Resp 3 Flashcards
What are the 5 main conditions that present with cough?
Pneumonia
TB
Bronchiestasis
Lung Cancer
Mesothelioma
What are the causes of an Acute Dry Cough?
Asthma
Drugs (ACE Inhibitor)
Heart Failure
URTI
What are the causes of an Acute Productive Cough?
Pneumonia
TB
What are the causes of a Chronic Dry Cough?
Asthma
Lung Cancer
GORD
Mesothelioma
What are the causes of a Chronic Productive Cough?
COPD
Bronchiestasis
Lung Cancer
Cystic Fibrosis
What are the main causative organisms of Community-Acquired Pneumonia?
Streptococcus pneumoniae
Haemophilus influenzae B
Moraxella catarrhalis
What are the main causative organisms of Atypical Pneumonia?
Mycoplasma pneumonia (Transverse myelitis)
Legionella pneumophilia (Air Conditioning)
Chlamydia psittaci (Pet birds)
Chlamydia pneumoniae
What are the main causative organisms of Hospital Acquired Pneumonia?
Staph aureus (cavitating lesions)
Pseudomonas aeruginosa
Klebsiella (cavitating lesions)
How does typical pneumonia present?
Fever
SOB
Cough
Chest Pain (Pleuritic)
Confusion
How does Atypical Pneumonia present?
Dry Cough
Headache
Diarrhoea
Mylalgia
Hepatitis
What might you observe on Auscultation of a patient with Pneumonia?
Coarse Bibasal Crackles
Bronchial Breathing
Increased Vocal Resonance
How would you investigate a possible case of Pneumonia?
FBC, CRP, ABG, Blood Cultures
Sputum MCS
Pleural Fluid MCS (Thoracentesis)
CXR
How might you investigate Atypical Pneumonia?
Serology
Urinary Antigens (Legionella, Strep)
Blood Film (Mycoplasma)
LFTs (Legionella)
How do Lobar/Bronchopneumonia differ on CXR?
Lobar - Single patch of consolidation
Broncho - Patchy consolidation
How would you assess the severity of Pneumonia?
CURB-65
How would you manage someone with Pneumonia?
Oxygen
IV Fluids
CPAP
Surgical Drainage
Antibiotics when stabilised
Which antibiotics would you use to treat the CAP?
Amoxicillin (+co-amoxiclav if severe)
How do you treat Atypical Pneumonia?
Clarithromycin
How would you treat Staph-caused HAP?
Flucloxacillin + Gentamycin
How would you treat MRSA?
Vancomycin
What is Aspiration Pneumonia and how do you treat it?
Pneumonia caused by Anaerobes from Gut Flora
Metronidazole
What are the main complications associated with Pneumonia?
Pleural Effusion
Pneumothorax
Lung Abscesses
Empyema
Sepsis
What symptoms are classically associated with Lung Abscesses?
Swinging Fevers
Persistent Pneumonia
Foul-Smelling Sputum
How does TB typically present?
Hx of Travel to TB-Region
FLAWS
Cough w/ green sputum
Haemoptysis
Lymphadenopathy
What is Miliary TB?
Lymphohaematogenous Dissemination of TB
What complications can TB cause?
Meningitis
Pleural Effusion
Pott’s Disease (TB of the Spinal Cord)
Epididymo-orchitis
Addison’s Disease
Erythema Nodosum
How would you investigate a possible case of TB?
Sputum MCS - Ziehl-Neelsen Stain for acid-fast bacilli
CXR
Lymph Node Biopsy
Mantoux Test (Cannot distinguish between latent and active TB)
What is Bronchiectasis?
Chronic Dilation of the airways alongside increased mucous production
What are the causes of Bronchiectasis?
Cystic Fibrosis
Primary Ciliary Dyskinesia (Kartagener’s)
Young’s Syndrome
What is the Triad of Young’s Syndrome?
Bronchiectasis
Sinusitis
Infertility
What is the classical triad of Kartagener’s Syndrome?
Primary Ciliary Dyskinesia
Sinusitis
Situs Inversus
How does bronchiecstasis present?
Chronic Cough
Haemoptysis
SOB
Chest Pain
Fever
Weight Loss
What are the signs of Bronchectasis?
Clubbing
Bibasal Crackles
What are the main causes of Bibasal Crackles?
Pulmonary Oedema
Pneumonia
Bronchiectasis
Interstitial Pulmonary Fibrosis
How would you diagnose Bronchectasis?
Recurrent Chest Infections
HR-CT (Signet Ring Sign)
How do you manage Bronchiectasis?
Conservative: Exercise, Good Diet, Good Hydration
Drugs: Salbutamol, ABx (Prophylactic), Vaccinations
What is the relative frequency of the different types of Lung Cancers?
Small Cell (15%)
Non-Small cell (85%):
- Adeno
- Squamous Cell
- Large Cell
What are the typical presenting symptoms of Lung Cancer?
Cough
FLAWS
Horner’s Syndrome (Apical Tumour)
SVC Obstruction
Remember SIADH
Where does Lung Cancer typically metastasise?
Bone
Brain
Liver
Lymphadenopathy
How would you investigate Lung Cancer?
CXR
Sputum Cytology
Bronchoscopy & Biopsy
Ca, ALP, LFT - Check for Mets
CT, PET, MRI (Staging)
What would you observe on the CXR of someone with primary Lung Cancer?
Consolidation
Bi-Hilar Lymphadenopathy
Upper Lobe Scarring
Cavitating Lesions
Pleural Effusions
What is Mesothelioma?
Malignant neoplasm of mesothelial cells of the pleura.
Exposure to Asbestos
How does Mesothelioma typically present?
Dry Cough
SOB
FLAWS
Pleural Friction Rub
How would you investigate a suspected Mesothelioma?
CXR
CT Chest
Pleural Fluid Cytology
