Resp Peer Teaching Flashcards
(121 cards)
<p>what is pneumonia</p>
<p>it is inflammation and fluid collection in the lungs due to infection</p>
<p>three different types of pneumonia based on how it's acquired</p>
<ul> <li>community acquired pneumonia</li> <li>hospital acquired pneumonia</li> <li>Aspiration pneumonia <ul> <li>e.g. people who can't swallow properly</li> </ul> </li> </ul>
<p>what causes 90% of pneumonia</p>
<p>strep pneumoniae</p>
<p>name 4 bacterial causes of pneumonia</p>
<p>Strep pneumoniae</p>
<p>Staph aureus</p>
<p>Legionella's (if recently come back from spain with chest infection)</p>
<p>Jirovecci in HIV patients</p>
<p>name 8 types ofpeople at risk of Pneumonia</p>
<p>Infants and the elderly</p>
<p>COPD and other chronic lung conditions</p>
<p>the immunocompromised</p>
<p>nursing home residents</p>
<p>those with impaired swallowing</p>
<p>diabetics</p>
<p>heart failure</p>
<p>alcoholics and IVDUs</p>
<p></p>
<p>name 4 signs of pneumonia</p>
<p>drop in BP</p>
<p>fever</p>
<p>increased resp rate</p>
<p>increased sputum production</p>
<p>what might the colour of sputum indicate</p>
<p>green/rust coloured: bacteria</p>
<p>thin and white: viral</p>
<p>name 6symptoms of pneumonia</p>
<p>confusion (particularly in the elderly)</p>
<p>tired (not enough O2 in the blood)</p>
<p>pleuritic chest pain</p>
<p>SOB</p>
<p>headache</p>
<p>malaise</p>
<p>what is the gold standard Ix for pneumonia</p>
<p>CXR where you would see consolidation</p>
<p>what tests should you do for pneumonia</p>
<p>sputum sample</p>
<p>blood culture</p>
<p>Thoracentesis</p>
<p>FBC</p>
<p>ABG</p>
<p>what tool can you use to calculate the severity of commuity acquired pneumonia</p>
<p>CURB-65</p>
<p>what does CURB65 stand for</p>
<ul> <li>Confusion</li> <li>Urea >7mmol/L</li> <li>Resp rate</li> <li>Blood pressure</li> <li>Age over 65</li> </ul>
<p>one point for each</p>
<p>what do the scores mean in CURB65</p>
<ul>
<li>score 1: treat aas out patient</li>
<li>score 2: consider short stay in hospital/monitor closely as an outpatient</li>
<li>score 3+: hospitalisation and consideration for ITU</li>
</ul>
<p>describe the overall treatment of pneumonia</p>
<p>ABCDE approach (e.g. IV fluids and CPAP)</p>
<p>Analgesia for chest pain</p>
<p>Empirical Abx</p>
<p>then Abx guided by M,C and S</p>
<p></p>
<p>what should you do if a pneumonia patient is admitted for more than 12 hrs</p>
<p>thromboprophylaxis with LMWH</p>
<p>empirical Abx if it's aspiration pneumonia</p>
<p>anaerobic cover with metronidazole</p>
<p>what is the empirical abx for mild community acquired pneumonia</p>
<p>Amoxicillin</p>
<p>what is the empirical treatment for moderate community acquired pneumonia</p>
<p>amoxicillin and then clarithromycin</p>
<p>what is the empirical treatment for severe community acquired pneumonia</p>
<p>co-amoxiclav and clarithromycin</p>
<p>what is the causative organism of TB - describe it</p>
<p>mycobacterium tuberculosis</p>
<p>it is an aerobic, non-motile, slightly curved rod</p>
<p>how is TB spread</p>
<p>airborne droplets</p>
<p>name 8notifiable diseases</p>
<p>yellow fever</p>
<p>mumps</p>
<p>TB</p>
<p>rabies</p>
<p>diptheria</p>
<p>smallpox</p>
<p>anthrax</p>
<p>leprosy</p>
<p>plague</p>
<p></p>
<p>signs and symptoms of latent TB</p>
<p>none</p>
<p>where does TB normally infect</p>
<p>the apex of the lung</p>
what are the signs and symptoms of active TB
signs: coughing up blood and looking unwell
symptoms: fever, night sweats, chills, chest pain
how is TB diagnosed
gold standard is doing 3x sputum tests
you can only diagnose if you find TB pathogen
what stain do you use for TB
Ziehl-Neelsen stain (this is used to identify acid fast organisms like mycobacteria)
other Ix for TB
Mantoux skin test
CXR
CT scan
Gohn complex may be visible on imaging
what is the treatment of TB
- RIPE
- Rifampicin
- Isoniazid
- Pyrazinamide
- Ethambutol
- Rifampicin and Isoniazid for six months
- Pyrazinamide and Ethambutol for the first two months of this
Rifampicin side effect
red body fluids: urine swear and tears
isoniazid side effect
peripheral neuropathy (tingling in hands and feet)
Pyrazinamide side effect
hepatitis
Ethambutol side effect
visual problems
what do all the TB drugs cause
hepatotoxicity
spirometry findings in lung obstruction
FEV1 is <80% expected for their age
FEV1/FVC is <0.7
what is a SABA and give an example
short acting beta agonist
an example is salbutamol
what is a LABA
give an example
long acting beta agonist
an example is salmetarol
how do SABAs and LABAs work?
they bind to B2 adrenergic receptors and cause smooth muscle relaxation and bronchodilation
4 adverse effects of beta agonists
hypokalaemia
tremor
palpitations
muscle cramps
how do corticosteroids work
they suppress multiple inflammatory genes - in resp med they reduce inflammation in the airway and therefore lead to wider airways
name three corticosteroids
methylprednisolone
dexamethasone
prednisolone
what are two side effects of inhaled corticosteroids
increased risk of oral candida infection
hoarse voice
give 4 general side effects of corticosteroids
weight gain
osteoporosis
high blood pressure
susceptibility to infection
what is a side effect of ACE inhibitors
cough due to buildup of bradykinin
what is the definition of COPD
it is a collection of lung diseases that cause irreversible obstruction to ariflow out of the lungs
what are the three diseases included in COPD
emphysema
chronic bronchitis
chronic obstructive airway disease
what happens in emphysema
alveoli become large and lose their elasticity
cannor recoil to expel air
this leads to breakdown of alveolar membranes and can lead to giant bullae
when individual breathes in the air sacs become more full than they should causing a barrel chest
name two causes of COPD
smoking causes 90%
alpha-1 anti-trypin deficiency also causes it
how does smoking cause emphysema
it causes damage to the airway which releases inflammatory factors
thes break down the collagen and elastin in the airways
how does smoking cause chronic bronchitis?
airways become inflamed and narrowed
mucus production increases since smoking increases number of goblet cells
irritants damage cilia meaning mucus isn't effectively removed from the airway, this causes a chronic cough, mucus and phlegm production
how can you distinguish COPD caused by smoking and COPD caused by a-1 anti-trypsin deficiency?
in a-1 anti-trypsin deficiency the individual will be young and will have a family history of COPD as well as liver disease
also a-1 anti-trypin deficiency causes COPD in the lower acinae of the lungs whereas smoking causes it higher up
6 signs of COPD
barrel shaped chest
use of accessory muscles to breathe
ankle swelling (from heart failure)
chronic cough
sputum
wheeze
three symptoms of COPD
fatigue
low mood
SOB
Ix for COPD
- spirometry
- FEV1/FVC = <0.7
- FEV1 = <80% expected for age
- Chest X ray
- DLCO
- ABG
what is DLCO
Diffusing capacity of the lungs for carbon monoxide
patient inhales a fixed amount of CO2 and the amount of CO2 exhaled is measured after a certain time period. This shows how well CO2 is diffusing in and out of the blood
what is the aim of COPD treatment
COPD is irreversable so the aim of treatment is to improve symptoms and slow progression
treatment for COPD
- Lifestyle
- stop smoking
- exercise
- pulmonary rehabilitation
- Pharmacological
- SABA
- LABA
- LABA and Corticosteroid
- LAMA
- Surgical
- Lung transplant
what is an example of a LAMA
tiotropium
what are the target oxygen sats for COPD patient
88-92%
what type of hypersensitivity reaction is asthma
type 1
what is the definition of asthma
it is a reversible chronic obstructive airway disease (air can't get out)
what are the two types of asthma
atopic and non-atopic
pathophys of atopic asthma
- allergen inhaled and engulfed by apc
- apc presents to T cell
- T cell releases cytokines that cause inflammation and clonal expansion of receptive B cells
- next time antigen inhaled B cells recognise it and IgE is produced
- IgE binds mast cells and when these enounter the antigen they degranulate releasing histamine
- this causes bronchoconstriction and inflammation
what are the causes of atopic asthma
genetics
environmental stimuli hygeine hypothesis
what are the causes of non-atopic asthma
stress
cold air
infection
name 9 things that can exacerbate asthma
infection
allergens
pollution
smoking
stress
ACE inhibitors
Beta blockers
cold weather
being overweight
signs and symptoms of asthma
signs: wheeze
symptoms: shortness of breath, dry cough worse in the morning
investigations for asthma
- spirometry
- FEV1/FVC <0.7
- reversibility testing
- distinguishes from COPD
- before and 20 mins after bronchodilator
- FEV1 will improve by more than 15% in pt with asthma
- peak flow
- diurnal variation
treatment for asthma
- lifestyle
- stop smoking
- avoid allergens and stress
- drugs (BTS guidelines)
- SABA
- corticosteroid
- corticosteroid and LABA
- Higher dose corticosteroid & biological therapy
- additional prednisolone
what are the two parts of the pleura
1.Parietal: Chest Wall
2.Visceral: Lungs
what stops the lungs collapsing
the pleural space is much lower pressure than the airways and this causes them not to collapse
where is pleural fluid made and where does it drain
it is made by cells of the parietal layer
it is drained into the lymphatics
what is pleural effusion
it is a buildup of pleural fluid in the pleural space - it limits how much the lungs can expand and thereby impairs breathing
what things can cause transudate in the pleural space
heart failure
cirrhosis
nephrotic syndrome (not enough albumin to pull fluid back)
what things can cause exudate in the pleural space
PE
bacterial pneumonia
cancer
infection
what is the difference between transudate and exudate
transudate: <25g/L protein
exudate: >25g/L protein
signs of pleural effusion
decreased chest movement
reduced breath sounds
dull to percussion
ix for pleural effusion
- CXR
- very large effusion may cause tracheal deviation
- percussion
- dull
- reduced breath sounds on auscultation
- thoracentesis to discover cause
- gram stain
- cytology
symptoms of pleural effusion
SOB
cough
chest pain
treatment for pleural effusion
aspirate/chest drain
what is a pneumothorax
it is a buildup of air in the pleural space
it causes the lung on the affected side to collapse (due to loss of pressure gradient) and inability for this lung to expand
how does pneumothorax present
sudden onset sharp one sided pleuritic chest pain and shortness of breath. pain worse when breathing in
what is the difference between a primary and secondary pneumothorax
primary: no underlying lung disease but risk factor
secondary: damage to the lungs caused by underlying pathology
which traumatic things can cause pneumothorax
rib fracture
gunshot
stabbing etc
what are the risk factors for primary pneumothorax
male
smoking
family history
connective tissue disease (marfans, ehlers danloss)
signs and symptoms of pneumothorax
- signs
- low blood pressure
- low oxygen levels
- diminished breath sounds on affected side
- symptoms
- SOB
- sharp one sided chest pain
what is the gold standard investigation for a pneumothorax
CXR
can differentiate from pleural effusion because pneumothorax appears black whereas pleural effusion appears white
treatment for pneumothorax
- small spontaneous ones can heal on their own (if they have caused no SOB)
- treat the underlying cause
- close hole if there's an open wound
- chest drain
- surgery
what is the difference between a pneumothorax and a tension pneumothorax
in a pneumothorax the hole allows air in and out
in tension pneumothorax the hole is more like a valve and onle lets air in and not out.
this causes the amount of air in the pleural space to increase rapidly
tension pneumothorax is a medical emergency
what would you see on a CXR of a tension pneumothorax
trachea would be deviated away from the affected lung
what is the treatment for tension pneumothorax
emergency --> immediately insert a chest drain
what is mesothelioma
this is a cancer of the pleura
what is the main cause of mesothelioma
asbestos
what are the symptoms of mesothelioma
fever
weight loss
fatigue
SOB
persistent cough
clubbed fingers
pain near affected side
Ix for mesothelioma
X-ray
CT scan
Biopsy
treatment for mesothelioma
- if found early (which is rare)
- radiotherapy and chemotherapy
- if found late (which is more common)
- palliative care
- pain relief
what are the two broad types of lung cancer
small cell (10-15%)
non-small cell (80-85%)
what are the most common types of non-small cell lung cancer
squamous cell carcinomas and adenocarcinoma
name 4 causes of lung cancer
smoking
asbestos
chromium
arsenic
what are the symptoms of lung cancer
cough
haemoptysis
dyspnoea
chest pain
what are the signs of lung cancer
weight loss
anaemia
clubbing
enlarged supraclavicular or axillary nodes
haemoptysis is your major red flag here
investigations for lung cancer
CXR
CT Chest
Bronchoscopy
needle or surgical biopsy
what is the management of stage 1 and 2 lung cancer
surgical excision and radical deep x-ray therapy
what is the management of stage 3 and 4 lung cancer
palliative chemotherapy and radiotherapy
palliative care
what is the inheritance pattern of CF
autosomal recessive
what is the mutation in CF
CFTR channel on chromosome 7
what happens in CF
- Cl- can't be drawn out into the lumen due to faulty channel
- water is therefore not drawn out into the channel due to osmosis
- mucus is thick and sticky
- this clogs the lumen
- Na+ moves into cells due to electrochemical gradient since Cl- is -ve
- this draws water into the cells with it (out of lumen) making mucus even thicker and stickier
signs of CF
steatorrhea
children with a failure to thrive
finger clubbing
rectal prolapse
symptoms of CF
heavy mucus production
cough
complications from CF
infertility
pancreatitis
resp tract infections
bronchiectasis
Ix for cystic fibrosis
sweat test: high NaCl collected from skin indicates CF
genetic testing
faecal elastase in newborns is a marker of pancreatic damage caused by CF
what is the life expectancy in CF
about 50 years
non-pharma therapy for CF
physio - techniques for airway clearance
liaison psych
pharmacological treatment of CF
Abx to prevent infections
anti-mucinolytics
bronchodilators
insulin to replace that not made by a damaged pancreas
bisophosphonates and supplements due to malabsorption
NB they can have lung surgery if very bad
what is bronchiectasis
it is irreversible dilation of the bronchioles due to recurrent damage and inflammation. there's scarring, dilation and loss of cilia
bacteria stagnate in the bronchioles causing recurrent infections
what are the causes of bronchiectasis
it is the end point of chronic lung diseases such as cystic fibrosis, and COPD as well as bad infections
Ix for bronchiectasis
HRCT shows wide bronchi
Sputum culture: look for infectious agents in airway to treat with Abx
treatment of bronchiectasis
can't be cured so manage symptoms
stop smoking
vaccinate
give abx prophylactically
bronchodilators
steroids
name 5 lung conditions that can be work related
hypersensitivity pneumonitis
bronchitis (from irritants such as silicon)
fibrosis
carcinoma
asthma
