RESPIRATORY - Bronchiectasis, CF and pneumonia Flashcards
What is bronchiectasis
Chronic dilatation of airways –> chronic infection/inflamm
Sx bronchiectasis (5)
Recurrent cough --> copious infected sputum Int haemoptysis Persistent hallitosis Dyspnoea Recurrent febrile eps/eps pneumonia
Signs bronchiectasis (4)
Clubbing
Coarse insp crackles over infected areas
Wheeze
Low body habitus
What is bronchiectasis’ most common differential
COPD
Most common cause bronchiectasis
No cause
Other causes bronchiectasis
Post infective CF Obstruction - tumour/FB Allergic broncho-pulmonary aspergillosis Ciliary Dyskinetic syndromes immune deficiency CT disease
Pathology bronchiectasis
Airways become dilated w/ purulent secretions + chronic inflamm b/c of inflamm granulomatous tissue
Granulomatous tissue can bleed –> haemoptysis
Repeated exaccerbations –> fibrous scarring –> resp failure
Ix bronchiectasis (4)
Sputum culture
CXR
CT
Spirometry
CXR findings bronchiectassis
cystic shadowing
CT findings bronchiectasis
Dilated airways w/ signet ring sign
What type of respiratory pattern does bronchiectasis have
Obstructive
Mx bronchiectasis
Assess for Tx'able causes Stop smoking physio postural drainage ABx for exacc Imms Bronchodilators Surgery (rare)
Complications bronchiectasis (6)
pneumonia pneumothorax empyema lung abscess haematogenous spread of infection Severe life threatening haemoptysis
CF genetics
Autosomal recessive
mutation CFTR gene chromo 7 post 508
What % of CF is ID’d by genetic screening
90%
What does the mutation in CF usually code for
cAMP regulated Cl- channels
Which are predominantly in resp tract and pancreas
Pulmonary features CF
Recurrent resp infections FTT Later in life - breathless, haemoptysis --> bronchiectasis chronic sinusitis + nasal polyps resp failure + cor pulmonale
GI features GF (4)
Mec ileus
Steatorrhoea + malabsorption
Incr gallstones + peptic ulcers
Cirrhosis
Other features (Non GI/pulm) of CF (4)
Clubbing
Infertilty - m + subfertility f
DM
Rickets/osteomalacia
early pathogens CF
S aureus
H influ
late pathogen CF
Pseudomonas
Def pneumonia
Infection of pulmonary parenchyma + shadowing cxr
Who most commonly gets pneumonia
elderly
male
smoker
alcoholics
SOCRATES - pneumonia
S - chest pain O - progressive C - pleuritic R - shoulder/ant abdo wall A - systemic illness, dry/painful cough --> productive mucopurulent. Dyspnoea T 0 days --> w S - moderate
O/E - pneumonia
tachypnoea Decr chest expansion Dull to percuss Coarse crackles/pleural rub Bronchial breathing Increased vocal resonance Upper abdo tenderness - LL pneumonia
Define HAP
Develops at least 48hrs after admission to hospital w/ no signs of incubation on admission
Or in someone that has been hospitalised in the last 10 days
Causes of CAP
Conventional bacteria = 70%
Atypical bacteria = 20%
Viruses = 10%
Who gets S. pnuemonia
People without COPD
How is S pneumonia prevented?
Vaccine
Who gets S pneumonia vaccine
Immunosuppresed pt
Classical PS S pneumonia
lobar pneumonia
Rust coloured sputum
Who gets H influenza pneumonia
pt w/ COPD
Who gets M pneumonia
Young pt
Epidemics
PS M pneumonia
Hx illness
+ prominent extrapulmonary features
Patchy consolidation across multiple lobes
extrapulmonary features M pneumonia
Rash Hepatitis D + V Pericarditis Meningoencephalitis
Tx M pneumonia
2 w erythromycyin
Who gets L pneumonia
Smokers who have returned from holidays
PS L pneumonia
Severe disease \+ SIADH \+ neuro involvement - CN palsy Proteinuria/haematuria Affects both lung bases
Tx L pneumonia
Erythromycin
Who gets C pneumonia
Infants
Elderly
What organism causes CAP during an influenza outbreak
S aureus
Mx CAP caused by S aureus
Fluclox added to standard regimens
Ix pneumonia
Obs/O2 Bloods - FBC, CRP, U+E, LFT Blood cultures CXR Sputum Urine - legionella/pneucoccal antigen Se mycoplasma IgM Throat swab (viral)
How to determine severity pneumonia
CURB 65 score
CURB 65 scoring
\+1 point for each C - confusion (MMS <8) U - urea >7 RR >30 BP <90 or <60 diast \+65 y/o
Mx Non-severe CAP
PO amox
or PO doxy if pen allergic
Mx moderately severe CAP
PO clarithroycin + amox
PO doxy if pen allergic
Admit pt
Mx severe CAP
IV clarithromycin + co-amoxiclav
Iv levofloxacin + vancomycin if MRSA/pen allergic
Tx at least 10 days
If in CAP you suspect aspiration - what is Mx?
Add metronidazole
+ PT to encourage effective coughing
Bronchopneumonia on XR
patchy consolidation
Who gets bronchopneumonia
Extremes of age
Lesions in bronchopneumonia
Initially focal and involve one or > lobules
If left untreated, what can happen in bronchopneumonia?
Can come confluent and involve whole lobe
Who gets acute lobar pneummonia
Young fit people
Causative organisms acute lobar pneumonia
H influ
Strep pneumoniae
Staph
What part of lung is affected in acute lobar pneumonia
Distal air spaces
–> whole lobe affected
Phase 1 acute lobar pneumonia
Congestion
Lungs dark and red
first couple of days
Phase 2 acute lobar pneumonia
Red hepatisation
Days 2-4
Lungs solidify - deep red and dry
Phase 3 acute lobar pneumonia
Grey hepatisation
Lungs solid and grey
B/c decr RBC in alveoli + incr neutrophils + dense fibrin
Phase 4 acute lobar pneumonia
Resolution
@8-10days
Restoration to normal fct
Uniform consolidation entire lobe
Complications pneumonia (9)
RF HoTN AF Pleural effusion Empyema Lung abscess Septicaemia Pericarditis/myocarditis Jaundice
