Session 9: Group Work Flashcards
What features of this history and examination cause you concern, and warrant hospital admission?
Severe left sided chest pain
Green sputum
Fever
RR
What do you think you might hear on auscultation of Yvonne’s chest?
Pulmonary crackles
Her arterial O2 is 87%. What is normal arterial O2 sat?
94-98%
CXR is done. The report indicates that this shows consolidation of the left lower lobe, with increased shadowing in the left lower lobe and loss of cardiac outline. Explain how these changes might have occured.
Exudate/fluid in the alveoli where the fluid obstructs the view of the heart.
What other tests would you order to help in the management of Yvonne’s condition?
Cough sputum test
Gram stain
Blood culture
U & E
CRP
ABGs
What is the most likely organism causing her illness?
S. pneumoniae
Yes looks like S. pneumoniae
Gram positive and diplococci that is sometimes in chains.
Which antibiotics would you choose to treat Yvonne?
Why these in particular?
This should be treated as severe pneumonia.
Treat with co-amoxiclav and doxycyclin
Treat with meropenem if penicillin allergy
What features in this history supports the diagnosis of pulmonary tuberculosis?
Tiredness
Weight loss
Fever
Cough
Haemoptysis
Diabetes
Left upper zone
Suggest one important condition to exclude in this patient?
Lung cancer
Consolidation/shadowing in left upper zone
This patient is likely to have post-primary TB due to reactivation of latent TB. What factor is most likely to have caused reactivation of TB in this patient?
Poorly controlled diabetes.
What other conditions can result in reactivation of latent TB?
HIV
Drug abuse
Long standing corticosteroids
Organ transplant
Blood transfusion
Severe kidney disease
Chemo
How can the diagnosis of active pulmonary TB be established.
TB Culture (golden standard)
Direct smear
CXR
NAAT
Would and IGRA assay or a Tuberculin skin test be useful in the diagnosis of pulmonary TB in this patient?
Explain your answer.
Not really. The tests can’t distinguish between latent or active TB.
There are other means of which you can test for active TB.
Anti TB treatment is commenced with 4 drugs. Name the four drugs commonly used in TB treatment.
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
Why are 4 drugs used in the treatment of TB?
Mycobacterium tuberculosis have random resistant strains to antibiotics. If you only give one, one of the strains might emerge and promote resistance.
In the case of giving 4 antibiotics it is very unlikely for the bacilli to be resistant to all 4.
All in all it is done to prevent resistance.
The GP warns him that his urine may turn orange. What is the explanation for this colour change?
Rifampicin rasies transaminases and induces cytochrome P450
The GP arranges for all members of the family to have a chest radiograph and IGRA test. Why?
To see if they have latent TB.
What condition does this patient have, as suggested by the clinical history, chest radiograph and CT findings?
Bronchiectasis
Sinusitis, pneumonia and cough
Visible bronchioles
Bronchioles larger than arteries
What is the pathological definition of this condition?
Chronic dilation of one or more bronchi with poor mucous clearance.
What underlying diseases may cause this condition?
Cystic fibrosis
Whooping cough
TB
Hypogammaglobulinaemia
What underlying disease most likely explains this patient’s symptoms?
Late onset CF
What further testing could this patient undergo to help diagnose her underlying disease?
Sweat test to check for Cl- levels. (They should be high)
Genetic test should be done after this.
