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Respiratory 2 Flashcards

1
Q

what is Wegener’s granulomatosis also known as?

A

granulomatosis with polyangitis (GPA)

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2
Q

what is the characteristic feature of Wegener’s granulomatosis?

A

necrotising granulomatous inflammation and vasculitis of small/medium vessels

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3
Q

name 3 respiratory features of Wegener’s granulomatosis

A

cough, haemoptysis, pleuritis, sinusitis, saddle-nose deformity, epistaxis, nasal obstruction

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4
Q

name 3 renal features of Wegener’s granulomatosis

A

proteinuria, haematuria, progressive glomerulonephritis

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5
Q

name 3 features, other than respiratory/renal features, of Wegener’s granulomatosis

A

skin purpura, peripheral neuropathy, mononeuritis multiplex. eye involvement - keratitis, conjunctivitis, scleritis, episcleritis, uveitis.

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6
Q

what would be the significant finding in the blood of Wegener’s granulomatosis patients?

A

ANCA +ve

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7
Q

how would you treat Wegener’s granuomatosis?

A

corticosteroids + cyclophosphamide for remission induction. Azathioprine + methotrexate for maintenance.

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8
Q

what prophylactic treatment would be given to Wegener’s granulomatosis patients? what does it protect against?

A

Co-trimoxazole. Pneumocystis jivorecii and staphylococcal colonisation.

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9
Q

list the possible sources of an embolus

A

FATBAT Fat Air Thrombus Bacteria Amniotic fluid Tumours

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10
Q

what is a likely cause of a PE?

A

DVT in pelvis/legs (iliofemoral veins)

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11
Q

give 4 risk factors for a PE

A

recent surgery (esp abdo/pelvis or hip/knee replacement). thrombophilia. immobility. malignancy. pregnancy/pill/HRT. previous PE. DVT.

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12
Q

list 3 steps taken to prevent PE in surgical patients

A

LMWH (e.g. dalteparin) given to all immobile patients. compression stockings. early mobilisation. stop HRT/Pill pre-op.

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13
Q

give 3 symptoms of PE

A

sudden onset dyspnoea, pleuritic chest pain, haemoptysis, dizziness, syncope

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14
Q

give 3 signs of PE

A

tachypnoea, pyrexia, cyanosis, tachycardia, hypotension, raised JVP, pleural rub

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15
Q

what 2 investigations are carried out to confirm a diagnosis of PE?

A

D dimer - neg result excludes, +ve doesn’t mean it is PE. CTPA (CT pulmonary angiography)

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16
Q

how would you manage a patient with a PE?

A

high flow oxygen, LMWH until INR 2-3, then start warfarin/stop heparin. massive PE - thrombolysis (alteplase)

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17
Q

what is the usual cause of the common cold? how is this spread?

A

rhinovirus infection. spread by droplets and close personal contact.

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18
Q

what 2 organisms usually cause sinusitis?

A

Strep pneumonia or H influenzae

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19
Q

how would you treat sinusitis?

A

broad spectrum abx (e.g. co-amoxiclav). topical corticosteroids, steam inhalation.

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20
Q

what is the surface of the influenza viruses coated with? what are these needed for?

A

haemaglutinin (H) and neuraminidase - needed for attachment to host respiratory epithelium.

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21
Q

give 3 clinical features of influenza

A

abrupt onset fever, generalised aching of limbs, severe headache, sore throat and dry cough

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22
Q

how would influenza be managed? what complication is the patient at risk of?

A

symptomatic - paracetamol, fluids, rest. pneumonia.

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23
Q

name 3 organisms that can cause community acquired pneumonia

A

common - *strep pneumoniae, H influenzae, Mycoplasma pneumoniae. also - staph aureus, Legionella spp, Moraxella catarrhalis and Chlamydia.

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24
Q

define nosocomial pneumonia

A

aka hospital-acquired. pneumonia acquired >48h after admission to hospital

25
Q

name some common causative organisms of hospital acquired pneumonia

A

Gram -ve enterobacteria or *Staph aureus. also - Pseudomonas, Klebsiella, Bacterioides, Clostridia.

26
Q

name 3 organisms that may cause pneumonia in immunocompromised patients

A

Strep pneumoniae, H influenzae, Staph aureus, M catarrhalis, M pneumonia, Gram -ve bacilli, Pneumocystic jivorecii.

27
Q

give 3 symptoms of pneumonia

A

fever, rigors, malaise, anorexia, dyspnoea, cough, purulent sputum, haemoptysis, pleuritic pain

28
Q

give 3 signs of pneumonia

A

pyrexia, cyanosis, confusion, tachypnoea, tachycardia, hypotension, signs of consolidation

29
Q

name 3 signs of lung consolidation you might find on examination

A

diminished expansion, dull percussion note, increased tactile vocal resonance, bronchial breathing + pleural rub

30
Q

list 3 differential diagnoses of pneumonia

A

PE, pulmonary oedema, pulmonary haemorrhage, bronchial carcinoma, hypersensitivity pneumonitis

31
Q

if a pneumonia patient was found to have a pleural effusion, what type would it be?

A

exudate - high protein

32
Q

what investigations might you perform in a case on pneumonia?

A

CXR - lobar infiltrates, cavitation or pleural effusion. blood tests and cultures. sputum MC&S. pleural fluid aspiration - MC&S.

33
Q

what are the components of the CURB-65 score?

A

Confusion Urea >7mmol/L Resp rate >30/min BP >65yo 0-1 home treatment 2 hospital treatment 3+ - severe mortality risk, consider ITU

34
Q

how would you treat a case of mild community acquired pneumonia? (CURB 1)

A

oral amoxicillin or erythromycin/clarithromycin if allergic.

35
Q

how would you treat a case of severe community-acquired pneumonia? (CURB >2)

A

IV cefuroxime / co-amoxiclav

36
Q

give 3 potential complications of pneumonia?

A

pleural effusion, empyema, lung abscess, respiratory failure, septicaemia, brain abscess, pericarditis, myocarditis, cholestatic jaundice

37
Q

which at risk groups are given the pneumococcal vaccine to protect against pneumonia? (apart from childhood imms)

A

>65yo. chronic heart/liver/renal/lung conditions. DM. immunosuppression. AIDS. those on chemo/prednisolone.

38
Q

name the causative organism of TB and how it can be transmitted

A

Mycobacterium tuberculosis/bovis. airborne - poor sanitation, overcrowding, coinfection with HIV

39
Q

how would you stain for the causative organisms on TB? what would they look like? what culture medium would be used?

A

Ziehl-Neelsen stain. Acid-fast bacilli (bright red). Lowenstein-Johnston medium.

40
Q

describe the typical granulomatous lesions of TB

A

central areas of CASEATION surrounded by epithelioid cells and Langhan’s giant cells

41
Q

give 3 features of pulmonary TB

A

cough, sputum, malaise, weight loss, night sweats, pleurisy, haemoptysis, pleural effusion

42
Q

what is miliary TB?

A

occurs following haematogenous dissemination of primary TB

43
Q

describe the features of miliary TB

A

nonspecific, overwhelming signs. nodular opacities on CXR. retinal disease. biopsies of lung/liver/lymph nodes or marrow show AFB or granuloma.

44
Q

give 3 GU features of TB

A

dysuria, frequency, loin pain, haematuria, sterile pyuria

45
Q

give 1 bone feature of TB

A

vertebral collapse. Pott’s vertebra.

46
Q

give 2 abdominal features of TB

A

peritonitis, GI upset.

47
Q

give 3 signs of TB seen on CXR

A

consolidation, cavitation, fibrosis, calcification

48
Q

describe 3 different methods of testing for TB

A

Mantoux test - tuberculin sensitivity skin test - identifies latent TB, active TB and BCG exposure. Quantiferon TB gold (IFN gamma test). MC&S for AFB of 3+ sputum samples (also pleural fluid, urine, pus ascites etc). PCR - for identifying drug resistance.

49
Q

how would you treat TB?

A

isoniazid, rifampicin, pyrazinamide and ethambutol for 2mths. then isoniazid and rifampicin for 4 further months. DOTS - directly observed therapy to ensure compliance + avoid resistance.

50
Q

give 1 main side effect of each of the drugs used to treat TB

A

rifampicin - orange urine/tears, inactivation of Pill, flu symptoms. isoniazid - neuropathy, low WCC. ethambutol - optic neuritis. pyrazinamide - hepatitis, arthralgia.

51
Q

why in type 2 respiratory failure do you not start the patient immediately on high flow O2? what respiratory disease is this common in?

A

common in COPD. px with type 2 resp failure is hypoxic but hypercapnic due to alveolar hypoventilation. due to chronic high CO2, body becomes desensitised to CO2 and so relies on hypoxic drive to breathe - if you raise their oxygen levels too quickly, they will lose this drive to breathe.

52
Q

how do antihistamines work?

A

block the H1 receptor, blocking the effects of excess histamine, which is usually released from mast cells in response to an antigen to induce features of immediate type 1 hypersensitivity.

53
Q

give 2 examples of antihistamines

A

cetirizine, loratadine, fexofenadine, chlorphenamine.

54
Q

give some examples of indications for mucolytic inhalers/nebulisers

A

treatment of abnormal, sticky or thick mucous secretions - chronic emphysema, bronchitis, pneumonia, CF, COPD

55
Q

how do mucolytics work? name an example.

A

acetylcysteine. dissolve thick mucus by splitting disulphide chemical bonds between mucoproteins in secretions, and lowers viscosity by altering the mucin containing components.

56
Q

give 2 examples of obstructive lung diseases

A

COPD asthma

57
Q

give 2 examples of restrictive lung diseases

A

interstitial fibrosis sarcoidosis pneumoconiosis interstitial pneumonias connective tissue diseases pleural effusion obesity kyphoscoliosis neuromuscular problems

58
Q

how would you treat a case of hospital-acquired pneumonia?

A

gentamicin IV + antipseudomonal penicillin (e.g. piperacillin) IV or cefotaxime (3rd gen cephalosporins)

Respiratory (9 decks)

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