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CP3 Medicine > RESPIRATORY - Bronchiectasis, CF and pneumonia > Flashcards

RESPIRATORY - Bronchiectasis, CF and pneumonia Flashcards

1
Q

What is bronchiectasis

A

Chronic dilatation of airways –> chronic infection/inflamm

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2
Q

Sx bronchiectasis (5)

A 
Recurrent cough --> copious infected sputum 
Int haemoptysis 
Persistent hallitosis 
Dyspnoea 
Recurrent febrile eps/eps pneumonia
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3
Q

Signs bronchiectasis (4)

A

Clubbing
Coarse insp crackles over infected areas
Wheeze
Low body habitus

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4
Q

What is bronchiectasis’ most common differential

A

COPD

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5
Q

Most common cause bronchiectasis

A

No cause

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6
Q

Other causes bronchiectasis

A 
Post infective 
CF
Obstruction - tumour/FB
Allergic broncho-pulmonary aspergillosis 
Ciliary Dyskinetic syndromes 
immune deficiency 
CT disease
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7
Q

Pathology bronchiectasis

A

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

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8
Q

Ix bronchiectasis (4)

A

Sputum culture
CXR
CT
Spirometry

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9
Q

CXR findings bronchiectassis

A

cystic shadowing

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10
Q

CT findings bronchiectasis

A

Dilated airways w/ signet ring sign

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11
Q

What type of respiratory pattern does bronchiectasis have

A

Obstructive

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12
Q

Mx bronchiectasis

A 
Assess for Tx'able causes 
Stop smoking 
physio 
postural drainage 
ABx for exacc 
Imms 
Bronchodilators 
Surgery (rare)
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13
Q

Complications bronchiectasis (6)

A 
pneumonia 
pneumothorax 
empyema 
lung abscess 
haematogenous spread of infection 
Severe life threatening haemoptysis
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14
Q

CF genetics

A

Autosomal recessive

mutation CFTR gene chromo 7 post 508

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15
Q

What % of CF is ID’d by genetic screening

A

90%

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16
Q

What does the mutation in CF usually code for

A

cAMP regulated Cl- channels

Which are predominantly in resp tract and pancreas

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17
Q

Pulmonary features CF

A 
Recurrent resp infections 
FTT
Later in life - breathless, haemoptysis --> bronchiectasis 
chronic sinusitis + nasal polyps 
resp failure + cor pulmonale
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18
Q

GI features GF (4)

A

Mec ileus
Steatorrhoea + malabsorption
Incr gallstones + peptic ulcers
Cirrhosis

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19
Q

Other features (Non GI/pulm) of CF (4)

A

Clubbing
Infertilty - m + subfertility f
DM
Rickets/osteomalacia

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20
Q

early pathogens CF

A

S aureus

H influ

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21
Q

late pathogen CF

A

Pseudomonas

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22
Q

Def pneumonia

A

Infection of pulmonary parenchyma + shadowing cxr

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23
Q

Who most commonly gets pneumonia

A

elderly
male
smoker
alcoholics

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24
Q

SOCRATES - pneumonia

A 
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
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25
Q

O/E - pneumonia

A 
tachypnoea 
Decr chest expansion 
Dull to percuss 
Coarse crackles/pleural rub
Bronchial breathing 
Increased vocal resonance 
Upper abdo tenderness - LL pneumonia
26
Q

Define HAP

A

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

27
Q

Causes of CAP

A

Conventional bacteria = 70%
Atypical bacteria = 20%
Viruses = 10%

28
Q

Who gets S. pnuemonia

A

People without COPD

29
Q

How is S pneumonia prevented?

A

Vaccine

30
Q

Who gets S pneumonia vaccine

A

Immunosuppresed pt

31
Q

Classical PS S pneumonia

A

lobar pneumonia

Rust coloured sputum

32
Q

Who gets H influenza pneumonia

A

pt w/ COPD

33
Q

Who gets M pneumonia

A

Young pt

Epidemics

34
Q

PS M pneumonia

A

Hx illness
+ prominent extrapulmonary features
Patchy consolidation across multiple lobes

35
Q

extrapulmonary features M pneumonia

A 
Rash
Hepatitis 
D + V
Pericarditis 
Meningoencephalitis
36
Q

Tx M pneumonia

A

2 w erythromycyin

37
Q

Who gets L pneumonia

A

Smokers who have returned from holidays

38
Q

PS L pneumonia

A 
Severe disease 
\+ SIADH
\+ neuro involvement - CN palsy 
Proteinuria/haematuria 
Affects both lung bases
39
Q

Tx L pneumonia

A

Erythromycin

40
Q

Who gets C pneumonia

A

Infants

Elderly

41
Q

What organism causes CAP during an influenza outbreak

A

S aureus

42
Q

Mx CAP caused by S aureus

A

Fluclox added to standard regimens

43
Q

Ix pneumonia

A 
Obs/O2
Bloods - FBC, CRP, U+E, LFT
Blood cultures 
CXR
Sputum 
Urine - legionella/pneucoccal antigen 
Se mycoplasma IgM 
Throat swab  (viral)
44
Q

How to determine severity pneumonia

A

CURB 65 score

45
Q

CURB 65 scoring

A 
\+1 point for each 
C - confusion (MMS <8) 
U - urea >7 
RR >30 
BP <90 or <60 diast
\+65 y/o
46
Q

Mx Non-severe CAP

A

PO amox

or PO doxy if pen allergic

47
Q

Mx moderately severe CAP

A

PO clarithroycin + amox
PO doxy if pen allergic
Admit pt

48
Q

Mx severe CAP

A

IV clarithromycin + co-amoxiclav
Iv levofloxacin + vancomycin if MRSA/pen allergic
Tx at least 10 days

49
Q

If in CAP you suspect aspiration - what is Mx?

A

Add metronidazole

+ PT to encourage effective coughing

50
Q

Bronchopneumonia on XR

A

patchy consolidation

51
Q

Who gets bronchopneumonia

A

Extremes of age

52
Q

Lesions in bronchopneumonia

A

Initially focal and involve one or > lobules

53
Q

If left untreated, what can happen in bronchopneumonia?

A

Can come confluent and involve whole lobe

54
Q

Who gets acute lobar pneummonia

A

Young fit people

55
Q

Causative organisms acute lobar pneumonia

A

H influ
Strep pneumoniae
Staph

56
Q

What part of lung is affected in acute lobar pneumonia

A

Distal air spaces

–> whole lobe affected

57
Q

Phase 1 acute lobar pneumonia

A

Congestion
Lungs dark and red
first couple of days

58
Q

Phase 2 acute lobar pneumonia

A

Red hepatisation
Days 2-4
Lungs solidify - deep red and dry

59
Q

Phase 3 acute lobar pneumonia

A

Grey hepatisation
Lungs solid and grey
B/c decr RBC in alveoli + incr neutrophils + dense fibrin

60
Q

Phase 4 acute lobar pneumonia

A

Resolution
@8-10days
Restoration to normal fct
Uniform consolidation entire lobe

61
Q

Complications pneumonia (9)

A 
RF
HoTN
AF
Pleural effusion 
Empyema
Lung abscess 
Septicaemia 
Pericarditis/myocarditis 
Jaundice

CP3 Medicine (29 decks)

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