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respiratory_week_4_20190518190116 Flashcards

1
Q

what does TB look like on chest x-ray

A

dense consolidation in right upper lobe with cavity formationheals with calcification

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2
Q

what are the main pathogens of TB

A

m. tuberculosis and m. bovis

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3
Q

how is TB spread

A

airborne

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4
Q

what is military TB

A

massive seeding of mycobacteria through bloodstream

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5
Q

what is general symptoms of TB

A

weight loss, malaise and night sweats

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6
Q

what is respiratory symptoms of TB

A

cough, haemoptysis, breathlessness and upper zone crackles

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7
Q

what are meningeal symptoms of TB

A

headache, drowsy, fits

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8
Q

what are GI symptoms of TB

A

pain, bowel, obstruction

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9
Q

what is spinal symptoms of TB

A

pain, deformity, paraplegia

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10
Q

what is other symptoms of TB

A

lymphadenopathy, cold access, pericardial tamponade, renal failure, septic arthritis and hypoadrenalism

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11
Q

what are infections with opportunistic pathogens

A

virus (cytomegalovirus), bacterium (mycobacterium avian intracellulare), fungi (aspergillus, candida, pneumocystis) and protozoa (cryptosporidia, toxoplasma)

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12
Q

how is TB diagnosed

A

Zn stain, AAFB, auramine stain, PCR

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13
Q

what is the histology of TB

A

multinucleate giant cell granulomas, caseating necrosis and sometimes visible mycobacteria

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14
Q

what drugs are used in the treatment of TB

A

two months of: rifampicin, isoniazid, pyrazinamide, ethambutol four months of: rifampicin, isoniazid

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15
Q

what is side effect if rifampicin

A

colours urine and all body fluids orange, also potent inducer of cytochrome enzymes (breaks down steroid molecules)

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16
Q

what is side effects of ethambutol

A

causes optic neuritis

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17
Q

what is latent TB

A

symptom free and culture negative - history of TB prior to 1960, calcification on X ray and exposure to high prevalence area

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18
Q

what is secondary TB

A

the reactivation of latent TB (due to age, coincident disease e.g. HIV, immunosuppressives)

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19
Q

how is previous exposure of TB tested for

A

interferon gamma release assay (blood test)mantoux test (skin test) - also tests for BCG - can cause type 4 hypersensitivity reason

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20
Q

what is treatment of latent TB

A

either treat or leave alonedrugs: 6 months of isoniazid or 3 month of rifampicin and isoniazid (both cause liver disturbance)

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21
Q

what is BCG immunisation

A

attenuated strain of mycobacterium bovis, most effective in neonates of high risk families

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22
Q

why should all TB cases be offering HIV test and vice versa

A

they go hand in hand

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23
Q

when should you consider pleural infection

A

when patient not settling with 2-3 days antibiotics

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24
Q

what can pleural infections rapidly coagulate and organise to form

A

fibrous peels even with antibiotics

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25
Q

what is risk factors for pleural infections

A

diabetes mellitus, immunosupression, gastro-oesophagel reflux, alcohol misuse, IV drug abuse

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26
Q

what is a complicated parapneumonic effusion

A

+ve stain, pH <7.2, low glucose, septations and loculations

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27
Q

what is pleural empyema

A

pus in pleural cavity

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28
Q

what is management of pleural infection

A

antibiotics and drainnutrition, VTE prophylaxis, fibrinolytic and reassess patients who do not improve

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29
Q

what are some gram positive upper respiratory tract colonisers

A

a-haemolytic streptococci: strep pneumoniaeb-haemolytic streptococci: strep pyogenes staphlyoccus aureus

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30
Q

what are some gram negative upper respiratory tract colonisers

A

haemophilus influenza moraxella catarrhalis

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31
Q

what bacteria could be responsible for acute exacerbation of COPD

A

haemophilus influenza, moraxella catarrhalis, streptococcus pneumoniae and others

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32
Q

which bacteria causes whooping cough

A

bordetella pertussis: gram negative coccobacillus

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33
Q

how is bordetella pertussis diagnosed

A

bacterial culture, PCR or serology

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34
Q

how is whooping cough treated in children under one month

A

clarythromycin

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35
Q

how is whooping cough treated in children over one month

A

clarythromycin / azithromycin

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36
Q

how is whooping cough treated in pregnancy

A

erthryromycin

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37
Q

what is cystic fibrosis

A

inherited disease which leads to abnormally viscous mucous - blockage of many tubular structures inc airways and lungs (repeated chest infection and chronic colonisation)

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38
Q

what bacteria most prominent in cystic fibrosis

A

pseudomonas aeruginosa and burkholderia cepacia

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39
Q

how is pneumonia caused

A

fluid (oedema) in alveolar airspaces causes swelling, leads to consolidation, thickened alveolar walls and congested capillaries

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40
Q

what is lobar pneumonia

A

only in specific lobe(s)

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41
Q

what is broncho pneumonia

A

infection starts in airway and spreads to lung (usually pre existing disease)

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42
Q

what is the most common bacteria in community acquired

A

streptococcus pneumoniae

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43
Q

what is used to assess severity of pneumonia

A

CURB65confusion urea >7resp rate >30/minblood pressure (<90/<60)65 or older add 10% if COPDscore 3 or greater severe

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44
Q

when is mycoplasma pneumoniae common and what is symptoms

A

older children and young adultsdry cough, autoimmune anaemia and erythema multiforme, atypical chest signs

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45
Q

what is used to treat mycoplasma pneumoniae

A

erythromycin / doxycycline resistant to beta lactams (penicillin etc)

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46
Q

what causes aspiration pneumonia

A

inhalation of foreign material into lungs

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47
Q

who is most likely to get PCP (pneumocystis carinii pneumonia/pneumocystis jirovecii) and what is signs

A

immunosuppressed patients (HIV, cancer, steroids) dry cough, no atypical chest signs

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48
Q

how is PCP treated

A

trimethoprim / sulfamethoxazole / co-trimoxazole

49
Q

what is legionella pneumonia and what is signs

A

inhalation of bacteria in contaminated water GI symptoms, renal failure - low sodium and lymphocytes in returning traveller - gram negative bacteria

50
Q

how is legionella pneumonia treated

A

clarithromycin, erythromycin and quinolones (levofloxacin)

51
Q

what is chlamydia trachomitis

A

STI that causes infantile pneumonia

52
Q

what is chlamydia pneumoniae

A

transferred person to person, causes mild respiratory tract infection

53
Q

what is staphylococcus aureus

A

recent influenza infection, IV drug user

54
Q

what is gram negative enterobacteria

A

alcoholic, usually from achalasia - vomiting

55
Q

what is fungal (aspergillus) pneumonia and how is it treated

A

fungal infection that result in pneumonia, breathlessness - treat with surgery, voriconazole, amphorericin B

56
Q

what is the treatment for severe hospital acquired pneumonia

A

IV amoxicillin + metronidazole + gentamicin allergic: co-trimoxazole + metronidazole + gentamicin

57
Q

what is haemophilus influenzae (hospital acquired)

A

bacteria, “atypical pneumonia”, nursery workers, people with COPD

58
Q

what is coxiella burnetti (hospital acquired)

A

Q fever - sheep, goats, cattle, farms culture negative endocarditis responds to tetracylline, macrolides

59
Q

what is chlamydophilia psittaci (hospital acquired)

A

caught from pet birds, presents as pneumonia

60
Q

what is klebsiella pneumoniae (hospital acquired)

A

gram negative anaerobe, caviating, alcoholism, diabetes, chronic lung diseasetreat with crabapenems (resistant to b lactams)

61
Q

general symptoms of pneumonia

A

malaise, anorexia, sweats, rigor, myalgia, arthralgia, headache, confusion, cough, pleurisy, haemoptysis, dyspnoea, preceding URTI, abdominal pain, diarrhoea

62
Q

general signs of pneumonia

A

dull to percuss, bronchial breathing (differentiated from PE), crackles, rub heard, cyanosis, hypotension, can reactivate mouth herpes, tachypnoea (rapid breathing)

63
Q

what are severity markers of pneumonia

A

temperature less than 35 or greater than 40 cyanosis PaO2 < 8kPawhite blood count <4 or >30multi-lobar involvement

64
Q

what investigations take place in diagnosis of pneumonia

A

blood culture (WCC and CRP), serology, PCR, arterial gases, full blood count, urea, liver function, CXR (consolidation)

65
Q

what are the complications of pneumonia

A

organisation (scarring), abscess/cavitation, metastatic lung infection, bronchiectasis, respiratory/ARDS/multi-organ failure, pleural / paraneumonic effusion, empyema, death

66
Q

what increases the risks of pneumonia

A

smoking, heart failure, diabetes, COPD/asthma, flu, steroids, proton pump inhibitors

67
Q

what is clinical features of phagocyte deficiencies

A

recurrent infection

68
Q

what organisms cause phagocyte deficiencies

A

common bacteria (staphylococcus aureus) unusual bacteria (burkholderia cepacia) mycobacteria (both TB and atypical) and fungi (candida, aspergillus)

69
Q

what does failure of neutrophil differentiation cause

A

severe congenital neutropenia and cyclic neutropenia = shortage of neutrophils - recurrent infection

70
Q

what does failure to express leukocyte adhesion markers cause

A

leukocyte adhesion deficiencies = recurrent infection

71
Q

what does any antibody or complement deficiency cause

A

failure of opsonisation

72
Q

what does failure of oxidative killing cause

A

chronic granulomatous disease

73
Q

what does failure of cytokine production cause

A

IFNy and IL-12 deficiency

74
Q

what is the life cycle of a T lymphocyte

A

arise from haematopoetic stem cells in bone marrow, exported as immature cells to thymus where undergo selection (10% survive), mature T lymphocyte enter circulation and reside in lymph nodes

75
Q

what is a defect of haemopoetic stem cells

A

recticular dysgensis - failure of production of neutrophils, lymphocytes, monocyte/macropages and platelets

76
Q

what does failure of lymphocyte precursors cause (T cell maturation)

A

severe combined immune deficiency

77
Q

what does failure of thymic development cause (T cell maturation)

A

DiGeorge syndrome

78
Q

what does failure of expression of HLA molecules cause (T cell maturation)

A

bare lymphocyte syndromes

79
Q

what does failure of signalling, cytokine production and effector functions cause (T cell maturation)

A

IFNy deficiency, IL-12 deficiency

80
Q

what does failure of normal apoptosis cause (T cell maturation)

A

autoimmune lymphopoliferative sundromes

81
Q

what does failure of B cell maturation cause

A

X-linked agammaglobulinaemia = few B cells

82
Q

what does failure of lymphocyte precursor cause (B cell maturation)

A

severe combined immune deficiency

83
Q

what does failure of production of IgG antibodies cause (B cell maturation)

A

common variable immune deficiency and selective antibody deficiency

84
Q

what does failure of IgA production cause (B cell maturation)

A

selective IgA deficiency

85
Q

what is causes of stridor in children

A

infections (croup, epiglottis, diphtheria), foreign body, anaphylaxis / angioneurotic oedema

86
Q

what is causes of stridor in adults

A

neoplasms of larynx, trachea and major bronchi, anaphylaxis, trauma (strangulation, burns)

87
Q

what is the management of malignant airway obstruction

A

tumour removal: laser, photodynamic therapy, cryotherapy, diathermy, surgical resection tumour compression by intraluminal stent radiotherapy, chemotherapy & steroids

88
Q

what is the treatment for anaphylxis

A

IM epinephrine (adrenaline)IV antihistamine or corticosteroids high flow O2nebulised bronchodilator endotracheal intubation

89
Q

what is snoring

A

relaxation of pharyngeal dilator muscles during sleep - upper airflow narrowing, turbulent airflow and vibration of palate and tongue base

90
Q

what is sleep apnoea

A

intermittent upper airway collapse

91
Q

what are risk factors for sleep apnoea

A

enlarged tonsils, obesity, retrognathia, hypothyroidism, oropharyngeal deformity, neurological issues, drugs, and post op period

92
Q

what is the consequences of sleep apnoea

A

daytime sleepiness, personality, cognitive impairment, increase RTA risk, hypertension, raised CRP, impaired endothelial function and glucose tolerance

93
Q

how to diagnose sleep apnoea

A

snoring, raised EDS score (normal <12/24), overnight sleep study and full polysmnography

94
Q

what is treatment of sleep apnoea

A

remove underlying cause, CPAP (continuous positive airway pressure)others: mandibular advancement device (snoring) and surgery (UPPP, laser Rx)

95
Q

what are the abnormal host responses which are risk factors for chronic pulmonary infection

A

immunodeficiency (IgA most common)immunosuppression (steroids, chemo etc)

96
Q

what are the abnormal innate host defences which are risk factors for chronic pulmonary infection

A

damaged bronchial mucosa (smoking, pneumonia, malignant)abnormal cilli (kartenagers or youngs syndrome)abnormal secretion (CF or channelopathies)

97
Q

what are the repeated insults which are risk factors for chronic pulmonary infection

A

aspiration (NG feeding, poor swallow)indwelling material (NG tube in wrong place, chest drain, inhaled foreign body)

98
Q

what is symptoms of pulmonary abscess

A

weight loss, lethargy, tiredness, weaknesscough, sputum high mortality usually a preceding illness e.g. pneumonic infectionflu-> staph pneumonia -> cavitating pneumonia -> abscess

99
Q

what pathogens cause pulmonary abscess

A

streptococcus, staphylococcus (post flu) E-coli, gram negatives and aspergillus

100
Q

what is a simple parapneumonic effusion

A

clear fluid, pH>7.2, LDH<1000, glucose>2.2

101
Q

simple can lead to complicated parapneumonic effusion - what is this?

A

pH<7.2, LDH>1000, glucose<2.2 - requires drainage

102
Q

complicated effusion can progress to empyema - what is this?

A

frank pus, look for D on CXR, aerobic organisms more frequently

103
Q

what gram positive organisms can cause empyema

A

Steph milleri or staph aureus (usually post op or nosocomial)

104
Q

what gram negative organisms can cause empyema

A

e-coli, pseudomonas, haemophilus influenza, kelbsiellae

105
Q

what is the treatment of empyema

A

drain, IV antibiotics (amoxicillin and metronidazole) or oral antibiotics

106
Q

what is bronchiectasis

A

localised, irreversible dilation of bronchial tree

107
Q

what is clinical presentation of bronchiectasis

A

recurrent chest infections, recurrent antibiotics with no/short lived response, persistent sputum production

108
Q

what is treatment of brochiectasis

A

stop smoking, flu vaccine, reactive antibiotics e.g. nebulised gentamicin or colomycin anti-inflammatory: clarithromycin or azithromycin

109
Q

how to tell difference between bronchiectasis and chronic bronchial sepsis

A

sepsis has all hallmarks of bronchiectasis but not on HRCTconfirmed positive sputum results often young / involved in childcare or old with COPD

110
Q

what are complications of cystic fibrosis

A

bronchiectasis, sputum, biliary obstruction, pancreatic dysfunction, infertility for males, psychological, salty sweat, recurrent lung infection, filled sinuses, gallbladder/liver disease

111
Q

what are health problems associated with cystic fibrosis

A

sinus problems, nose polyps, enlarged heart, trouble breathing, gallstones, trouble digesting food, fatty BMs

112
Q

how is cystic fibrosis formed

A

chloride channel CFTR (pushes chloride out of cell) is dysfunction - more Na moves into cell and this causes dry sputum

113
Q

what does the management of cystic fibrosis need to include

A

treatment for pancreas, bowels and liver

114
Q

what is given for pancreas

A

exocrine failure (slugged up ducts) -CREON endocrine (destruction of pancreatic cells) - annual OGTT, CGMS

115
Q

what is given for bowels

A

DIOS - mucus blocks intestines - gastrograffin, laxido, fluids

116
Q

what is given for liver

A

slugged up hepatic ducts and portal hypertension - TIPSS (reduced anastomoses and bleeding risk)

117
Q

what is the G55ID gene mutation in cystic fibrosis

A

type III mutation, normal CFTR, non functional channeltreatment - ivacafactor (improves chlorine flow)

118
Q

what is given for F508del mutation in cystic fibrosis

A

lumacftor

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