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All conditions - Year 3 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are the 3 features characterising Asthma

A

Reversible airway obstruction
Airway hyper-responsiveness
Bronchial inflammation

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2
Q

What are common triggers of Asthma

A 
Dust mites
Pollen
Pets
Cigarette smoke
Viral respiratory tract infection
Aspergillus fumigatus spores
Occupational allergens
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3
Q

What are the signs and symptoms of Asthma

A

Wheeze
Breathlessness
Cough
Previous hospitalisations due to acute attacks

Tachypnoea
Use of accessory muscles
Prolonged wheeze
Polyphonic wheeze
Hyperinflated chest
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4
Q

What are the signs of a Severe and a life-threatening asthma attack

A 
Severe:
PEFR <50% Predicted
Pulse >110
RR > 25
Inability to complete sentences
Life-threatening:
PEFR <33%
Silent chest
Cyanosis
Bradycardia
Hypotension
Confusion
Coma
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5
Q

What are appropriate investigations in Asthma

A

PEF or FEV1 Monitoring - <60% Severe
O2 Sats - <90% Severe
CXR - Hyperinflation
Bloods - IgE, Eosinophilia, Aspergillus AntiB

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6
Q

How are acute exacerbations of Asthma treated

A

Moderate - Severe:
Oxygen + Inhaled Salbutamol + Oral Corticosteroid
A - Inhaled Anticholinergic (Atropine)
A - Mg

Potential ICU for mechanical ventilation this would be with an inhaled Anticholinergic with the salbutamol + Systemic Corticosteroids (Start with IV switch to oral ASAP)
A - Heliox

If sputum super thick (Antibiotics)

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7
Q

How is Asthma treated chronically

A

1 - Short Acting Beta agonist (SABA) - PRN
2 - Add Low-dose inhaled corticosteroid (ICS)/Leukotriene-receptor antagonist (LTRA)
3 - Either LABA with ICS OR increase ICS to medium dose OR combine ICS with LTRA
4 - LABA + Medium ICS OR Medium ICS + LTRA
5 - LABA + High ICS (A - Immunomodulator - Omalizumab)
6 - LABA + High ICS + Oral Corticosteroid (A - Immunomodulator - Omalizumab)

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8
Q

What is Bronchiectasis

A

Chronic bronchial dilation, impaired mucociliary clearance and frequent bacterial infections

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9
Q

What is Bronchiectasis caused by

A

Chronic, recurrent of severe infections secondary to an underlying disorder

H. Influenzas
S. Pneumoniae
S. Aureus
P. Aeruginosa

CF, Ciliary dyskinesia, Alpha 1 anti-trypsin deficiency

Foreign body, Connective tissue, Tumour

Immunosuppression, immunodeficiency

Childhood respiratory infection due to viruses
Mycobacteria infection or severe bacterial pneumonia
Exaggerated response to inhaled Aspergillus fumigatus

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10
Q

What are signs and symptoms of Bronchiectasis

A

Persistent cough (Worse lying down)
Mucopurulent sputum (Green/Rusty coloured)
SOB
Haemoptysis

Crackles on auscultation
Squeaks and pops on inspiration
Fever

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11
Q

What are the appropriate investigations for Bronchiectasis

A

O2 Sats
CXR - First line - Tram track sign
High resolution CT - Best/Most appropriate/Gold standard diagnostic - String of beads

FBC - Raised WCC, Eosinophilia
Sputum culture
PFT - Reduced FEV1

Other:
Alpha 1 anti-trypsin
Sweat NaCl - CF
Skin prick - Aspergillus

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12
Q

How is Bronchiectasis treated

A
  • Exercise, improved nutrition
  • Airway clearance therapy (Percussion and postural drainage)
  • Inhaled bronchodilator (Salbutamol)
  • Inhaled hyperosmolar agent

A - Antibiotics

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13
Q

What is COPD

A

Chronic obstruction of airflow that is not fully reversible. Encompassing both emphysema and chronic bronchitis

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14
Q

What is the primary cause of COPD

A

SMOKING!!
Air pollution and occupational pollutants
Alpha-1 antitrypsin (Autosomal dominant)

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15
Q

How is Chronic bronchitis clinically defined

A

Having a productive cough for more than 3 months each year for 2+ consecutive years

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16
Q

What are the symptoms of COPD

A

Productive cough
Wheeze
SOB (Exertional)
Fatigue due to nocturnal cough

Infectious exacerbation:
Severe SOB
Increase sputum volume and purulence
Fever
Chest pain
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17
Q

What are signs of COPD

A

GI:
Tar staining
Cyanosis
Barrel chest

Palpation:
Reduced expansion
Hyper-resonance

Auscultation:
Reduced air movement
Wheezing
Coarse crackles

Signs of RHF (Cor pulmonale):

  • Raised JVP
  • Peripheral Oedema
  • Hepatomegaly
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18
Q

What is cor pulmonale

A

This is RVH secondary to pulmonary hypertension

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19
Q

How is COPD diagnosed

A

Spirometry is the first-line test and will show reduced FEV1 and FEV1/FVC ratio.
COPD is defined by a post-bronchodilator FEV1/FVC <0.7. If FVC can’t be achieved then FEV6 can be used.

In acute exacerbation O2 Sats and ABG precede any other tests

O2 Sats <92% = ABG
ABG = Low sats/FEV1 <35%/Respiratory depression
PaCO2 >50mmHg &/or
PaO2 <60mmHg

CXR - Hyperinflation

FBC - Raised Ht, Raised WCC

ECG - RVH

Other
- Alpha-1 antitrypsin (Early onset)

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20
Q

Outline the survival altering treatments for chronic COPD

A

Improved survival:

  • Smoking cessation
  • Annual Flu Vaccine
  • Pneumococcal vaccination (once before 65 and once after)
  • Long-term O2 therapy (at least 15hrs/day) - Aim is maintain between 88-92%
  • Lung volume reduction surgery

Give O2 therapy to:

  • O2 saturation <88% - ABG
  • PaO2 <7.3kPa - ABG

If they have right heart failure or a raised hematocrit then O2 therapy is given when:

  • O2 saturation <90% - ABG
  • PaO2 <8kPa - ABG

Hypoxaemia is important to maintain as this is part of what stimulates the respiratory drive for people with CO2. It is also important because it helps blood get directed to places that will actually get good air supply. This helps explain why lung reduction surgery can be beneficial

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21
Q

Outline the symptom altering treatments for chronic COPD

A
  1. (80-100) SABA (Salbutamol) OR SAMA (Ipratropium bromide)
  2. (50-79) SABA + LABA (Salmeterol) OR SAMA + LAMA (Tiotropium)
  3. (30-49) LABA + LAMA OR LABA + ICS (Symbicort)
  4. (<30) LABA + LAMA + ICS
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22
Q

How is an acute exacerbation of COPD treated

A

24% O2 given through either a nasal cannula or Venturi mask (Blue) - Fraction of O2 can be precisely controlled

Inhaled bronchodilators are most effective - SABA & SAMA used simultaneously given through a nebuliser (Salbutamol 5mg, IB 0.5mg)

Oral or IV corticosteroids are given along side (IV hydrocortisone 200mg or oral prednisolone 40-50mg)

IV amoxicillin

BiPAP (T2 respiratory failure) (NIV)

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23
Q

What are the classifications for Pneumothoracies

A

Primary spontaneous - No underlying respiratory illness

Secondary spontaneous - Associated underlying respiratory pathology

Traumatic - After trauma

Tension - This is a complication of any type of pneumothorax

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24
Q

What are risk factors for Pneumothoracies

A 
Primary:
Smoking
Marfan's syndrome
Homocysteinuria
FHx
Tall
Slender
Young male

Secondary:
COPD
CF
TB
Pneumocystis jirovecii respiratory infection - HIV patients susceptible
Thoracic endometriosis - Catamenial pneumothorax (Usually right sided)

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25
Q

What are symptoms of Pneumothoracies

A

SOB
Chest pain
Usually occurring at rest

Tension:

  • Laboured breathing
  • Cyanosis
  • Profuse sweating
  • Tachycardia
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26
Q

What are signs of Pneumothoracies

A

Hyperinflation

Palpation + Percussion:
Reduced chest expansion
Hyper-resonant

Auscultation:
Reduced vocal resonance
Reduced breath sounds

Tension:
- Tracheal shifts to contralateral side

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27
Q

How is a Pneumothorax diagnosed

A

CXR would be first line
CT chest -
US - Absent pleural sliding
Bronchoscopy - Visualise the endobronchial obstruction

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28
Q

How is Pneumothorax treated

A

Primary and <50yo
<2cm - O2 + discharge
>2cm - O2 + Aspiration (Chest drain if unsuccessful)

Secondary of >55yo
<2cm - O2 + Aspiration
>2cm - O2 + Chest drain

Tension: Immediate needle decompression - 2nd ICS MCL + O2

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29
Q

Define Acute respiratory distress syndrome

A

Non-cardiogenic pulmonary oedema and diffuse lung inflammation syndrome

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30
Q

What are the diagnostic criteria for ARDS

A

Acute onset (<1 week)
Bilateral opacities on CXR
PaO2/FiO2 Ratio (Arterial/Inspired) <300 on PEEP OR on CPAP > 5cmH2O

If there are no risk factors for ARDs then acute pulmonary oedema as a result of HF should be ruled out

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31
Q

What are the causes of ARDs

A

Sepsis - Most common (Usually of pulmonary origin e.g. pneumonia)

Aspiration, inhalation injury, trauma, burns, pulmonary confusion

Acute pancreatitis, fat emboli, drug overdose (Smoking, alcohol)

Cardiopulmonary bypass, DIC

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32
Q

What are the signs and symptoms of ARDs

A

Acute onset SOB
Hypoxaemia -> Acute respiratory failure
Cough - Frothy pulmonary oedema sputum

Creps
Crackles
Increased RR

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33
Q

What are appropriate investigations for ARDs

A
  • CXR - Bilateral infiltrates
  • ABG - Decreased PaO2 (Allows for assessment of PaO2/FiO2 Ratio)
  • Sputum/Blood/Urine Cultures - Source of infection
  • Amylase and/or lipase - 3x more in acute pancreatitis
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34
Q

What are the different types of Lung carcinomas

A

Non-small cell (80% of all lung carcinomas)

  • Adenocarcinoma (45%)
  • Squamous cell carcinoma (25-30%, later mets)
  • Large cell carcinoma (10%)

Small cell

Metastases

Mesothelioma

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35
Q

Outline features of the main types of lung cancer

A

Small cell:

  • Strongest association with smoking
  • Arise in central lung
  • Fast growing, highly malignant
  • May produce endocrine hormones (ACTH or ADH)

Adenocarcinomas:

  • Most common type in never-smokers
  • Most common type in women
  • Arise in peripheral lung
  • Most common type to have pleural involvement

Squamous cell:

  • Most commonly occurs in male smokers
  • Strong association with smoking
  • Arise in central lung
  • May produce PTHrP

Large cell:

  • Can arise centrally or peripherally
  • Poor prognosis

Metastatic:

  • Most common sources are breast and colon carcinomas
  • More common than primary tumours
36
Q

What are the symptoms of Lung cancer

A

(f)LAW(s)
Cough - Haemoptysis
SOB

37
Q

What are the signs of Lung cancer

A 
Horner's syndrome
Cachexia
Anaemia
Clubbing
Paraneoplastic syndromes

Possible:

  • Wheeze
  • Crackles
  • Dullness to percussion
  • Reduced breath sounds
38
Q

How is Lung cancer diagnosed

A

CXR - Identification of initial lesion
Contrast enhanced CT
Definitive diagnosis - Biopsy

Sputum cytology - Better for central tumours

39
Q

What are causes of Pulmonary embolism (PE)

A

Stasis - COPD, Varicose, Age >40, Immobility (Long-haul/Paralysis), GA, MI/Stroke

Hyper-coagulability - Cancer, High oestrogen (OCP, Obesity, pregnancy), IBDs, Nephrotic syndrome, Sepsis

Vessel wall damage - Trauma, Previous DVT, Surgery, Central venous catheterisation

40
Q

What are the signs and symptoms of PE

A

Acute onset:

  • Pleuritic chest pain
  • SOB
  • Sense of apprehension
  • Haemoptysis + syncope

Fever
Cough
Unilateral tenderness or swelling of calves
Tachycardia

41
Q

How is PE diagnosed

A

Wells criteria/Geneva score Initial test
CTPA (V/Q scan if CTPA is contraindicated) - If high suspicion
D-dimer if low suspicion

Monitor:

  • Coagulation studies
  • U&Es
  • FBC

ECG - Sinus tachycardia, right axis deviation, RBBB, ‘S1 Q3 T3’ - very uncommon
CXR - Pleural effusion, elevation of hemidiaphragm

42
Q

How is PE treated

A

Conservative:

  • Analgesia
  • Oxygen - Aim Sat for >94%
  • Fluids

Low - Intermediate + Haemodynamically stable - Anticoagulation (If giving a LMWH then give with warfarin)

Intermediate - High or Haemodynamically unstable - Add Thrombolysis (Alteplase)/Embolectomy

IVC Filter to be used if anticoagulation is contraindicated

43
Q

What are complications of PE

A 
Acute bleeding
Recurrent VTE
Pulmonary infarct
Cardiac arrest
Heparin-associated thrombocytopenia
44
Q

What is Interstitial lung disease

A

This is an umbrella term for a large group of disorders that cause scarring (fibrosis) of the lungs. The scarring causes stiffness in the lungs which makes it difficult to breath.

45
Q

What are causes of Idiopathic pulmonary fibrosis

A

Well it idiopathic but it is caused by over activation of fibroblasts due to recurrent alveolar damage

Drugs can produce a similar illness (bleomycin, methotrexate, amiodarone)

Risk factors:

  • Advanced age
  • Smoking
  • Male
  • Animal/Vegetable dusts
  • Occupational exposure to metal or wood
46
Q

What are the signs and symptoms of Idiopathic pulmonary fibrosis

A

Gradual onset Exertional dyspnoea
Dry cough
No wheeze
Potential constitutional symptoms - Fatigue + weight loss

Bibasal fine inspiratory crackles
Clubbing
RHF - In advanced disease

47
Q

How is Idiopathic pulmonary fibrosis diagnosed

A

Bloods

  • ABG - Normal in early disease, PO2 decreases with exercise, Normal PCO2, which rises in late stage disease
  • ANA and RF - 1/3 of patients are positive for ANA or RF

CXR

  • Usually normal at presentation
  • Early disease may show ground glass shadowing
  • Late disease shows reticulonodular shadowing, signs of cor pulmonale and eventually honeycombing

PFTs

  • Restrictive features (Reduced FEV1 and FVC, with preserved or increased FEV1/FVC)
  • Decreased lung volume
  • Decreased lung compliance
  • Decreased TLC

High resolution CT - Can be diagnostic

Lung Biopsy - Diagnostic gold standard
Histological patterns - Interstitial pneumonia

Bronchoalveolar lavage - Exclude infection and malignancy

Echo - PHTN

48
Q

What are the causes of Extrinsic allergic alveolitis (Hypersensitivity pneumonitis)

A

It is caused by inhalation of antigenic dusts that induce a hypersensitivity response in susceptible individuals

Mainly due to occupational risk:

  • Farmers - Mouldy hay with thermophilic actinomycetes
  • Bird-keeper - Bloom of bird feathers
  • Mushroom worker’s
  • Humidifier - Plumbers
  • Malt workers - Barley with aspergillum clavatus
49
Q

What are the signs and symptoms of Extrinsic allergic alveolitis (Hypersensitivity pneumonitis)

A

Exposure to antigen will be in the history

Exertion dyspnoea
Dry cough
Fever
Constitutional symptoms - Fever, weight loss

Clubbing
Bibasal fine inspiratory crackles

50
Q

How is Extrinsic allergic alveolitis (Hypersensitivity pneumonitis) diagnosed

A

Bloods

  • FBC - Neutrophilia, leukocytosis, ACD
  • ESR elevated

Immunological response to causative antigen - IgG to fungal or avian antigens

CXR

  • Acute = Normal
  • Chronic = Fibrosis
  • Ground glass shadowing

PFTs

  • Restrictive features (Reduced FEV1 and FVC, with preserved or increased FEV1/FVC)
  • Decreased lung volume
  • Decreased lung compliance
  • Decreased TLC

High resolution CT - Can be diagnostic

Lung Biopsy - Occasionally performed to clear up doubt

Bronchoalveolar lavage - Increased cellularity - Lymphocytosis

51
Q

What causes Pneumoconiosis

A

Chronic Inhalation of mineral dusts:

  • Coal
  • Silica
  • Asbestos (Strong correlation to smoking)

Occupational exposure coal mining, quarrying, iron and steel foundries, stone cutting, sandblasting, insulation industry, plumbers, ship builders

Co-factors such as smoking and TB also contribute

52
Q

What are the signs and symptoms of Pneumoconiosis

A

Incidental finding - Asymptomatic = Simple

Insidious onset SOB
Dry cough
Black sputum - Coalworker’s
Pleuritic chest pain - Asbestosis

Coalworker's and silicosis:
- Decreased breath sounds
Asbestosis:
- End-inspiratory crepitations
- Clubbing
Both have signs of RHF
53
Q

How is Pneumoconiosis diagnosed

A

CXR:

  • Simple = micro-nodular mottling
  • Complicated = bilateral lower zone reticulonodular shadowing and pleural plaques (asbestosis is fibrotic changes, not just plaques) and nodular opacities, micronodular shadowing; eggshell calcification (silicosis)

High resolution CT – fibrotic changes

PFTs

  • Restrictive features (Reduced FEV1 and FVC, with preserved or increased FEV1/FVC)
  • Decreased lung volume
  • Decreased lung compliance
  • Decreased TLC
54
Q

What is Sarcoidosis

A

Multisystem granulomatous inflammatory disorder

55
Q

What are causes Sarcoidosis

A

Unknown but link to Mycobacterium tuberculosis and Borrelia burgdorferi

56
Q

What are the signs and symptoms of Sarcoidosis

A

General: Fever, malaise, weight loss, bilateral parotid swelling, lymphadenopathy, hepatosplenomegaly

Pulmonary (Most common symptoms): SOB, dry cough, chest discomfort, minimal clinical signs

MSK: Bone cysts, Polyarthritis, Myopathy

Eyes: Dry eyes (Keratoconjuctivitis sicca), uveitis, papilloedema

Skin: Lupus pernio, Erythema nodosum, Maculopapular eruptions

Neurological: Lymphocytic meningitis, SOL, Pituitary infiltration, Cerebellar ataxia, CN palsies, Peripheral neuropathy

Cardiac: Arrhythmia, BBB, Pericarditis, Cardiomyopathy, CHF

57
Q

What are the signs and symptoms of Sarcoidosis

A

General: Fever, malaise, weight loss, bilateral parotid swelling, lymphadenopathy, hepatosplenomegaly

Pulmonary (Most common symptoms): SOB, dry cough, chest discomfort, minimal clinical signs

MSK: Bone cysts, Polyarthritis, Myopathy

Eyes: Dry eyes (Keratoconjuctivitis sicca), uveitis, papilloedema

Skin: Lupus pernio, Erythema nodosum, Maculopapular eruptions

Neurological: Lymphocytic meningitis, SOL, Pituitary infiltration, Cerebellar ataxia, CN palsies, Peripheral neuropathy

Cardiac: Arrhythmia, BBB, Pericarditis, Cardiomyopathy, CHF

58
Q

How is Sarcoidosis diagnosed

A

Bloods:
High Ca –> Hypercalciuria
High serum ACE
High ESR

PFTs
Restrictive picture

CXR
Stage 0: Normal
Stage 1: Bilateral hilarity lymphadenopathy
Stage 2: + Pulmonary infiltrates
Stage 3: Pulmonary infiltrates only
Stage 4: Extensive fibrosis with distortion

High resolution CT
Ground glass appearance + features from CXR

Bronchoscopy + Lavage
Low sensitivity –> Lymphocytosis with CD4-CD8 ratio >3.5

Transbronchial lung biopsy - Diagnostic - Non-caseating granulomas

59
Q

What is a Mesothelioma

A

This is an aggressive epithelial neoplasm arising from the lining of the lung, abdomen, pericardium, or tunica vaginalis

60
Q

What causes Mesothelioma

A

Asbestos exposure is the main risk factor (80%). There is a weak correlation to smoking

There is a latency period of 20-40 yrs

61
Q

What are signs and symptoms of Mesothelioma

A

Dry cough
SOB
Chest pain
Classic constitutional symptoms: Weight loss especially

Clubbing
Muffled breath sounds on auscultation - Pleural effusion

62
Q

How is Mesothelioma diagnosed

A

CXR - Unilateral Pleural effusion, irregular thickening of the pleura, reduced lung volume, fibrosis
CT - Similar findings more accurate

Pleural biopsy is diagnostic

63
Q

What is Obstructive sleep apnoea

A

Recurrent prolapse of the pharyngeal airway and apnoea (cessation of airflow for >10s) during sleep followed by arousal from sleep

64
Q

What are causes of Obstructive sleep apnoea

A 
Weight gain
Smoking
Alcohol
Sedative use
Enlarged tonsils and adenoids in children
Macroglossia
Marfan's syndrome
Craniofacial abnormalities

Male more common

65
Q

What are signs and symptoms of Obstructive sleep apnoea

A 
Excessive daytime sleepiness
Unrefreshing or restless sleep
Morning headaches
Dry mouth
Difficulty concentrating
Irritability and mood changes
Partner reporting snoring, nocturnal apnoeic episodes or nocturnal choking
Large tongue
Enlarged tonsils
Long or thick uvula
Retrognathia (Pulled back jaw)
Neck circumference: More than 42 cm in males (40 in females)
Obesity
HTN
66
Q

How is Obstructive sleep apnoea diagnosed

A

Sleep study: Polysomnography (airflow monitoring; respiratory effort; pulse oximetry and heart rate)

67
Q

What are the 3 main Aspergillus lung diseases

A

Allergic bronchopulmonary aspergillosis (ABPA) - Hypersensitivity reaction to mould when bronchi become colonised by A. fumigatus

Invasive aspergillosis - Invasion of lung tissue and fungal dissemination mainly occurring in the immunosuppressed

Asperigilloma - Fungal ball growth in pre-existing lung cavity (Post-TB, Old infarct or abscess)

68
Q

What are the signs and symptoms of ABPA

A

Hx of Asthma/CF/Atopy
SOB, wheeze, cough (mucus)
Fever
Weight loss

Clubbing & Cyanosis
Reduced breath sounds
Dullness in affected lung

69
Q

How is ABPA diagnosed

A

Skin prick test - A. fumigatus
Serum IgE - Raised
Eosinophilia
Serum specific IgG/IgE to A. fumigatus

CXR - Not essential criterion - Transient patchy shadows, collapse, distended mucous-filled bronchi

PFT - Restrictive

70
Q

What are the signs and symptoms of Aspergilloma

A

Asymptomatic
Potentially a massive haemoptysis

Tracheal deviation
Reduced breath sounds
Dullness in affected lung

71
Q

How is Invasive aspergillosis diagnosed

A

Aspergillus is detected in cultures or by histological examination

Bronchoalveolar lavage fluid or sputum may be used diagnostically

Chest CT - Nodules surrounded by a ground-glass appearance (halo sign)
- This is caused by haemorrhage into the tissue surrounding the fungal invasion

serum Aspergillus galactomannan (GM) antigen by enzyme immunoassay (EIA)

72
Q

How is Aspergilloma diagnosed

A

CXR - Sinlge upper lobe lesion

CT or MRI - CXR is unclear

Sputum culture

73
Q

How is Aspergilloma diagnosed

A

CXR - Sinlge upper lobe lesion

CT or MRI - CXR is unclear

Sputum culture

74
Q

What is Tuberculosis

A

An infectious disease caused by mycobacterium tuberculosis. in many causes becoming dormant before progressing to an active infection.

75
Q

What are the risk factors for TB and what are the different disease states

A

Mycobacterium tuberculosis
Immunosuppression from medication for another disease, or from HIV infection.

Malnutrition is the main risk factor for people of no fixed abode (homeless).

Patients infected withM tuberculosiswho have no clinical, bacteriological, or radiographic evidence of active TB are said to have latent TB infection. Active TB may occur from re-activation of previously latent infection or from progression of primary infection.

Approximately 10% of individuals with latent infection will progress to active disease over their lifetime.

The likelihood of transmission depends on

  • the infectivity of the source case (e.g., smear status and extent of cavitation on CXR),
  • the degree of exposure to the case (e.g., proximity, ventilation, and the length of exposure)
  • susceptibility of the person in contact with an infected case
76
Q

What are signs and symptoms of TB

A

Cough - 2-3 week duration (Starts dry goes to productive)
Drenching night sweats
FLAWS
Haemoptysis <10%

Crackles, bronchial breathing
Erythema nodosum

Pleuritic chest pain 
Signs of pleural effusion
Collapse
Consolidation
Fibrosis
77
Q

What are the appropriate investigations for TB

A

FBC - Raised WCC, Low Hb
CXR - Fibronodular opacities on upper lobes. Atypical = Opacities in middle or lower lobe, hilar or paratracheal lymphadenopathy and/or pleural effusion

Sputum - acid-fast bacilli Positive, using Ziehl-Neelson staining, On Lowestein-Jensen agar

Sputum culture - Most sensitive and specific test - Positive (3 Samples at least 8 hrs apart)

NAAT - Positive for M tuberculosis

78
Q

What is Pneumonia

A

Inflammation of the alveoli which can be caused by bacteria, viruses or fungi. Inflammation results in air sacs filling with fluid or pus.

79
Q

What are the different types of Pneumonia

A
  • Community Acquired Pneumonia
  • Hospital Acquired Pneumonia
  • Aspiration Pneumonia
  • Atypical
80
Q

What are the usual causative agents in CAP, HAP and Atypical pneumonia

A

CAP: Streptococcus pneumonia & Haemophilus influenzae
then
Staph. aureus or Group A strep
COPD - Moraxella catarrhalis

HAP: Pseudomonas aeruginosa, E. coli, Klebsiella pneumoniae, Acinetobacter species, Staph. aureus

Atypical: Mycoplasma pneum, Chlamydophila pneum, Legionella pneum, Coxiella burnetii

81
Q

What are the signs and symptoms of Pneumonia

A
  • Productive cough - Coloured sputum
  • SOB
  • Pleuritic chest pain
  • Cough
Fever
Confusion
High HR and RR
Hypotension
Cyanosis
Decreased chest expansion
Dull percussion
Increased resonance
Bronchial breathing
Coarse crackles
Empyema - Clubbing

Atypical:

  • Headache
  • Myalgia
  • Diarrhoea/abdominal pain
  • Dry cough
82
Q

How is Pneumonia diagnosed

A

Bloods
FBC - WCC raised
CRP - Raised

Sputum sample - MC&S

Blood cultures - (if severe)

CXR - Diagnostic

  • Consolidation
  • Alveolar opacification
  • Air bronchograms
  • Lobar or patchy shadowing

Atypical viral serology

83
Q

How is Pneumonia treated

A

Assess severity using the British thoracic society guideline - CURB65 (1 Point each)

Confusion
Urea >7
Resp rate >30
BP <90/60
>65

0-1 Treat at home if possible
2 Consider hospital treatment
3 or more Severe, consider ITU

Emirical antibiotics

  • Low Severity – oral amoxicillin
  • Moderate – oral/IV amoxicillin + macrolide
  • High severity – IV Co-Amoxiclav + macrolide

Atypical

  • Legionella - IV Ciprofloxacin or Clarythromicin
  • Pneumocystis Jirovercii - High dose co-trimoxazole
  • Pseudomonas aeruginosum - Piptazobactam (piperacillin + Tazobactam)
  • Mycoplasma pneumonia - Erythromycin/Clarythromycin (Marcolide)
  • Staph. Aureus - Flucloxacillin (Vancomycin if MRSA)
84
Q

Outline features of Atypical pneumonias

A

Legionella

  • Bacteria - Aqueous environments - Inhalation of contaminated water droplets
  • Atypical pneumonia symptoms + N+V

Pneumocystis Jirovercii
- Opportunistic fungal infection and is an AIDS defining illness

Pseudomonas aeruginosum
- Bronchiectasis or CF

Mycoplasma pneumonia

  • Seen in community setting (University)
  • Red cell agglutinins and transverse myelitis

Staph. aureus
IVDU

85
Q

What are complications of Pneumonia

A
  • Septic shock
  • C. difficile infection from antibiotic use
  • Death from HF, RD in the elderly or severely unwell

All conditions - Year 3 (16 decks)

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