Respiratory Flashcards
Differentials for pyrexia + productive cough
Pneumonia (bacterial - typical bc atypical), viral, fungal
TB
PE
Inv pyrexia + productive cough
Bloods Cultures ABG CXR Sputum culture Urine - legionella antigen
Mgmt pyrexia + productive cough
Paracetamol
Oxygen
Broad spec antibiotics - co-amoxiclav + clarithromycin
Common atypicals
Mycoplasma pneumonia
Chlamydophila pneumonia
Legionella pneumonia
How does Mycoplasma pneumonia
present
Person to person ↑ young peopl Slow onset Resolves in a few week Interstitial reticular pattern on CXR Extrapulmonary picture
test PCR
How does Chlamydophila pneumonia
present
Slow onset Hoarse voice (laryngitis)
CXR: pleural effusion in 15%
How does Legionella pneumonia present
Air conditioning - been on holiday - water
Prodrome cough, fever
SOB pleuritic chest pain, haemopysis, GI symptoms
Relative bradycardia (wouldn’t expect with fever)
CXR: bibasal consolidation, pleural effusion in 50%
Investigate for severe CAP
Who should you test legionella for, how to test
Investigate for severe CAP
Urine
Q fever
Spread by farm animals
Coxiella burnett
Acute - non specific
risk endocarditis
Psittaci
Spread by birds
Horders spots
splenomegaly
Viral pneumonia
RSV most common
risk secondary bacterial
Recent chicken pox which pneumonia to consider?
Varicella pneumonias - 3-4 days after rash
Describe Peumocystis pneumnoa
pneumocystis jirovecii
immunocompromosed
ground glass
HIV pt
Desbribe Fungal
endemic vs opportunistic
Risk factor - travel (e) or immunocompromised
Fever + dry cough
Tx antifungals
Aspergillosis
Allergic bronco pulmonary aspergillosis - hypersensitivity to colonisation, common in asthma/CF?bronchiectasis
Dry cough, multiple painful joints, erythema nods DD
Sarcoidosis
Rheumatoid
TB
Inv
Bloods
CXR
Mgmt
Lifestyle mgmt
NSAIDs
Consider oral steroids
Sarcoidosis
Granulomatous disorder
Adults ages 20-30
F>M
Afro-carribeam
Sarcoidosis how does present
often incidentally finding
constutyak symptoms
inflammation of parotid glands, facial nerve plays
Inv results
↑ESR
CXR- bilateral hilar lymphadenopathy
Tissue biopsy
DD bilateral hilar lymphadenopathy
Sarcoidosis
TB
Malignancy (e.g. lymphoma)
Mgmt sarcoid
Lifestyle, NSAIDS
Gold standard investigation for bronchiectasis + other investigation
What see on XR
High resolution CT → signet ring sign XR- tramlines Sputum cultue Immune function test If < 40 years - CF?
Mgmt bronchiectasis
Chest physio, consider bronchodilators
Antibiotics according to sensitivities - for 14 days (ciprofloxacin or IV abx for pseudomonas)
Refer to resp
Describe bronchiectasis
Permanent dailation of bronchi and bronchioles
Causes: post-infective, immunocompromised
Persistent cough, lots of sputum
pneumoconiosis
Caused by inhalation of dusts
> 10 years exposure and onset
Coal workers pneumoconiosis = asymptomatic or chronic bronchitis
CXR - round opociates in upper zones
Can process to fibrosis
Silicosis - fibrosis - diffuse nodules
Abestosis - ↑ lung cancer risk + mesothelioma
Extrinsic allergic alveolitis
Inlahed allergens causing hypersensitivity
Bird-fanciers lung, farmers lung
Acute- fever, malaise
Chronic - fibrosis - Tx - avoid allergen and steroids
Pleural effusions
Transudate - describe features, cause
Protein level < 30
HF, cirrhosis, low albumin, peritoneal dialysis
Tx cause
Exudate describe features, cause. mgmt
Protein level > 30 pneumonia, malignancy plural aspiration → send for culture and cytology Tx cause Tap/drain for symptomatic relief
What is lights criteria
Pleural fluid 25-35
Pleural fluid houd be consider an execute is some criteria are met (looks at LDH)
