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Medicine Year 4 > Chest medicine > Flashcards

Chest medicine Flashcards

1
Q

Commonest cause of pneumonia?

A

Steptococcus pneumoniae

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2
Q

Chlamidophila psittaci, how would you contract this bacteria?

A

Birds, this is a zoonosis

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3
Q

CURB-65 breakdown?

A 
C - confusion
U - urea >7mmol/L
R - resp rate >30/min
B - BP (sys <60)
Age - greater than 65
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4
Q

SARS - what type of pathogen is it?

A

Coronavirus

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5
Q

Atypical cause of pneumonia in HIV +ve patients with CD4 less than 200/mm3?

A

Pneumocystis pneumonia caused by Pneumocystis jiroveci

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6
Q

Common causes of HAP?

A

G-ve bacteria (E coli & P aerunginosa) 50%
Staph aureus 20%
Strep pneumoniae 15%

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7
Q

Typical features?

A

Cough, purulent sputum, fever with pleuritic chest pain and breathlessness

Localised chest signs: crackles, dullness, bronchial breathing

Resp failure indicated by cyanosis and tachypnoea

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8
Q

Investigations?

A

CXR - consolodation
Haematology and biochem tests
Pulse oximetry & ABG

Sputum gram stain
Sputum culture
Blood culture
Pleural fluid aspiration

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9
Q

Antibiotics in CAP and HAP?

A

CAP - amoxicillin (plus clarithromycin if atypical)

HAP - aminoglycacide and 3rd gen cephlasporin

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10
Q

What is ARDS?

A

a form of acute respiratory failure by PULMONARY OEDEMA

resulting from ENDOTHELIAL DAMAGE

due to a cascade of INFLAMATORY EVENTS

developing in responce to an INTIATING INJURY/ILLNESS

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11
Q

ARDS - pathogensis?

A

Usually pulmonary oedema results from increased hydrostatic pulmonary capillary pressure (e.g. left ventricular failure), but in ARDS it is a result of increased alveolar capillary PERMIABILITY

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12
Q

Prognosis of ARDS?

A

50% mortality

Survivors often left with fibrosis

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13
Q

ARDS - clinical features?

A

Occurs in response to:
DIRECT injury - aspiration, severe pneumonia

INDIRECT injury - sepsis, major trauma, pancreatitis

12 - 24hrs after precipitating events. First signs are of dyspnoea and tachypnoea

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14
Q

How to differentiate causes of pulmonary oedema?

A

Pulmonary capillary wedge pressure is typically <18mmHg in ARDS.

In cadiogenic pulm oedema, the pulmonary artery pressure increases above 18mmHg

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15
Q

What are the two disease of large airways?

A

Asthma and COPD

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16
Q

What are the three RCP question regarding asthma?

A
  1. Have you had trouble sleeping?
  2. Have you had any symptoms during the day time?
  3. Has your asthma interfered with your usual activities?
17
Q

Finding of asthma o/e?

A

Freq normal
Hyperinflation
Wheeze: exp., diffuse and polyphonic (‘musical’)
Signs of atopy: exzema, conjunctivitis

18
Q

Differential of asthma?

A 
COPD
Heart Failure
Bronchiectasis 
GORD
Pulm fibrosis
19
Q

What findings would lead you away from asthma?

A

cough no wheeze
no variation of symtpoms
no relief with B2 agonist
voice disturbances

20
Q

Two key investigations?

A

PEFR
Spirometry

(Also, cultures, bloods, imaging)

21
Q

Steps in the management of asthma?

A

Step 1 - B2 agonist
Step 2 - add steroid
Step 3 - add LABA
Step 4 - trial of increased steroid dose. Leukotriene antagonist. Theophiline.
Step 5 - daily steroid tablet and specialist care referal.

22
Q

Acutely unwell patients can be managed with MOVE acronym- standing for…?

A

M - monitor (cardiac, BP, pulse ox, ect.)
O - oxygen
V - venous access
E - ECG

23
Q

Specifically for asthma, the OSHIT acronym can be used, it stands for:

A 
O - oxygen
S - salbutamol
H - hydrocortisone
I - Ipratropium bromide
T - theophiline/magnesium

& MONITOR

24
Q

Severity scale for asthma:

A

Moderate:
worsening symptoms
PEFR 50-75% best

Acute severe:
PEFR 33-50%
RR >25
HR >110
Unabble to speak in sentences 
Life threatening:
PEFR <92%
silent chest
cyanosis
poor resp effort 
arrythmia
exhaustion

Near fatal:
increased PaCO2 requiring ventilaiton

25
Q

In a suspected chest infection what does a swinging fever suggest?

A

Indicative of a collection of pus outside of the pneumonia

I.e. empyema or para-pneumonic infection

26
Q

CXR findings in pneumonia?

A

Walled off cavity lesion with fluid level

27
Q

With every admission of asthma,what should be done?

A

Follow up within 30 days

Review of self-medication skills and inhaler programme

28
Q

In an admission of asthma, if a severely unwell patient recovers to >75% PEFR what should you do?

A

Send patient home

29
Q

What might you see in a person who is losing control of their asthma management?

A

Waking at night with wheeze, cough, chest pain

Increase use of bronchodilator therapy

Decreased effectiveness of bronchodilators

Missing work days

Change in exercise tolerance

30
Q

If a patient comes in with an acute asthma attack, when can you discharge them home?

A

When they have been stable of their regular medication for 24hrs, prior to discharge

or if PEFR is >75% best

31
Q

What advice should you give to a patient about how they should act if they suffer an asthma attack?

A
  1. Take inhaler (B2) immediately
  2. Sit down loosen clothing
  3. Take the inhaler every minute for 5 minutes.
  4. No improvement call 999
  5. Continue step 3 until ambulance arrives.
32
Q

What is the pathological process that occurs in CF that allows for easy infection of the lungs?

A

CF results in permanent dilatation of the bronchioles, allowing for repeated infections of the airways

33
Q

What signs would you find in a young adult with CF?

and in a neonate?

A

Finger clubbing; bilateral coarse crackles; cyanosis

Failure to thrive; meconium ileus; rectal prolapse.

34
Q

Patients with COPD are prone to developing hypercapnia when they are on oxygen therapy, how would this present and how would you treat it?

A

Increasing confusion and tiredness/lethargy after being on oxygen therapy

Trial NIV (BiPAP) in these patients

35
Q

A patient with lung tumours can secrete PTH, leading to hypercalaemia. What are the symptoms of primary hyperthyroidism?

A

‘Bones’ - pain and sometimes pathological # (ostitis fibrosa cystica)

‘Stones’ - renal stones

‘Groans’ - abdo pain from ulcers, nausea, indigestion and constipation

‘Psychic moans’ - lethagy, fatigue, depression

36
Q

A patient presents with a likely lung cancer but she is hyponatraemic, what is going on?

A

The lung cancer is a small cell cancer which can cause SIADH leading to low sodium levels.

Medicine Year 4 (15 decks)

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