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Y6 Senior Med > Resp > Flashcards

Resp Flashcards

1
Q

classical sx of pneumonia

A
  • Fever, rigors, sweating
  • Malaise
  • Cough
  • Sputum (yellow, green, rusty in S pneumoniae)
  • Breathlessness
  • Pleuritic chest pain
  • Confusion (severe cases, elderly, legionella)
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2
Q

atypical pneumonia presentation

A

headache, mnyalgia, diarrhea, abdominal pain

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3
Q

signs of pneumonia

A
  • Pyrexia
  • Tachypnoea, tachycardia
  • Hypotension
  • Cyanosis
  • Decreased chest expansion, dullness to percussion, increased vocal fremitus, bronchial breathing (inspiration phase length = expiration phase length), coarse crepitations on affected side
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4
Q

Ix for suspected pneumonia

A

Bedside: flu swab, covid swab

Sputum culture

Consider urine culture– for pneumonoccus and legionella antigens

Bloods
o	FBC (abnormal WCC)
o	U&E (low Na+ esp with Legionella)
o	LFT
o	Blood culture
o	ABG (assess pulmonary function)
o	Blood film (RBC agglutination by mycoplasma caused by cold agglutinins)

CXR – lobar or patchy shadowing, pleural effusion, repeat 6-8 weeks later if abnormal, suspect underlying pathology e.g. lung cancer.

Atypical viral serology (increase antibody titers between acute and convalescent samples)

Bronchoscopy and broncheolaveolar lavage if pneumonia fails to resolve or clinically progresses

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5
Q

What score do you use to assess for pneumonia and explain it

A

CURB 65

Confusion (AMTS <=8)
Urea >7 
Resp rate >30 
BP <90/60
65 years old or older
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6
Q

How do you manage pts based on CURB 65

A

Score of 1: Home abx
Score of 2: admission abx
Score >=3= ITU

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7
Q

What antibiotics do you give as examples for pneumonia? (ALWAYS FOLLOW HOSPITAL GUIDELINES)

A

mild: amoxicillin
Severe: co-amoxiclav + clarythromycin

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8
Q

What defines a HAP

A

Occurrence >48 hours from hospital admission

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9
Q

How do you manage a HAP

A

Non-severe: Co-amox or doxy

Severe: Piptazobactam

ALWAYS FOLLOW LOCAL GUIDELINES

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10
Q

what other management other than abx (long term) is important in pneumonia

A

Prevention is important in vulnerable groups (e.g. elderly, spenectomized) – give prophylactic pneumococcal or H influenzae type B vaccination.

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11
Q

What is a pleural effusion

A

buildup of fluid in pleural space

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12
Q

what are sx of a pleural effusion

A

dyspnoea
cough
pleuritic chest pain

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13
Q

what are the two kinds of pleural effusion you can get

and what criteria do you use to assess

A

TRANSUDATE V EXHUDATE

LIGHT CRITERIA

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14
Q

Explain the difference in protein in TRANSUDATE vs EXHUDATE

A 
TRANSUDATE = low protein (<30g) 
EXHUDATE = high protein (>30g) (= EGG)
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15
Q

What are causes of transudate in pleural effusion

A

Due to factorsa that alter hydrostatic preessure / pleural permeability / oncotic pressure

e.g. CCF, cirrhosis, nephrotic syndrome

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16
Q

What are causes of exhudate in pleural effusion

A

Due to change in local facotrs that influence the formation and absorption of pleural fluid

e.g. Infection (pneumonia, lung empyema)
PE 
Trauma 
Pancreatitis 
Malignancy
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17
Q

What are ix for suspected pleural effusion

A

Exam, obs, urine dip for protein
Baseline bloods esp LFT, CRP, clotting, blood culture
CXR (shows costophrenic blunting) > then considercontrast CT (if exhudative cause) or echo (CCF)

USS guided pleural aspiration and chest draWin

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18
Q

Why aree you doing a USS guided pleural aspiration

A

to get details on the sample

e.g. MC&S, cytology, pH, LDH, glucose, protein, TB, amylase, Hb

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19
Q

What do you do if the aspirate from the pleural effusion is turbid, tests positive on MCS or has pH <7.2?

A

Insert Chest DRAIN

Then treat underlying cause

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20
Q

What is percussion like in PLEURAL EFFUSIOON

A

STONY DULL

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21
Q

What is vocal fremitus like in PLEURAL EFFUSION

A

Reduced

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22
Q

What is lung ascultation like in PLEURAL EFFUSION

A

Reeduced

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23
Q

why do you get RBBB in a PE

A

due to increased strain on the right side of the heart

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24
Q

what else must you do in unprovoked PE patient while after starting on DOAC

A

try to find CAUSE

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25
Q

what is COPD

A

chronic bronchitis + emphysema

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26
Q

What are investiigations for COPD

A

Bedside: sputum sample (for iinfective exacerb), SPIROMETRY (gold standard)
Bloods: baseline bloods (incl FBC for secondary polycythaemia), CRP, ABG, BNP
Imaging: CXR, HR-CT
consider ECG, echo (cor pulmonale)
consider alpha1 antitrypsin levels if young / non smoker

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27
Q

What is conservative management of long-term COPD

A

smoking cessation
mucolytics
vaccines
consider prophylactic azithromycin

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28
Q

when do you give prophylactic azithromycin in COPD

A

250mg TDS if

  • non smoker
  • optimised medical mx
  • referred pulm rehab
  • x4 infective exacerbations per year AND at least one hospitalisation per year
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29
Q

what is medical COPD mx

A

1, SAMA or SABA, PRN

  1. LABA + (LAMA or inhaled corticosteroids (if asthmatic features))
  2. LABA + LAMA + ICS
  3. senior input e3.g. theophylline
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30
Q

when would you give inhaled corticosteroids vs LAMA in COPD mx

A

corticosteroids if asthmatic featurres (e.g. oesinophilia, history of atopic conditions, which make them more lkely to be steroid responsive )

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31
Q

what are the two key components of asthma

A

airway hypersensitivity

reversible airway obstruction

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32
Q

investigations of asthma

A 
spirometry 
FeNO (marker of airway inflammation)
Peak flow variability (getting them to keep an peak flow diary)
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33
Q

long term asthm management

A
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + LTRA
  4. SABA + ICS + LTRA + LABA
  5. SABA + “ICS+LABA” + LTRA
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34
Q

WHat is ICS+LABA

A

MART THERAPY
both reliever and prophylactic
i.e. take in morning and evening every day, but also iif you get acutely out of breath

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35
Q

example of SABA

A

salbulamol

Beta 2 agonist

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36
Q

example of SAMA

A

itratropium

muscarinic antagonist

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37
Q

example of LAMA

A

tiotropium

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38
Q

example of LABA

A

salmeterol

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39
Q

what does atypical pneumonia mean

A

one that does not present with typical symptoms

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40
Q

how do you manage a typical CAP

A

Amoxicillin (mild)
Co-amoxiclv (severe)

often also add clarythromycin if atypical pneumonia cannot be excluded

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41
Q

what are the top thjree most common typical CAPS

A

S pneumonia
H influenza
M catarrhalis

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42
Q

How does S pneumonia typically present

A

rusty sputum
lobar pattern
reactivated HSV

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43
Q

how does H influenza present

A

pre-existing lung disease e.g. COPD

bronchoalveolar pattern, affecting lower lobes mainly

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44
Q

how does Klebsiella pneumoniae present present

A 
redcurrant jelly sputum 
alcoholism 
DM 
elderly 
haemoptysis
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45
Q

How do you treat an atypical pneumonia

A

clarythromycin

or doxycycline

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46
Q

what are common pathogens that cause atypical pneumonia

A 
Legionella pneumophilia (air conditioners, hyponatraemia, urinary antigen) 
Chlamydia pneumoniae (children) 
Chlamydia psittaci (birds, haemolytic anaemia)
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47
Q

what are common HAPs and what timeline do they occur in

A 
Strep pneumonia (48h-4 days) 
Enterobacteria, S aureus, Pseudomonas (>4 days)
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48
Q

how do you treat HAP

A

mild: co-amox or doxy
severe: piptazobactam

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49
Q

What are TB tests you can do

A

IGRA (no cross reaction with BCG)
TST (cross reacts with BCG)
Sputum smear x3 > NAAT (also Ziehl Neelsen stain)
Sputum culture is gold standard

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50
Q

when is auramine staining used for TB

A

for screening

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51
Q

how do you manage TB

A

RIPE
Rifampicin + Isoniazid 6m
Pyrazinamide + Ethambutol 2 months

52
Q

Side effect of rifampicin

A

orange secretions

enzyme inducer

53
Q

Side effect of isoniazid

A

peripheral neuropathy > GIVE WITH PYRIDOXINE

54
Q

SE of pyrazinamide

A

liver injury

55
Q

SE of ethambutol

A

visual disturbance

56
Q

what is pulmonary fibrosis / interstitial lung disease

A

umbrella term for disorders of lung parenchuma

57
Q

what are causes of pulmonary fibrosis

A

idiopathic
hypersensitivity pneumonitis (to organic dusts)
pneumonicosis (to inorganic dusts)

58
Q

how does pulmonary fibrosis show up in HR CT

A

honeycombing

59
Q

what are signs and symptoms of IPF

A

progressive exertional dyspnoea
dry cough
clubbing
bibasal fine end espiratory creps

60
Q

key Ix for IPF

A

HR CT
spirometry (restrictive)
lung biopsuy

61
Q

management for IPF

A

smoking cessation
pysiotherapy
pulm rehabilityation

Pirfenidone, immunospuuressants if AI

lung transplant

62
Q

what is sarcoidosis

A

chronic disease characterised by formation of granulomas in various tissue (with no infective cause)

63
Q

signs and symptoms of sarcoidosis

A

SOB, dry cough
fatigue, joint aches
dry eyes
erythema nodosum

64
Q

invesitgations of sarcoidosis

A

Serum ACE (raised as ACTH producing)
Serum calcium (raised)
CXR (bihilar lymphadenopathy> pulmonary infiltrates > fiibrosis)
biopsy

65
Q

what is a pancoast tumour and how does it present

A

lung tumour at apex of lung

  • Horner’s syndrome
  • Wasting of T1 in hand
66
Q

what is bronchiectasis

A

permanent dilation of airways secondary to chronic inflammation (irreversible)

67
Q

what is bronchiectasis due to

A

Post infectious - TB, measles, pertussis, pneumonia
Obstruction (foreign body)
AI (selective gA, hypogammaglobulinaemia, ABPA, RA, SLE)
CF, Kartageners, Youngs, yellow nail syndrome

68
Q

what pneumonia do you see in AIDS

A

PCP (pneumocisti jirovecii)

69
Q

hhow do you manage PCP

A

co-trimoxazole

70
Q

what is the genetic defect in CF

A

Defecting CFTR (CF transmembrane conoductance regulator) on Chr 7

71
Q

Sx CF

A

Meconium ileus
recurring chest infectionos, wheezing, coughing, SOB
diarrheoa / consiptation
Male sterility

faltering growth
jaundice (due to cirrhosis, portal HTN)
DM

72
Q

how do you ix CF

A 
Immunoreactive trypsinogen (on Guthrie)
Sweat test (raised sodium)
CXR (hyperinflation, peribronchial shadowing)
73
Q

how do you mx CF (broad outline)

A

ROUTINE REVIEWS with MDT APPROACH, involve specialist CF centre

  • Resp
  • Infection
  • nutritional
  • other
74
Q

Resp mx CF

A
  • chest physio x2 daily

- mycolytics (dornase alpha, mannitol dry powder)

75
Q

Infection mx CF

A

PROPHYLACTIC ORAL ABX (with fluclox, azithhromyciin)

76
Q

what bacteriium are we worried aboout in CF pneumonia

A

Pseudomonaas aerogiinosa

77
Q

Nutritional mx CF

A

hiigh calorie + high fat diet
fat soluble vitamin supplements
pancreatic enzyme replacement (CREON) with every meal

78
Q

What is Mx of CF in adults?

A
  1. DM therapy
  2. Liver therapy (ursodeoxycholic acid to improve flow; may require transplant)
  3. Intestinal obstruction (oral laxatives)
  4. Male sterility
79
Q

what lung cancer is typical in smokers

A

Small cell lung cancer

80
Q

what are associations of SCLC

A

smokers
central

SIADH
ACTH
LEMS

81
Q

what is the most common yupe of lung cancer

A

non-SCLC

82
Q

test criteria threshold for ASTHMA diagnosis

A

<70% FEV1/FVC
>40 FeNO

> 12% variability FEV1 after SABA administration
20% PEFR variability

83
Q

2 key fts of Kartageners

A

situs invertus

cilia immobiliity

84
Q

2 key fts of yellow nail syndrome

A

lymphoedema

pleural effusion

85
Q

what is finding of bronchiectasis on CT

A

“signet ring” appearance of thickened bronchi

86
Q

which iniherited condition can predispose to COPD

A

alph 1 antitrypsin deficiency

87
Q

what is alpha 1 antitripsin deficinecy (mode of inheritance, pathophys)

A

autosomal co-dominant condition
alpha 1 antitrypsin usually inhibitss neutrophil elastase in lungs

so absence of it causes early COPD development

88
Q

what does a CXR show in COPD

A

hyperinflated lungs
decreased peripheral markings
may show elongated cardiac silouhette (cor pulmonale)

89
Q

what does spirometry show inn COPD

A

FEV1/FVC <70%

increased lung volume

90
Q

what does an FBC show in COPD

A

secondary polycythaemia

91
Q

criteria for long term oxygen therapy in COPD

A

NON SMOKER

AND:

  • PaO2 <7.3 (x2 measurements)

OR

PaO2 of 7.3-8 + secondary polycythhaemia/ pulm oedema / pulm HTN

92
Q

who is a pink puffer and who is a blue boater in COPD

A

pink puffer = emphysema dominant

blue boater = bronchitis dominant

93
Q

describe a pink puffer

A

Alveolar ventilation INCREASED
Build is THIN
Cx is T2RF

94
Q

describe a blue boater

A

Alveolar ventilation DECREASED
Build is STOCKY
Cx is cor pulmonale

95
Q

what is chronic bronchitis

A

chronic cough and sputum min 3 months min 2 consecutve years

96
Q

what is emphysema

A

alveolar destruction > bullae formation

97
Q

what is life expectancy for idiopathic pulmonary fibrosis

A

3 years

98
Q

how do you manage idiopathic pulmonary fibrosis

A

Steroids (for 3 months) then reassess

99
Q

what antibiotic do you give for Pseudomonas aeroginosa (so CF/ chemo / bronchiectasis pt)?

A

Tazocin, ciprofloxacin

100
Q

How do you manage sarcoidosis

A

Steroids
NSAIDS
Steroid-sparing agent

101
Q

what is hypersensittivity pneumonitis

A

hypersensitivity induced lung damage due to inhaled organic particles

102
Q

examples of hypersensittivity pneumonitis

A

bird lung
farmers lung
malt workers lung

103
Q

mx hypersensittivity pneumonitis

A 
avoid causative agen t
oral glucocorticoids (second line)
104
Q

what abx can you give for IE of COPD

A

amoxicillin
doxy
clarythromycin

105
Q

what is SVCO caused by

A

mainly lung cancer

other causes include sarcoid, lymphoma, aortic aneurysm

106
Q

what is SVCO presentation

A

facial and upper limb swelling

107
Q

when do patients admitted with pneumonia need a follow up CXR

A

ALL patients admtted need a follow upp CXR at 6-12 weeks

This is to detect any underlying pathology and ensure resolution

108
Q

what are causes of upper lobe pneumonicosis?

A 
C- Coal worker's pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis
109
Q

features of moderate asthma

A

PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
Pulse < 110 bpm

110
Q

features of severe asthma

A

PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm

111
Q

features of life threatening asthhma

A 
CHEST: 
Cyanosis 
Hypotension, bradycardia 
Exhaustion (PEFR < 33%, SpO2 < 92%)
Silent chest 
Too confused or coma
112
Q

when does the HR go above 110 in asthma

A

in SEVERE asthma

113
Q

whenn does SpO2 go below 92 in asthma

A

in life threatening asthma

114
Q

what is atelectasis , what is it caussed by

A

post-operative complication
= basal alveolar collapse which leads to respiratory difficulty
It is caused when airways become obstructed by bronchial secretions

115
Q

how do you manage atelectasis

A

deep breathing exercises and chest physiotherapy.

116
Q

what does lupus pernio occur with

A

with sarcoidosiss

117
Q

what does lupus pernio look like

A

raised purple plaque of indurated skin that affects the tip of her nose and the skin around the right nostril

118
Q

what is ABPA

A

Allergic Broncopulmonary Aspergillosis

= allergic response in asthmatics, causing bronchiectasis

119
Q

how do you managge ABPA

A

PREDNISOLONE

120
Q

when can you start corticosteroid tx for sarcoid

A

parenchymal lung disease, uveitis, hypercalcaemia and neurological or cardiac involvement

121
Q

which drugs can precipitate an astthma atttack / must you avoid in asthmatics?

A

beta blockers

NSAIDS

122
Q

how does bronchiectasis present

A

history of cause (e.g. infection as a child)
recurrent chest infections, refractory to abx
chronic productive cough
lots of phlegm

123
Q

O/E bronchiectasis

A

coarse crepitations, wheeze

124
Q

ix bronchiectasis

A

sputum sample MCS (Pseudomonas), sweat test (exclude CF()
Baseline bloods, CRP, Ig, CF genetic test, aspergillus markers
CXR, HR CT (signet ring, tram lining)
Spirometry (obstructive)

125
Q

Mx bronchiectasis

A

Correct underlying cause if possible
Conservative:
- physiotherapy, pulmonary rehab
- smoking cessation

Medical:

  • mucolytic (carbocystine)
  • antibiotics
  • bronchodilators

Y6 Senior Med (29 decks)

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