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Year 3 MedEd > Resp1 > Flashcards

Resp1 Flashcards

Cough

1
Q

What is bronchiectasis?

A

Increased mucus production and permanent dilation of the bronchi secondary to an underlying cause

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2
Q

Which organisms commonly cause bronchiectasis?

A

H influenzae
S pneumoniae
S aureus
P aeruginosa

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3
Q

What are some common causes of bronchiectasis?

A 
Cystic fibrosis
Ciliary dyskinesia
Alpha 1 anti-trypsin deficiency
Obstruction
Immunosuppression
Childhood viral infx
Aspergillus fumigatus
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4
Q

What are the symptoms of bronchiectasis?

A

Persistent cough
Green/rusty cough
SOB
Haemoptysis

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5
Q

What are the signs of bronchiectasis?

A

Crackles on auscultation
Squeaks/pops on inspiration
Signs of underlying disorder
Fever

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6
Q

What investigations would you do on a Pt with bronchiectasis?

A

CXR (first line)
High res CT (gold standard/most appropriate)
Observations (hypoxia)
FBC (raised WCC)
Sputum culture
Pulmonary function (dec FEV1, inc RV/TLC)
Serum alpha-1 antitrypsin levels
Sweat NaCl concentration and genetic testing for CFTR

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7
Q

What will you see in a CXR and CT in bronchiectasis?

A

CXR- dilated thickened walls

CT- signet ring sign

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8
Q

What is the management of a Pt with bronchiectasis?

A

Exercise and nutrition
Airway clearance therapy (postural drainage/percussion)
Inhaled bronchodilator (salbutamol)
Inhaled hyperosmolar agent (hypertonic saline)
ABx

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9
Q

What is the prognosis of a Pt with bronchiectasis?

A

Irreversible

Depends on the severity and recurrence of exacerbations

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10
Q

What are the complications of a Pt with bronchiectasis?

A

Haemoptysis
Respiratory failure
Cor pulmonale

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11
Q

What is pneumonia?

A

Inflammation of the lung parenchyma caused by bacteria, virus, or fungi, resulting in fluid/pus air sacs

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12
Q

What are the three types of pneumonia?

A

Community acquired pneumonia
Hospital acquired pneumonia
Aspiration pneumonia

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13
Q

What are the common causes of CAP?

A

Streptococcus pneumoniae
Haemophilus influenzae
Staphylococcus aureus

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14
Q

What are the common causes of HAP?

A

Pseudomonas aeruginosa
Escherichia coli
Klebsiella pneumoniae
MSSA

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15
Q

What are the common causes of atypical pneumonias?

A

Mycoplasma pneumoniae
Chlamydophila pneumoniae
Legionalla pneumophila
Coxiella burnetti

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16
Q

What are the mechanisms of entries for pneumonia?

A

Inhalation (viral/atypical)
Aspiration of URT secretions
Haematogenous from local infx (endocarditis)
Direct extension from local foci (TB via lymphatics)

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17
Q

What are the symptoms of pneumonia?

A

Productive cough with coloured sputum
SOB
Pain on inspiration (pleuritic)

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18
Q

What are the signs of pneumonia?

A 
Fever
Confusion
Dull percussion
Increased fremitus
Bronchial breathing
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19
Q

What are the main investigations for pneumonia?

A

CXR- area of consolidation
FBC- raised WCC
Sputum sample- MC and S
Blood cultures- if severe

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20
Q

What is the scoring system for pneumonias?

A

CURB-65

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21
Q

What is CURB-65?

A 
Confusion
Urea >7
Resp rate >=30
Blood pressure (S<90, D<=60)
Age >=65
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22
Q

What should you do for a Pt with a CURB-65 of 0-1?

A

Treat at home

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23
Q

What should you do for a Pt with a CURB-65 of 2?

A

Consider hospital treatment

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24
Q

What should you do for a Pt with a CURB-65 of 3+?

A

Severe pneumonia, treat in ITU

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25
Q

What should you treat a low severity pneumonia with?

A

Oral amoxicillin

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26
Q

What should you treat a medium severity pneumonia with?

A

Oral/IV amoxicillin + macrolide (clarithromycin)

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27
Q

What should you treat a high severity pneumonia with?

A

IV co-amoxiclav + macrolide (clarithromycin)

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28
Q

What should you after giving a Pt with pneumonia antibiotics?

A

Repeat CXR in 6 weeks

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29
Q

What is the prognosis of a CURB-65 of 0-1?

A

30 day mortality <1%

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30
Q

What is the prognosis of a CURB-65 of 2?

A

30 day mortality 5-15%

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31
Q

What is the prognosis of a CURB-65 of 3+?

A

30 day mortality 20-50%

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32
Q

What are the complications of pneumonia?

A

Septic shock
C difficile from ABx use
HF/resp failure in elderly

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33
Q

How is Legionella transmitted?

A

Via aqueous environments such as air conditioners and contaminated water supplies

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34
Q

What is the difference between Legionnaire’s disease and Pontiac fever?

A

LD- Legionella pneumonia

PF- non-pneumatic Legionella

35
Q

What are the symptoms of a Legionella pneumonia?

A

Prodromal flu-like symptoms (fever, malaise, myalgia)
Dry cough, can become productive
Nausea, DnV

36
Q

Why are atypical pneumonias different from typical pneumonias?

A

They cannot be detected by Gram stains and cannot but cultured by standard methods

37
Q

What investigations would you do for a Legionella pneumonia?

A

Sputum culture
Urinary antigen detection
U+E- hyponatraemia
CXR- bibasal consolidation

38
Q

What is the treatment for a Legionella pneumonia?

A

IV fluoroquinolones OR macrolides

eg. ciprofloxacin OR clarithromycin

39
Q

What are the characteristics of a Pneumocystis jirovecii infection?

A

Opportunistic fungal infx

AIDS defining illness

40
Q

What is the treatment for a Pneumocystis jirovecii infection?

A

high dose Co-trimoxazole

41
Q

What are the characteristics of a Pseudomonas aeruginosa infection?

A

Seen in Pts with bronchiectasis/CF

42
Q

What is the treatment for a Pseudomonas aeruginosa infection?

A

Treat with piptazobactam (piperacillin + tazobactam)

43
Q

What is the presentation of Mycoplasma pneumonia?

A

Insidious onset
Persistent cough
Low grade fever
From a close community setting

44
Q

What is seen in the blood film of a Mycoplasma pneumonia infection?

A

Red cell/cold agglutinins

45
Q

What is the treatment for a Mycoplasma pneumonia infection?

A

Erythromycin/clarithromycin

46
Q

What type of Pt often presents with a Staph aureus infection?

A

IVDU

47
Q

What is seen in a CXR of a Pt with a Staph aureus infection?

A

Patchy consolidation

Forms abscesses

48
Q

What is the treatment for a Staph aureus infection?

A

Flucoxacillin

49
Q

What is the treatment for an MRSA infection?

A

Vancomycin

50
Q

What is the modality of transport for TB?

A

Aerosol droplets

51
Q

What are the two conditions required for a Pt to present with TB?

A

Infection of Mycobacterium tuberculosis

Inadequate immune system

52
Q

What are the risk factors for TB?

A

Recent travel to Asia, Latin America, or Africa
Immunosuppression
Malnutrition
Alcoholism

53
Q

What is the pathophysiology of TB?

A

Droplets enter the lungs
Macrophages + T lymphocytes contain the infection, forming a granuloma
In weak immune systems, the infection escapes

54
Q

What are the symptoms of TB?

A

Cough for 2-3 weeks
From dry to wet
FLAWS especially S
Haemoptysis in <10%

55
Q

What are the signs of TB?

A

Fever
Crackles
Bronchial breathing
Erythema nodosum

56
Q

What are the investigations you should do for TB?

A 
Obs
CXR
Sputum smear
Sputum culture
Nucleic acid amplification test (NAAT)
Biopsy- caseating granulomas
57
Q

What are the 3 buzzwords for a TB sputum smear?

A

Acid fast bacilli
Ziehl-Neelson staining
Lowenstein-Jensen agar

58
Q

What are the types of lung cancer?

A

Small cell (20%)
Non-small cell (80%)
-Adenocarcinoma (45% of NSCLC, peripheral in lungs)
-Squamous cell carcinoma (25-30%, later mets)
-Large cell carcinoma (10%, central)
Metastases
Mesothelioma

59
Q

What are the risk factors for lung cancer?

A

Smoking
Exposure to tobacco smoke, radon gas, asbestos
COPD

60
Q

Facts about lung cancer epidemiology

A

Most common cause of cancer mortality worldwide

3rd most common cancer in Europe

61
Q

What are the characteristics of small cell carcinomas?

A

Strongest association with smoking
Arise in central lung
Rapid growth, highly malignant
May secrete ectopic hormones (ATCH/ADH)

62
Q

What are the characteristics of adenocarcinomas?

A

Most common lung cancer in non-smokers
Most common lung cancer in females
Arise in peripheral lung
Most have pleural involvement

63
Q

What are the characteristics of squamous cell carcinomas?

A

Most common lung cancer in male smokers
Strong association with smoking
Arise in central lung
Can produce PTHrP

64
Q

What are the characteristics of large cell carcinomas?

A

Can arise centrally or peripheral

Poor prognosis

65
Q

What are the symptoms of a Pt with lung cancer?

A

FLAWS
SOB
Cough
Haemoptysis

66
Q

What signs can you find in a Pt with lung cancer?

A 
Horner's syndrome
Cachexia
Anaemia
Clubbing
Paraneoplastic syndromes
Wheeze, crackles, dull percussion, reduced breath sounds
67
Q

What investigations would you do on a Pt with lung cancer?

A 
Obs
CXR
CT
Sputum cytology (assessment of lung secretions)
Bronchoscopy
Biopsy (for definitive diagnosis)
68
Q

What would you see in a CXR of a SCLC?

A

Central mass
Hilar lymphadenopathy
Pleural effusion

69
Q

What would you see in a CXR of a NSCLC?

A

Single/multinodular nodes
Pleural effusion
Lung collapse
Mediastinal/hilar fullness

70
Q

What is a mesothelioma?

A

An aggressive epithelial neoplasm arising from the lining of the lung, abdomen, pericardium, or tunica vaginalis

71
Q

Which environmental exposure puts people at risk of developing a mesothelioma?

A

Asbestos

72
Q

What 2 conditions can be caused by asbestos exposure?

A

Asbestosis

Mesothelioma

73
Q

What is asbestosis?

A

Diffuse interstitial fibrosis

Due to inhalation of asbestos fibres

74
Q

What is the difference between asbestosis and asbestos-induced mesothelioma?

A

Asbestosis- asbestos fibres deposited in the alveoli

Mesothelioma- asbestos fibres deposited in the lining of the lungs

75
Q

Which of the two (asbestosis and asbestos-induced mesothelioma) has a stronger correlation with smoking?

A

Asbestosis

76
Q

What are the risk factors for a mesothelioma?

A

Asbestos exposure (shipyard/construction workers)

77
Q

What are the symptoms and signs for a mesothelioma?

A

Dry cough
SOB
Muffled breath on auscultation (due to pl effusion)

78
Q

What are the investigations for a mesothelioma?

A

CXR

CT

79
Q

What findings would you see in a CXR/CT of a Pt with mesothelioma?

A

Thickened pleural plaques
Fibrosis
Honeycomb appearance

80
Q

25F presents to A&E with 2/7 Hx of productive cough, SOB and fever. The cough is worse at night. She has brought up green mucus 2/7. O/E you hear crackles throughout. Her PMHx is cystic fibrosis at birth and has had similar symptoms in the past.
What is the most likely diagnosis?

A. Asthma
B. Pneumonia
C. Chronic sinusitis
D. Bronchiectasis

A

D. Bronchiectasis

Resp symptoms, mucus, Hx of CF
All leads to bronchiectasis being the most likely.

81
Q

25F presents to A&E with 2/7 Hx of productive cough, SOB and fever. The cough is worse at night. She has brought up green mucus 2/7. O/E you hear crackles throughout. Her PMHx is cystic fibrosis at birth and has had similar symptoms in the past.
What is the first line investigation for this patient?

A. Bloods (FBC, CRP)
B. CXR
C. CT
D. Pulmonary function

A

B. CXR

Everyone with these symptoms should get a CXR as a first line investigation. CT is the gold standard but only used when you have a high suspicion of bronchiectasis.

82
Q

50M smoker with diabetes + HTN presents to A&E with 1/7 confusion and productive cough with yellow sputum. O/E he is apyrexial, BP 150/95 mmHg, HR 90 bpm, RR of 20 breaths per min. His oxygen saturation is 96% at rest. There are crackles at the left base. His urea is 5 mmol/L.
What is the most likely causative organism in this case?

A. Staphylococcus aureus
B. Mycoplasma pneumoniae
C. Streptococcus pneumoniae
D. Pseudomonas aeruginosa
E. Legionella pneumophila
A

C. Streptococcus pneumoniae

83
Q

50M smoker with diabetes + HTN presents to A&E with 1/7 confusion and productive cough with yellow sputum. O/E he is apyrexial, BP 150/95 mmHg, HR 90 bpm, RR of 20 breaths per min. His oxygen saturation is 96% at rest. There are crackles at the left base. His urea is 5 mmol/L.
How should we treat this patient?

A. Admit and give IV co-amoxiclav + macrolide
B. Admit and give oral amoxicillin
C. Admit for observations
D. Give him a smoke cessation leaflet
E. Send home with oral amoxicillin and advise to return if he becomes severely unwell

A

E. Send home with oral amoxicillin and advise to return if he becomes severely unwell

His CURB-65 score is only 1, due to the confusion.

Year 3 MedEd (29 decks)

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