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MedEd Flashcards

1
Q

a 59y/o female with a 30 pack year history presents with progressive SOB and a productive cough. O/E you hear an audible wheeze

a pulmonary oedema
b asthma
c pneumonia
d idiopathic pulmonary fibrosis
e COPD
A

COPD

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2
Q

a 27y/o female of afrocaribbean origin presents with SOB that has come on over the last few months. she says it is increasingly difficult to complete her morning runs. O/E you noticed tender, erythematous nodules on both of her shins

a asthma
b sarcoidosis
c pneumonia
d idiopathic pulmonary fibrosis
e pulmonary embolism
A

sarcoidosis

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3
Q

a gentleman presents with acute breathlessness. O/E his RR is 25bpm with good air entry in all fields. His ECG shows RAD.

a pneumothorax
b pulmonary oedema
c pneumonia
d pleural effusion
e pulmonary embolism
A

pulmonary embolism

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4
Q

a 62y/o male presents with an 8 month history of exertional dyspnoea & a non-productive cough

a sarcodosis
b bronchogenic carcinoma
c pulmonary oedema
d idiopathic pulmonary fibrosis
e COPD
A

idiopathic pulmonary fibrosis

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5
Q

a 70y/o woman presents with fevers, SOB, right sided pleuritic chest pain. o/e the right side of her chest shows reduced expansion & dull percussion

a pneumothorax
b bronchogenic carcinoma
c pneumonia
d pleural effusion
e pulmonary oedema
A

pneumonia

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6
Q

what is COPD

A

chronic obstructive pulmonary disorder

a progressive disorder of lower respiratory tract characterized by airway obstruction with little or no reversibility

1 chronic bronchitis
-cough & sputum production on most days for 3 months over 2 consecutive years
2 emphysema
-enlarge air space`s distal to terminal bronchioles
-destruction of alveolar walls

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7
Q

what is the difference between asthma & COPD in terms of reversibility

A

asthma is reversible

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8
Q

how would COPD be classified

A 
1 mild
-FEV1/FVC <70%
-FEV1 (% predicted) >80%
2 moderate
-FEV1/FVC <70%
-FEV1 (% predicted) 50-80%
3 severe
-FEV1/FVC <70%
-FEV1 (% predicted) 30-49%
4 life threatening
-FEV1/FVC <70%
-FEV1 (% predicted) <30%
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9
Q

aetiology of COPD

A 
1 smoking (90%)
2 occupational exposure
3 alpha-1 antitrypsin deficiency
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10
Q

what is A1AT

A

alpha-1 antitrypsin deficiency
autosomal recessive disorder
A1AT normally inhibits neutrophil elastase (a protease), a deficiency means raised levels of neutrophil elastase and increased breakdown of elastin in alveoli

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11
Q

what is the pathophysiology of COPD in terms of chronic bronchitis & emphysema

A

1 chronic bronchitis
-inflammation of bronchi
-scarring & thickening of walls
-increased mucus production
-small airway narrowing
2 emphysema
-proteases breakdown connective tissue of alveolar walls & septae
-loss of lung recoil due to breakdown of elastin
-limited expiratory flow & air trapping

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12
Q

why do COPD patients have a hyperinflated chest

A

due to emphysema (loss of lung recoil causing limited expiratory flow & air trapping) there is an increased total lung capacity

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13
Q

symptoms of COPD

A

productive cough
wheeze
SOB

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14
Q

symptoms of infective exacerbation of COPD

A

worsening SOB

increased sputum/change in sputum colour

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15
Q

signs of COPD

A

polyphonic wheeze

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16
Q

signs of severe COPD

A

tachypnoeic
prolonged expiratory phase (to blow off CO2)
accessory muscle use
pursing of lips on expiration ( to blow off CO2)
hyperinflation & hyper-resonance
signs of hypercapnia

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17
Q

what are the signs of hypercapnia

A

vasodilation
bounding pulse
asterixis

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18
Q

def of sarcoidosis

A

multisystem granulomatous disorder of unknown cause

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19
Q

epi of sarcoidosis

A

more common in african americans
more common in women
20-40yrs

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20
Q

clinical findings of sarcoidosis

A 
1 CXR
-bilateral hilar lymphadenopathy 
2 systemic
-fever
3 pulmonary
-dry cough
-progressive SOB
-reduced exercise tolerance
4 extra-pulmonary
-erythema nodosum (legs)
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21
Q

investigations in suspected sarcoidosis

A

1 Lung function tests
-restrictive (FEV1/FVC is 80-85%)
2 CXR
-bilateral hilar lymphadenopathy
3 decreased CO diffusion capacity test (DLCO)
4 bronchoscopy & biopsy
-non-caseating granulomas (bacteria -ve) is diagnostic

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22
Q

what is the diagnostic investigations for sarcoidosis

A

bronchoscopy & biopsy

-non-caseating granulomas (bacteria -ve)

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23
Q

management of sarcoidosis

A

NSAIDs for flare ups

corticosteroids for severe sarcoidosis of extrapulmonary disease

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24
Q

def of PE

A

sudden occlusion in pulmonary artery or one of its branches

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25
Q

aetiology/pathophysiology of PE

A

thrombi from deep venous system

often DVT from lower extremities moves to the lung and occludes a PA

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26
Q

symptoms of PE

A

ACUTE ONSET

  • SOB
  • pleuritic chest pain
  • haemoptysis if large PE
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27
Q

signs of PE

A 
tachycardia &amp; tachypnoea
fever
lower limb swelling/oedema
cyanosis
accentuated S2, S3/S4 gallop
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28
Q

investigations & management of PE

A

NICE GUIDELINES
Two-level Wells score
1 Wells score >4 - PE likely - admit & immediate CTPA
2 Wells score 4 or less - PE unlikely - D-dimer - if positive - admit & CTPA

CONFIRMED PE
1 haemodynamically stable - anticoagulate - LMWH for at least 5 days until INR >2 for at least 24h
2 haemodynamically unstable - thrombolytic therapy or embolectomy

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29
Q

what is the treatment if immediate CTPA is not possible

A

LMWH/fondaparinux

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30
Q

what ECG signs could be found in PE

A

sinus tachycardia
RAD
T wave inversion in leads V1-3
p pulmonale

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31
Q

what is p pulmonale

A

tall, narrow, peaked P waves in leads II, III & aVF
often a prominent P wave in V1
cor pulmonale

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32
Q

def of IPF

A

a chronic progessive fibrosing interstitial lung disease of unknown cause

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33
Q

epi of IPF

A

elderly

M>F

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34
Q

symptoms of IPF

A

dry cough
progressive exertional dyspnoea
weight loss
arthralgia (joint pain)

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35
Q

signs of IPF

A

cyanosis
digital clubbing
fine end inspiratory crepitations (like walking on snow)

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36
Q

investigations of IPF

A 
1 lung function tests
-FEV1:FVC normal-high - restrictive
2 bloods
-raised CRP &amp; ESR
-ABG (hypoxia)
3 bronchoscopy &amp; biopsy
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37
Q

what is the diagnostic investigation for IPF

A

bronchoscopy & biopsy

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38
Q

treatment for IPF

A 
supportive
-O2
-pulmonary rehab
-palliation
medical
-prednisolone or immunosuppressants 
-antifibrotics
-lung transplant
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39
Q

name an antifibrotics

A

pirfenidone

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40
Q

prognosis of IPF

A

50% 5yr survival rate

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41
Q

symptoms of pneumonia

A 
productive cough
SOB
fever
chest pain
confusion in elderly
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42
Q

signs of pneumonia

A

tachypnoea & tachycardia
reduced expansion
dull percussion
coarse crackles

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43
Q

an elderly gentleman presents with SOB, productive cough of pink frothy sputum. o/e he is tachycardic, has bibasal end-inspiratory crackles, a raised JVP
what is the diagnosis

A

pulmonary oedema caused by HF

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44
Q

21y/o male has a productive cough, wheeze, steatorrhoea. o/e he is clubbed & cyanosed & has bilateral course crackles, blood glucose level is measured at 11mmol/l

a lung cancer
b CF
c Goodpasture's disease
d Pneumonia
e TB
A

CF

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45
Q

a middle aged man comes to a&e with cough, haemoptysis & fever. he doesnt have a permanent home & you notice his clothes look very loose on him

a sarcoidosis
b COPD
c lung cancer
d pneumonia
e TB
A

TB

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46
Q

a 16y/o girl comes to the GP with an irritating cough. she says it bothers her at night and when she wakes up in the morning

a asthma
b CF
c Goodpasture's disease
d pneumonia
e post-nasal drip
A

asthma

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47
Q

what is CF

A

autosomal recessive
mutation in CF transmembrane conductance regulator gene (CTFR) which leads to an inability to secrete chloride & hydrate secretions

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48
Q

where does CF affect and what is the consequence

A 
1 lungs
-recurrent infections leading to bronchiectasis
2 pancreas
-malabsorption
-diabetes
3 liver
-cirrhosis
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49
Q

clinical features of CF

A 
1 failure to thrive in children
2 respiratory
-bilateral coarse crackles
-cough
-cyanosis
-clubbing
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50
Q

aetiology of TB

A

mycobacterium TB

high risk in homeless or overcrowding

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51
Q

pathophysiology of TB

A

immune response leads to caseating granulomas

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52
Q

what is a granuloma

A

focal collection of inflammatory cells at sites of tissue infection

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53
Q

what does caseation mean

A

necrotic regions

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54
Q

symptoms in TB

A

productive cough
weight loss
fevers & night sweats

haemoptysis may be present

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55
Q

investigations in TB

A 
1 CXR
-consolidation +/- cavitation (usually in upper zones)
-lyphadenopathy
2 sputum
-stain Ziehl-Neelson - acid-fast bacilli
-culture Lowenstein-jenson
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56
Q

investigations for latent TB

A

tuberculin skin test

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57
Q

why does TB commonly colonise in the upper zones

A

most oxygen in the upper zones

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58
Q

what does cavitation on a CXR mean

A

formation of an empty space

will appear darkened

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59
Q

management of TB

A

6 months for pulmonary TB
1 rifampycin, isoniazid, pyraminazide, ethambutol for the first 8 weeks
2 rifampycin & isoniozid for a further 16 weeks
3 pyridoxine throughout

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60
Q

why must pyridoxine be given in management of TB

A

to prevent isoniazid causing peripheral neuropathy

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61
Q

definition of asthma

A

chronic inflammatory condition of lung airways

reversible

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62
Q

epi of asthma

A

commonly young onset

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63
Q

aetiology of asthma

A 
combination of genetic &amp; environmental factors
1 genetic: atopy
-asthma
-eczema
-hayfever
2 environmental: allergens
-house dust-mites
-pets
-fungal spores
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64
Q

pathophysiology of asthma

A

bronchial muscle contraction, mucosal inflammation, increased mucus leads to airway narrowing

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65
Q

symptoms of asthma

A

recurrent, intermittant episodes of:

  • cough
  • wheeze
  • SOB (worse at night and in the morning, precipitated by cold air, exercise)
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66
Q

what drugs make asthma worse

A

NSAIDs

Beta blockers

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67
Q

signs of asthma

A 
tachypnoea
audible wheeze
hyperinflation
hyper-resonant percussion
polyphonic wheeze
reduced air entry
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68
Q

the following are more likely to be associated with COPD or asthma

1 smoker or ex-smoker
2 symptoms <35
3 chronic productive cough
4 SOB
5 night time waking with SOB
6 significant diurnal or day-to-day variation of symptoms
A 
1 COPD
2 asthma
3 COPD
4 persistant &amp; progressive in COPD, variable in asthma
5 asthma
6 asthma
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69
Q

what is goodpasture’s disease

A

diffuse pulmonary haemorrhage & rapidly progressive glomerulonephritis
anti-GBM positive
SOB, cough, haemoptysis, oedema, HTN

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70
Q

what are the three most common causes of chronic cough in a non-smoker

A

1 asthma
2 post-nasal drip (mucus irritates cough receptors)
3 GORD (reflex irritates cough receptors)

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71
Q

a 20y/o male comes to GP complaining of coughing & wheezing at night. you suspect asthma
what is your first step

a inhaled salbutamol
b oral prednisolone
c inhaled beclomethasone
d inhaled salmeterol
e nebulised salbutamol
A

inhaled salbutamol

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72
Q

a 20y/o male comes to GP complaining of coughing & wheezing at night. you suspect asthma
you prescribe inhaled salbutamol
you send him home with a PEFR monitor. However a few weeks later he is using the inhaler more often and his numbers are getting worse. What treatment is most appropriate to add ?

a inhaled salbutamol
b oral prednisolone
c inhaled beclomethasone
d inhaled salmeterol
e nebulised salbutamol
A

inhaled beclomethazone

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73
Q

a 20y/o male comes to GP complaining of coughing & wheezing at night. you suspect asthma
you prescribe
you send him home with a PEFR monitor. However a few weeks later he is using the inhaler more often and his numbers are getting worse.
you prescribe inhaled beclomethazone
Despite new treatment, he comes back 2 months later still coughing at night. What treatment could you add next?

a inhaled salmeterol
b oral prednisolone
c inhaled beclomethasone
d increase inhaled steroid dose
e nebulised salbutamol
A

inhaled salmeterol

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74
Q

what are the guidelines on asthma management

A 
1 SABA PRN
2 SABA + inhaled corticosteroid
3 SABA + inhaled corticosteroid + LABA
-inadequate/no response to LABA increase steroid
-if still inadequate LRA or theophylline
4 increase steroid, LRA or theophylline
5 oral steroid
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75
Q

what does LRA stand for

A

leukotriene receptor antagonist

montelukast

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76
Q

you suspect your patient has COPD. what is the most important diagnostic tool

a peak flow
b CT scan
c spirometry
d pulse oximetry
e CXR
A

spirometry

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77
Q

You are a GP…

1) You have diagnosed Mr Barker with COPD. What is the first therapy you start? (2 correct options)
2) 2 months later, he remains breathless, what could you try? (2 options)
3) Several years later, despite aggressive treatment his COPD is uncontrolled. The expert respiratory doctor decides he needs to start a drug and asks you to monitor the blood levels. What is it? (Bonus question, answer not to the right)

A) Long acting B2 agonist
B) Inhaled corticosteroid,
C) Short acting B2 agonist 
D) Short acting muscarinic antagonist
E) Long acting muscarinic antagonist
F) Long acting B2 agonist with inhaled corticosteroid
A 
1
-Short acting B2 agonist 
-Short acting muscarinic antagonist
2
-Long acting B2 agonist &amp; Inhaled corticosteroids
OR
-Long acting muscarinic antagonist
3
-theophylline
78
Q

what is the step-wise management of COPD

A 
1 short acting bronchodilator
-SABA
-SAMA
2 if SOB persists
-LABA+ ICS
OR
-LAMA
3 if SOB persists
-LABA + ICS
OR
-LABA + LAMA
4 if SOB persists
-LABA + LAMA + ICS
5 if SOB persists
-consider nubuliser
consider theophylline
79
Q

what are the indications for long term oxygen therapy

A

1 PaO2 <7.3kPa

2 PaO2 7.3-8.0kPa plus peripheral oedema

80
Q

why does respiratory depression occur in COPD

A

COPD patients have chronically raised CO2 levels caused by CO2 retention
hypercapnia is usually what drives breathing in normal adults
with chronically raised CO2, there is a switch to a hypoxic drive to breath
if oxygen is given and O2 levels rise to quickly, the body’s drive to breath is lost causing respiratory depression

81
Q

a 45y/o male presents with a fever + SOB associated with confusion. O/E there is decreased expansion on the left side + the patient has a RR of 35/min

a UTI
b pneumonia
c PE
d pneumothorax
e pleural effusion
A

pneumonia

82
Q

A 25 year old man has a 3 day history of shivering, general malaise and a cough productive of rusty coloured sputum. The x-ray shows right lower lobe consolidation.

a haemophilus influenzae
b streptococcus pneumoniae
c legionella pneumophilia
d mycoplasma pneumonia
e chlamydophila pneumonia
A

streptococcus pneumoniae

83
Q

A 14 year old girl is brought in by her parents with fever and difficult breathing. He parents say she frequently attends clinic for her genetic respiratory illness.

a pseudomonas aeruginosa
b s. aureus
c pneumocystis pneumonia
d aspergillosis
e mycoplasma pneumonia
A

pseudomonas aeruginosa

84
Q

An 85 year old male presents with increasing confusion and shortness of breath. On examination there is decreased expansion on the left side and the patient has a respiratory rate of 35/min. His bloods show Urea 8 mmol/L.

a cup of tea
b admit + treat
c treat at home
d consider ITU
e refer to palliative care
A

consider ITU

85
Q

A 55 year old man has a 3 day history of shivering, general malaise & productive cough and is vomiting. The x-ray shows right lower lobe consolidation. He is diagnosed with a moderate pneumonia, what is the first line therapy

a oral amoxicillin
b IV co-amoxiclav + clarithromycin
c doxycycline
d IV amoxicillin + clarithromycin
e vancomycin
A

IV amoxicillin + clarithromycin

86
Q

def of pneumonia

A

acute lower respiratory tract infection associated with:

  • fever
  • symptoms + signs in the chest
  • abnormalities on CXR
87
Q

where in the lungs does pneumonia affect

A

lower respiratory tract

lung parenchyma

88
Q

aetiology of pneumonia

A

infection in the the lung parenchyma (alveoli)
infection/inflammation causes the alveoli to be filled with pus/fluid
infection can be bacterial, viral or fungal

89
Q

what are the three common organisms causing pneumonia

A

1 streptococcus pneumoniae
2 haemophilus influenzae
3 mycoplasma pneumoniae

90
Q

what are atypical causes of pneumonia

A

legionella
chlamydia species
pseudomonas aeruginosa
s aureus

91
Q

epi of pneumonia

A 
incidence
-5-11/1000PA 
-increases with age
mortality
-14% in hospital
92
Q

`symptoms of pneumonia

A 
1 fever
-malaise
-rigors
2 chest symptoms
-dyspnoea
-cough
-purulent sputum
-haemoptysis
-pleuritic chest pain
93
Q

signs of pneumonia

A

1 pyrexia
2 cyanosis
3 tachypnoea + tachycardia
4 hypotension

94
Q

what would you expect of chest expansion in pneumonia

A

reduced chest expansion

95
Q

what would you expect of percussion in pneumonia

A

dull

96
Q

what would you expect of TVF/VR in pneumonia

A

increased

97
Q

what would you expect of auscultation in pneumoniae

A

bronchial breathing

98
Q

risk factors of CAP

A 
1 primary or secondary (if underlying disease present)
2 age (70%>65yrs)
99
Q

risk factors of HAP

A

1 pre-existing illness
2 exposure time

increased likelihood of atypical organisms in HAP

100
Q

risk factors of aspiration pneumonia

A 
compromised swallowing ability can lead to aspiration of oropharyngeal anaerobes
1 neuro
-stroke
-myasthenia gravis
2 GIT
-oesophageal disease (achalasia, GORD)
101
Q

risk factors of immunocompromised pneumonia

A

HIV

chemotherapy

102
Q

investigations in suspected pneumonia

A

1 establish diagnosis
2 identify pathogen
3 assess severity

  • oxygenation (SAO2, ABGs if <92%)
  • bloods (FBC, UEs, CRP)
  • blood cultures
  • sputum MC+S
  • CXR
  • pleural fluid aspirate
103
Q

what pathogens which cause pneumonia could be found in urine antigen tests

A

streptococcus pneumoniae

legionella

104
Q

what would be observed on a CXR in pneumoniae

A

1 alveolar opacification

2 +/- air bronchograms

105
Q

what is an air bronchogram

A

a tubular outline of an airway made visible by filling of the surrounding alveoli by fluid or inflammatory exudates

106
Q

what are the six causes of air bronchograms

A 
1 lung consolidation
2 pulmonary oedema
3 non-obstructive pulmonary atelectasis
4 severe interstitial disease
5 neoplasm
6 normal expiration
107
Q

what is CURB-65

A 
used in prognosis
Confusion <8AMT
Urea >7mmol/L
RR >30/min
BP <90SBP, <60DBP
Age >65yrs

one point each

108
Q

how do the points determine treatment in CURB65

A

0-1 points: home treatment if possible
2 points: hospital therapy
3 points: severe - consider ITU

109
Q

what are the additional risk factors for ICU

A
  • hypoxaemia (SAO2 <92%)
  • co-existing disease
  • bilateral/multilobar pneumonia involvement
110
Q

complications of pneumonia

A 
1 T1RF
2 pleural effusion
3 empyema (pus in pleural space)
4 lung abscess (cavitating area of localised, suppurative infection)
5 heart
-AF
-myocarditis + pericarditis
6 other
-septicaemia
-hypotension
-cholestatic jaundice
111
Q

how do lung abscesses occur in pneumonia

A

poorly treated pneumonia
aspiration pneumonia
pulmonary function

112
Q

what signs would there be for a lung abscess caused by pneumonia

A

1 swinging fever
2 purulent foul-smelling sputum
3 haemoptysis
4 clubbing

113
Q

management of pneumonia

A 
ABC approach
1 airways
-treat hypoxia if SAO2 <88% with O2
2 blood pressure
-treat hypotension/shock with IV fluids
3 circulation
-assess dehydration
If no improvement
1 consider CPAP
2 if hypercapnia will require NI/I ventilation
antibiotics
1 mild - oral amoxicillin
2 moderate - oral/IV amoxicillin + clarithromycin
3 severe - IV co-amoxiclav + clarithromycin
follow up @6wks
114
Q

what antibiotics are given in mild pneumonia

A

oral amoxicillin

115
Q

what antibiotics are given in moderate pneumonia

A

oral/IV amoxicillin + clarithromycin

IV if vomiting

116
Q

what antibiotics are given in severe pneumonia

A

IV co-amoxiclav + clarithromycin

117
Q

what is the management for hypoxia in pneumonia

A

oxygen
aim for:
PAO2 >8
SAO2 >94%

118
Q

what is the management for dehydration or shock in pneumonia

A

IV fluids

119
Q

what is the management for pleuritic pain in pneumonia

A

paracetomal

120
Q

who do atypical pneumonias generally affect

A

young patients

121
Q

symptoms of atypical pneumonia

A 
1 malaise + headache
followed by
2 dry cough
3 myalgia
4 abdominal pain
5 N+V
122
Q

A 35 year old previously healthy man returned from a conference in the USA 5 days ago. He travels frequently and gives a 30 pack year history. He presents with mild confusion, a productive cough, diarrhoea and is pyrexic. His chest examination is normal. CXR shows infiltrates in the RUL.

A

LEGIONELLA PNEUMOPHILIA

123
Q

A plumber renovating old properties presented to casualty with fever & loss of consciousness. On examination he had bilateral consolidation. Plasma sodium was low. The doctor sent for urinary antigen & serology. On the results he was treated with azithromycin & ciprofloxacin and improved.

A

LEGIONELLA PNEUMOPHILIA

124
Q

what is legionella infecting the lungs called

A

1 legionnaires disease

2 legionella pneumonia

125
Q

where are gram negative rods (such as legionella) commonly found

A

aqueous environments

  • contaminated water systems
  • air conditioned hotels
126
Q

signs + symptoms of legionella pneumophilia

A 
1 flu like symptoms
-fever
-malaise
-myalgia
followed by:
2 dry cough
3 SOB
4 confusion + coma
5 hyponatraemia
6 abdominal pain
7 diarrhoea
8 hepatitis
9 renal failure
10 bradycardia
127
Q

how is diagnosis of legionella pneumophilia

A

urine antigen diagnosis

128
Q

investigations of suspected legionella pneumophilia

A 
1 CXR
-bibasal consolidation
2 bloods
-hyponatraemia
-lymphopenia
-deranged LFTs
129
Q

what is the treatment for legionella pneumophilia

A 
1 fluoroquines (ciprofloxacin)
plus
2 macrolide (clarithromycin, azithromycin)
130
Q

A 20 year old previously healthy woman presents with general malaise and a headache, severe cough & breathlessness which has not improved with a 7 day course of amoxicillin. There is nothing significant to find on examination, chest is clear on auscultation. The x-ray shows patchy shadowing throughout the lung fields. The blood film shows clumping of red cells with suggestion of cold agglutinins.

A

MYCOPLASMA PNEUMONIA

131
Q

what are the symptoms of pneumonia caused by mycoplasma pneumonia

A 
insidious onset + prolonged symptoms
1 flu like symptoms
-fever
-headache
-myalgia
2 dry cough (non-resolving)
132
Q

what would be observed on a CXR in pneumonia caused by mycoplasma pneumonia

A

reticulonodular shadowing in lower zones

133
Q

who does mycoplasma pneumonia commonly affect

A

young people who live in close quarters

134
Q

complications of mycoplasma pneumonia

A

transverse myelitis

135
Q

what would commonly be found on investigation of blood in mycoplasma pneumonia

A

cold agglutinins
(when temperature is decreased, blood cells stick together)
mycoplasma pneumonia associated with cold AIHA

136
Q

how is diagnosis of mycoplasma pneumonia made

A

PCR sputum or serology

137
Q

what is the treatment for pneumonia caused by mycoplasma pneumonia

A

1 macrolides (erythromycin + clarithromycin)

add clari for moderate/severe CAP

138
Q

A 44 year old man presents with a headache and general malaise. On taking a history he admits to increasing SOBOE as well as some Diarrhoea. He as not been abroad recently, and his chest examination is unremarkable. Whilst taking him to the ward, he asks if he can ring his daughter to feed his parrots this evening.

A

CHLAMYDOPHILA PSITTACI

139
Q

what is the commonest chlamydial infection

A

c pneumoniae

140
Q

what is the illness in chlamydophila pneumoniae like

A

biphasic
1 pharyngitis, hoarseness, otitis
2 pneumonia

141
Q

how is diagnosis of chlamydophila pneumoniae made

A

chlamydophilia complement fixation test

PCR

142
Q

where is chlamydophila psittaci commonly acquired

A

birds (parrots)

143
Q

symptoms of chlamydophila psittaci

A 
headache
fever
dry cough
lethargy
D+V
144
Q

diagnosis of chlamydophila psittaci

A

chlamydophila serology

145
Q

treatment of chlamydophila psittaci

A

doxycycline or clarithromycin

146
Q

what is mycoplasma pneumonia associated with

A

cold AIHA

cold agglutins

147
Q

what is legionella pneumoniae associated with

A

hyponatraemia
deranged LFTs
altered consciousness

148
Q

treatment of legionella pneumophilia

A

fluroquinolones (ciprofloxacin) + macrolide (clarithromycin/azithromycin)

149
Q

treatment of mycoplasma pneumoniae

A

macrolides (erythromycin + clarithromycin)

150
Q

treatment of chlamydophila species

A

tetracycline (doxycycline) or clarithromycin

151
Q

A 36 year old popstar presents with fever, a cough & an itchy vesicular rash. Chest x-ray shows mottling through both lung fields

A

VARICELLA ZOSTER VIRUS

152
Q

what is the commonest cause of viral pneumonias

A 
viral influenzae
others
-measles
-CMV
-VZV
153
Q

A holiday worker had a severe chest infection abroad & was diagnosed to have influenza A infection. He was improving but suddenly deteriorated with the last 24 hours becoming breathless, febrile & septic. X-ray chest showed circular opacities some with a fluid level. Gram stain of sputum showed Gram positive cocci in clusters.

A

STAPHYLOCOCCUS AUREUS

154
Q

what are two common pathogens causing HAP

A

1 s. aureus (most common)

2 pseudomonas aeruginosa

155
Q

infection with s. aureus is common in what sort of people

A

IV drug users

156
Q

what sort of bacteria is s. aureus

A

gram positive cocci

157
Q

what is the treatment for s. aureus

A

flucloxacillin +/- rifampicin

158
Q

what is the treatment for MRSA

A

vancomycin

159
Q

pseudomonas aeruginosa is common in what conditions

A

bronchiectasis

CF

160
Q

what is the treatment for pseudomonas aeruginosa

A

piptazobactam or ciprofloxacin

± IV gentamicin

161
Q

what sort of drug is ciprofloxacin

A

a fluroquinolone

162
Q

what is the general treatment for HAP

A

treat for 10 days

severe pneumonia
-IV co-amoxiclav + clarithromycin
suspected s. aureus
-plus flucloxacillin +/- rifampicin
suspected MRSA
-plus vancomycin
suspected gram negative bacilli, pseudomonas, anaerobes
-plus gentamicin + antipseudomonal penicillin + IV cephalosporin
163
Q

what sort of drug is gentamicin

A

aminoglyoside

164
Q

what is the treatment for aspiration pneumonia

A

IV cephalosporin (cefuroxime) + metronidazole (streptococcus pneumoniae)

165
Q

A 26 year old man presents with severe shortness of breath and a dry cough which he has had for several weeks. He is an IV drug user. There are purple patches on the arms and in the mouth. CXR shows reticular perihilar opacities. Chest examination is unremarkable.

A

PNEUMOCYSTIS PNEUMONIA

166
Q

what is pneumocystis pneumonia caused by

A

Pneumocystis jirovecii

167
Q

what sort of organism is neumocystis jirovecii

A

a fungal organism

168
Q

what is pneumocystis pneumonia a defining feature of

A

AIDs

immunosuppressed individuals

169
Q

what are the symptoms of pneumocystis pneumonia

A

insidious onset
1 dry cough
2 fever
3 SOB

170
Q

what are the signs of what are the symptoms of pneumocystis pneumonia

A

bilateral crepitations

171
Q

what are the investigation findings in suspected pneumocystis pneumonia

A

bilateral perihilar interstitial shadowing

172
Q

how is diagnosis of pneumocystis pneumonia made

A

‘boat shaped’ organisms on BAL or induced sputum

173
Q

what is the treatment for pneumocystis pneumonia

A

1 high dose co-trimoxazole

174
Q

what is co-trimoxasole

A

trimethoprim + sulphamethazole

175
Q

A 45 year old doctor from Ethiopia with a 6 week history of fever, drenching night sweats and a cough. He is a heavy smoker. On examination he is thin and looks unwell. He has nicotine stained fingers. Dull to percussion at the right upper zone with reduced breath sounds.

A

MYCOBACTERIUM TUBERCULOSIS

In HIV Individuals THINK PCP, TB, CRYPTOCOCCUS

176
Q

def of aspergillus lung disease

A

fungi/mould which affects the lungs

aspergillus lung disease is aspergillosis infection of the lungs

177
Q

what can aspergillus lung disease present as

A

pneumonia

affects immunocompromised

178
Q

what illnesses does aspergillus lung disease cause

A 
1 asthma (T1 hypersensitivity atopic reaction to spores)
2 ABPA (non-invasive)
3 invasive aspergillosis
4 aspergilloma
5 EAA (extrinsic allergic alveolitis)
179
Q

what are the risk factors for invasive aspergillosis

A

immunocompromised

after broad-spectrum antibiotics

180
Q

what investigations would be performed in suspected aspergillus lung disease

A 
1 CXR
-consolidation
-bronchiectasis
2 sputum
-aspergillus (fungal hyphae)
3 aspergillus skin test
-aspergillus specific IgE 
4 bloods
-eosinophilia
-raised IgE levels
181
Q

What signs would you expect on physical examination of someone with pneumonia

a deviated trachea, reduced expansion, dull to percussion
b bronchial breathing, decreased expansion, decreased TVF
c central trachea, reduced expansion, increased TVF
d dull to percussion, increased expansion, pyrexia
e tachycardia, increased expansion, cyanosis

A

central trachea, reduced expansion, increased TVF

182
Q

A 43 year old businessman who has just returned from a conference in Cuba presents to his GP with a dry cough and dyspnoea lasting 2 days. He reports having felt generally unwell for the last 3 days before his cough started. LFTs are deranged, and CXR shows bibasal consolidation.

a Haemophilus influenzae
b Streptococcus Pneumoniae
c Legionella Pneumophilia
d Mycoplasma pneumonia
e Chlamydophila pneumonia
A

legionella pneumophilia

183
Q

A 55 year old professional boules player hasn’t been on his game recently due to increasing SOB. He has been brought to A&E by his daughter as he has become very confused. He is tachypnoeic RR 35, has a fever, BP 85/60mmHg . From his X-ray you decide to admit him for treatment.

a Oral Amoxicillin
b IV Co-amoxiclav + Clarithromycin
c IV Amoxicillin + Clarithromycin
d Flucloxacillin ± Rifampicin
e Doxycyclin
A

IV Co-amoxiclav + Clarithromycin

184
Q

A 24 year old swimmer is referred by his GP to A&E for increasing SOB, a fever, and a productive cough. On Examination he is responsive and lucid, tachypnoeic with RR 35, he has reduced chest expansion on the right which is dull to percussion on his lower chest. His BP is 120/80. His Urea is 6.8mmol/L. What is his severity Score?

1
2
3
4
5
A

1

185
Q

An In-patient develops SOB, cough after a serious viral chest infection on the ward. X-ray shows Bilateral Cavitating lesions, and gram stain of his sputum shows gram-positive cocci in clusters. What Antibiotics should he be given.

a Oral Amoxicillin
b IV Co-amoxiclav + Clarithromycin
c Vancomycin
d Flucloxacillin ± Rifampicin
e Doxycycline + Clarithromycin
A

Flucloxacillin ± Rifampicin

186
Q

what causes a rise in carbon monoxide transfer factor

A 
1 asthma
2 pulmonary haemorrhage
3 polycythemia
4 male gender
5 exercise
187
Q

what causes a fall in carbon monoxide transfer factor

A 
1 pulmonary fibrosis
2 pneumonia
3 PE
4 pulmonary oedema
5 emphysema
188
Q

a 72y/o woman was admitted with reduced consciousness and required invasive ventilation. 5 days later she is deterioratin and is found to have new bilateral patchy consolidation on her CXR

A

s aureus

189
Q 
a 21yo woman is thought to have undiagnosed CF. Which of the following is least suggestive of this?
a bronchiectasis
b infertility
c psuedomonas infection
d recent onset of DM
e stearorrhoea and low BMI
A

b infertility

190
Q

what investigation is most likely to confirm diagnosis of asthma

A

peak flow

Respiratory (18 decks)

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