Respiratory Flashcards
What is the organism responsible for TB?
Mycobacterium tuberculosis (rod shaped acid fast bacilli)
What stain is used to detect TB?
Zeihl Neelsen (bright red against blue background)
List the sx of TB?
Night sweats
Cough, fever, malaise
WL
Haemoptysis
Pleuritic chest pain
Lymphadenopathy
Erythema nodosum
What is the GS Ix for TB?
Sputum culture
What is the mx of TB and for how long?
4 drugs for 2 months and 2 drugs for 4 months
Rifampicin (6m)
Isoniazid (6m)
Pyrazinamide (2m)
Ethambutol (2m)
What is the SE of Isoniazid?
Neuropathy
What medication can be prescribed to prevent against the adverse effects of isoniazid?
Pyridoxine
What is the SE of Rifampicin?
Red/orange coloured urine
What is the SE of Ethambutol?
Optic neuritis (colour vision first to be affected)
What is the SE of Pyrazinamide?
Hepatitis, Arthralgia, Gout
What is Cystic fibrosis?
An autosomal recessive disorder caused by a mutation in the CFTR gene on chromosome 7 thus causing increased viscosity of secretions.
What is the pathophysiology behind CF?
The CFTR gene is a channel protein that pumps Cl- into various secretions.
Cl- ions help draw water into secretions, thus thinning them down.
The mutation in the CFTR gene means the protein gets folded, thus cannot transport ions into secretions to thin them down thus thick.
What are the sx of CF?
FTT
Steatorrhoea
Recurrent infections
Wet cough
Failure to pass meconium
Digital clubbing
What is the mx of CF?
Genetic counselling
Chest physiotherapy
Exercise
High calorie diet
CREON tablets
Bronchodilators
What is the GS ix for CF?
Sweat test
What is the 1st line Ix for CF?
Newborn screening and genetic testing
What is a pneumothorax?
When air gains access and accumulates in the pleural space
List the causes of pneumothorax?
Spontaneous- smoking, tall slender young male
Trauma
Iatrogenic-lung biopsy, central line insertion
Structural abnormalities-Marfans, Ehlers Danlos
Lung pathology- Asthma, COPD
List the signs and sx of a pneumothorax?
Hyper-resonance on percussion
Diminished breath sounds on affected sign
Reduced expansion
Sx- pleuritic chest pain, SOB
List the signs and sx of a tension pneumothorax?
Respiratory distress
Tachycardia, hypotension
Distended neck veins
Trachea deviation away from affected side
Increased percussion
What is the Ix for pneumothorax, and how is this different to an Ix for tension pneumothorax?
1st line- CXR in stable patient
A CXR should not be initiated in a tension pneumothorax as this will delay management
What is the mx for a suspected tension pneumothorax?
Immediate decompression
Insert large bore cannula into the 2nd intercostal space in midclavicular line or 4th/5th intercostal space in the midaxillary line
+high O2, chest drain + hospital admission
What is the mx of a pneumothorax?
If no SOB or <2cm rim of air-No tx required. Follow up in 2–4 weeks
if SOB or >2cm air rim-aspiration and reassessment
What is the most common organism that causes CAP?
Streptococcus pneumonia
List 3 causes of typical and atypical pneumonia?
Typical- H.influenza, Staph aureus, Group A streptococci, Moraxella catarrhalis
Atypical-Mycoplasma pneumonia, Legionella, Chlamydophilla
List the sx of pneumonia?
Fever
Cough with increasing sputum
Rigors
Dyspnoea
Pleuritic Chest pain
List the signs of pneumonia?
Dullness to percussion
Diminished expansion
Hypotension
Tachycardia
What is the scoring system used to determine the severity of pneumonia?
CURB-65
What is the 1st line and GS Ix for pneumonia?
1st line- FBC, U&Es, CRP, Pulse oximetry
GS- CXR
What are the parameters of CURB-65?
Confusion
Urea >7mmol/l
Resp rate >30
Blood pressure <90mmHg systolic or <60mmHg diastolic
Age >65
What does a CURB score of 0-1 indicate?
Home-based care, give oral amoxicillin for 5 days (macrolide e.g. clarithromycin, doxycycline or tetracycline if penicillin allergic).
What does a CURB score of 2 indicate?
Hospital-based care, 7-10 day course of dual antibiotic therapy with amoxicillin (IV or oral) and a macrolide
What does a CURB score of >3 indicate?
Hospital/ITU-based care, 7-10 day course of dual antibiotic therapy with IV co-amoxiclav /ceftriaxone/tazocin and a macrolide.
In which patient population is the likelihood of klebsiella pneumonia prevalent?
Typically, following aspiration or UTIs
More common in alcoholics and diabetics
What is a key feature of klebsiella pneumonia?
Red currant jelly sputum
and
Often affects upper lungs
What organism is the common cause of pneumonia in elderly patients with COPD?
Haemophilus influenzae
What organism is responsible for a pneumonia with a gradual onset of a cough?
Mycoplasma
What is the causative organism of whooping cough?
Bordetella pertussis
What is Bronchiolitis?
Inflammation and infection in the bronchioles
What is the most common causative organism for bronchiolitis?
RSV
What is Bronchiectasis?
Permanent dilation of bronchi and bronchioles due to chronic inflammation leading to destruction of elastic and muscular components
List 5 causes of bronchiectasis?
Congenital-Primary ciliary dyskinesia, Kartageners syndrome
Post infection
COPD
RA, UC
CT disease
Idiopathic
List 5 signs and Sx of Bronchiectasis?
Cough with green/yellow sputum
Dyspnoea
Haemoptysis
Chest pain
Fatigue
Weight loss
signs:
Coarse crackles on auscultation
Wheeze
Rhonchi (snoring sounds caused by secretions in the larger airways)
Finger clubbing
What is the GS of bronchiectasis?
HRCT Chest-thickened dilated airways
What is the mx of Bronchiectasis?
Cx:
Postural drainage BD
Rx-
Treat with antibiotics tailored to sputum cultures
List the sx of whooping cough?
Cough
Inspiratory whoop
Rhinorrhoea
Post tussive vomiting
Absent/low grade fever
Decreased appetite
What is the gold standard Ix for whooping cough?
Culture of nasopharyngeal aspirate/swab from posterior pharynx
What is hypersensitivity pneumonitis?
A non IgE mediated inflammation of alveoli and distal bronchioles caused by immune response to inhaled pathogens (Type 3 HR)
What is the mx of hypersensitivity pneumonitis?
1st line- avoid antigen
acute sx- corticosteroid taper
Chronic sx- long term low dose corticosteroids
List the 3 causes of drug induced and secondary causes of pulmonary fibrosis?
drugs: Nitrofurantoin, Methotrexate and Amiodarone
Secondary- RA, Alpha-1 alphatrypsin deficeincy, SLE, Systemic sclerosis
How does IPF affect spirometry in terms of FEV1 and FVC?
Decreases total lung capacity
Decreases FVC
Decreases FEV1
List the causes of fibrosis that predominately affects the upper zone?
TB
Hypersensitivity pneumonitis
Fibrosis
Silicosis
Sarcoidosis
Ankylosing spondylitis
List the causes of fibrosis that predominately affects the lower zone?
IPF
Connective tissue disorders e.g. SLE
Drug induced fibrosis
Asbestosis
List the sx of IPF?
Cough
SOB
End expiratory Crackles
Digital clubbing
WL
Fatigue
Resp failure
What are the medications that can slow down the progression of IPF disease?
Pirfenidone
Nintedanib
What is sarcoidosis?
A multisystem chronic granulomatous disorder of unknown cause commonly affecting lungs, skin and eyes?
How do the granulomas of TB and sarcoidosis differ?
Sarcoidosis granulomas are non-caseating- no tissue necrosis in the centre
List the sx and signs of sarcoidosis?
Bilateral hilar lymphadenopathy
Erthema nodosum
Lupus pernio
Facial palsy
Dyspnoea
Non productive cough
swinging fever
Malaise
WL
Hypercalcaemia
Polyarthralgia
What is the GS Ix for sarcoidosis?
Tissue Biopsy/Histology
What is the mx of sarcoidosis?
no or mild sx- Bed rest + NSAIDs
1st line-oral steroids + bisphosphonates
2nd line- methotrexate or azathioprine
List the signs of respiratory distress?
Use of accessory muscles
Nasal flaring
Head bobbing
Tracheal TUGGING
Cyanosis
Intercostal/subcostal recession
What is the prophylaxis drug for bronchiolitis?
Pavlizumab
What is a pleural effusion?
Fluid collection between the parietal and visceral pleural of the lungs
How is an exudative and transudative pleural effusion categorised?
Exudative- high protein content >30g/L
Transudative- lower protein content <30g/L
List the pathophysiology and causes of exudative pleural effusion?
Related to inflammation- inflammation leads to increased microvascular permeability, thus drainage may be impaired
Lung cancer
Infection
RA/SLE
Pancreatitis
PE
Trauma
List the pathophysiology and causes of transudative pleural effusion?
Where changes in oncotic and hydrostatic pressure causes fluid to leak from vasculature
Heart failure
Hypoalbuminaemia (Liver disease, Nephrotic syndrome, malabsorption)
Hypothyroidism
Meig’s syndrome
List the sx of a pleural effusion?
Dyspnoea
Pleuritic chest pain
Cough
List the signs of a pleural effusion?
Dullness to percussion
Decrease/absent tactile fremitus
Quieter breath sounds
Reduced chest expansion
Loss of vocal resonance over effusion
Large PE may cause tracheal deviation away from effusion