Resp - Lecture Flashcards
What vaccines useful in preventing CAP
Influenza and Pneumococcal Vaccine
List some risk factors for CAP
Age >50 Alcoholism Asthma COPD Dementia CHF Immunosuppression Indigenous Smoking Stroke
What do peripheral chemoreceptors respond to
- Oxygen (critical response PaO2 <60mmHg)
- Carbon Dioxide
- H+
What do central chemoreceptors respond to
- CO2
2. H+
Where are peripheral chemoreceptors located
Type 1 Glomus Cell In Carotid Bodies (CN9) and Aortic Bodies (CN10)
Where are central chemoreceptors located
Ventral Medulla
Give an example of a Schedule 2 (Pharmacy Medicine)
Aspirin, Paracetamol, Ibuprofen
Give an example of a Schedule 3 (Pharmacist Only)
Ventolin, Pseudoephedrine
Give an example of a Schedule 4 (Prescription Only)
BZD, SSRI, Retenoids
Give an example of a Schedule 5 (Caution)
Phenergan, Lomotil
Give an example of a Schedule 8 (Controlled Drug)
Morphine
List some key features of mucosal immunity
Mucus IgA MALT Microbiota Tolerance
What is the difference in Ig between Mucosal vs Systemic Immunoglobulins
Mucosal = 80% IgA Systemic = 52 % IgG, 30% IgA
Where is IgA1 Predominantly
- Nasal Mucosa
- Respiratory Tract
- Lacrimal Gland
What Interleukins are important for differentiating B cells to Plasma Cells
IL-5 and IL-6 (From Th2)
What are important mediators of immune regulation
IL-10 and TGF-beta
The mucosal immune system is made up of EPITHELIUM and LAMINA PROPRIA, give examples of the cell types of each
E = M cells, Goblet Cells LP = IgA, CD4/8, Macrophage, Mast, Plasma Cells
What components are important in an occupational history
- Age
- Occupation - title and role
- Exposure - FUMES/DUST/CHEMICALS
- Years
List 3 complications of Asbestosis
- Pleural Plaque
- Lung Cancer
- Mesothelioma
List come complications of Crystalline Silica (SiO2) Inhalation
- Acute/Chronic Silicosis
- Lung Cancer
- Industrial Bronchitis
- TB
List complications of Coal Inhalation
- Coal Worker Pneumoconiosis
- Bronchitis
- Airflow Obstruction
List some bacterial causes of CAP
Streptococcus pneumoniae Haemophilus influenzae Staphylococcus aureus (post influenza) Moraxella catarrhalis Anaerobes (aspiration) Mycoplasma pneumoniae Legionella
List some viral causes of CAP
Influenza A and B
RSV
Rhinovirus
Adenovirus Type 4 and 7
List some fungal causes of CAP
Aspergillus
Pneumocystis jirovecii
How can you differentiate bronchitis vs pneumonia on a CXR
Pneumonia = consolidation on CXR (not in bronchitis)
What contextual features are important in a ?pneumonia history
- CAP vs Nosocomial
- Immunocompromised vs competent
- Travel +/- Endemics
Patient query CAP has recently travelled to the tropics. What microbiology are of interest
Meliodosis
Acinetobacter
Patient query CAP who owns an aviary (birds). What microbiology are of interest
Chlamydia psittaci
Patient query CAP works in an abbatoir. What microbiology are of interest
Coxiella burnetti
Patient query CAP works as a gardner. What microbiology are of interest
Legionella
Patient query CAP is an alcoholic. What microbiology are of interest
S.pneumoniae
Klebsiella
Anaerobes
Acinetobacter
What is the antibiotic treatment for pneumococcus pneumonia
Beta-Lactam (AMOXYCILLIN)
What is the antibiotic treatment for atypical pneumonia (legionella, mycoplasma, chlamydia)
Macrolide (ROXITHROMYCIN)
What is the antiobiotic treatment for nosocomial pneumonia
Extended Spectrum Beta-Lactamase
3rd Gen Cephalosporin
What are some DDx for pneumonia that has poor treatment response
Obstruction Abscess Parapneumonic Effusion Empyema Drug Fever Not Pneumonia
What are important investigations in Pneumonia
Sputum Culture and PCR Oropharyngeal Swab Blood Culture Sets Serology CXR
What microbiology are of interest in immunocompromised CAP
S.pneumoniae
Mycoplasma
Legionella
What microbiology are of interest in decreased lymphocyte CAP
Pneumocystis jirovecci
TB
CMV
What does a failure of oxygenation cause
Hypoxia
What does a failure of ventilation cause
Hypercapnia
What level of PaO2 defines respiratory failure
<55
<60 in organ failure/damage
What defines Type 2 Respiratory Failure
PaO2 <55 mmHg
PaCO2 >45 mmHg
What pH and bi-carb would suggest ACUTE T2RF
pH <7.35 (acidosis)
Normal HCO3- (no compensation)
What bi-carb would suggest ACUTE on CHRONIC T2RF
HCO3- >28 (renal alkalosis compensation - with acidosis)
What pH and bi-carb would suggest CHRONIC T2RF
Normal pH
Bi-Carb >28 (fully compensated)
What is oxygenation
Uptake of oxygen by Hb
What is ventilation
Removal of CO2 from blood
What are 5 mechanisms of HYPOXAEMIA
- Impair diffusion (ILD, Pulm edema)
- V/Q Mismatch
- Hypoventilation
- R to L Shunt
- Reduced FiO2 (High Altitude)
What are 2 mechanisms of HYPERCAPNIA
- Hypoventilation
2. V/Q Mismatch
What is a DDx for the ACUTE SOB patient
RESP (PE, pneumothorax, obstruction, effusion)
CARDIO (AMI, Tamponade, ACPO, CHF, Arrhythmia)
INF (Sepsis/Bacteraemia)
SHOCK (haemorrhage, anaphylaxis, obstructive)
What are important acute investigations in the SOB patient
CXR
ABG
ECG
BLOOD (FBP. Glucose)
