Which of the following causes of atypical pneumonia is linked to exposure to bodily fluids of animals? - Mycoplasma pneumonia - Chlamydophilia pneumoniae - Coxiella burnetii (or Q-fever) - Chlamydia psittaci - Pneumocystis juroveci pneumonii (PCP)

- Coxiella burnetii (or Q-fever)

Which of the following causes of atypical pneumonia is associated with immunocompromised patients? - Mycoplasma pneumonia - Chlamydophilia pneumoniae - Coxiella burnetii (or Q-fever) - Chlamydia psittaci - Pneumocystis juroveci pneumonii (PCP)

- Pneumocystis juroveci pneumonii (PCP)

Respiratory Flashcards by Julia Terreros-Martin

Oxygen saturation targets for patients at risk of hypercapnia (e.g., COPD patients)?

= 88-92%

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What is the assessment tool used to assess severity of pneumonia called?

CRB-65 (used out of hospital)
CURB-65 (in hospital)

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What does CURB-65 stand for?

C - confusion
U - urea > 7 mmol/L
R - RR >/= 30
B - BP </= 90 systolic, </= 60 diastolic
65 - >/= 65 year old

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What CURB-65 score advises hospital admission?

> /= 2

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Most common cause of bacterial pneumonia?

= Streptococcus pneumoniae

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Alongside Streptococcus pneumoniae, what is the second to most common cause of bacterial pneumonia?

= Haemophilus influenzae

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Pneumonia: Pseudomonas aeruginosa as a causative organism commonly associated with which patients?

= those with cystic fibrosis or bronchiectasis

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Pneumonia: Staphylococcus aureus as a causative organism is commonly associated with which patients?

= those with cystic fibrosis

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Legionella pneumophilia is caused by?

= inhaling water from infected systems such as air conditioning

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Which of the following is the causative organism of a milder pneumonia, and is associated with a rash called erythema multiforme, and can cause neurological symptoms

Mycoplasma pneumonia
Chlamydophilia pneumoniae
Coxiella burnetii (or Q-fever)
Chlamydia psittaci
Pneumocystis juroveci pneumonii (PCP)

Mycoplasma pneumonia

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Which of the following causes of atypical pneumonia is associated with a mild-moderate chronic pneumonia which can cause wheezing in school-age children?

Mycoplasma pneumonia
Chlamydophilia pneumoniae
Coxiella burnetii (or Q-fever)
Chlamydia psittaci
Pneumocystis juroveci pneumonii (PCP)

Chlamydophilia pneumoniae

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Which of the following causes of atypical pneumonia is linked to exposure to bodily fluids of animals?

Mycoplasma pneumonia
Chlamydophilia pneumoniae
Coxiella burnetii (or Q-fever)
Chlamydia psittaci
Pneumocystis juroveci pneumonii (PCP)

Coxiella burnetii (or Q-fever)

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Which of the following causes of atypical pneumonia is associated with contact with infected birds?

Mycoplasma pneumonia
Chlamydophilia pneumoniae
Coxiella burnetii (or Q-fever)
Chlamydia psittaci
Pneumocystis juroveci pneumonii (PCP)

Chlamydia psittaci

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Which of the following causes of atypical pneumonia is associated with immunocompromised patients?

Mycoplasma pneumonia
Chlamydophilia pneumoniae
Coxiella burnetii (or Q-fever)
Chlamydia psittaci
Pneumocystis juroveci pneumonii (PCP)

Pneumocystis juroveci pneumonii (PCP)

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How long should a patient with mild-community acquired pneumonia typically be treated for?

= 5 days

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First-line treatment for mild-community acquired pneumonia?

= Amoxicillin

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If patient is allergic to Penicillin what should be used instead to treat pneumonia?

= macrolide (e.g., Clarithromycin) or Tetracycline (e.g., Doxycycline)

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Drugs: -cycline

= tetracycline antibiotics

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Drugs: -mycin/ -micin

= aminoglycoside antibiotics

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Drugs: -floxacin

= fluoroquinolone antibiotics

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What is reversibility testing?

= involves giving a bronchodilator (e.g., Salbutamol), before repeating spirometry to see if this impacts the results

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What is forced expiratory volume in 1 second (FEV1)?

= air a person can forcefully exhale in 1 second

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FVC + FEV1 in restrictive lung disease?

FVC - low
FEV1 - low

(equally reduced)

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FVC + FEV1 in obstructive lung disease

FVC - normal
FEV1 - low

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FEV1:FVC ratio < 70% is suggestive of which of the following - obstructive lung disease - restrictive lung disease

- obstructive lung disease

FEV1:FVC ratio > 70% is suggestive of which of the following - obstructive lung disease - restrictive lung disease

- restrictive lung disease

What does a low FVC and a low FEV1:FVC ratio indicate?

= indicates a combination of obstructive + restrictive lung disease

What is the 'atopic triad' made up of?

- atopic asthma - eczema - allergies (hay fever, food etc.)

Drugs to avoid in patients with asthma? (2)

= beta-blockers + NSAIDs

Recommended initial investigations for asthma (2)

- Fractional exhaled nitric oxide (FeNO) - Spirometry with bronchodilator reversibility

What is FeNO a marker of?

= airway inflammation

In which patients may FeNO testing not be very useful when diagnosing asthma?

= smokers, smoking can lower FeNO making results unreliable

What is first-line in treating a patient with newly diagnosed asthma?

= short-acting beta-2 agonist (SABA) e.g., Salbutamol

Salmeterol

= long-acting beta-2 agonists

Montelukast

= leukotriene receptor antagonist (LTRA)

What are the steps in treating asthma?

1. SABA, as required 2. Inhaled corticosteroid, ICS (low dose), take regularly 3. Leukotriene receptor antagonists (LTRA), taken regularly 4. LABA (e.g., Salmeterol), taken regularly 5. Consider changing to a maintenance and reliever therapy (MART) regime 6. Increase the ICS to a moderate dose 7. Consider high-dose ICS or additional drugs (e.g., LAMA or theophylline) 8. Specialist management (e.g., oral corticosteroids)

Is a monophonic wheeze suggestive of an asthma diagnosis?

= no

Is a polyphonic expiratory wheeze suggestive of an asthma diagnosis?

= yes

What may a monophonic wheeze suggest? (3)

= foreign body, tumour or thick sticky mucus plug

First-line medical treatment in COPD?

= SABA

What is a pneumothorax?

= occurs when air enters the pleural space, separating the lung from the chest wall

What is a primary vs secondary pneumothorax?

Primary - occurs without underlying lung disease Secondary - occurs in patients with pre-existing lung disease

What is an iatrogenic pneumothorax?

= pneumothorax caused by a complication of a medical procedure

Investigation of choice for a patient with a suspected simple pneumothorax?

= erect CXR

Management of a PRIMARY pneumothorax?

If rim air < 2cm, AND not SOB - can discharge home Other, aspiration should be inserted If this fails, chest drain should be inserted

Management of a SECONDARY pneumothorax?

SOB OR rim air > 2cm - insert chest drain Otherwise (1-2cm) - aspiration If < 1cm - oxygen at admit for 24 hours (all require admission for at least 24 hours)

Where is a chest drain inserted?

= 5th intercostal space mid-axillary line (triangle of safety)

What does 'swinging' mean, in regards to chest drains?

= this is when the water in the drain rises and falls due to pressure changes in the chest

Surgical management for treating recurrent pneumothorax?

= video-assisted thoracoscopic surgery (VATs) Options: abrasive pleurodesis, chemical pleurodesis or pleurectomy (removal of pleura)

What is pleurodesis?

= involves creating an inflammatory reaction in pleural lining so pleura stick together and pleural space becomes sealed This prevents further pneumothoraxes from developing

How does a tension pneumothorax form?

= caused by trauma to the chest wall and creates a one-way valve that lets air in, but not out the pleural space

Signs of a tension pneumothorax (5)

- tracheal deviation - reduced air entry on affected side - increased resonance on percussion - tachycardia - hypotension

Management of a tension pneumothorax?

= insert a large bore cannula into the second intercostal space in the mid-clavicular line

Patient presents with recurrent venous thromboembolism and also recurrent miscarriages. What may be worth excluding?

= antiphospholipid syndrome

What is the Well's Score used for?

= predicts the risk of patient presenting with symptoms having a DVT or PE

What Well's score indicates a DVT is likely?

= 2 points or more

If a DVT is likely (according to Wells score), what is the next step?

Within 4 hours: proximal leg vein USS OR, D-dimer (if not done) + anticoagulation + scan within 24 hours

If a DVT is unlikely (according to Wells score), what is the next step?

Within 4 hours: d-dimer OR, Anticoagulation whilst awaiting d-dimer

Initial treatment for a DVT?

= anticoagulation with DOAC (e.g., Apixaban or Rivaroxaban)

Choice of anticoagulant for DVT treatment in patient with cancer?

= DOAC (e.g., Apixaban or Rivaroxaban)

Choice of anticoagulant for DVT treatment in patient with severe renal impairment?

= LMWH

Choice of anticoagulant for DVT treatment in patient that has antiphopholipid syndrome?

= LMWH

If VTE is provoked, when can treatment be stopped?

= after initial 3 months

If VTE is provoked and patient has active cancer, when can treatment be stopped?

= after 3-6 months

If VTE is unprovoked when can treatment be stopped?

= after 6 months

If VTE is unprovoked when can treatment be stopped?

= after 6 months

What bacteria causes TB?

= mycobacterium tuberculosis

Zeihl-Neelsen stain is used to stain bacteria in which condition?

= TB

What is secondary TB?

= when TB is reactivated from a latent form

What is miliary TB?

= when immune system cannot control TB disease, this causes a disseminated, severe disease referred to as miilary TB

What is BCG vaccine for protection against?

= TB

Before BCG vaccine can be given what test is done prior?

= Mantoux test

What is Mantoux test?

= looks for previous immune responses to TB

If Mantoux test is positive, and patient has no features of TB, what test can be used to confirm latent TB?

= interferon-gamma release test

Pharmacological treatment for acute pulmonary TB?

RIPE R - Rifampicin - 6 months I - Isoniazid - 6 months P - Pyrazinamide - 2 months E - Ethambutol - 2 months

What may be co-prescribed with Isoniazid to prevent side-effects? (in TB treatment)

= Pyridoxine (vit. B6)

Side-effect associated with Rifampicin

= red/ orange pee (red-an-orange-pissin)

Side-effect associated with Isoniazid

= peripheral neuropathy (im-so-numb-azid)

Side-effect associated with Pyrazinamide

= hyperuricaemia, gout

Side-effect associated with Ethambutol

= colour blindness + reduced visual acuity (eye-thambutol)

What is Pott's disease of the spine?

= spinal TB

Which is more common: - small-cell lung cancer - non-small cell lung cancer

- non-small cell lung cancer

Most common type of non-small cell lung cancer?

= adenocarcinoma

Type of lung cancer which is mostly due to smoking?

= small-cell lung cancer

Which type of non-small cell lung cancer is most associated with smokers?

= squamous cell carcinoma

Mesothelioma is strongly associated with?

= asbestos inhalation/ exposure

Referral criteria for URGENT CXR in suspected lung cancer

> 40 with, - clubbing - lymphadenopathy - recurrent or persistent chest infections - thrombocytosis - chest signs of lung cancer

2 key examination findings that automatically indicate urgent CXR for suspected lung cancer?

- finger clubbing - supraclavicular lymphadenopathy

In patients >40, how many unexplained symptoms do you need to have to warrant a CXR (in suspected lung cancer), if you have - never smoked - have smoked OR had asbestos exposure

Never smoked: 2 or more Smoked or had asbestos exposure: 1 or more

First-line investigation in suspected lung cancer?

= CXR

First-line treatment option in non-small cell lung cancer? if not tolerated what next?

= surgery if not radiotherapy

Small-cell lung cancer is usually treated with what 2 things?

= radio- and chemotherapy

Which has a worse prognosis? -small cell lung cancer - non-small cell lung cancer

- small cell lung cancer