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1
Q

What test can be done ona suspected case of lung cancer?

A 
FBC + Clotting Screen
Serum Calcium
Bone Profile
LFT + RFT
CXR
Biopsy
Bronchoscopy + bronchoalveolar lavage
Aspirate any pleural effusion
PET Scan + Bone Scan
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2
Q

How does Lung Cancer present?

A 
Dyspnoea
Chest Pain
Chronic cough +/- Haemoptysis
Recurrent Chest Infections
Weight Loss
Wheezing - Dysphagia - Bone Pain - Shoulder Pain - Horners Syndrome - Swollen neck/face - Hoarseness
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3
Q

What are the most common causative organisms in pneumonia>

A 
Strep Pneumoniae
Mycoplasma Pneumoniae
Haemophilus Influenzae
Viral
Pseudomonas Aeruginosa
Staph Aureus
Legionella
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4
Q

Explain the Curb 65 Score for severity and treatemnt of Pneumonia?

A 
C - Confusion
U - Urea>7mmol/L
R - Resp. rate > 30/m
B - BP <60 or 90
65 - >65yrs
o = community treated
1-2 = Hospital Treated
3-5 = ITU
o-1 = Clarithromycin (macrolide) or Amoxicillin (B-lactam) or Doxycyclin
2 = Clarithromycin and Amoxicillin (or Levofloxacin - Fluroquinolone)
3-5 = Clarithromycin &amp; Co-Amoxiclav (Or Levofloxacin)

Add Vancomycin for MRSA
Add Flucloxacillin for Staph
Can also add rifampicin in severe cases

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5
Q

What are the complications of Pneumonia?

A

Lung abscess
Pleural Effusion
Empyema
Bronchiectasis

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6
Q

What tests are done on suspected pneumoina?

A 
FBC - CRP - ABG - U&amp;E - LFT
CXR
Bronchoscopy + Bronchoalveolar Lavage
Sputum &amp; Blood Cultures
Urinary Legionella
Throat Swab for atypical Pathogens
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7
Q

What none antibiotic treatments are there for pneumonia?

A 
Analgesia
Anti-pyretics
Fluids (IV if necessary)
O2 - CPAP - Intubate
CCS~ help with inflammation
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8
Q

What are the common organisms behind a lung abscess?

A

Pseudomonas Aeruginosa Or Staph Aureus

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9
Q

What treatments are there for lung abscess?

A

Postural Drainage
Percutaneous Drainage
Long course of antibiotics
Surgical Excision

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10
Q

How do we test for a mesothelioma and how does it present?

A

Dyspnoea - Chest Wall Pain - Pleural effusions/pneumothorax - Haemoptysis - Weight loss - Fatigue - Fever - Night Sweats - Clubbing - Cough

CXR - Diffuse or localised pleural thickening (unilateral)
Biopsy
Aspirate Effusion

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11
Q

What could make sinusitis chronic and what would we do?

A

Nasal Polyps - Immunocompromised - Allergy - Asthma - Smoking

CT/MRI/XR - Nasal Endoscopy

Amoxicillin - Nasal Irrigation - Surgical Intervention

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12
Q

How do we treat Otitis Media and what are the common organisms?

A

Analgesia and ~antibiotics

Haemophilus Influenzae or Strep Pneumoniae

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13
Q

What causes Croup vs epiglottitis?

A

Croup: Parainfluenza Virus Type 1
Epiglottitis: Haemophilus Influenzae B

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14
Q

Compare Croup and Epiglottitis presentation?

A

Croup:
Hoarse - Barking Cough - Dyspnoea worse at night - Stridor - Look relatively well - Slow onset

Epiglottitis:
Little Cough - Drools - Dyspnoea better when leaning forward - Stridor - Dysphagia - Look very Sick - Rapid onset

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15
Q

How do we treat croup vs epiglottis?

A 
Croup;
Oral CCS (Add O2 an Adrenaline if dyspnoea severe)
Epiglottitis:
Secure Airway with O2 and intubation 
Throat Swab for culture and viral smears
Blood culture for bacteraemia
FBC - Raised WCC
ANTIBIOTICS
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16
Q

How do we diagnose TB?

A

With 3 postive sputum cultures on consecutive days

17
Q

How do we treat TB and what are the drug interactions of rifampicin?

A

Rifampicin + Isoniazid (6 months)
Ethambutol + Pyrazinamide (just 2 months)

Rifampicin:
Induces cytochrome P-450 enzymes rendering various drugs useless:
The Pill - Anti-convulsants - Prednisalone

18
Q

What are the smyptoms of TB?

A 
Night Sweats
Weight Loss (Consumption)
Fever
Pleuritic Pain
Clubbing 
Crackles/Bronchial Breating
Dyspnoea
Cough + Purulent Sputum + Haemoptysis
19
Q

How id CF inherited?

A

Autosomal Recessive

20
Q

What are the isngs of CF?

A

Clubbing

Coarse Crackles

21
Q

How do we monitor the severity of CF in small kids?

A

Record and chart thier growth

22
Q

How do we treat CF?

A 
Azithromycin to suppress bacterial load
Treat infective exacerbations
Bronchodilator
Ivacaftor
Mucolytics
Drainage
NSAIDS / CCS
23
Q

What are the common infections caught in CF?

A

Pseudomonas Aeruginosa
Staph Aureus
Haemophilus Influenzae
Burkolderia Cepacchi (BAD)

24
Q

How does cerebral palsy affect kids sleep and what do we do for it?

A

Causing fragmented and delayed sleep

We give them melatonin

25
Q

How does Duchennes muscular dystrophy affect kids sleep and what do we do?

A

Leads to nocturnal desaturation eventually leading to resp failure and death
We give them BiPAP

26
Q

What are most secondary Pneumothoraxes caused by?

A

COPD

27
Q

What are the signs of a tension pneumothorax?

A 
Progressing Dyspnoea
Tracheal DEviation away from affected side
Mediastinal Shift
Raised JVP
Haemodynamic Instability
28
Q

What is surgical emphysema?

A

Bubble wrap like air tracking in the subcutaneous fat, quite common in severe or tension pneumonthorax

29
Q

What are the symptoms/signs of a pleural effusion?

A

Symptoms:
Dull Ache - malaise/fever - Night sweats - Weight loss - Dyspnoea - Pleuritic Pain - Dry Cough

Signs:
Bronchial breathing - Decreased Vocal Resonance - Decreased Expansion - Stony Dullness

Cause related:
Tar Staingin - Raised JVP - Clubbing - Lymphadenopathy - Tracheal Deviation - Peripheral Oedema - Orthopnea/PND

30
Q

What commonly causes Transudate vs exudate oedemas?

A

Transudate:
LVF - Liver Cirrhosis - PE - Hypoalbuminaemia - Mitral Stenosis - Constrictive Pericarditis

Exudate:
Pneumonia - Bronchiectasis - lung Abscess - Malignancy - PE - Post MI - Rheumatoid Arthritis - Autoimmune - Pancreatitis

31
Q

What test can you do on the fluid from a pleural effusion?

A 
Cytology - Malignant cells etc
M,c &amp; S
Total Protein
LDH
Amylase - Pancreatitis
Glucose
32
Q

What are the risk factors for a PE?

A 
The pill or HRT
Pregnancy
Inherited Thrombophilia
Bed or chair bound or travel
Previous PE or DVT
Recent Surgery or Trauma
Hypertension
Cardiopulmonary Disease e.g. MI
33
Q

How do we investigate a suspected PE?

A 
Clincial probability assessment e.g. Wells Score
D dimer
ECG
Chest XR
CT Pulmonary Angiogram
Echo
FBC + ABG
V/Q scan
Thrombophilia testing
34
Q

How does a PE present?

A

Dyspnoea
Pleuritic Pain
Cough +/- Haemoptysis
Fever - pleural Rub - Tachypnoea/tachycardia - cyanosis - Maybe pleural effusion

Massive PE:
Syncope & Collapse + Hypotension

35
Q

How do you treat a pulmonary embolism?

A

Symptoms - O2

Break up clot - Anticoagulants (DOAC - Rivaroxaban/LMWH for 5 days/Warfarin 3-6 months)

Remove Clot - Embolectomy

In an acute massive PE you might do thrombolysis with alteplase

36
Q

Describe adenocarcinoma?

A

Tends to be peripheral
Tends to grow more slowly
Most common tumour in the young and non-smokers

37
Q

White Asbestos

A

White asbestos - Chrysotile
Brown - Amosite
Blue - Crocidolite
Asbestos and smoking have a synergistic effect on lung cancer risk

38
Q

treat croup/epiglottitis?

A 
Croup;
Oral CCS (Add O2 an Adrenaline if dyspnoea severe)
Epiglottitis:
Secure Airway with O2 and intubation 
Throat Swab for culture and viral smears
Blood culture for bacteraemia
FBC - Raised WCC
ANTIBIOTICS
39
Q

What is the most common organism in pneumonia, CF and Lung abscess following pneumonia?

A

Pneumonia - Strep pneumoniae
CF - Pseudomonas
Abscess - pseudomonas/Staph. aureus

Resp. Illness (31 decks)

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