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Medicine Year 1 > Week 118 Bronchial sepsis > Flashcards

Week 118 Bronchial sepsis Flashcards

1
Q

What is pleuritic chest pain?

A

Sharp pain on inhalation/movement like a bad stitch

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2
Q

What are rigors?

A

Feeling cold with a temperature/sweats and vice a versa

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3
Q

If a pt has recently been on holiday, what is this significance of this?

A

TB

Certain pathogens

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4
Q

What is palmar erythema and what is it significant of?

A

Red palms

Vasodilation because of shock with low bp

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5
Q

What are causes of low bp?

A 
Bleeding 
Shock- sepsis or anaphylactic
Endotoxic shock
Pump failure 
Tablets 
 (hypovolemia)
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6
Q

If a pt had a haemorrhage, how might their palms appear?

A

White and clammy

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7
Q

What do crackles sounds like?

A

Velcro

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8
Q

What does pleural rub sound like?

A

Someone walking on snow

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9
Q

How do you know if RLZ is affected? (CXR)

A

Can’t see diaphragm border

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10
Q

How do you know if right middle zone (lingular) is affected (CXR)?

A

Can’t see right heart border

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11
Q

What is a white-ish shadow potentially on a CXR?

A

Consolidation

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12
Q

How many ribs should be seen on a CXR?

A

8 anterior

6 posterior

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13
Q

What are signs of type 1 respiratory failure?

A

Low o2 low co2

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14
Q

What are signs of type 2 resp failure?

A

Low o2 high co2

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15
Q

What is CRP?

A

Protein made in liver, over 100 indicates infection/inflammation

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16
Q

What type of resp failure is pneumonia?

A

Type 1

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17
Q

What is high d-dimer indicative of in blood results?

A

Blood losing ability to clot so bruising and bleeding occurs e.g. overdose, kidney/liver failure

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18
Q

What is the average tidal volume?

A

500ml

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19
Q

How much air is processed in the lungs a day?

A

10-20,000 L

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20
Q

Describe features of typical pneumonia

A
  • Abrupt onset
  • High fever
  • Purulent sputum (green)
  • Focal consolidation
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21
Q

Describe features of atypical pneumonia

A

Gradual onset
Dry cough
Myalgias
Headache

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22
Q

When do you see helminths/protozoa infecting people?

A

Africa (sub-saharan), Asia

Immune deficient

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23
Q

What colour do gram +ve bacteria stain?

A

Blue

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24
Q

Describe features of streptococcus pneumonia

A 
•Gm +ve 
•Lives in resp tract 
•Rapid multiplication  •Abrupt onset 
•Very ill  
•Medical emergency
community acquired/aspiration

mild- amoxicillin
moderate- am and clarithromycin
aspiration- CephalosporinIV+metronidazoleIV

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25
Q

What presents on a CXR differentiating pneumonia from cancer?

A

black dots (bronchal…? research)

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26
Q

Describe features of haemophilus influenza

A 
BACTERIA 
heamophilus lives in mouth, nose, doesnt cause massive infection- weak bug that grows over a few days
•URTI common  
•Usually encapsulated (typeable forms)  
•Small pleural effusions can occur 
•Empyema / cavitation rare

community acquired- clarithromycin

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27
Q

Where does staphylococcus normally grow?

A

Hands

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28
Q

Describe features of Staphylococcus aureus

A

-common in anyone with breakage in skin e.g. drug addict- look for needle marks
•Gram +ve
•Spread via airways (viral) or •Bacteraemia (e.g. endocarditis)
•Lung tissue lysis leads to cavitation
•Septicaemia, empyema, abscesses are common

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29
Q

Describe features of Klebsiella

A 
•Gram –ve (not blue)
•Colonise oropharynx  •Nosocomial 
nosocomial= nursing home
old people cant fight this off and have comorbidity 
•Comorbidity common  
•Very ill 
•Haemoptysis 
•Poor prognosis
not dark blue stain

lives in stomach, intestines, oropharynx

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30
Q

Describe features of Escherichia coli

A

lives in gut- association with comorbities, aspiration

poor prognosis because already ill and unwell

  • Gram –ve
  • Comorbidity
  • Chronically ill patient •Aspiration
  • Often lower lobes
  • Poor prognosis
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31
Q

Why is infection more common in right, lower lobe?

A

comes in lower lobe because of gravity - if you aspirate will go down
most common in RLL because right main bronchus is wider and more vertical and more likely to get infection in

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32
Q

Why can you see an endotracheal tube on an xray?

A

Has metal on it

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33
Q

Describe features of Pseudomonas aeriginosa

A
  • Gram –ve
  • Chronically ill
  • Structural lung disease •Gradual onset
  • Copious very green sputum
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34
Q

Describe features of Legionella pneumophilia

A
  • Gram –ve intracellular
  • Water / air con •Immunosupressed
  • Dry cough, fever, myalgia,diarrhoea, rash •Oliguria, ARF, rhabdomyolysis, HSM
  • 5-30% mortality
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35
Q

Mycoplasma pneumoniae

A
  • Closed populations
  • 50% URTI
  • Arthralgias, LNs, myalgia, diarrhoea, myocarditis, meningitis, hepatitis, IHA, skin eruptions, vomiting
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36
Q

Chlamydia psittacci

A

•Intracellular bacterium •Inhalation from birds
•Fever, myalgia, macular rash, splenomegaly, severe cough, dyspnoea, depression
•1% mortality
•Lower lobe infiltrates, persist 4-6 weeks
Prolonged treatment

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37
Q

Mycobacterium tuberculosis

A

•Complex pathogen!
•Foreign travel, immunocompromised •Gradual onset, fever, chest pain, weight loss, dry cough, haemoptysis
•Cavitation, effusion, miliary •Highly infectious
A great mimic

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38
Q

Pneumocystis carinii

A
  • Fungus? •Immunocompromised •Progressive SOB, dry cough, fever, weight loss
  • Often minimal signs
  • CXR anything!
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39
Q

Fungal (aspergillus,cryptococcus)

A
  • Immunocompromised •Similar to bacterial pneumonia

* Cavitation common •Haemoptysis, weight loss •Poor prognosis

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40
Q

Order bacterial organisms causing pneumonia from most common to least

A 
Step Pneum
H. Influenza
Staph Aureus
Gm -ve
Anaerobes
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41
Q

What organisms infect healthy individuals?

A 
Strep pneum
Outbreak
Water
Birds
Occupation
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42
Q

What organisms infect hospitalised pts?

A

Gram -ve
Staph aureus
MRSA

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43
Q

What organisms infect immunocompromised pts?

A

PCP
TB
Fungal

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44
Q

Describe the Bohr effect

A

O2 curve changing= Bohr effect
Shift to right= ^co2 or reduced pH - acid drives off o2 from Hb at any given p02
right shift= blood gives off more o2 that it would because it encounters co2 and acid from metabolising tissues
Bohr effect assists o2 delivery

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45
Q

Describe what 2,3 BPG does

A

BPG- shifts curve to right
Purified Hb= far left therefore without BPG wouldn’t let fo of 02
BPG conc rises as anaemia develops to maintain o2 delivery to tissue
BPG prevents channel from becoming narrow
Stabilises dHb and shifts curve to right, improving o2 delivery

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46
Q

What are the most common hospital-acquired organisms for pneumonia?

A

Most commonly Gram negative enterobacteria or Staph. aureus.

Also Pseudomonas, Klebsiella, Bacteroides, and Clostridia.

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47
Q

Describe causes of pnuemonia

A

Community acquired
Hospital acquired
Aspiration
Immunocompromised pt

Aspiration Those with stroke, myasthenia, bulbar palsies, consciousness (eg post- ictal or drunk), oesophageal disease (achalasia, reflux), or with poor dental hygiene risk aspirating oropharyngeal anaerobes.

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48
Q

What defines severity of pneumonia?

A 
Confusion (abbreviated mental test ≤8); 
Urea >7mmol/L; 
Respiratory rate ≥30/min; 
BP <90 systolic and/or 60mmHg diastolic); 
age ≥65.
0–1 home  possible; 
2 hospital therapy; 
≥3 severe pneumonia indicates mortality 15–40%—consider ITU.
Confusion
Urea
Resp rate
Bp
Age
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49
Q

What are complications of pneumonia?

A

Pleural effusion, empyema, lung abscess, respiratory failure, septicaemia, brain abscess, pericarditis, myocarditis, cholestatic jaundice. Repeat CRP and CXR in patients not progressing satisfactorily.

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50
Q

Treatment for pneumonia

A

Breathing (o2)
Antibiotics (underlying cause)
Pain (analgesics)
Pneumococcal vaccines (for diabetics, those over 65)

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51
Q

What is needed for the lungs to function well?

A
  • lots of air volume
  • lots of tubes
  • lots of blood
  • lots of SA
  • moisture and something to stop the thin walls from sticking together
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52
Q

What system/tract does the resp system develop from?

A

Gut tube, gi tract

foregut: (at level of future oesophagus) tracheosophageal septum develops from it and becomes bronchial buds

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53
Q

Describe the development of the lining of the airways

A

Lungs are lined by epithelium derived from endoderm (like the epithelium of the gut tube).

The lung bud is covered in splanchnopleuric mesoderm - will become connective tissue, muscle and cardiovascular structures of the lungs.

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54
Q

How do the lung buds develop?

A

The bud starts with 2 branches which will be the main bronchi (primary bronchial buds).
Then those branches branch to give the lobar bronchi (secondary bronchial buds)

left side gives 2 lobar branches and the right side gives 3 (evolutionary)

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55
Q

Describe the pseudoglandular stage

A

bronchial tubes branch, and branch, and branch.

- most about of surface area development here

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56
Q

What are the first cells to appear off the bronchial tree?

A

Primitive and type II pneumocytes (alveolar cells)

57
Q

Why do we have smooth muscle in the airways?

A

Remnant of GI tract- we dont need it, hence becomes a problem in asthma

58
Q

What divides the single cavity within the embryo into 2?

A

Septum transversum

59
Q

What is a congenital hiatus hernia?

A

Diaphragm doesnt form properly so the intestines push up and stop the lungs growing

60
Q

What are primitive alveoli?

A

Tubes bud sacs

61
Q

Describe primitive alveoli

A

Epithelia of primitive alveoli thin and become type 1 pneumocytes (or squamous alveolar cells) with capillaries inside

62
Q

What are type II pneumocytes?

A

Secrete surfactant

develop after type I from week 24 onwards

63
Q

What is the function of surfactant?

A

reduces the surface tension of the fluids in the alveoli and stops the thin walls of the alveoli from sticking to each other (would make breathing difficult and gas exchange inefficient)

give artificial if premature

64
Q

Name 5 stages of lung development and what develops

A

Embryonic
3-5 weeks
bud, branching

Pseudoglandular
6-16 weeks
Branching

Canalicular
17-24 weeks
terminal bronchioles

Saccular
25 weeks to term
primitive alveoli and capillaries

Alveolar
8 months to childhood
more alveoli

65
Q

What is respiratory distress syndrome?

A

Not enough surfactant

atelectasis (lung collapse)

66
Q

How is respiratory distress syndrome treated?

A

steroids, surfactant therapy, oxygen therapy, CPAP

premature mum may be given injection of steroids 24 hours before birth

67
Q

How are fistulas formed?

A

Oesophagus and trachea remain linked

oesophagus ends abruptly

68
Q

What is a complication of a fistula

A

Pneumonia may occur after birth as fluid may enter trachea through oesophageal fistula (surgery required).

A blind ending oesophagus can lead to polyhydramnios (too much amniotic fluid as it can’t be swallowed by the foetus).

69
Q

What layer of the embryo does the respiratory tract arise from?

A

Endoderm

70
Q

What phase is where branching of the bronchial tree most occurs?

A

Psuedoglandular

71
Q

What is a primary limiter of gas exchange in lungs of a baby born at 28 weeks?

A

Limited alveolar surface area

72
Q

What type of cell is a type I pneumocyte?

A

Squamous

73
Q

What increases risk of respiratory distress syndrome in preterm infants?

A

Caesarean delivery

74
Q

Which is most associated with deaths in the UK?

A. Pharyngitis
B. Laryngitis
C. Epiglottitis
D. Sinusitis

A

pharyngitis

75
Q

3 year old boy is brought to you by his mother (who works at the local nursery). He has had 24 hours of intermittent fevers, sore throat and difficulty feeding. His mum is concerned he has developed some pain, drooling and difficulty swallowing. They’re going on holiday in 2 days, and she wants you to prescribe antibiotics. What do you do?

A

Admit to hospital

  • difficulty feeding/swallowing
  • drooling

BAD

76
Q

What is used to assess someone’s severity when admitted with pneumonia?

A

CURB 65

Confusion (Y/N)
Urea >7
Resp rate
BP
over 65
77
Q

What pathogen is most associated with pneumonia and rash?

A

Mycoplasma (because abnormal clotting)

78
Q

73 year old retired miner presents with cough, disorientation, chest pain. Temp 38.5, BP 105/55, RR 25/min CRP 280, WCC 14. 7, D-Dimer +ve Na 137, K 3.4, Urea 5.3, Creat 74 What’s his Mortality at 30 days?

A

1/4

79
Q

What is normally the class of pathogen for upper respiratory infection?

A

Usually Viral (i.e. Rhinovirus, coronavirus, Respiratory Syncytial Virus/RSV, Parainfluenza & Influenza)

80
Q

What is the border dividing upper from lower resp infections?

A

Above larynx

81
Q

What secondary infections can occur from URT infections?

A

Secondary infections (H.influenza/Streptococcus) leading to Sinusitis, Otitis Media, Bronchitis or Pneumonia

82
Q

What can the common cold lead to?

A

Can lead to otitis media, bronchitis, pneumonia

83
Q

Why is pharyngitis so dangerous?

A

Airways can become swollen and completely close e.g. from quinsy- pus at back of throats- swelling can choke you and may need surgery

84
Q

What pathogens can cause pharyngitis?

A

Viral, Group A B-haemolytic Strep, Mycoplasma

85
Q

What are symptoms of pharyngitis?

A

Fever, Sore throat, Erythema of Pharynx

86
Q

What are complications of pharyngitis?

A 
Complications 
Glandular Fever 
Tonsillitis 
Quinsy (pus infection)
Streptococcal infections 
  Glomerulonephtitis 
  Rheumatic Fever

can cause systemic infection

87
Q

Describe glandular fever

A

Epstein Barr virus
Monospot test will be +ve
Rash with amoxicillin
aka infectious mononucleosis

88
Q

Describe Croup

A

Acute Larygotracheobronchitis Cause: RSV
Barking Cough
Treatment
Usually self limiting
If admission required oral/nebulised steroids

common in babies

89
Q

What is dysphonia?

A

Difficulty talking

90
Q

What are features of epiglottitis?

A 
Inflammation of Vocal Cords  Drooling 
Dysphonia 
Dysphagia 
Drawn facies dical emergency 
Limited examination

Medical emergency - Secure airway
IV cefuroxime

91
Q

Describe features of a LRTI

A

Below the Larynx
Usually considered sterile environment in healthy individuals
Likely pathogen is determined by route of transmission, co-morbidities, travel history, pre-disposing factors.
Treatment can be tailored due to severity, likely pathogen and history.

92
Q

What is the definition of pneumonia?

A

Inflammation and consolidation of the lung tissue due to an infectious agent

Clinical:
Acute LRTI, fever, symptoms, signs in chest and abnormal CXR

93
Q

Name signs and symptoms of pneumonia

A

Symptoms:

  • Fever (chills)
  • Cough (sputum)
  • Pain
  • Dyspnoea
  • Coryza/pharyngitis (URTI)
  • Vomiting
  • Headache/myalgia
  • General malaise

SIGNS 
temperature (high or low)
Confusion
Tachypnoea

  • Percussion
  • Crackles
  • Bronchial breathing
  • Tactile Vocal Fremitus
94
Q

What are risk factors for RTIs?

A

Host Factors Immunocompromise (HIV, immuodeficiency)
Alcohol misuse
Co-morbidities (Diabetes, Respiratory Disease)
Smoking

Physical Factors Tracheostomy/Laryngectomy Aspiration Risk – Stroke/Neuromuscular Disease

Drugs
MST and atropine (low mucociliary escalator)
Sedatives e.g. alcohol (low cough, epiglottic function) Steroids/Salicylates (low phagocytosis

95
Q

What makes you three times more likely to get pneumonia?

A

Being over 65

96
Q

Where does legionella come from?

A

Mediterranean

97
Q

Where does pseudomonas come from?

A

SE asia, northern australia

98
Q

What initial investigations are conducted with RTIs?

A

Routine Bloods
Blood Culture
Sputum Culture (AFB & MCS) Urine Pneumococcocal/Legionella (& Urine Output)
Specific tests – mycoplasma etc

CXR/ECG
CT Thorax/Thoracic Ultrasound (in specific cases)

99
Q

How do you differentiate between pleural effusion and pneumonia on an x-ray?

A

Pleural effusion will have the curved meniscus sign on an xray

100
Q

What are signals for mycoplasma (atypical)?

A

Extrapulmonary Symptoms e.g. Erythema Nodosum or Skin Rashes 25%

Neurological Signs in 5% (i.e. Meningo-encephalitis, Cerebellar Ataxia, Peripheral Neuropathy)

Can develop Arthralgia, Splenomegally, Hepatitis, Haemolytic Anaemia
Children/Young Adults

101
Q

What are signals for legionella pneumonia (atypical)?

A

Hotel Stay in Last 14 days Delirium, Diarrhoea, Abdominal Pain, Derranged LFTs
Contaminated Water Humification Systems/Storage Tanks/Heating
Does not spread from person-to-person
Rapid urinary antigen testing available

102
Q

What are signals for Staph aureus (atypical)?

A

Cavitating/Necrotising Pneumonia
Flu-like illness initially Severe, high mortality
?Blood-bourne spread i.e. IV Drug Use, Central Lines, Dialysis Lines
?Bacterial Endocarditis

103
Q

What is treatment for pneumonia in uncomplicated situations?

A

Amoxycillin and clarithromycin or cephalosporin

104
Q

What is treatment for pneumonia in complicated situations?

A

i.v cefuroxime + p.o clarithromycin

Or i.v. augmentin + p.o clarithromycin

105
Q

What ABs are used in atypical infections?

A

Clarithromycin
rifampicin
tetracycline

106
Q

What ABs are used when cavitation occurs?

A

Cerfuroxime
Metronidazole
Flucloxacillin

107
Q

What pathogens cause cavitation?

A

clebsiella, e coli and stpah cause holes

108
Q

What ABs are used if aspiration occurs?

A

Cerfuroxime

Metronidazole

109
Q

What are complications of pneumonia?

A 
Empyema
ARDS
Abscess
Bronchiectasis (long term scarring)
Pulmonary emboli
110
Q

What are risk factors for lung abscess?

A

Bacterial load

Reduced cough

111
Q

What are treatments for lung abscess?

A

IV ABs
Drainage
Surgery

112
Q

DR DEAC PIMP: TB

A

Definition
Infection by M. tuberculosis or M. bovis

Risk Factors 
Low BMI
HIV
Alcohol
Travel
Immunosuppressed
Genetic component?
Crowded living conditions
Vegetarianism
Elderly / young
Lung damage (silicosis etc)
Diabetes
Renal failure
Smoking (20+ => 2-3x risk)
Differential diagnosis 
Pneumonia
Noicardiosis
Upper zone fibrosis:
Sarcoidosis
Lung cancer
Extrinsic allergic alveolitis
Single unilateral infiltrate
Sarcoidosis
Carcinoma
Bilateral infiltrates
Sarcoidosis
Hilar lymphadenopathy
Sarcoidosis
Lymphadenopathy (other cause)
Multiple cavities
Pneumonia (cf timing)
Wegener's granulomatosis
PMF (progrssive massive fibrosis)
Single cavities
Abscess
Carcinoma
Rheumatoid
Legionella
Anthrax
Mesothelioma (aspestos cancer)
Epidemiology 
1/3 of world infected
African/asian/indian/eastern europe
2-3 million die per year
1 new infection per second
>40/100,000 = 'Endemic'
15 - 23% of AIDS deaths are from TB
On the rise
99% of infections don't show (many) symptoms and => latent
10% of latent infections will reactivate later

Aetiology
Droplets in air spread mycobacteria
Usually infects lungs initially
Immune response to bacteria causes damage

Clinical features 
Upper zone fibrosis
Bacteria prefer high up (more oxygen)
Night sweats
Productive cough
Fever and 
Weight loss
Anorexia
Pleural effusion
Finger clubbing
Rales
Pneumonia
Pathophysiology 
Type IV hypersensitivity
Bacteria enveloped by macrophages
Waxy cell wall => resistant to breakdown
MCHII presentation, T cell activation
Primary focus (Gohn focus)
Secondary foci in lymph nodes
=> Il1, IL12, TNFa release
=> PMN infiltration
Macrophages turn into
Epitheliod cells
Which fuse to form Langhans cells
Fibroblasts infiltrate and lay down fibrin
=> caseating granulomas
Investigations
Hx
Mantoux
Positive result is:
>5mm HIV
>10mm high-riskers
>15mm everyone else
NB false positives
Steroids
Immunosuppression
Milliary TB?
Quantiferon-TB Gold
=> IFN-g levels
CXR
Nodules
Cavities
Little scars
Hilar caseous lymph nodes
Upper lobe
Sputum
3 different samples
ZN stains
Bacteria in sputum (direct visualisation) => infective
Bacteria can be cultured => latent?
Takes 3 weeks
Management
NB DOTS treatment
Directly observed treatment, short duration
Isoniazid
6 months
Blocks mycolic acid synthesis
Peripheral neuropathy
Prevent with vitamin B6 injections
Rifampicin
6 months
Inhibits DNA polymerase
Stains body fluids pink
Ethambutol
2 months
Blocks arabinosyl transferase
=> blocks cell wall production
Colour vision -
Pyrazinamide
First 2 months only
Blocks fatty acid synthesis?
Or disrupts membrane potential?
Joint pain
Pyridoxine
2 months
Reduces ioniazid side-effects
Prognosis
Untreated active disease kills 50%
Miliary TB almost 100% fatal
Treatment very effective if followed
Secondary TB
Peyers patches
Mesentary
Spine (Pott's spine)
Liver
Miliary TB (blood-born foci)
Scrofula of neck (lymphatic spread
113
Q

What is the definition of TB?

A

Infection by mycobacterium tuberculosis complex

114
Q

What is the aetiology of TB?

A

Inhalation of
M. tuberculosis
M. africanum
M. bovis

115
Q

Who are the risk groups for TB?

A
  • Immigrants (56% of notifications in 2008)
  • HIV (3% of tuberculosis also co-infected)
  • Cancer
  • Drug abusers
  • Elderly
  • Homeless ( x150 rate of national average) •Healthcare workers
116
Q

What is the sex ratio for getting TB?

A

male to female 1:1

117
Q

What parts of the world has the highest rates of TB?

A

India
Indonesia
South Africa
Brazil

118
Q

What is the presentation of TB?

A

Pulmonary symtoms

  • Cough (80%)
  • Chest pain
  • Fever/night sweats
  • Weight loss
  • Haemoptysis

Non-pulmonary

  • lymphadenopathy
  • Fatigue
  • GI
  • CVS
  • CNS
  • Bones
  • GU tract

Primary infection (Ghon complex)

Secondary infection (lungs/other)

Reactivation (0-3%)

119
Q

What are the investigations for TB?

A 
AFB (acid fast bacilli)
Culture
Bactec
PCR 
CXR
UBEX
U
Blood: Gamma interferon (FBC, ESR, CRP)
ECG
X-ray

Heaf/Mantoux
PCR (except blood)
Histology

120
Q

How does the interferon gamma release assay work for TB?

A

Whole blood exposed to antigen specific to TB (ESAT6 and CFP 10)

  • Measures the amount of interferon-γ released
  • Not affected by prior BCG vaccination or other mycobacteria

-Highly sensitive for the diagnosis of latent disease
–QuantiFERON TB Gold 80-90%
–Elispot TSPOT TB test): >95%: favoured in I mmunosuppressed

121
Q

How does primary TB normally appear on a CXR?

A

Primary TB usually appears as a central apical portion with a left lower-lobe infiltrate or pleural effusion

consolidation of the upper zone with ipsilateral hilar enlargement due to lymphadenopathy

122
Q

What is the treatment for a pt infected with TB but has no disease?

A

chemoprophylaxis

123
Q

What is the treatment for a pt with overt disease (TB)?

A

Quadruple therapy

124
Q

What is the quadruple therapy for TB?

A 
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
For at least 2 months

after 2 months, if cultures are fully sensitive, ethambutol and pyrazinamide may be stopped

125
Q

What are common side effects of rifampicin?

A

Orange body secretions, hepatitis,

flu-like syndrome, thrombocytopaenia

126
Q

What are common side effects of Isoniazid?

A

Peripheral neuropathy, hepatitis,
seizures,
psychoses

127
Q

What are common side effects of Pyrazinamide?

A

Hyperuricaemia
Hepatitis
Rash
Gout

128
Q

What are common side effects of Ethambutol?

A

Optic neuritis

Rashes

129
Q

What is the criteria for close contacts in TB?

A

•Close contacts
> 8 hrs total in same room disease occurs in about 1% close contacts
10% total TB notifications

130
Q

What are causes of TB drug resistance?

A 
–Over the counter availability of drugs 
–Inappropriate treatment regimens 
–Inferior pharmaceutical preparations 
–Erratic drug supplies 
–Poor concordance
131
Q

HIV and TB

A
  • TB is commonest cause of death in HIV
  • Difficulties in diagnosis •Serious adverse drug reactions
  • Perceptions of the disease •Shear size of problem /overburdened health care systems
  • Only infection that affects HIV -ve contacts
132
Q

A 20 y/o man who is otherwise fit and well presents with a 3 day history of shortness of breath, fever and a productive cough. He mentions that his girlfriend had similar symptoms but has now recovered. He has rusty sputum and on examination there are bronchial breath sounds present and crackles. What is the most likely causative organism?

A

Streptococcus Pneumonia- rusty sputum

133
Q

A 67 y/o man with COPD and with a 48 units / week history of alcohol consumption presents with symptoms consistent with pneumonia. He mentions coughing up currant jelly sputum. Which of the following is the most likely causative organism?

A

Klebsiella
Currant jelly sputum
Alcoholics
COPD

134
Q

Pneumonia features of Pseudomonas

A

green, cystic fibrosis

135
Q

Pneumonia features of Legionella

A

Legionella - water tanks, deranged LFTs

136
Q

Pneumonia features of Chlamydia psittaci

A

Parrots

137
Q

Pneumonia features of Staphylococcus

A

upper lobe cavitation, IV drugs

138
Q

A newborn baby has hyaline membrane disease and is treated with exogenous surfactant. This condition is associated with dysfunction in which of the following cell types?

A

Type 2 pneumocytes make surfactant
Hyaline membrane disease - disorder of Type 2 cells
Can be given steroids prior to delivery

Type 1 cells provide the large surface area

Medicine Year 1 (13 decks)

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