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
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
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
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
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
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
7
Q
what is the difference between asthma & COPD in terms of reversibility
A
asthma is reversible
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%
9
Q
aetiology of COPD
A
1 smoking (90%) 2 occupational exposure 3 alpha-1 antitrypsin deficiency
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
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
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
13
Q
symptoms of COPD
A
productive cough
wheeze
SOB
14
Q
symptoms of infective exacerbation of COPD
A
worsening SOB
increased sputum/change in sputum colour
15
Q
signs of COPD
A
polyphonic wheeze
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
17
Q
what are the signs of hypercapnia
A
vasodilation
bounding pulse
asterixis
18
Q
def of sarcoidosis
A
multisystem granulomatous disorder of unknown cause
19
Q
epi of sarcoidosis
A
more common in african americans
more common in women
20-40yrs
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)
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
22
Q
what is the diagnostic investigations for sarcoidosis
A
bronchoscopy & biopsy
-non-caseating granulomas (bacteria -ve)
23
Q
management of sarcoidosis
A
NSAIDs for flare ups
corticosteroids for severe sarcoidosis of extrapulmonary disease
24
Q
def of PE
A
sudden occlusion in pulmonary artery or one of its branches
25
aetiology/pathophysiology of PE
thrombi from deep venous system
| often DVT from lower extremities moves to the lung and occludes a PA
26
symptoms of PE
ACUTE ONSET
- SOB
- pleuritic chest pain
- haemoptysis if large PE
27
signs of PE
```
tachycardia & tachypnoea
fever
lower limb swelling/oedema
cyanosis
accentuated S2, S3/S4 gallop
```
28
investigations & management of PE
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
29
what is the treatment if immediate CTPA is not possible
LMWH/fondaparinux
30
what ECG signs could be found in PE
sinus tachycardia
RAD
T wave inversion in leads V1-3
p pulmonale
31
what is p pulmonale
tall, narrow, peaked P waves in leads II, III & aVF
often a prominent P wave in V1
cor pulmonale
32
def of IPF
a chronic progessive fibrosing interstitial lung disease of unknown cause
33
epi of IPF
elderly
| M>F
34
symptoms of IPF
dry cough
progressive exertional dyspnoea
weight loss
arthralgia (joint pain)
35
signs of IPF
cyanosis
digital clubbing
fine end inspiratory crepitations (like walking on snow)
36
investigations of IPF
```
1 lung function tests
-FEV1:FVC normal-high - restrictive
2 bloods
-raised CRP & ESR
-ABG (hypoxia)
3 bronchoscopy & biopsy
```
37
what is the diagnostic investigation for IPF
bronchoscopy & biopsy
38
treatment for IPF
```
supportive
-O2
-pulmonary rehab
-palliation
medical
-prednisolone or immunosuppressants
-antifibrotics
-lung transplant
```
39
name an antifibrotics
pirfenidone
40
prognosis of IPF
50% 5yr survival rate
41
symptoms of pneumonia
```
productive cough
SOB
fever
chest pain
confusion in elderly
```
42
signs of pneumonia
tachypnoea & tachycardia
reduced expansion
dull percussion
coarse crackles
43
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
pulmonary oedema caused by HF
44
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
```
CF
45
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
```
TB
46
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
```
asthma
47
what is CF
autosomal recessive
mutation in CF transmembrane conductance regulator gene (CTFR) which leads to an inability to secrete chloride & hydrate secretions
48
where does CF affect and what is the consequence
```
1 lungs
-recurrent infections leading to bronchiectasis
2 pancreas
-malabsorption
-diabetes
3 liver
-cirrhosis
```
49
clinical features of CF
```
1 failure to thrive in children
2 respiratory
-bilateral coarse crackles
-cough
-cyanosis
-clubbing
```
50
aetiology of TB
mycobacterium TB
| high risk in homeless or overcrowding
51
pathophysiology of TB
immune response leads to caseating granulomas
52
what is a granuloma
focal collection of inflammatory cells at sites of tissue infection
53
what does caseation mean
necrotic regions
54
symptoms in TB
productive cough
weight loss
fevers & night sweats
haemoptysis may be present
55
investigations in TB
```
1 CXR
-consolidation +/- cavitation (usually in upper zones)
-lyphadenopathy
2 sputum
-stain Ziehl-Neelson - acid-fast bacilli
-culture Lowenstein-jenson
```
56
investigations for latent TB
tuberculin skin test
57
why does TB commonly colonise in the upper zones
most oxygen in the upper zones
58
what does cavitation on a CXR mean
formation of an empty space
| will appear darkened
59
management of TB
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
60
why must pyridoxine be given in management of TB
to prevent isoniazid causing peripheral neuropathy
61
definition of asthma
chronic inflammatory condition of lung airways
| reversible
62
epi of asthma
commonly young onset
63
aetiology of asthma
```
combination of genetic & environmental factors
1 genetic: atopy
-asthma
-eczema
-hayfever
2 environmental: allergens
-house dust-mites
-pets
-fungal spores
```
64
pathophysiology of asthma
bronchial muscle contraction, mucosal inflammation, increased mucus leads to airway narrowing
65
symptoms of asthma
recurrent, intermittant episodes of:
- cough
- wheeze
- SOB (worse at night and in the morning, precipitated by cold air, exercise)
66
what drugs make asthma worse
NSAIDs
| Beta blockers
67
signs of asthma
```
tachypnoea
audible wheeze
hyperinflation
hyper-resonant percussion
polyphonic wheeze
reduced air entry
```
68
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
```
```
1 COPD
2 asthma
3 COPD
4 persistant & progressive in COPD, variable in asthma
5 asthma
6 asthma
```
69
what is goodpasture's disease
diffuse pulmonary haemorrhage & rapidly progressive glomerulonephritis
anti-GBM positive
SOB, cough, haemoptysis, oedema, HTN
70
what are the three most common causes of chronic cough in a non-smoker
1 asthma
2 post-nasal drip (mucus irritates cough receptors)
3 GORD (reflex irritates cough receptors)
71
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
```
inhaled salbutamol
72
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
```
inhaled beclomethazone
73
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
```
inhaled salmeterol
74
what are the guidelines on asthma management
```
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
```
75
what does LRA stand for
leukotriene receptor antagonist
| montelukast
76
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
```
spirometry
77
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
```
```
1
-Short acting B2 agonist
-Short acting muscarinic antagonist
2
-Long acting B2 agonist & Inhaled corticosteroids
OR
-Long acting muscarinic antagonist
3
-theophylline
```
78
what is the step-wise management of COPD
```
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
what are the indications for long term oxygen therapy
1 PaO2 <7.3kPa
| 2 PaO2 7.3-8.0kPa plus peripheral oedema
80
why does respiratory depression occur in COPD
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
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
```
pneumonia
82
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
```
streptococcus pneumoniae
83
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
```
pseudomonas aeruginosa
84
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
```
consider ITU
85
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
```
IV amoxicillin + clarithromycin
86
def of pneumonia
acute lower respiratory tract infection associated with:
- fever
- symptoms + signs in the chest
- abnormalities on CXR
87
where in the lungs does pneumonia affect
lower respiratory tract
| lung parenchyma
88
aetiology of pneumonia
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
what are the three common organisms causing pneumonia
1 streptococcus pneumoniae
2 haemophilus influenzae
3 mycoplasma pneumoniae
90
what are atypical causes of pneumonia
legionella
chlamydia species
pseudomonas aeruginosa
s aureus
91
epi of pneumonia
```
incidence
-5-11/1000PA
-increases with age
mortality
-14% in hospital
```
92
`symptoms of pneumonia
```
1 fever
-malaise
-rigors
2 chest symptoms
-dyspnoea
-cough
-purulent sputum
-haemoptysis
-pleuritic chest pain
```
93
signs of pneumonia
1 pyrexia
2 cyanosis
3 tachypnoea + tachycardia
4 hypotension
94
what would you expect of chest expansion in pneumonia
reduced chest expansion
95
what would you expect of percussion in pneumonia
dull
96
what would you expect of TVF/VR in pneumonia
increased
97
what would you expect of auscultation in pneumoniae
bronchial breathing
98
risk factors of CAP
```
1 primary or secondary (if underlying disease present)
2 age (70%>65yrs)
```
99
risk factors of HAP
1 pre-existing illness
2 exposure time
increased likelihood of atypical organisms in HAP
100
risk factors of aspiration pneumonia
```
compromised swallowing ability can lead to aspiration of oropharyngeal anaerobes
1 neuro
-stroke
-myasthenia gravis
2 GIT
-oesophageal disease (achalasia, GORD)
```
101
risk factors of immunocompromised pneumonia
HIV
| chemotherapy
102
investigations in suspected pneumonia
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
what pathogens which cause pneumonia could be found in urine antigen tests
streptococcus pneumoniae
| legionella
104
what would be observed on a CXR in pneumoniae
1 alveolar opacification
| 2 +/- air bronchograms
105
what is an air bronchogram
a tubular outline of an airway made visible by filling of the surrounding alveoli by fluid or inflammatory exudates
106
what are the six causes of air bronchograms
```
1 lung consolidation
2 pulmonary oedema
3 non-obstructive pulmonary atelectasis
4 severe interstitial disease
5 neoplasm
6 normal expiration
```
107
what is CURB-65
```
used in prognosis
Confusion <8AMT
Urea >7mmol/L
RR >30/min
BP <90SBP, <60DBP
Age >65yrs
```
one point each
108
how do the points determine treatment in CURB65
0-1 points: home treatment if possible
2 points: hospital therapy
3 points: severe - consider ITU
109
what are the additional risk factors for ICU
- hypoxaemia (SAO2 <92%)
- co-existing disease
- bilateral/multilobar pneumonia involvement
110
complications of pneumonia
```
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
how do lung abscesses occur in pneumonia
poorly treated pneumonia
aspiration pneumonia
pulmonary function
112
what signs would there be for a lung abscess caused by pneumonia
1 swinging fever
2 purulent foul-smelling sputum
3 haemoptysis
4 clubbing
113
management of pneumonia
```
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
what antibiotics are given in mild pneumonia
oral amoxicillin
115
what antibiotics are given in moderate pneumonia
oral/IV amoxicillin + clarithromycin
| IV if vomiting
116
what antibiotics are given in severe pneumonia
IV co-amoxiclav + clarithromycin
117
what is the management for hypoxia in pneumonia
oxygen
aim for:
PAO2 >8
SAO2 >94%
118
what is the management for dehydration or shock in pneumonia
IV fluids
119
what is the management for pleuritic pain in pneumonia
paracetomal
120
who do atypical pneumonias generally affect
young patients
121
symptoms of atypical pneumonia
```
1 malaise + headache
followed by
2 dry cough
3 myalgia
4 abdominal pain
5 N+V
```
122
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.
LEGIONELLA PNEUMOPHILIA
123
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.
LEGIONELLA PNEUMOPHILIA
124
what is legionella infecting the lungs called
1 legionnaires disease
| 2 legionella pneumonia
125
where are gram negative rods (such as legionella) commonly found
aqueous environments
- contaminated water systems
- air conditioned hotels
126
signs + symptoms of legionella pneumophilia
```
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
how is diagnosis of legionella pneumophilia
urine antigen diagnosis
128
investigations of suspected legionella pneumophilia
```
1 CXR
-bibasal consolidation
2 bloods
-hyponatraemia
-lymphopenia
-deranged LFTs
```
129
what is the treatment for legionella pneumophilia
```
1 fluoroquines (ciprofloxacin)
plus
2 macrolide (clarithromycin, azithromycin)
```
130
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.
MYCOPLASMA PNEUMONIA
131
what are the symptoms of pneumonia caused by mycoplasma pneumonia
```
insidious onset + prolonged symptoms
1 flu like symptoms
-fever
-headache
-myalgia
2 dry cough (non-resolving)
```
132
what would be observed on a CXR in pneumonia caused by mycoplasma pneumonia
reticulonodular shadowing in lower zones
133
who does mycoplasma pneumonia commonly affect
young people who live in close quarters
134
complications of mycoplasma pneumonia
transverse myelitis
135
what would commonly be found on investigation of blood in mycoplasma pneumonia
cold agglutinins
(when temperature is decreased, blood cells stick together)
mycoplasma pneumonia associated with cold AIHA
136
how is diagnosis of mycoplasma pneumonia made
PCR sputum or serology
137
what is the treatment for pneumonia caused by mycoplasma pneumonia
1 macrolides (erythromycin + clarithromycin)
add clari for moderate/severe CAP
138
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.
CHLAMYDOPHILA PSITTACI
139
what is the commonest chlamydial infection
c pneumoniae
140
what is the illness in chlamydophila pneumoniae like
biphasic
1 pharyngitis, hoarseness, otitis
2 pneumonia
141
how is diagnosis of chlamydophila pneumoniae made
chlamydophilia complement fixation test
| PCR
142
where is chlamydophila psittaci commonly acquired
birds (parrots)
143
symptoms of chlamydophila psittaci
```
headache
fever
dry cough
lethargy
D+V
```
144
diagnosis of chlamydophila psittaci
chlamydophila serology
145
treatment of chlamydophila psittaci
doxycycline or clarithromycin
146
what is mycoplasma pneumonia associated with
cold AIHA
| cold agglutins
147
what is legionella pneumoniae associated with
hyponatraemia
deranged LFTs
altered consciousness
148
treatment of legionella pneumophilia
fluroquinolones (ciprofloxacin) + macrolide (clarithromycin/azithromycin)
149
treatment of mycoplasma pneumoniae
macrolides (erythromycin + clarithromycin)
150
treatment of chlamydophila species
tetracycline (doxycycline) or clarithromycin
151
A 36 year old popstar presents with fever, a cough & an itchy vesicular rash. Chest x-ray shows mottling through both lung fields
VARICELLA ZOSTER VIRUS
152
what is the commonest cause of viral pneumonias
```
viral influenzae
others
-measles
-CMV
-VZV
```
153
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.
STAPHYLOCOCCUS AUREUS
154
what are two common pathogens causing HAP
1 s. aureus (most common)
| 2 pseudomonas aeruginosa
155
infection with s. aureus is common in what sort of people
IV drug users
156
what sort of bacteria is s. aureus
gram positive cocci
157
what is the treatment for s. aureus
flucloxacillin +/- rifampicin
158
what is the treatment for MRSA
vancomycin
159
pseudomonas aeruginosa is common in what conditions
bronchiectasis
| CF
160
what is the treatment for pseudomonas aeruginosa
piptazobactam or ciprofloxacin
| ± IV gentamicin
161
what sort of drug is ciprofloxacin
a fluroquinolone
162
what is the general treatment for HAP
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
what sort of drug is gentamicin
aminoglyoside
164
what is the treatment for aspiration pneumonia
IV cephalosporin (cefuroxime) + metronidazole (streptococcus pneumoniae)
165
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.
PNEUMOCYSTIS PNEUMONIA
166
what is pneumocystis pneumonia caused by
Pneumocystis jirovecii
167
what sort of organism is neumocystis jirovecii
a fungal organism
168
what is pneumocystis pneumonia a defining feature of
AIDs
immunosuppressed individuals
169
what are the symptoms of pneumocystis pneumonia
insidious onset
1 dry cough
2 fever
3 SOB
170
what are the signs of what are the symptoms of pneumocystis pneumonia
bilateral crepitations
171
what are the investigation findings in suspected pneumocystis pneumonia
bilateral perihilar interstitial shadowing
172
how is diagnosis of pneumocystis pneumonia made
'boat shaped' organisms on BAL or induced sputum
173
what is the treatment for pneumocystis pneumonia
1 high dose co-trimoxazole
174
what is co-trimoxasole
trimethoprim + sulphamethazole
175
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.
MYCOBACTERIUM TUBERCULOSIS
In HIV Individuals THINK PCP, TB, CRYPTOCOCCUS
176
def of aspergillus lung disease
fungi/mould which affects the lungs
| aspergillus lung disease is aspergillosis infection of the lungs
177
what can aspergillus lung disease present as
pneumonia
| affects immunocompromised
178
what illnesses does aspergillus lung disease cause
```
1 asthma (T1 hypersensitivity atopic reaction to spores)
2 ABPA (non-invasive)
3 invasive aspergillosis
4 aspergilloma
5 EAA (extrinsic allergic alveolitis)
```
179
what are the risk factors for invasive aspergillosis
immunocompromised
| after broad-spectrum antibiotics
180
what investigations would be performed in suspected aspergillus lung disease
```
1 CXR
-consolidation
-bronchiectasis
2 sputum
-aspergillus (fungal hyphae)
3 aspergillus skin test
-aspergillus specific IgE
4 bloods
-eosinophilia
-raised IgE levels
```
181
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
central trachea, reduced expansion, increased TVF
182
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
```
legionella pneumophilia
183
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
```
IV Co-amoxiclav + Clarithromycin
184
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
```
1
185
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
```
Flucloxacillin ± Rifampicin
186
what causes a rise in carbon monoxide transfer factor
```
1 asthma
2 pulmonary haemorrhage
3 polycythemia
4 male gender
5 exercise
```
187
what causes a fall in carbon monoxide transfer factor
```
1 pulmonary fibrosis
2 pneumonia
3 PE
4 pulmonary oedema
5 emphysema
```
188
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
s aureus
189
```
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
```
b infertility
190
what investigation is most likely to confirm diagnosis of asthma
peak flow
