Revision- Resp. Other

Question 1

what is an ‘empyema’?

Answer 1

Purulent fluid collection in the pleural space, most commonly caused by pneumonia

Question 2

what does ‘primary empyema’ mean?

Answer 2

NOT caused by pneumonia

Question 3

what are causes of empyema?

Answer 3

aerobic organisms
gram +ves: strep pneumoniae, strep milleri, staph aureus
gram -ves: E.coli, pseudomonas, H. Influenzae. Klebsiella
anaerobes: usually in severe pneumonia/ poor dental hygiene

Question 4

pH of what differentiates simple/ complicated pleural effusion?

Answer 4

pH of < 7.2

Question 5

swinging fever

Answer 5

empyema

Question 6

best investigation for empyema?

Answer 6

ultrasound

Question 7

empyema management?

Answer 7

• Broad spectrum IV antibiotics initially (amoxicillin and metronidazole (anaerobic))
• Oral antibiotics once cultures come back directed towards cultured bacteria, usually 6 weeks of co-amoxiclav (anaerobic/ aerobic)
• Chest tube drainage - 5th intercostal space, midaxillary line in the safe triangle (anterior border of latissimus dorsi, posterior border of pectoralis major, axial line superior to nipple)

Question 8

what is bronchiectasis ?

Answer 8

Irreversible and abnormal dilation of the bronchial tree caused by cycles of bronchial inflammation -> excess mucus and bacteria build-up and progressive airway destruction

Question 9

most common cause(s) of bronchiectasis?

Answer 9

Cystic fibrosis
H. influenzae, pseudomonas aeruginosa
also COPD, ABPA, pneumonia, TB, immunodeficiency, rheumatoid arthritis

Question 10

recurrent “chest infections”, recurrent antibiotic prescriptions, no response to antibiotics/ short lived response

Answer 10

think bronchiectasis

Question 11

bronchiectasis investigation?

Answer 11

HRCT
showing thick, dilated airways, ‘signet rings’, tram line shadowing

Question 12

bronchiectasis management?

Answer 12

• Treat underlying cause
• Physiotherapy - airway clearance techniques
• Antibiotics for acute exacerbations - colymicin
• Consider long-term antibiotics in frequent exacerbators

Question 13

what is colymicin used for?

Answer 13

first line bronchiectasis antibiotic therapy (acute exacerbations)

Question 14

what is an intrapulmonary abscess?

Answer 14

Parenchymal necrosis with confined cavitation that results from a pulmonary infection

Question 15

Typically presents as a pneumonia that worsens despite treatment

Answer 15

intrapulmonary abscess

Question 16

what is used to differentiate between empyema and abscess?

Answer 16

CT

empyema - ultrasound
intrapulmonary abscess- CXR

Question 17

intrapulmonary abscess treatment?

Answer 17

• Broad spectrum antibiotics- prolonged courses
• Surgical drainage/resection may be necessary
  (drainage is less common)

Question 18

what is/happens in CF?

Answer 18

Genetic disease which leads to abnormally viscous mucus; mucus blocks many structures including the conducting airways and lungs - results in repeated chest infections and chronic colonisation

Question 19

what is faulty in CF?

Answer 19

CFTR (ATP regulated chlorine channel)

Question 20

what causes sticky secretions in CF?

Answer 20

faulty CFTR -> no Cl into lumen -> Cl goes into cell, water follows -> sticky secretions in lumen

Question 21

most common gene involved in CF?

Answer 21

F508

Question 22

cystic fibrosis management?

Answer 22

physiotherapy
prophylactic antibiotics
CFTR modulators - kaftrio, ivacaftor, orkambi
lung transplant consider when FV1 <40%
Creon (for exocrine failure)
TIPPS (hepatic ducts become blocked)

Question 23

what can be given for exocrine pancreas insufficiency?

Answer 23

CREON
(e.g. in CF, chronic pancreatitis, hepatobiliary cancer)

Question 24

what are causes of transudative pleural effusion?

Answer 24

heart failure
liver cirrhosis
(<30g/L protein)

Question 25

causes of exudative pleural effusion?

Answer 25

malignancy
infection

Question 26

causes of straw coloured aspirate?

Answer 26

cardiac failure
hypalbuminaemia

Question 27

pH of effusion that requires drainage?

Answer 27

pH LESS than 7.2

Question 28

pleural effusion management?

Answer 28

treat underlying disorder e.g. cardiac failure
> 7.2, antibiotics
<7.2, chest drain, antibiotics

Question 29

what is lung interstitium?

Answer 29

fluid and connective tissue supporting gas exchange units of lung

Question 30

causes of pulmonary venous hypertension?

Answer 30

• Left ventricular systolic dysfunction
• Mitral regurgitation/stenosis
• Cardiomyopathy e.g. alcohol, viral

back pressure effect