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Year 3 > MedEd cough > Flashcards

MedEd cough Flashcards

1
Q

What is the most common cause of bacterial CAP?

A

Strep pneumoniae

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2
Q

What atypical pneumonia organism is associated with air conditioning systems?

A

Legionella pneumophilia

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3
Q

What scoring system is used to assess CAP severity?

A

CURB 65

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4
Q

What is pneumonia?

A

Infection of the lung parenchyma

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5
Q

What are risk factors for pneumonia?

A 
Old age
Aspiration
Smoking
Travel
Chronic lung condition
Immunosupression
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6
Q

What area of the lung is infected in pneumonia?

A

Parenchyma

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7
Q

What is hospital pneumonia by definition?

A

Pneumonia that occurs 48 hrs after admission into hospital

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8
Q

What organism is also known as pneumococcus?

A

Strep pneumoniae

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9
Q

Who is haemophilius influenzae as a causative agent of pneumonia more common in?

A

Those with chronic lung conditions eg bronchiectasis and COPD

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10
Q

Who is staph aureus as a causative agent of pneumonia more common in?

A

IV drug users

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11
Q

What is staph aureus as a causative agent of pnuemonia associated with on chest x ray?

A

Cavitating lesions

Abscess

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12
Q

Who is klebsiella as a causative agent of pneumonia more common in?

A

Chronic alcoholics

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13
Q

What is klebsiella as a causative agent of pnuemonia associated with on chest x ray?

A

Cavitating lesions

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14
Q

What are the typical cuasative organisms of CAP?

A

Strep pneumoniae/pnuemococcus
Heamophilius influenza B
Staph aureus
Klebsiella pneumonia

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15
Q

What are the atypical cuasative organisms of CAP?

A 
Mycoplasma pneumoniae
Legionella pneumophilia
Chlamydia psittaci
Chlamydia pneumoniae
Coxiella burnetii
PCP (pneumocystis jirovecii)
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16
Q

Who is mycoplasma pneumoniae as a causative agent of pneumonia more common in?

A

Young patients

Patients who got pneumonia due to close contact

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17
Q

What is mycoplasma pnuemoniae as a causative agent of pnuemonia associated with?

A

Erythema multiforme, transverse myelitis

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18
Q

What is legionella pneumophilia as a causative agent of pneumonia associated with?

A

Faulty a/c

Causes hyponatraemia and deranged LFTS

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19
Q

If legionella pneumophilia is the causative agent of a pneumonia what will you see on bloods?

A

Hyponatraemia

Deranged LFTs

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20
Q

What is chlamydia psittaci as a causative agent of pneumonia associated with?

A

Have to be immunocompromised to get it eg HIV

Associated with birds and parrot fever

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21
Q

What is PCP as a causative agent of pneumonia associated with?

A

You must check if they have HIV and AIDs

Check for Kaposi’s sarcoma

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22
Q

What is commonly seen in kaposi’s sarcoma?

A

A purple patch on the nose

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23
Q

What organism causes aspiration pnuemonia?

A

Anerobes from the gut flora

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24
Q

What acronym can be used to remember causes of a cavitating lung lesion and what does it stand for?

A 
CAVITY:
cancer
autoimmune
vascular
infective 
ty??
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25
Q

What will a cavitating lung lesion look like on CXR?

A

A circle shaped lesion with a white border, will be grey inside and may have a fluid in it which will be white. You will be able to see the fluid level line clearly

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26
Q

What 2 pneumonia organisms can cause cavitating lung lesions?

A

Staph aureus

Klebsiella

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27
Q

What type of bacteria is strep pneumoniae?

A

Gram positive cocci

Usually as diplococci and can be isolated or in a chain

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28
Q

What type of bacteria is staph aureus?

A

gram positive cocci

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29
Q

What causative agents of pneumonia are gram negative?

A 
haemophilius influenza
klebsiella pneumoniae
pseudomonas aeruginosa
legionella pneumophilia
moraxella catarrhalis
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30
Q

What are the symptoms of pneumonia?

A 
Productive cough commonly with green sputum
Fever 
SOB
Pleuritic chest pain
Confusion (often in elderly people)
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31
Q

What are the causes of pleuritic chest pain?

A 
Pneumothorax
Pneumonia
PE
Pericarditis
Pleural effusion
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32
Q

What are the symptoms of atypical pneumonia?

A 
Dry cough
Fever
Headache
Diarrhoea
Myalgia 
Hepatitis
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33
Q

Why is there a dry cough in atypical pneumonia?

A

Because the alveoli are spared so mucus is not produced

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34
Q

What are clinical signs of pneumonia?

A 
Respiratory distress
Cyanosis 
Reduced chest expansion/ asymetrical chest expansion on palpation
Dullness to percussion
Basal crepitation ie coarse crackles 
Bronchial breathing
Increased vocal resonance
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35
Q

What type of crackles do you get in pnuemonia?

A

Coarse

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36
Q

What makes crackles coarse?

A

Fluid in the alveoli

When you breath in and the alveoli open the fluid makes them pop which makes

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37
Q

Is there clubbing in pneumonia?

A

No

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38
Q

What is the most likely cause of pneumonia in all patients?

A

Strep pneumonia

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39
Q

What investigations are done for pneumonia? What will you see

A 
Sputum sample
Urinary antigens
FBC- raised WCC
UEs
CRP- raised
ESR- raised
LFTs
ABG
Culture- if sepsis is suspected 
CXR to image- may have pleural fluid in MCS
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40
Q

What pneumonia organism can be tested for using bedside urinary antigen test?

A

Legionella

Strep pneumoniae

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41
Q

What will you see on CXR in pneumonia?

A

An area of consolidation in one or more lung zones (appears as a white opacification)

CAB: consolidation, alveolar opacification, (air) bronchograms

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42
Q

What acronym is used to remember features of pneumonia on CXR and what does it stand for?

A

CAB:
consolidation
alveolar opacification
consolidation

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43
Q

What might you see on CXR when there is an atypical pnuemonia? Which one specifically

A

Diffuse patchy infiltrates bilaterally- especially PCP

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44
Q

What severity scoring system is used for pneumonia and what does it stand for? Include the numerical values needed to gain a point for each one

A 
CURB 65:
Confusion (AMTS <8)
Urea (>7 mmol/L)
Resp rate (>30/min)
BP(<90 systolic or <60 diastolic) 
Over 65 in age
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45
Q

How is CURB 65 used to decide the course of care for pnuemonia?

A

Score 0-1= treat as an outpatient
Score 2 or higher= consider hospital admission
Score 3 or higher= consider ITU admission

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46
Q

What might be used instead of CURB 65 and how do scores determine treatment?

A

CRB 65- this is done if primary care or urea are unavailable

If the patient scores 1 or over hospitalisation is recommended

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47
Q

What abx are used for treatment for CAP? Describe what each does

A

ACD:
amoxicillin- typical cover
clarithromycin- atypical cover and if allergic to penicillin
doxycycline- if allergic to penicillin

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48
Q

What type of abx is amoxicillin?

A

Penicillin

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49
Q

What abx are used to treat penicillin based off CURB 65 score? Include where the patient will be treated

A

0 or 1 = treat at home with amoxicillin
2 = treat in hospital with amoxicillin and clarithromycin
3 = treat in hospital/ITU with co amoxiclav and clorthiromycin

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50
Q

If CURB 65 is 0/1 what abx are given and where is the patient treated?

A

Amoxicillin is given at home

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51
Q

If CURB 65 is 2 what abx are given and where is the patient treated?

A

Amoxicillin and clarithromycin are given in hospital

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52
Q

If CURB 65 is 3 what abx are given and where is the patient treated?

A

Co amoxiclav and clarithromycin are given in hospital

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53
Q

What does co amoxiclav contain that amoxicillin doesnt? How does this help

A

A bacteria lactulose inhibitor which helps combat more resistant organisms

54
Q

What abx is given to pregnant women with pneumonia?

A

Erythromycin

55
Q

What is the first line abx for HAP?

A

Co amoxiclav

56
Q

What is given in HAP if its MRSA resistant?

A

IV vancomycin

57
Q

What abx are given for HAP due to pseudomonas?

A

IV tazocin and gentamicin

58
Q

What is given for aspiration pneumonia?

A

Amoxicillin and metronidazole

59
Q

What abx is given for pneumonia caused by staph aureus?

A

Flucloxacillin

60
Q

What abx is given for PCP?

A

co-trimoxazole

61
Q

What is A-E for pneumonia?

A 
Airway- make sure its patent
Breathing- give oxygen if needed and sit the patient up, CPAP if needed
Circulation- give IV fluids if BP is low
Disability- check if they are ok
E- give IV painkillers and abx
62
Q

What is bronchiectasis?

A

A chronic lung condition where this is abnormal, irreversible dilation of the bronchi and bronchioles

63
Q

What are the most common causes of bronchiectasis in the world vs the western world?

A

In the world= most commonly caused by TB

Western world= most commonly caused by cystic fibrosis

64
Q

What are some causes of bronchiectasis?

A 
Post infection eg TB
Immunodeficiency
Chronic aspiration eg GORD, dysphagia 
Chronic inflammation eg RA, IBD
Chronic airway obstruction eg asthma, COPD, cancer
Congenital eg cystic fibrosis
65
Q

What is the triad for Kartagener’s syndrome?

A

Bronchiectasis
Sinusitis
Situs inversus- everything in the body is on the opposite side to normal anatomy

66
Q

How will bronchiectasis present?

A 
Chronic daily productive cough with large amounts of sputum (foul smelling, pus, can be green or yellow otherwise mucoid, is rust coloured due ot flecks of blood)
Haemoptysis
SOB
Fever
Weight loss
Non pleuritic chest pain
Recurrent pneumonia or chest pain
67
Q

What are the 7 respiratory causes of clubbing?

A 
Lung cancer
ILD
Cystic fibrosis
Bronchiectasis
Lung abscess
Emphysema
TB
68
Q

What are the 7 respiratory causes of clubbing?

A 
Lung cancer
Bronchiectasis
Cystic fibrosis
ILD
Lung abscess 
TB
Emphysema
69
Q

What is heard on ausculatation in bronchiectasis?

A

Coarse crackles in the lower lung zones

70
Q

Describe the sputum in bronchiectasis?

A

Large volumes
Mucopurulent- white, can be yellow/green if there is infection
Haemoptysis- makes sputum rust coloured because it is flecked with blood

71
Q

What investigations are done for bronchiectasis? What will they show

A

Sputum culture
Bloods: FBC has WCC raised, CRP raised, do UEs, LFTs, ABG, culture if sepsis is suspected
CXR- may see tram tracking
HRCT is gold standard

72
Q

What are causative agents of brinchiectasis?

A

Most common= haemophilius influenzae
pseudomonas aerunginosa
Strep pneumonia

73
Q

What is the gold standard investigation for imaging in bronchiectasis?

A

High resolution CT

74
Q

What might you see on CXR in someone with bronchiectasis?

A

Tram tracking

75
Q

When should you suspect allergic bronchopulmonary aspergillosis?

A

When someone has bronchiectasis with IgE and eosinophils

76
Q

What sign might be seen on HRCT in bronchiectasis?

A

Signet ring sign

77
Q

How is bronchiectasis managed?

A

Airway clearance by chest physiotherapy first line

Conservative= exercise, good diet, stop smoking, vaccinations, airway clearance
Pharmacological= steroids/ bronchodilators, IV abx if theres an acute exacerbation, oral abx
Surgery= rare, only done if a localised part of the lung is damaged
78
Q

What causative agent of bronchiectasis acute exacerbation is potentially deadly? How is it treated?

A

Pseudomonas

Treat with ciprofloxacin (oral)

79
Q

What is tuberculosis?

A

A chronic infective disease affecting multiple organs, caused by mycobacterium tuberculosis

80
Q

What lobes does TB most commonly affect?

A

Upper lobes

81
Q

What happens to the virus in latent TB?

A

TB is contained in caseating granulomas

82
Q

What are some RF for TB?

A

Immunocompromised
Overcrowding
Travel to sub saharan africa/ india/ bangladesh

83
Q

What are signs and symptoms for TB?

A 
Poductive cough
SOB
Haemoptysis 
Pleural effusion
FLAWS- low grade fever, gradual weight loss
Lymphadenopathy
Erythema nodosum
84
Q

What are causes of erythema nodosum?

A

TB
IBD
Sarcoidosis

85
Q

What are some things TB can cause? What do they mean?

A 
LRTI/pnuemonia
Meningitis
Erythema nodosum
Clubbing 
Pott's disease- osteomyelitis of the spine 
Addison's disease
Pyuria
86
Q

What is the most common cause of Addison’s disease worldwide?

A

TB

87
Q

What are some investigations for TB? What will you see?

A

Sputum MCS- 3 samples one in early morning, for microscopy use AFB stain (zeihl neelsen), culture takes 6-8 weeks
FBC- high WCC, anaemia, high CRP, ABG, HIV screen
Chest x ray- bilateral lymphadenopathy
Lymph node biopsy- will show caseating granulomas

88
Q

How is sputum culture done in TB?

A

3 samples are taken, one in the early morning
On microscopy use AFB stain (zeihl neelsen)
Culture will take 6-8 weeks

89
Q

What is seen on CXR in active TB?

A

Bilateral hilar lymphadenopathy

90
Q

What disease cause non caseating vs caseating granulomas?

A

Non caseating= Crohn’s disease and sarcoidosis

Caseating= TB

91
Q

How do you test for latent TB? When might you do these tests? What do you do if they are positive?

A

Mantoux test- tuberculin protein is injected into the skin and if the skin reacts (over a certain sized bump appears) then it means you have been exposed to TB before
Interferon gamma assay- blood sample is tested for how much interferon gamma is released

Do them to trace contacts

If they are positive do a chest x ray

92
Q

How do you test for latent vs active TB?

A

You can’t tell it apart, you need to differentiate using the clinical picture and things like CXR

Can do a mantoux test or interferon gamma assay to see if they have been exposed to TB before

93
Q

What is the mantoux test for?

A

To check if someone has been exposed to TB before

94
Q

What is interferon gamma assay for?

A

To check if someone has been exposed to TB before

95
Q

Which test for latent TB is difficult to interpret if they have had a previous BCG vaccine?

A

Mantoux test

96
Q

What is seen on CXR in TB?

A 
Consolidation which is patchy and heterogeneous 
Bi hilar lymphadenopathy
Upper lobe scarring 
Cavitating lesions
Pleural effusion
97
Q

What is miliary TB? What does it signify

A

nodular shadowing on CXR

It signifys that the TB has gotten really bad- lymphohaematogenous dissemination of TB throughout the body

98
Q

What acronym is used to remember the drugs for TB? What does it stand for?

A 
RIPE:
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
99
Q

What are side effects of the abx used for TB?

A

Rifampicin- causes red/orange secretions (pee)
Isoniazid- causes peripheral neuropathy and vitamin B6 deficiency so give pyridoxine
Pyrazinamide- causes hyperuricaemia (gout)
Ethambutol- causes optic neuritis (remember e for eye) which results in reversible red green colour blindness

100
Q

What side effects must you warn the patient about when giving drugs for TB?

A

Red/orange secretions
Peripheral neuropathy and vit B6 deficiency- this can be comabtted by giving pyridoxine
Hyperuricaemia (gout)
Optic neuritis

101
Q

What is given alongside TB drugs to prevent the side affect of peripheral neuropathy and vit B6 deficiency

A

Pyridoxine

102
Q

What is the difference between primary and secondary lung cancer?

A 
Primary= from the lung
Secondary= metastasised from somewhere else
103
Q

What are the types of lung cancer?

A

Small cell lung cancer

Non small cell lung cancer- consists of adenocarcinoma, squamous cell carcinoma and large cell carcinoma

104
Q

What 3 things might small cell lung cancer cause?

A

SIADH
Ectopic ACTH
Lamber eaton syndrome

105
Q

What cells does small cell lung cancer arise from?

A

Endocrine cells

106
Q

What cells does lung adenocarcinoma arise from?

A

Goblet cells

107
Q

What part of the lung is SMLC found in?

A

Central

108
Q

What part of the lung is adenocarcinoma found in?

A

Peripheral parts of the lung

109
Q

What cells does squamous cell carcinoma of the lung originate from?

A

Squamous epithelial cells

110
Q

What part of the lung is squamous cell carcinoma found in?

A

Central parts of the lung

111
Q

What is squamous cell carcinoma of the lung associated with releasing? What effect does this have?

A

Releases PTH related peptide

Has the same affects as PTH

112
Q

What cells does large cell lung carcinoma originate from?

A

Goblet cells

113
Q

What 2 types of lung cancer are similar and why? How are they differentiated?

A

Small cell lung cancer and large cell lung cancer
They are similar to each other as they both arise from goblet cells
Large cell lung cancer is just less differentiated and so less aggressive

114
Q

What are risk factors for lung cancer?

A

Smoking
Increasing age
Asbestos exposure

115
Q

What are symptoms of lung cancer?

A 
Cough (can be dry or productive) 
Haemoptysis
SOB
Weight loss
Anorexia
Night sweats
116
Q

What are signs of lung cancer?

A

Clubbing
Tar staining
Lymphadenopathy
Dull to percussion, stony dull if theres pleural effusion
Auscultation you’ll hear crepitations and increased vocal resonance

117
Q

Where does lung cancer metastasise to? What symptoms might this cause?

A

Bone- bone pain, fractures
Brain- headaches, blurry vision
Liver- hepatomegaly

118
Q

What is a complication of lung cancer that would cause eye symptoms?

A

Horner’s syndrome

119
Q

What is the triad for Horner’s syndrome?

A

Miosis
Partial ptosis
Anhydrosis

120
Q

What is the physiology behind Horner’s syndrome?

A

Compression of the sympathetic trunk

121
Q

What type of cancer causes Horner’s syndrome?

A

Pancoast tumor

122
Q

What is an atypical type of lung cancer to know?

A

Pancoast tumor

123
Q

What are the 4 components of pancoast syndrome?

A

Horner’s syndrome- miosis, partial ptosis, anhydrosis
Compression of the brachial plexus- shoulder/arm pain, parasthesia
Compression of the recurrent laryngeal nerve- hoarse voice and bovine cough
Compression of the vena cava- pemberton’s sign (patient lifts their arm and gets facial flushing and swelling- this occurs when the tumor is in the right lung apex

124
Q

Where is pancoast’s tumor loacted?

A

apices of the lung

125
Q

In aspiration pneumonia what lobe are gastric contents most likely to fall into?

A

The right lower and middle lobes

126
Q

How many lobes do the right and left lungs have?

A 
Right= 3 lobes
Left= 2 lobes
127
Q

In someone with sarcoidosis what will be raised in the serum?

A

ACE and calcium

128
Q

What symptoms will someone with sarcoidosis present with?

A 
Fever
Weight loss
SOB
May have bone pains
Erythema nodosum
Bilateral hilar lymohadenopathy
129
Q

What 2 features of a question make a diagnosis of sarcoidosis likely?

A

Bilateral hilar lymphadenopathy

Erythema nodosum

130
Q

How can you differentiate between TB and sarcoidosis in a question?

A

TB question will have something about recent travel to an endemic country
Other than this the 2 have very similar signs and symptoms

Year 3 (104 decks)

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