Passmedicine Flashcards
What are the features of AECOPD?
Dyspnoea, wheeze, cough
If infective may have increase in sputum
If hypoxic may have acute confusion
What are the 3 most common bacterial causes for infective AECOPD?
H. influenzae (most common)
Strep pneumoniae
Moraxella catarrhalis
What is the most common viral cause for infective AECOPD?
Rhinovirus
How is AECOPD managed?
Increase freq. of bronchodilator use + consider giving via nebuliser
Prednisolone 30mg for 7-14 days
Amoxicillin/clarithromycin/doxycyline if sputum purulent/signs of pneumonia
What is psittacosis?
Infection caused by chlamydia psittaci
What things should make you suspect psittacosis?
Typical fever with history of bird contact
OR pneumonia + severe headache/organomegaly + failure to respond to penicillins
What kind of organism is Chlamydia psittaci?
Gram negative obligate intracellular bacterium
How is Chlamydia psittaci spread?
From birds/bird urine/faeces
What is the typical presentation of psittacosis?
Subacute onset of flu symptoms (fever, headache, myalgia) + respiratory symptoms (SoB, dry cough, chest pain)
What chest signs do you see in psittacosis?
Unilateral creps + vesicular breathing
Uncommonly may see pleural effusion
What abdomen signs might you rarely see in psittacosis?
Hepatomegaly, splenomegaly
What will investigations reveal in psittacosis?
Raised inflammatory markers
Consolidation on CXR
How do you confirm the diagnosis of psittacosis?
Serology (atypical pneumonia screening)
What is the treatment of psittacosis?
1st line: tetracycline, e.g. doxycyline
2nd line: macrolide, e.g. erythromycin
What is sarcoidosis?
Multisystem disorder of unknown aetiology characterised by non-casating granulomas
What are the features of sarcoidosis?
Acute: erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia
Insidious: SoB, dry cough, malaise, wt loss
What skin condition do people with sarcoidosis get?
Lupus pernio
What electrolyte disturbance do you get in sarcoidosis?
Hypercalcaemia - macrophages in granulomas cause increased conversion of vit D to its active form
What syndromes are associated with sarcoidosis?
Lofgren’s syndrome
Mikulicz syndrome
Heerfordt’s syndrome
What is Lofgren’s syndrome?
Acute form of sarcoidosis where there is bilateral hilar lympadenopathy, erythema nosodum, fever, polyarthralgia
What is Mikulicz syndrome?
Enlargement of the parotids + lacrimal glands due to sarcoidosis, TB or lymphoma
What is Heerfordt’s syndrome?
Parotid enlargement, fever, uveitis secondary to sarcoidosis
How should asymptomatic bilateral hilar lympadenopathy be treated in sarcoidosis?
It should not be treated
What is involved in the general management of COPD?
Smoking cessation advice
Annual flu vaccine
One off pneumococcal vaccine
Pulmonary rehab (for those functionally disabled by COPD)
What is the first line treatment of COPD?
SABA or SAMA
What determines the second line treatment of COPD?
Whether patient has asthmatic features or not
If a patient has asthmatic features what is the second line treatment of COPD?
LABA + ICS
What is third line treatment for someone with asthmatic features and COPD?
Triple therapy - LABA, LAMA, ICS
What is the second line treatment of COPD without asthmatic features?
LABA + LAMA
What features are suggestive of asthmatic features/steroid responsiveness in COPD?
Any prev. diagnosis of asthma/atopy
Those with a higher blood eosinophil count
Substantial variation in FEV1 over time (at least 400ml)
Substantial diurnal variation in peak expiratory flow (at least 20%)
What patients may be treated with theophylline for COPD?
After trials of short and long acting bronchodilators or to those who can’t use inhaled therapies
What antibiotic is recommended in some patients with COPD?
Azithromycin prophylaxis
What COPD patients may get azithromycin prophylaxis?
Those who don’t smoke, have optimised standard treaments, and continue to have exacerbations
Must have bronchiectasis ruled out with CT thorax and have sputum culture done to rule out atypical infections + TB
