Respi Flashcards
What is the definition of pneumonia?
Acute lower respiratory tract infection of lung parenchyma with new chest X-ray consolidation
Differentiated into hospital and community acquired pneumonia.
How is pneumonia diagnosed?
Based on signs and symptoms, chest X-ray showing consolidation, bilateral hazy opacity, effusion, or cavitary lesions
Strep pneumoniae is the most common pathogen.
What are the treatment options for outpatient community-acquired pneumonia?
If no risk fx for MRSA, pseudomonas or comorbidities: Amoxicillin, doxycycline or macrolide. With comorbids: Augmentin or cephalosporin and macrolide/doxycycline or monotherapy with fluoroquinolone
If co-morbid, consider augmentin/cephalosporin with doxy/azithromycin or monotherapy with respiratory fluoroquinolone
What is the goal of tuberculosis treatment?
To cure patients and minimize transmission
Treatment involves the RIPE regimen: Rifampicin, Isoniazid, Pyrazinamide, Ethambutol.
What are the side effects of Isoniazid?
Neuropathy and elevated liver function tests (LFT)
Isoniazid should be given with vitamin B6 to prevent neuropathy.
What are the signs of pulmonary embolism?
Dyspnea, tachycardia, productive cough, low-grade fever, pleural effusion
May also include signs of circulatory collapse and hypoxia.
What is the management for acute massive pulmonary embolism?
ABCs, respiratory and hemodynamic support, empiric anticoagulation
Thrombolysis may be indicated if PE is confirmed.
What is the prognosis for chronic thromboembolic pulmonary hypertension (CTEPH)?
Very poor, with median survival of 1-2 years
5-year survival rate is about 10%.
What is the RIPE regimen for tuberculosis treatment?
Rifampicin, Isoniazid, Pyrazinamide, Ethambutol
Each drug has specific side effects and monitoring requirements.
What is the definition of bronchiectasis?
Cough >8weeks with sputum production most days of the week and one of the HRCT findings:
1. Airway - bronchoarterial ratio >1
2. Airways in periphery of lung
3. Lack of tapering airways
Commonly overlaps with COPD.
What are the management steps for exacerbations in bronchiectasis?
Stepwise approach based on symptoms and history of exacerbation
Physical exam findings may include clubbing and dull sounds on percussion.
What are common diagnostic imaging findings in bronchiectasis?
Tram track and ring shadows on X-ray, HTC: bronchoarterial ratio >1 (internal airway
lumen vs adjacent pulmonary artery), Lack of tapering
Diagnosis is based on clinical suspicion and imaging.
Which airway clearance techniques should be taught?
➢Offer active cycle of breathing techniques or oscillating posi
tive expiratory pressure to individuals with bronchiectasis. (D)
➢ Consider gravity assisted positioning (where not contrain
dicated) to enhance the effectiveness of an airway clearance
technique.
What treatments improve outcomes for patients
f 3 or more exacerbations/yr
despite Step 2* (PT and mucoactive treatment)
1) If Pseudomonas aeruginosa,
long term inhaled anti
pseudomonal antibiotic or
alternatively long term macrolide
2) If other Potentially Pathogenic
Microorganisms, long term
macrolides or alternatively long term
oral or inhaled targeted antibiotic
*
3) If no pathogen, long term
macrolides
What is the role of surgery in managing bronchiectasis?
Consider lung resection in patients with localised disease
whose symptoms are not controlled by medical treatment
optimised by a bronchiectasis specialist. (D)
Consider transplant referral in bronchiectasis patients aged
65 years or less if the FEV1
is <30% with significant clin
ical instability or if there is a rapid progressive respiratory
deterioration despite optimal medical management. (D)
Subacute management of bronchiectasis
➢ Offer annual influenza immunisation to all patients with
bronchiectasis. (D)
➢ Offer polysaccharide pneumococcal vaccination to all
patients with bronchiectasis. (D)
➢ Consider long term oxygen therapy for patients with bron
chiectasis and respiratory failure, using the same eligibility
criteria as for COPD. (D)
Clinical signs and symptoms of bronchiectasis
– chronic cough with abundant persistent purulent
sputum
– Dyspnea (70-80%), hemoptysis ( up to 50%)
– Persistent coarse crepitations on auscultation
(75%); clubbing; wheezing in 22%
– In severe cases, persistent respiratory failure and
signs of right heart failure
Approaches to bronchiectasis, history taking components
- Bronchial obstruction - FB or aspiration risk
- Immune deficiency - Haem disease, HIV, history of thymoma
- Impaired secretions - fertility, sinusitis, otitis media
- Infections - previous severe pneumonia, pTB/NonTB mycobacteria (NTM), asthma/COPD, RA/ other connective tissue disease, IBD/GERD
What is the definition of HAP
Nosocomial pneumonia (HAP): develops in patients admitted to
the hospital for >48 h and usually the incubation period is at
least 2 days
Explain the use of CURB 65
It is a severity scoring for pneumonia. It is an acronym for: Confusion
Urea > 7 mmol/L
Respiratory rate ⩾ 30/min
Blood pressure (SBP<90mmHg or DBP≤ 60mmHg
Age ≥ 65 year
Score:
0-1 likely for home
2 consider hospital supervised treatment
>=3 Assess for ICU admission
Duration of therapy for pneumonia
Most patients will achieve clinical stability within the first 48 to 72
hours, a total duration of therapy of 5 days will be appropriate for most
patients.
Duration of therapy for CAP due to suspected or proven MRSA or P.
aeruginosa should be 7 days
Complications of CAP
Pulmonary
- parapneumonic effusion
- empyema
- lung abscess
- ARDs
Extrapulmonary
- phlebitis at IVC
- metastatic infection
- septiciemia
- end organ sequelae of septicemia
