Recurrent chest infections
  • Progressive SOB
  • Fatigue
  • Haemoptysis
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16
Q

Describe the signs of bronchiectasis on examination

A

General: may have weight loss
Hands: clubbing
Chest: widespread coarse crackles, rhonchi, wheeze

17
Q

Describe the investigations for bronchiectasis

A
  • History and exam suggestive
  • Sputum sample (MCS)
  • Bloods (exacerbation): FBC, CRP, U+Es
  • CXR (if suspecting acute infection- not for Dx)
  • HRCT (diagnostic!!!): dilatation, signet ring sign, tram lines
  • Spirometry

To investigate cause:

  • Chloride sweat test
  • Serum a1 antitrypsin
  • Ig levels
  • HIV serology
  • RF and antibody screen
18
Q

Describe the management of bronchiectasis

A

Conservative:

  • Chest physio
  • Vaccinations
  • Smoking cessation

Medical:

  • Maintenance: mucolytics, nebulised hyperosmolar solutions (hypertonic saline), prophylactic antibiotics (may have emergency pack at home)
  • Acute exacerbations: antibiotics

Surgical:
-For complications eg. pneumothoraces

19
Q

Describe the complications of bronchiectasis

A 
Pneumonia
Pleural effusions
Pneumothorax
Pulmonary HTN and RHF
Massive haemoptysis
20
Q

Describe the epidemiology of CF

A

One of the commonest genetic conditions

Common among white people

21
Q

Describe the pathophysiology of CF

A

Defects in the CFTR gene encoding a transmembrane chloride channel -> impaired absorption of electrolytes + water -> thick mucous in exocrine glands

22
Q

Describe the presentation of CF

A

May be detected:

1) Antenatally
2) At birth on Guthrie spot test
3) With cough, failure to thrive in childhood
4) Later in life with recurrent infections, bronchiectasis, etc

23
Q

Describe the signs of CF on examination

A

General: thin/malnourished, pale
Hands: clubbing
Chest: hyperinflation, signs of infection (coarse crackles), bronchiectasis (rhonchi, crackles)

24
Q

Describe the investigations for CF

A

Diagnosis:

  • Guthrie spot: immune reactive trypsinogen
  • Chloride sweat test to confirm/later life Dx
  • Genetic mutation testing
  • Faecal elastase for pancreatic insufficiency

Investigations if general presentation (eg. infection):

  • Sputum sample
  • Bloods: FBC, CRP, U+Es
  • CXR
25
Q

Describe the management of CF

A 
MDT approach at specialist centre
Conservative:
-Chest physio 
-Dietician 
-No smoking, vaccinations
-Psych

Medical:

  • Mucolytics
  • Antibiotic prophylaxis/acute ABx treatment
  • Pancreatic enzymes (Creon)
  • CFTR modulators eg. ivacaftor
26
Q

Describe the complications of CF

A

Respiratory:

  • Infective exacerbations, pneumonia
  • Respiratory failure
  • Bronchiectasis
  • Cor pulmonale

GI-related

  • Malnutrition
  • Intestinal obstruction
  • DM
27
Q

Describe the epidemiology of aspergillus lung disease

A

Aspergillus is ubiquitous in the environment, found all over the world
IA only really affects immunocompromised hosts eg.
-SC and SO transplant patients
-Haem malignancies
-Respiratory disease
-HIV

28
Q

Describe the types of aspergillus lung disease

A

Pathogens: Aspergillus fumigatus + flavus most common
Types:
-Invasive aspergillosis: fever + cough + CP, may disseminate to other organs
-Allergic bronchopulmonary aspergillosis (ABPA): hypersensitivity rxn in asthmatics + CF
-Aspergilloma: fills existing lung cavity eg. post-TB

29
Q

Describe the presentation of ABPA

A
  • Affects asthmatic + CF

- Worsening symptoms: cough, SOB, wheeze, fever, mucous plugs

30
Q

Describe the investigations for invasive aspergillosis

A
  • History and exam suggestive: immunocompromised host + nonspecific symptoms (fever, cough, CP)
  • Sputum sample
  • Bloods: FBC, CRP, U+Es, beta-D-glucan, galactomannan
  • CXR
  • HRCT (nodules, halo sign, air-crescent sign)
  • Bronchoalveolar lavage
31
Q

Describe the management of invasive aspergillosis

A
  1. Treat fungal infection:
    - Ambisome, caspofungin, etc
  2. Reverse immunodeficiency:
    - Where possible
    - G-CSF may help neutropenia
32
Q

Describe the investigations for ABPA

A
  • History and exam
  • Sputum sample
  • Bloods: FBC, CRP, U+Es, serology
  • CXR
  • HRCT
  • Skin testing
33
Q

Describe the management of ABPA

A
  • High dose pred for 1-2 weeks then taper

- Treat asthma/CF

Respiratory finals (5 decks)

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