Respiratory Flashcards by Anna Hay

Differentials for pyrexia + productive cough

Pneumonia (bacterial - typical bc atypical), viral, fungal
TB
PE

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Inv pyrexia + productive cough

Bloods
Cultures
ABG
CXR
Sputum culture 
Urine - legionella antigen

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Mgmt pyrexia + productive cough

Paracetamol
Oxygen
Broad spec antibiotics - co-amoxiclav + clarithromycin

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Common atypicals

Mycoplasma pneumonia
Chlamydophila pneumonia
Legionella pneumonia

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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

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How does Chlamydophila pneumonia

present

Slow onset 
Hoarse voice (laryngitis)

CXR: pleural effusion in 15%

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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

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Who should you test legionella for, how to test

Investigate for severe CAP

Urine

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Q fever

Spread by farm animals
Coxiella burnett
Acute - non specific
risk endocarditis

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Psittaci

Spread by birds
Horders spots
splenomegaly

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Viral pneumonia

RSV most common

risk secondary bacterial

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Recent chicken pox which pneumonia to consider?

Varicella pneumonias - 3-4 days after rash

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Describe Peumocystis pneumnoa

pneumocystis jirovecii
immunocompromosed
ground glass
HIV pt

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Desbribe Fungal

endemic vs opportunistic
Risk factor - travel (e) or immunocompromised
Fever + dry cough
Tx antifungals

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Aspergillosis

Allergic bronco pulmonary aspergillosis - hypersensitivity to colonisation, common in asthma/CF?bronchiectasis

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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)