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pneumonia CF aspergillus (+ bronchiectasis) Flashcards

1
Q

what are the 2 anatomic types of pneumonia?

A

bronchopneumonia

lobar pneumonia

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2
Q

what suggests bronchopenumonia?

A

patchy consoldtaion of different lobes

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3
Q

what suggests lobar pneumonia?

A

fibrosuppurative consolidation of a single lobe

congestion-> red-> grey-> resolution

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4
Q

what microbiology suggests community acquired pneumonia?

A

penumococcus
mycoplasma
haemophilus

S. aureus, moraxella
chamydia, legionella
viruses 15%

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5
Q

what microbiology suggests hospital acquired pneumonia + what is the timescale?

A

grame negative enterobacteria
S aureus
>48h after hospital admission

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6
Q

what can cause an aspiration pneumonia?

A

anaerobes

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7
Q

what risk does aspiration pneumonia pose to the patient?

A 
increases risk of:
stroke
bulbar palsy
reduced GCS
GORD
achalasia
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8
Q

what microbiology suggests immunocompromised pneumonia?

A 
PCP
TB
fungi
CMV/HSV
\+ the usual
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9
Q

what are the symptoms of pneumoina?

A 
fever, rigors
malaise, anorexia
dyspnoea
cough, pururulent sputum, haemoptysis 
pleuritic chest pain
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10
Q

what are the signs of pneumonia?

A 
tachycardia, tachypnoeic 
cyanosis
confusion
consolidation: 
- reduced expansion
- dull percussion 
- bronchial breathing
- reduced air entry
- crackles
- pleural rub
- increased vocal resonance
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11
Q

what investiagtions would you do for pneumonia?

A

1) bloods- FBC, UE, LFT, CRP, culure, ABG if reduced SpO2
2) urine- Ag tests (pneumococcal, legionella)
3) sputum- MC&S
4) imaging- CXR
5) special tests
- paired sera abs for atypicals- mycoplasma, chalmydia, legionella
- immunofluorescence for PCP
- BAL
- pleural tap

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12
Q

what can be seen on CXR for pneumonia?

A

infiltrates
cavities
effusion

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13
Q

how do you measure severity in pneumonia + when would you do it?

A 
only if x ray changes
CURB-65
confusion AMT8
urea>7mM
RR>30
BP<90/60
>/65

0-1 home management
2 hospital management
>/3 consider ITU

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14
Q

what is the management of pneumonia?

A

1) abx
2) O2” paO2>/8, SpO2 94-98
3) fluids
4) analgesia
5) chest physiotherapy
6) consider ITU if shock, hypercapnoea, hypoxia
7) follow up at 6 weeks with CXR- check for underlying cancer

p37 AS notes for abx

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15
Q

what antibiotics would you give for a mild/<5d HAP?

A

co-amoxiclav 625mg PO TDS 7 days

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16
Q

what antibiotics would you give for a severe/>5d HAP?

A

tazocin +/- vanc +/- gent 7 days

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17
Q

what antibiotics would you give an aspiration pneumonia?

A

co-amoxiclav 625mg PO TDS 7 days

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18
Q

when would you give pneumovax?

A

pneumococcal vaccine against 23 pneumococcal bacteria types

>/65yo
chronic HLKP failure or conditions 
DM
immunosuppression- hyposplenism, chemo, HIV
CI: P, B, fever 
revaccinate every 6 years
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19
Q

what are the complications of pneumonia?

A 
resp failure
hypotension
AF
pleural effusion 
empyema
lung abscess 
other- sepsis, pericarditis/myocarditis, jaundice
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20
Q

what is type 1 resp failure?

A

PaO2<8kPa

PaCO2<6kPa

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21
Q

what is type 2 resp failure?

A

PaO2<8kPa

PaCO2>6kPa

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22
Q

what is the management of resp failure?

A

Oxygen

ventilation

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23
Q

what is the cause of hypotension complication in pneumonia?

A

dehydration

septic vasodilation

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24
Q

what is the management of hypotension in pneumonia?

A

SBP<90 give 250ml fluid challenge over 15 min

if no improvement- central line + IV fluids

if refractory: ITU for inotropes

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25
what is the management of AF in pneumonia?
usually resolves with treatment | digoxin or bb for rate control
26
what type of pleural effusion do you get in pneumonia?
exudate
27
what is the management of pleural effusion in pneumonia?
pleural tap | send for MC&S, cytology + chemistry
28
what is empyema?
pus in pleural cavity associated with recurrent aspiration patient with resolving pneumonia develops recurrent fever
29
what bugs cause empyema?
anerobes staph gram negative
30
what is the management of empyema?
pleural tap | US guided chest drain + abx
31
what does a pleural tap show in empyema?
turbid ph<7.2 decreased glucose increased LDH
32
what causes lung abscesses?
1) aspiration 2) bronchial obstruction- tumour, foreign body 3) septic emboli- sepsis, IVDU, RH endocarditis 4) pulmonary infarction 5) subphrenic/hepatic abscess
33
what are the clinical features of lung abscess?
``` swinging fever cough, foul pruurlent sputum, haemoptysis malaise, weight loss pleuritic chest pain clubbing empyema ```
34
what investigations would you do for lung abscess?
1) blood- FBC, ESR, CRP, cultures 2) sputum- micro, culture, cytology 3) CXR 4) consider CT + bronchoscopy
35
what would you see on CXR with a lung abscess?
cavity with fluid level
36
what is the management of a lung abscess?
abx accordign to sensitivities aspiration surgical excision
37
what type + causes of jaundice is there in pneumonia complicatons?
cholestatic usually causes: sepsis, drugs- fluclox, augmentin mycoplasma, legionella
38
what criteria suggests sepsis?
T>38 <36 HR >90 RR>20 or paCO2<4.6kPa wcc>12x10^9/L or <4x10^9/L or >10% bands caused by infection
39
what is severe sepsis?
sepsis with at least 1 organ dysfunction or hypoperfusion
40
what is septic shock
severe sepsis with refractory hypotension
41
what is MODS?
multiple organ dysfunction syndrome impairment of >/2 organ systems homeostasis cannot be maintained without therapeutic intervention
42
what is the pathogenesis of CF?
autosomal recessive, 1:2000 live caucasian births mutation in CFTR gene on chr7 leads to decreased luminal Cl- secretion and more Na+ reabsortption so viscous secretions in sweat glands less Cl + Na reabsorption-> salty sweat
43
what are the clinical features of CF in neonates?
FTT meconium ileus rectal prolapse
44
what are the clinical features of CF in children/young adults?
nose- nasal polyps, sinusitis resp- cough, wheeze, infx, bronchiectasis, haemoptysis, pneumothorax, cor pulmonale other- male infertility, osteoporosis, vasculitis GI: - pancreatic insufficiency- DM, steatorrhoea -distal instestinal obstruction syndrome -gallstones -cirrhosis 2* to biliary
45
what are the signs of CF?
clubbing +/- HPOA cyanosis bilatral coarse creps
46
what are the common respiratory organisms in CF (early)?
S. aureus | H. influenza
47
what are the common respiratory organisms in CF (late)?
P. aeruginosa 85% | B. cepacia 4%
48
how do you diagnose CF?
1) sweat test- Na + Cl >60mM 2) genetic screening for common mutations 3) faecal elastase- tests pancreatic exocrine function 4) immunoreactive trypsinogen- neonatal screening (IT)
49
what investigations do you do for CF?
1) bloods- FBC, LFT, clotting, ADEK levels, glucose TT 2) sputum MC&S 3) CXR- bronchiectasis 4) abdo USS 5) spirometry 6) aspergillus serology/skin test (20% develop ABPA)
50
what can you see on abdo USS in CF?
fatty liver cirrhosis pancreatitis
51
what does spirometry show in CF?
obstructive defect
52
what is the general management of CF?
MDT- physician, GP, physio, dietician, specialist nurse chest + GI management treat other complications: risk of complications eg DM fertility + genetic counselling DEXA osteoporosis screen
53
what specific chest management is there for CF?
1) physio- postural drainage, forced expiratory techniques 2) abx- acute infx + prophylaxis 3) mucolytics- DNAse 4) bronchodilators 5) vaccinate
54
what specific GI management is there for CF?
1) pancreatic enzyme repalacement pancreatin (Creon) 2) ADEK supplements 3) insulin 4) ursodeoxycholic acid for imapired hepatic function- stimulates bile secretion
55
how do you manage advanced lung disease in CF?
1) O2 2) diuretics- cor pulmonale 3) NIV 4) heart/lung transplant
56
what diseases are caused by aspergillus (mould)?
``` asthma- T1H reaction to spores ABPA aspergilloma (mycetoma) invasive aspergillosis extrinsic allergic alveolitis ```
57
what is ABPA?
allergic bronchopulmonary aspergillosis T1 +T3 HS reaction to aspergillus fumigatus bronchoconstriction leads to bronchiectasis
58
what are the symptoms of ABPA?
wheeze productive cough dyspnoea
59
what investigations would you do for ABPA?
``` CXR- bronchiectasis aspergillus in sptum (black on silver stain) aspergillus skin test or IgE RAST postive se precipitins elevated IgE + eosinophils ```
60
what is the management of ABPA?
pred 40mg/d + itraconazole for acute attacks pred maintenance 5-10mg/d bronchodilators for asthma
61
what as aspergilloma (mycetoma)
fungus ball within a pre-existing cavity eg TB or sarcoid
62
what are the features of aspergilloma?
usually asymptomatic can have haemoptysis (Severe) lethargy, weight loss
63
what investigations would you do for aspergilloma?
CXR- round opacity within cavity, usually apical sputum culture positive se precipitins aspergillus skin test/RAST
64
what is the management of aspergilloma?
consider excision for solitary lesions or severe haemoptysis
65
what is invasive aspergillosis?
aflatoxins -> liver cirrhosis and HCC (especially A. flavus) 30% mortality
66
what are the risk factors for invasive aspegillosis?
immunocomprimse- HIV, leukaemia, wegener's | post-broad spectrum abx
67
what investigaitons would you do for invasive aspergillosis?
``` CXR- consolidation, abscess sputum MC&S BAL positive se precipitins serial galactomannan ```
68
what is the management of invasive aspergillosis?
voriconazole
69
what is extrinsic allergic alveolitis?
sensitivity to aspergillus clavatus-> malt worker's lung

RESP (4 decks)

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