resp extra notes Flashcards
what is the most common cause of acute epiglottitis
haemophilus influenzae B
what are the 3 main causes of HAP
pseudomonas aerginosa
SA/MRSA
Klebsiella
how is acute bronchitis differentiated from pneumonia
chest XR clear in bronchitis
what are the 3 main atypical pneumonias
mycoplasma
legionella
chlamydophilia pneumonia
what is the most common cause of aspiration pneumonia
klebsiella
-ve enterococcus
what microorganism is associated with farm/plants/harvest
aspergillus fumigatas
what is the treatment for PE
LMWH e.g. dalteparin
warfarin for 3 months or LMWH for 3 months if secondary to malignancy
what does bilateral lower zone reticulonodular shadowing show
fibrosis
how is an empyema treated
US guided chest drain and antibiotics
what does faecal elastase test test
assess exocrine pancreatic dysfunction in CF
what microorganisms infect CF
SA H. influenzae LT - Pseudomonas Aeruginosa Burkholderia Cepecia ( less common)
what are... amphotericin vonconazole itraconazole caspofungin
antifungals
what should be measured in acute exac of COPD
ABGs
32 YO LT asthma suspected pneumonia CXR - unusual pattern of changing infiltrates eosinophilia inflammatory markers raised biopsy of lung tissue - eosinophilic infiltrate, granuloma p-ANCA +ve
Chung Strauss - eosinophilic infiltration causing vasculitis of small arteries and veins
tin miner
pneumoconiosis
smoker haemoptysis SOB, tired inspiratory crackles throughout lungs impaired renal function raised anti-GBM antibody
Goodpastures syndrome
long standing cough, multiple fits every day, cold 2 months ago
pertusis
worked in coal industry
rheumatoid arthritis
worsening breathlessness
Xray - small nodules throughout lung fields
Caplans syndrome - rheumatoid pneumoconiosis
early pregnancy
acetalasis on XR
resp assistance required
newborn respiratory distress syndrome
SOB clubbing bibasal crepitations stiff hand joints lost weight CRP and ESR raised
rheumatoid
SOB when active
non-productive cough
pmhx rheumatoid arthritis
takes methotrexate and folic acid
interstitial lung disease - possibly drug induced fibrosis
chest pain worse in deep breaths/cough poorly localised rash across face fmhx: T1 diabetes, rheumatoid arthritis
pleuritis
worked in ship yards weight loss night sweats worsening breathlessness imaging - extensive pleural disease and peritoneal deposits
mesothelioma
what is the treatment for croup
nebulised adrenaline
what is a s/s SLE
pleurisy
inflamed sinuses, lungs, throat, kidney
haemoptysis
nose bleeds
wegners granulomas - granulomatous disease affecting small arteries
gradual onset SOB
reduced chest expansion
dullness on percussion
pleural effusion
what is a CF screening test that can be done in the GP
faecal elastase
what is seen in sweat test of CF
high sodium
what does CF show on spirometry
obstructive
what is the treatment of a tension pneumothorax
large bore cannula 2nd ICS MCL
then chest drain 4th/5th ICS MAL
recurrent - pleurodesis
how does a pneumothorax look on a CXR
straight line with no lung markings outside it
what is kartageners syndrome
AR disease
ciliary dyskinesia assoc. abnormal mucociliary clearance –> recurrent resp infections, infertility, pancreatic problems
dextrocardia
35 year old woman chest pain SOB red rash across face (butterfly rash) raised ds-DNA and ANA abs
SLE
14 month old baby
sternal recession and indrawing
bronchiolitis
infection affecting distal airspaces usually accompanied by inflammatory exudate causing consolidation
pneumonia
fixed dilation of bronchi usually as a result of scarring or distal to a chronic obstruction
bronchiectasis
infection at 4 months old
developing normally, after supportive treatment goes on to develop normally
transient hypogammaglobulinaemia of infancy
3 month old infections
family history early infant death
differential WBC - low T cell and raised B cell
diarrhoea
SCID
15 day old baby severely unwell febrile difficult to settle extensive oral ulcers lost weight low neutrophil count
AR - Kostmann syndrome
repeated infections recurrent oral candidiasis multiple facial features suggesting genetic cause low T cell count and hypocalcaemia abnormal CVS
DiGeorge syndrome
what can you test the function of with NBT
neutrophils
what is a test for haemophilus influenza
X and V test, chocolate agar
what are the most common microorganisms seen to infect in COPD
haemophilus influenza
strep. pneumonia
moraxella catarrhalis
what are 4 common causes of coryza
adenovirus
rhinovirus
RSV
coronavirus
what is a cause of pharyngitis
adenovirus
what is youngs syndrome
bronchiectasis + rhinosinusitis + reduced fertility
AR
what is chronic bronchial sepsis
bronchial sepsis but no bronchiectasis on HRCT
younger patients esp women in child care
what is the most common cause of brochiectasis
CF
what does inhalation of NO do to V/Q
improves
what happens in CF
Failed opening of Cl channel -> ↑cAMP, resulting in ↓Cl and ↑Na -> ↑viscosity of airway secretions.
what is there a deficiency of in bronchiectasis
IgA
what cells do glucocorticoids act on
Th2
what is seen in bronciectasis
tram track signs
signet ring signs?
what is seen in a ghon focus
epithelial cells
langhans giant cells
where does TB tend to stay
apices of lungs
- fibrosing and cavitating apical lesions
what is IGRT
specific test for M. tuberculosis - but doesn’t differentiate latent, active or previously treated TB
what is the main side effect of Rifampicin
orange urine and tears
hepatitis
what is the main side effect of isoniaside
pins and needles
hepatitis
what is the main side effect of pyrazinamide
gout
hepatitis
what is the main side effect of ethambutol
arthralgia
retrobulbar neuritis
what does steeple sign on CXR indicate
croup
egg shell calcification in hilar region
silicosis
heart failure cells in alveolar spaces
chronic pulmonary oedema/LV failure/LT pulmonary hypertension
assman focus
secondary TB
top of lung
coin lesion
primary/secondary cancer
granuloma
abscess
thumbprint sign of head Xray
epiglottitis
snow storm appearance on X ray
baritosis/silicosis
large PE tx
thrombolysis
small PE tx
LMWH
child with barking cough
croup
right sided chest pain
probably pneumonia
CT scan showing bronchiole wider than neighbouring arteriole
signet ring sign
bronchiectasis
CXR showing tram line
bronchiectasis
what are some job causes of silicosis
glass working
mining
stone working
foundry working
what causes a spontaneous pneumothorax
rupture of sub pleural air cysts (blebs)
what causes secondary pneumothorax
secondary to resp disease
how can resp distress syndrome be prevented
steroids to expectant mother
what mothers are more prone to children with resp distress syndrome
diabetics
what is treatment for severe resp distress syndrome
artificial surfactant
oxygen
what is the blue inhaler
salbutamol
in obstructive lung disease there is trouble with
exhaling
what is stridor
inspiratory wheeze
what are some causes of cor pulmonale
COPD
PE
sleep apnoea
CF
what are some s/s cor pulmonale
cyanosis tachycardia raised JVP RV heave Pan systolic murmur (tricuspid regurg)
what is the treatment of croup
single dose of prednisolone
what is a complication of coryza
bronchitis
what is the treatment of whooping cough
erythromycin
how is whooping cough diagnosed
pernasal swab
serology for bordetella pertussis
what is the treatment for obstructive sleep apnoea
lose weight
reduce alcohol
CPAP
what is the treatment for central sleep apnoea
treat cause
NIPPV
Cheyne-Strokes respiration
central sleep apnoea
what is the treatment for ARDS
ICU ventilation
what breathing is seen in ARDS
rapid shallow breathing
what are some s/s of a lung abscess
Swinging Fever Foul Smelling Sputum Pleuritic Chest Pain Haemoptysis Malaise Weight Loss FBC - anaemia and neutrophilia CXR - walled cavity with fluid level
what is the expansion in pneumonia
diminished
what is the resonance in pneumonia
increased
what is seen on XR of pneumonia
new shadowing
what breathing is seen in pneumonia
bronchial breathing
patient with resolving pneumonia gets a fever
what do you suspect
empyema
what are some s/s empyema
chest pain on inspiration
pleural rub
CXR
drainage
A one year old child, caucasian with loose oily stools and failure to thrive presents. They have had persistent chest infections. Cause?
CF
what is the treatment for CF
- ABs given early, high dose, for longer
- salbutamol to relieve symptoms
- corticosteroids to reduce inflammation
- pancreatic enzymes, vitamins, high calorie diet
what is seen on the CXR of fibrosis
reduced lung volume
honeycombing
bilateral lower zone reticulonodular shadows
what are some s/s asthma
diminished air entry
audible wheeze
hyper inflated chest
what are some s/s bronchiectasis
lower lobes
course crackles
clubbing
what is the treatment for drug induced asthma e.g. by aspirin
montelukast
what do mast cells in asthma secrete
histamine
LTC4
PGD2
what is the pathophysiology of coal worker pneumoconiosis
Coal dust enters the lungs which cannot be removed or destroyed
It is ingested by macrophages and causes the macrophages to release inflammatory mediators
Causes inflammation and fibrosis
what is seen in massive fibrosis of coal worker pneumoconisos
Very large, nodular, fibrinotic masses in the upper lungs
Shortness of breath, chronic cough, Black sputum, lung dysfunction
what is the general order of treatment for asthma
SABA ICS LABA CysLTA (oral) prenisolone
