resp Flashcards
Features of Streptococcus pneumoniae infection?
Abrupt onset of illness, with high fevers and rigors
Crackles or bronchial breathing on examination
Herpatic cold sores
Older patients may present with general deterioration or confusion
Capsular polysaccharide antigen may be detected in serum, sputum, pleural fluid or urine
Increasing incidence o penicillin-resistance especially in Spain.
Features of Mycoplasma pneumoniae infection?
Typically affects young adults
Prodrome usually >2 weeks
Extrapulmonary complications: pericarditis, myocarditis, erythema multiforme, erythema nodosum, Steven-Johnsons, haemolytic anaemia, DIC, thrombocytopaenia, meningoencephalitis, cranial and peripheral neuropathies, bulous myringitis, hepatitis, pancreatitis
May have a normal WCC
Cold agglutinins in 50%
Features of Legionella pneumophila?
Contaminated water-cooling systems including showers and air conditioning,
Common in ‘European resorts’
Middle-aged to older patients often with underlying lung disease
Men: women= 3:1
Diagnosis is by driect fluorescent antibody staining or serological tests; antigen may be detected in urine
features of staphylococcus aureus pneumonia?
May follow a viral illness
More common in IVDUs
Toxin production with extensive tissue necrosis
Staphylococcal skin lesions
CXR= patchy infiltrates and abscess formation in 25%
CRB-65 score?
Confusion (<8/10 on AMT)
RR >30
BP <90 systolic or <60 diastolic
Age >65
Score 3 or above= hosp admission
1-2= consider hosp admission
0= treated at home
Markers of increased pneumonia severity?
Hypoxaemia (Po 8kPa despite oxygen therapy)
Multi-obar incolvement
WCC < 4 or >20.3
Hypoalbuminaemia
Positive blood culture
Features of pneumocystis jirovecci pneumonia?
Common in immunodeficiency
Presents with T1RF and exertional dyspnoea
Significant CXR findings despite normal physical examination
Rx= co-trimoxazole and/or corticosteroids if severe.
What mechanisms contribute to hypoxia in Primary Pulmonary Hypertension?
Shunting
Reduced diffusion capacity due to arterial fibromuscular hyperplasia
What bacterias are the most common cause of pneumonia in cystic fibrosis patients?
Early years= Staphylococcus Aureus
20s onwards= Psuedomonas becomes increasingly more prevalent
FVC supine lower compared to FVC standing?
Phrenic nerve palsy
Characteristic clinical feature of chronic bronchitis?
Chronic cough and sputum production for at least 3 months of 2 consecutive years.
What is emphysema?
Abnormal, permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls without obvious fibrosis.
Pathophysiology of COPD?
An inflammatory reaction to inhaled stimuli leads to:
- airway narrowing
- an increased number of goblet cells
- mucous-secreting gland enlargement
- vascular bed changes
The end result of these inflammatory-changes differs slightly:
-in emphysema, elastin is broken down and alveolar integrity is lost
-in bronchitis, there is excessive mucus secretion due to the combination of larger/increased numbers of goblet cells and ciliary dysfunction.
NB: the role of eosinophils in COPD is limited to exacerbations only
Clinical signs of Cor pulmonale?
Raised JVP, right ventricular heave, loud P2, tricuspid regurgitation, peripheral oedema and hepatomegaly.
Diagnostic criteria for COPD?
Age > 35
Presence of a risk factor e.g smoking, or occupational exposure to chemicals or dust
Typical symptoms
Pulmonary Function Tests in COPD?
- FEV1/FVC< 0.7
- FEV1 classically <80% predicted, but COPD may be diagnosed in patients with an obstructive FEV1:FVC ratio and FEV1>80% if they have typical symptoms
- Large lung volumes
- Reduced diffusing capacity of the lung for CO in emphysema
How is degree of airflow obstruction in COPD measured?
mild: FEV1 > 80% predicted
moderate: FEV1 50–79% predicted
severe: FEV1 30–49% predicted
very severe: FEV1 < 30% predicted.
Possible ECG changes in COPD?
- P-pulmonale
- Right axis deviation
- RBBB
Treatment guidelines COPD?
- Initial therapy: Inhaled short acting bronchodilators (SABA) OR inhaled short acting antimuscarinics (SAMA)
- Combined therapy:
(2a) no asthmatic or steroid responsiveness features, offer LABA + LAMA
(2b) OR asthmatic or steroid responsiveness features present, offer LABA + ICS - Triple therapy: Either add ICS to 2a option or LAMA to 2b option.
NB: If a patient has day-to-day symptoms that adversely impact quality of life and the inclusion of ICS (to a LABA + LAMA combination therapy) does not improve symptoms, they should revert back to LABA + LAMA.
Surgical options for COPD?
Lung volume reduction surgery (for patients with severe emphysema) or bullectomy
Transplantation may be considered in patients under 65 years with:
-a FEV1 and DLCO < 20% predicted
-a history of hospitalisation with an exacerbation associated with acute hypercapnia
-pulmonary hypertension, and/or cor pulmonale despite oxygen therapy.
Which factor on PFTs correlates with mortality in COPD?
FEV1
BTS guidelines for abx in severe CAP?
IVs:
Co-amoxiclav 1.2 g three times daily or
cefuroxime 1.5 g three times daily or
cefotaxime 1 g three times daily or
ceftriaxone 2 g once daily
&
Erythromycin 500 mg four times daily or
clarithromycin 500 mg twice daily
How do you tests or legionella?
Urinary antigen test
Mainstay treatment of bronchiectasis?
Postural drainage
