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MBBS - Year 2 > Respiratory - Lung Infections > Flashcards

Respiratory - Lung Infections Flashcards

1
Q

Specifics for resp hx

A 
Age 
Gender 
Occupation 
Smoking hx 
Asbestos exposure 
Pets/ birds at home
Hx of childhood resp illness
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2
Q

Classification of resp diseases

A 
Airways diseases 
Lung parenchymal diseases 
Pleural diseases 
Pulmonary vascular diseases 
Lung infections 
Lung cancer 
Thoracic oncology
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3
Q

Examples of airway diseases

A

Asthma

Allergic rhinitis

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4
Q

Examples of lung parenchymal diseases

A

Emphysema

ILD

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5
Q

What’s included in the conducting airways

A

Trachea
Bronchi
Bronchioles
Terminal bronchioles

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6
Q

What included in the acinar airways

A

Transitional bronchioles
Alveolar ducts
Alveolar sacs

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7
Q

What does the control of respiration involve

A

Higher brain centres, chemoreceptors and other reflexes

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8
Q

Common symptoms to look out for

A

Breathlessness
Cough
Chest pain

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9
Q

General inspection for resp

A 
Pallor 
Jaundice 
Clubbing 
Cyanosis 
Oedema 
Lymphadenopathy 
Pulse and RR
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10
Q

Common resp ix

A 
Pulse oximetry 
Lung physiology - LFTs/ PFTs 
Gas exchange analysis - ABG 
Radiological modalities - CXR, CT 
Bronchoscopy 
Pleural procedures 
Blood test, sputum test
Urine antigens
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11
Q

Lung defence mechanisms

A

Muco-cillairy apparatus
Alveolar macrophages
Cytotoxic T cells and NK cells: intracellular pathogens

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12
Q

Epidemiology of CF

A

Most common inherited lethal disease

1 in 2500 babies born have CF

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13
Q

Inheritance of CF

A

Autosomal recessive inheritance on long arm of chromosome 7

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14
Q

What genes is affected in CF

A

CFTR gene contains code to create CFTR chloride channel
LOF mutation causes increased Na and Cl in sweat and increased reabsorption of water from resp system –> viscous mucus and dehydration of epithelium

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15
Q

Clinical features of CF

A 
C/c sinusitis 
Abnormal sweat [Na] and [Cl]
Bronchiectasis 
Liver disease 
Constipation 
Male infertility - loss of vas deferens
Finger clubbing 
Pancreatic insufficiency, pancreatitis, DM
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16
Q

The Sweat test

A

Pads soaked in pilocarpine are placed on skin to stimulate sweat
Sweat is collected then amount of chloride is measure - should be high to get a +ve result

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17
Q

Dx and ix for CF

A 
Clinical assessment and examination 
Oxygen saturations
Resp secretions samples 
LFT - FEV1, FVC, FEF
Infant screening test - trypsinogen
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18
Q

Aims of CF treatment

A

Prevent or delay serious lung problems

Maintain lung function and clinical stability for long periods

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19
Q

Symptoms associasted w. exacerbation of pulmonary infection

A

Increased frequency and duration of cough
Increased sputum production
Increased SOB
Decreased exercise tolerance
Decreased appetite
Feeling of increased congestion in the chest

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20
Q

Signs associated w/ exacerbation of pulmonary infection

A 
Increased RR 
Use of accessory muscles for breathing 
Fever and leukocytosis
Wt loss 
New infiltrate on CXR
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21
Q

Prophylactic abx given for Staph A

A

Fluclox

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22
Q

Treatment of Staph A infections

A

Fluclox

Co-amoxiclav

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23
Q

Mx of Psuedomonas A

A

Needs combo of nebuliser and systemic abx
Nebulised - 3/12 of nebuliser Colistin OR 1/12 of individual abx
PLUS
Systemic: 3/52 of po Ciprofloxacin (or 3/52 of iV ceftazidime/ Tobramycin)

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24
Q

Treating a/c infections of Aspergillus

A

Antifungals

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25
Q

Treatment of ABPA

A

Steroids and antifungals

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26
Q

ABPA

A

Allergic Bronchopulmonary Aspergillosis

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27
Q

When would we give mucolytics and hydrators

A

Impaired muco-cilairy clearance
Decreased airway surface liquid volume
Secretions that are difficult to expectorate

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28
Q

Mucus degrading agent used in CF

A

Dornase alfa

Long-term maintenance therapy is required

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29
Q

Practical issues of dornase alfa

A

Given via nebuliser
Expensive - hosp prescription
Given at least 30 mins - 1hr before PT

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30
Q

What does hypertonic saline do

A

Expectorant
Increases thickness of ASL
Promotes coughing

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31
Q

ASL

A

Airway Surface Layer

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32
Q

Order of inhaled medicines

A

Bronchodilator
Mucolytics
Airways clearance
Inhaled abx

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33
Q

How is pancreatic insufficiency assessed in CF pts

A

Clinically

By stool elastase

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34
Q

Dietary mx of CF pts

A

Start on lifelong PERT
Regular growth monitoring
Fat soluble Vit supplementation - A, D, E, K
Higher caloric needs

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35
Q

Ionising ix of lung

A

CXR
CT
Nuclear med
Conventional angiography

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36
Q

Non-ionising ix of lung

A

MRI

Ultrasound

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37
Q

VQ scan

A

Ventilation/ perfusion scan
Inhaling radioactive material to examine airflow and blood flow in lungs
Usually looking for PE

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38
Q

When are pts most likely to have a PET scan

A

When they are candidates for surgery - to complete staging

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39
Q

Use of MRI in resp med

A

Charcterising mediastinal masses
Paravertebral masses (neurogenic tumours)
Monitoring of thoracic aneurysms

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40
Q

Use of ultrasound in resp med

A

Detects pleural abnormalities

Probe can be placed in IC space

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41
Q

What types of imaging are used in image-guided biopsy or drainage

A

Ultrasound

CT

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42
Q

Collapse (atelectasis)

A

Reduction of volume in various parts of lung

Obstruction or compression

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43
Q

AP vs PA CXRs

A

Cannot see scapula in PA view

Postero-anterior is preferred over antero-posterior

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44
Q

Silhouettes of CXR

A

Image margins or areas of contrast where structures that are bordering have a clear delineation

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45
Q

Is loss of silhouette shadowing on CXR normal

A

No

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46
Q

Normal silhouette on CXR

A

Lung, heart and hemipericardium border

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47
Q

Silhouette sign on CXR

A

Increased shadowing of interface of lung and heart border

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48
Q

What does the silhouette sign on a CXR indicate

A

Abnormalily - loss of normal silhouette

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49
Q

Clinical definitions of consolidation

A

Dull to percussion
Reduced breath sounds
Bronchial breathing

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50
Q

Histopathological definition of consolidation

A

Filling of the alveolar spaces w/ pus, water, blood, tumour or protein

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51
Q

Air space opacity on CXR

A

Abnormal density in areas that should normally be aerated in X-ray contrast

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52
Q

Air bronchogram

A

Part of lung is consolidated - alveoli filled w/ fluid but larger airways are patent

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53
Q

Radiological definition of consolidation

A

Presence of air bronchogram

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54
Q

Types of loss of lung volume

A

Lung
Lobar
Segmental
Subsegmental

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55
Q

Diagnosing loss of volume of X-ray

A 
Mediastinal shift - main factor 
Tracheal deviation 
Elevation of diaphragm 
Displaced hilum 
Rib crowding
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56
Q

Hilar point on CXR

A

Angle between lower lobe & pulmonary artery and upper lobe & pulmonary vein

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57
Q

Other patterns of consolidation

A 
Diffuse 
Multifocal 
Perihilar - Bat's wing 
Bibasal 
Peripheral
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58
Q

Contusion

A

An injury to the lung parenchyma (bruised) leading to haemorrhage and oedema

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59
Q

What is pneumonia caused by

A

Invasion and overgrowth of pathogens in lung parenchyma

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60
Q

Symptoms of pneumonia

A 
Dyspnoea - harsh breathing sounds 
Fever 
Rigours
Shaking chills 
Dry/ productive cough 
Chest pain 
Malaise
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61
Q

Pathophysiology of pneumonia

A

Infection to the lung initiates an infl response
Causing alveolar oedema + exudate formation
Alveoli & resp bronchioles fill w/ serous exudate, blood cells, fibrin bacteria
Consolidation of lung tissues

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62
Q

Pathogen factors affecting infection

A

Virulence factors

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63
Q

Host factors affecting infection

A

Innate immunity - physical-mechanical, complement
Phagocytes - macrophages, neutrophils
Cellular immunity - B cells, T cells
Cytokine, chemokine

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64
Q

Environmental factors affecting infection

A 
Travel, occupation 
Medical devices (ventilators)
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65
Q

Pneumonia classification

A

Community (CAP)
Hosp (HAP)
Immune compromised

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66
Q

Age group affected in CAP

A

All ages

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67
Q

Classic infection seen in CAP

A

Bacterial or viral

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68
Q

When does HAP occur

A

2-3 days after admission

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69
Q

Who gets immuno-compromised pneumonia

A

HIV pts
Transplant pts
Cancer pts
1’ immunodeficiency pts

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70
Q

CAP epidemiology

A

6th leading cause of death in world
Leading cause of death due to infectious diseases
Highest incidence <5yrs and >65yrs - incidence increases w/ age and in winter

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71
Q

Resp tract bacterial pathogens

A

Strep pyogenes
Strep pneumonia
H. influenza

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72
Q

Bacterial/ viral pathogens causing CAP

A

Strep pneumonia and H. influenza cause 85% of cases
Moraxella catarrhalis
Influenza - Staph A
Resp viruses

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73
Q

Atypical bacteria causing CAP

A 
Chlamydia psittaci 
Coxiella birmetoo - Q fever 
Mycoplasma pneumonia 
Legionnaire's disease 
Mycobacterium TB
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74
Q

DDx signs of pneumonia

A

Sputum
Halitosis
General appearance
Haemoptysis

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75
Q

Most common symptoms of bacterial pneumonia

A

Productive cough

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76
Q

How can colour of sputum help suggest pathogen

A

Rust (S. Pneumoniae)
Green (Pseudomonas)
Redcurrant (Klebsiella)
Bad-smelling (anaerobes)

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77
Q

What is a sudden onset on pneumonia symptoms associated with

A

Bacterial infection

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78
Q

What is slow onset of URTI and wheezing associated w/ in pneumonia

A

Viral infection

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79
Q

Who gets pneumococcal pneumonia

A

V young and v elderly
People w/ asplenia or functional asplenia
People w/ other cases of impaired immunity and certain c/c condns

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80
Q

What is lobular pneumonia likely to progress to in pneumococcal pneumonia

A

Empyema or pleural effusion if treated insufficiently

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81
Q

Empyema

A

Collection of pus in pleura

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82
Q

How many serotypes are there of pneumococcal pneumonia

A

90

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83
Q

Vaccines against pneumococcal pneumonia

A

13-valent pneumococcal conjugate vaccine - intro childhood immunisation in 2010
23-valent pneumococcal polysaccharide vaccine

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84
Q

What months do pneumococcal pneumonia peaks in

A

Dec and Jan

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85
Q

CURB-65

A

Tool used to determine whether pts w/ pneumonia should be admitted or not

Confusion 
Urea >7mmol/l
RR > 30
BP < 90/60 mmHg
Age > 65
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86
Q

CURB-65 score of 0-1

A

Low severity
<3% mortality
Treatment at home if 0 or hosp If 1

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87
Q

Ix for CAP

A

CXR
Sputum culture - viral throat swabs
Hospitilisation
Resp virus PCR and further bloods - CRP/ESR, serology

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88
Q

When do abx need to be started for CAP

A

Within 4 hrs of admission

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89
Q

Treatment for moderate/severe CAP

A 
Empirical therapy (dual) - penicillin (amoxicillin, tazobactam) and macrolide (clarithromycin)
Antivirals --> oseltamovir for 7/7 (but within 3/7 - 5/7 of start of symptoms)
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90
Q

Smoking and CAP

A

Associated w/ 2x fold increase

91
Q

Epidemiology of HAP

A

4th most common HAI

Prevalence 14.1%

92
Q

Risk factors for HAP

A 
Abx 
Surgery 
C/c lung disease 
Advanced age 
Immunosuppression 
Tracheal intubation 
Mechanical ventilation
93
Q

Types of HAP

A

Ventilator associated pneumonia
Aspiration pneumonia
Environmental source
Hosital transmission

94
Q

Causative organisms of ventilator associated HAP

A 
Pseud aeruginosa 
Haemophilia 
Staph A - MRSA
E. coli, Kleb pneumoniae, Enterobacter 
Strep 
Fungi (Candida spp Aspergillus)
95
Q

Causative organism of aspiration HAP

A

Gram -ve organisms
Anaerobes
Strep pneumonia

96
Q

Initial stages of aspiration HAP

A

Pneumonitis then further infection by pathogens ensue

Makes course long and characteristic

97
Q

Examples of humoral immune dysfunction

A

Complement deficient

Ig deficient

98
Q

Examples of cellular immune dysfunction

A

Neutropenia (e.g. chemo)

Lymphopenia (e.g. HIV transplant)

99
Q

How does low CD4 T cell count increase chances of catching pneumonia

A

Reactivation of dormant virus (CMV, HSV, etc)
Reactivation of dormant bacteria e.g. TB
Susceptible to intracellular bacteria (TB, atypical mycobacteria)
Susceptible to fungi

100
Q

How does poor phagocyte function in HIV increase risk of pneumonia

A

Susceptible pneumococcus

101
Q

CXR in HIV pneumonia

A

Ground glass showing

102
Q

Treatment of HIV pneumonia

A

Trimethoprim - sulfanethoxazole

103
Q

CXR in CMV pneumonitis

A

Ground glass shadows

104
Q

Treatment of CMV pneumonitis

A

Ganciclovir

105
Q

CXR in TB

A

UL consolidation

Nodular

106
Q

Symptoms of TB

A 
Productive cough 
Fever 
Night sweats 
Wt loss
Erythema nodusum
107
Q

Treatment of TB

A

Isoniazid/ Rifampicin/ Pyrazinamide/ Ethambutol for 2/12 then I & R for further 4/12
TB drugs are hepatotoxic for measure LFTs

108
Q

Atypical mycobacterium

A

M avid - intracellular complex

109
Q

Cause of pneumonia in neutropenic pts

A 
Chemo 
Leukaemia 
Bone marrow transplant 
Steroids 
DM
110
Q

CXR in invasive aspergillosis

A

Consolidation

111
Q

Treatment for invasive aspergillosis

A

Amphotericin B or caspofungin

112
Q

Types of samples

A 
Swabs 
Secretions 
Invasive samples 
Blood 
Urine
113
Q

Where do we take a swab sample from

A

Ear
Throat
Pemasal

114
Q

Types of secretion samples

A

NPA

Sputum

115
Q

Types of invasive samples

A

Aspirates
Washings
Biopsies

116
Q

Urine sampling for resp pathogens

A

Antigen detection - Legionella, pneumococcus

117
Q

Sputum collection for TB culture

A

Sputum specimenn are essential to confirm dx
Should be from lung secretions
Collect 3 specimen on 3 diff days

118
Q

What type of sputum is best for TB culture

A

Spontaneous morning sputum vs induced specimens

119
Q

Staining mycobacteria

A

Ziel-Nielsen stain
Auramin stain
AFB

120
Q

Serology (blood) for resp pathogens

A

Antibody titre

Ag detection

121
Q

Primary prevention of infection

A

Prevent or reduce exposure

Immunisation (pnumococus, influenza)

122
Q

Secondary prevention of TB

A

Chemoprophylaxis

Contact tracing

123
Q

Tertiary prevention of infection

A

Minimise disability arising from infection
Effective treatment
PT

124
Q

What does the URT incl

A 
Anterior snares 
Nasal passages 
Paranasal sinuses 
Nasopharynx 
Oropharynx 
Portion of larynx ABOVE vocal cords
125
Q

What does the LRT incl

A 
Portion of larynx beneath viral cords 
Trachea 
Bronchi 
Bronchioli 
Alveoli
126
Q

Lab techniques used to identify bacteria

A

Microscopy - gram stain, immunofluorescence
Bacterial culture or DNA/ PCR sequencing
Antigen detection - EIA/ ELISA
Antibody deduction

127
Q

Treatment of Strep pneumonia

A

Penicillin

Macrolides

128
Q

Does Strep pneumonia affect URT or LRT

129
Q

Bacterial causes of bacterial throat infection

A

Gp A Strep (also Gp C & G)

C. diphtheria

130
Q

When is Strep pneumonia vaccinated against in children

A

Pneumococcal vaccine at 2, 4, 12/12

131
Q

Who do bacterial sore throats primarily affect

A

School-age children

132
Q

Less serious complications of Gp A Strep infections caused by Strep progenies

A

Quinsy
Otitis media/ sinusitis
Mastoiditis

133
Q

Systemic complications of Gp A Strep infections caused by Strep pyogenes

A

Scarlet fever

134
Q

Immune mediated complications of Gp A Strep infections caused by Strep pyogenes

A

Rheumatic fever
Glomerulonephritis
Rheumatic heart disease

135
Q

What does Coryne diphtheriae cause

A

Toxins that destroy epithelium coating resp system

136
Q

Is C diphtheriae Grame -ve or +ve

A

Gram +ve bacilli

137
Q

Complications of C. diphtheriae

A

Resp obstruction - fatal
Toxic myocardiopathy
Toxic neuropathy

138
Q

Treatment of C. diphtheriae

A

Antitoxin

Erythromycin

139
Q

Prevention of C. diphtheriae infections

A

Immunisation - DTaP/ IPV/ Hib at 2/3 and 4/12

Close contacts - 7/7 erythromycin

140
Q

Is H influenzae Gram -ve or +ve

A

Gram -ve coccobacilli

141
Q

Treatment for H. influenza infections

A

Amoxi
Co-amoxiclav
Doxy

142
Q

Pertussis (whooping cough)

A

Known for uncontrollable, violent coughing which often makes it hard to breathe
Results in ‘whooping’ sound ad can be v serious

143
Q

Bacterium causing pertussis

A

Bordetella pertussis

144
Q

What does horizontal transmission incl

A 
Direct contact 
Inidrect contact 
Droplet 
Airborne 
Vector borne
145
Q

Typical presentation of H. influenza infection

A

66 M w/ hx of COPD and recurrent LRTIs

146
Q

Typical presentation of pneumocystis jiroveci

A

47 F w/ known HIV presents w/ fever and B/L infiltrates in lungs

147
Q

Typical px of M tuberculosis

A

37 M Latvian origin prensts w/ R upper lobe cavity
Flu like symptoms
Erytheme multiforme

148
Q

Typical presentation of RSV

A

2 F productive cough and wheeze

149
Q

Typical px of Strep pneumonia

A

48 M w/ CAP

Most common cause of CAP

150
Q

Typical px of Pseudomonas

A

27 M w/ CF and productive cough

151
Q

What do tetracyclines target

A

30S subunit

152
Q

What does penicillin target

A

Cell wall synthesis

153
Q

What does Rifampicin target

A

RNA polymerase

154
Q

What does Quinolone (Ciprofloxacin) target

A

DNA gyrase

155
Q

What does trimethoprim target

A

Folate synthesis

156
Q

What do macrolide target

A

50S subunit

157
Q

How can bacteria become resistant to abx

A

Either intrinsically resistant due to inherent structural characteristics or acquired through horizontal and vertical transmission

158
Q

Why do Gram -ve bacteria have intrinsic resistance

A

Due to reduced permeability of cell wall

159
Q

Most common URTI

A

Common cold - self limiting illness

160
Q

Causative viruses of the common cold

A 
Rhinoviruses (30-40%)
Adenovirus (5-10%)
Coronaviruses (10-15%)
Influenzavirus (25-30%)
Parainfluenzavirus (5%)
161
Q

Bronchiectasis

A

Irreversibly damaged bronchi - dilated and thickens

Usually colonised w/ bacteria –> pus formation and mucus hypersecretion

162
Q

Examples of obstructive airways disease

A 
COPD (c/cbronchitis, emphysema)
Asthma
Bronchiectasis
CF 
Bronchiolitis
163
Q

What do obstructive airway diseases affect

A

Your ability to exhale all the air in the lungs

164
Q

What does mucus consist of

A

Musins (5%) and water (95%)

This contributes to 10x expansion

165
Q

What does mucus production respond to

166
Q

Approach to mx of bronchiectasis pts

A 
Consider it as possible dx 
Confirm dx - HRCT 
Think about underlying cause 
Assessments - sputum microbiology 
Structure a mx plan - airway clearance and abx?
167
Q

When should bronchiectasis be considered in adults

A 
Younger pts 
Long hx of symptoms 
No smoking hx 
Large volumes of purulent sputum 
Haemoptysis
168
Q

When should bronchiectasis be considered in children

A 
C/c productive cough 
Asthma not responding to treatment 
Episode of severe pneumonia or recurrent pneumonia 
Localised c/c bronchial obstruction 
Unexplained haemoptysis
169
Q

HRCT in bronchiectasis

A

Signet ring sign - white circle (blood vessel) smaller than black circle (dilated airways)
Tram line appearnce

170
Q

Clinical features of bronchiectasis

A

Regular, daily sputum production over long period that is mucoid or purulent in colour
Cough
Social embarrassment related to symptoms

171
Q

Symptoms seen in a/c exacerbations of bronchiectasis

A

Increasing sputum volume
Worsening sputum colour
Haemoptysis
Malaise/ tiredness

172
Q

Examination findings of bronchiectasis

A

Crackles over affected area

173
Q

Causes of bronchiectasis

A 
Resp infections 
Direct damage - foreign body inhalation, GORD 
Mucocililary disorders 
Allergic/ infl 
Immune effects 
CTD - rhA, SScl
174
Q

Mucocilliary disorders causing bronchiectasis

A

Cilliary dyskinesia

CF

175
Q

Allergic/ infl cause of bronchiectasis

176
Q

Resp infections leading to bronchiectasis

A

Bacterial pneumonia
Mycoplasma pneumonia
Mycobacterium
Viral

177
Q

Bacterial pneumonia infections causing bronchiectasis

A

Bordetella pertussis
Staph A
H influenza
Klebsiella

178
Q

Viral infections casing bronchiectasis

A

Measles
Adenoviruses
Influenza

179
Q

Ciliary defects as a cause of bronchiectasis

A

Primary ciliary dyskniesia (1 in 30,000)
No real mx
Seen in Kartagener’s syndrome

180
Q

Kartagener’s syndrome

A

Inherited disorder of ciliary function
V rare - 1 in 60,000
Triad of features - bronchiectasis, sinusitis, situs invertus

181
Q

Who is ABPA most likely to occur in

A

Asthmatics

CF pts

182
Q

What does ABPA cause

A

Intense bronchial infl

IgE and IgG antibodies to aspergillus

183
Q

Secondary immune defects causing bronchiectasis

A

Lymphoid malignancy

HIV/ AIDS

184
Q

Primary immune defects causing bronchiectasis

A

Hypogammaglobulinaemia (early childhood onset)

Common variable immunodeficiency (late childhood/ adult onset)

185
Q

Humoral immune defects and bronchiectasis

A

Disorder of antibody production

Low incidence but immune defects important to excl as treatable w/ IV Ig replacements

186
Q

Common presentation of primary humeral defects

A

Sepsis (lungs and sinuses)

187
Q

Ix for bronchiectasis

A 
Bloods 
Specialist tests 
Sputum culture - repeated and regular 
Radiology 
Lung function
188
Q

Blood for bronchiectasis

A

Ig
IgG and Aspergillus-spp IgE/ IgG
RhF and ANA

189
Q

Specialist tests for CF

A

CF sweat tests/ genetics

Immunology tests

190
Q

Imaging for bronchiectasis

A

CXR

HRCT - tram line, signet sign

191
Q

Testing lung function for bronchiectasis

A

Spirometry - obstructive pattern

192
Q

What pathogens can amoxicillin treat in bronchiectasis

A

Strep pneumonia

H. Influenza

193
Q

What pathogens can macrolide treat in bronchiectasis

A

Strep pneumonia
(M. Catarrhalis)
(H. influenza)

194
Q

What pathogens can co-amoxiclav treat in bronchiectasis

A

Strep pneumonia
M. Catarrhalis
H. Influenza
Pseud. aeruginosa

195
Q

What pathogens can ciprofloxacin treat in bronchiectasis

A

Strep pneumonia
M. Catarrhalis
H. Influenza
Pseud. aeruginosa

196
Q

What pathogens can ceftazidime (IV) treat in bronchiectasis

A

Pseud. aeruginosa

197
Q

Mx of bronchiectasis

A

Treat underlying disorders e.g. steroids (ABPA), Ig replacement
PT
Abx
Prophylaxis - po, nebuliser

198
Q

PT’s role in treating bronchiectasis

A

Regular BD airway clearance techniques – active cycle, forced expiratory, postural drainage

199
Q

Treatment of a/c exacerbations of bronchiectasis

A

Amoxicillin - po
Ciprofloxacin - IV
10 - 14 days at home or in hosp

200
Q

Common symptoms seen in lung infections

A 
Cough 
Wheezing 
Sneezing 
Facial pain - sinusitis  
Chest pain 
Breathless/ SOB 
Fever 
Haemoptysis and other red flag symptoms
201
Q

Main ddx for chest pain

A 
PE 
Pneumonia 
Pleurisy 
PTX 
MI 
Aortic dissection
202
Q

PTX

A

Pneumothorax

203
Q

Pleurisy

A

Infl of pleura (lining of lungs)

204
Q

Main ddx of SOB

A

HF

Anaemia

205
Q

Ddx of c/c cough

A 
Lung cancer 
CF 
COPD 
ACEi 
GORD 
Bronchiectasis 
C/c rhino sinusitis (PND syndrome)
206
Q

PND syndorme

A

Post -nasal drip syndrome

207
Q

Features of Horners syndrome

A

Ptosis
Miosis
Enophthalmos

208
Q

Why do we assess for tremors in resp exam

A

Associated w/ (over)use of beta 2 agonist

209
Q

What causes asterixis (flapping tremor)

A

CO2 retention in conditions that result in type 2 resp failure e.g. COPD

210
Q

When does Horner’s syndrome develop

A

The sympathetic trunk is damaged by lung cancer affecting apex of lung (Pancoasts tumour)

211
Q

Why do we look for oral candidiasis in resp exam

A

Associated w/ steroid inhaler use (local immunosuppression)

212
Q

Resp causes of displaced apex beat

A

RV hypertrophy (pulmonary HTN, COPD, ILD)
Large pleural effiusion
Tension PTX

213
Q

Causes of symmetrical reduced chest expansion

A

Pulmonary fibrosis (reduced lung elasticity)

214
Q

Causes of asymmetrical reduced chest expansion

A

PTX
Pneumonia
Pleural effusion

215
Q

What does increased vocal resonance suggest

A

Increased tissue density e.g. consolidation, tumour, lobar collapse

216
Q

What does decreased vocal resonance suggest

A

Presence of fluid or air outside lung e.g. pleural effusion, PTX

217
Q

Special features of empyema

A

Failure to recover fully w/ abx

Characteristic ‘swinging’ fever

218
Q

Risk factors for empyema

A

Trauma
Pneumonia
Immunocompromised status

219
Q

Treatment of empyema

A

Urgent drainage

IV abx

220
Q

Ddx of hameoptysis

A 
PE 
Pneumonia 
TB 
Aspergilloma 
Bronchiectasis 
Lung cancer 
Granulomatous w/ polyangitiis
221
Q

Sepsis 6

A

Take lactate, blood cultures, measure urine output

Give fluids, IV abx and oxygen

222
Q

Side effects of isoniazid

A 
Peripheral neuropathy (give pyridoxine)
Liver toxicity
223
Q

Side effects of rifampicin

A

Liver toxicity

Turns bodily fluids red/ orange colour

224
Q

Side effects of ethambutol

A 
Visual disturbances (colour disturbances, loss of acuity)
Avoid in CKD

MBBS - Year 2 (20 decks)

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