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RESP > pneumonia CF aspergillus (+ bronchiectasis) > Flashcards

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
Q

what is the management of AF in pneumonia?

A

usually resolves with treatment

digoxin or bb for rate control

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26
Q

what type of pleural effusion do you get in pneumonia?

A

exudate

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27
Q

what is the management of pleural effusion in pneumonia?

A

pleural tap

send for MC&S, cytology + chemistry

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28
Q

what is empyema?

A

pus in pleural cavity
associated with recurrent aspiration
patient with resolving pneumonia develops recurrent fever

29
Q

what bugs cause empyema?

A

anerobes
staph
gram negative

30
Q

what is the management of empyema?

A

pleural tap

US guided chest drain + abx

31
Q

what does a pleural tap show in empyema?

A

turbid
ph<7.2
decreased glucose
increased LDH

32
Q

what causes lung abscesses?

A

1) aspiration
2) bronchial obstruction- tumour, foreign body
3) septic emboli- sepsis, IVDU, RH endocarditis
4) pulmonary infarction
5) subphrenic/hepatic abscess

33
Q

what are the clinical features of lung abscess?

A 
swinging fever
cough, foul pruurlent sputum, haemoptysis
malaise, weight loss
pleuritic chest pain 
clubbing 
empyema
34
Q

what investigations would you do for lung abscess?

A

1) blood- FBC, ESR, CRP, cultures
2) sputum- micro, culture, cytology
3) CXR
4) consider CT + bronchoscopy

35
Q

what would you see on CXR with a lung abscess?

A

cavity with fluid level

36
Q

what is the management of a lung abscess?

A

abx accordign to sensitivities
aspiration
surgical excision

37
Q

what type + causes of jaundice is there in pneumonia complicatons?

A

cholestatic usually
causes:
sepsis, drugs- fluclox, augmentin
mycoplasma, legionella

38
Q

what criteria suggests sepsis?

A

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
Q

what is severe sepsis?

A

sepsis with at least 1 organ dysfunction or hypoperfusion

40
Q

what is septic shock

A

severe sepsis with refractory hypotension

41
Q

what is MODS?

A

multiple organ dysfunction syndrome
impairment of >/2 organ systems
homeostasis cannot be maintained without therapeutic intervention

42
Q

what is the pathogenesis of CF?

A

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
Q

what are the clinical features of CF in neonates?

A

FTT
meconium ileus
rectal prolapse

44
Q

what are the clinical features of CF in children/young adults?

A

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
Q

what are the signs of CF?

A

clubbing +/- HPOA
cyanosis
bilatral coarse creps

46
Q

what are the common respiratory organisms in CF (early)?

A

S. aureus

H. influenza

47
Q

what are the common respiratory organisms in CF (late)?

A

P. aeruginosa 85%

B. cepacia 4%

48
Q

how do you diagnose CF?

A

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
Q

what investigations do you do for CF?

A

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
Q

what can you see on abdo USS in CF?

A

fatty liver
cirrhosis
pancreatitis

51
Q

what does spirometry show in CF?

A

obstructive defect

52
Q

what is the general management of CF?

A

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
Q

what specific chest management is there for CF?

A

1) physio- postural drainage, forced expiratory techniques
2) abx- acute infx + prophylaxis
3) mucolytics- DNAse
4) bronchodilators
5) vaccinate

54
Q

what specific GI management is there for CF?

A

1) pancreatic enzyme repalacement pancreatin (Creon)
2) ADEK supplements
3) insulin
4) ursodeoxycholic acid for imapired hepatic function- stimulates bile secretion

55
Q

how do you manage advanced lung disease in CF?

A

1) O2
2) diuretics- cor pulmonale
3) NIV
4) heart/lung transplant

56
Q

what diseases are caused by aspergillus (mould)?

A 
asthma- T1H reaction to spores
ABPA
aspergilloma (mycetoma)
invasive aspergillosis
extrinsic allergic alveolitis
57
Q

what is ABPA?

A

allergic bronchopulmonary aspergillosis
T1 +T3 HS reaction to aspergillus fumigatus

bronchoconstriction leads to bronchiectasis

58
Q

what are the symptoms of ABPA?

A

wheeze
productive cough
dyspnoea

59
Q

what investigations would you do for ABPA?

A 
CXR- bronchiectasis
aspergillus in sptum (black on silver stain)
aspergillus skin test or IgE RAST 
postive se precipitins 
elevated IgE + eosinophils
60
Q

what is the management of ABPA?

A

pred 40mg/d + itraconazole for acute attacks

pred maintenance 5-10mg/d
bronchodilators for asthma

61
Q

what as aspergilloma (mycetoma)

A

fungus ball within a pre-existing cavity eg TB or sarcoid

62
Q

what are the features of aspergilloma?

A

usually asymptomatic
can have haemoptysis (Severe)
lethargy, weight loss

63
Q

what investigations would you do for aspergilloma?

A

CXR- round opacity within cavity, usually apical
sputum culture
positive se precipitins
aspergillus skin test/RAST

64
Q

what is the management of aspergilloma?

A

consider excision for solitary lesions or severe haemoptysis

65
Q

what is invasive aspergillosis?

A

aflatoxins -> liver cirrhosis and HCC (especially A. flavus)

30% mortality

66
Q

what are the risk factors for invasive aspegillosis?

A

immunocomprimse- HIV, leukaemia, wegener’s

post-broad spectrum abx

67
Q

what investigaitons would you do for invasive aspergillosis?

A 
CXR- consolidation, abscess
sputum MC&amp;S
BAL
positive se precipitins
serial galactomannan
68
Q

what is the management of invasive aspergillosis?

A

voriconazole

69
Q

what is extrinsic allergic alveolitis?

A

sensitivity to aspergillus clavatus-> malt worker’s lung

RESP (4 decks)

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