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RESP - 1 > Passmedicine > Flashcards

Passmedicine Flashcards

1
Q

What are the features of AECOPD?

A

Dyspnoea, wheeze, cough
If infective may have increase in sputum
If hypoxic may have acute confusion

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2
Q

What are the 3 most common bacterial causes for infective AECOPD?

A

H. influenzae (most common)
Strep pneumoniae
Moraxella catarrhalis

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3
Q

What is the most common viral cause for infective AECOPD?

A

Rhinovirus

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4
Q

How is AECOPD managed?

A

Increase freq. of bronchodilator use + consider giving via nebuliser
Prednisolone 30mg for 7-14 days
Amoxicillin/clarithromycin/doxycyline if sputum purulent/signs of pneumonia

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5
Q

What is psittacosis?

A

Infection caused by chlamydia psittaci

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6
Q

What things should make you suspect psittacosis?

A

Typical fever with history of bird contact

OR pneumonia + severe headache/organomegaly + failure to respond to penicillins

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7
Q

What kind of organism is Chlamydia psittaci?

A

Gram negative obligate intracellular bacterium

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8
Q

How is Chlamydia psittaci spread?

A

From birds/bird urine/faeces

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9
Q

What is the typical presentation of psittacosis?

A

Subacute onset of flu symptoms (fever, headache, myalgia) + respiratory symptoms (SoB, dry cough, chest pain)

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10
Q

What chest signs do you see in psittacosis?

A

Unilateral creps + vesicular breathing

Uncommonly may see pleural effusion

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11
Q

What abdomen signs might you rarely see in psittacosis?

A

Hepatomegaly, splenomegaly

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12
Q

What will investigations reveal in psittacosis?

A

Raised inflammatory markers

Consolidation on CXR

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13
Q

How do you confirm the diagnosis of psittacosis?

A

Serology (atypical pneumonia screening)

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14
Q

What is the treatment of psittacosis?

A

1st line: tetracycline, e.g. doxycyline

2nd line: macrolide, e.g. erythromycin

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15
Q

What is sarcoidosis?

A

Multisystem disorder of unknown aetiology characterised by non-casating granulomas

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16
Q

What are the features of sarcoidosis?

A

Acute: erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia
Insidious: SoB, dry cough, malaise, wt loss

17
Q

What skin condition do people with sarcoidosis get?

A

Lupus pernio

18
Q

What electrolyte disturbance do you get in sarcoidosis?

A

Hypercalcaemia - macrophages in granulomas cause increased conversion of vit D to its active form

19
Q

What syndromes are associated with sarcoidosis?

A

Lofgren’s syndrome
Mikulicz syndrome
Heerfordt’s syndrome

20
Q

What is Lofgren’s syndrome?

A

Acute form of sarcoidosis where there is bilateral hilar lympadenopathy, erythema nosodum, fever, polyarthralgia

21
Q

What is Mikulicz syndrome?

A

Enlargement of the parotids + lacrimal glands due to sarcoidosis, TB or lymphoma

22
Q

What is Heerfordt’s syndrome?

A

Parotid enlargement, fever, uveitis secondary to sarcoidosis

23
Q

How should asymptomatic bilateral hilar lympadenopathy be treated in sarcoidosis?

A

It should not be treated

24
Q

What is involved in the general management of COPD?

A

Smoking cessation advice
Annual flu vaccine
One off pneumococcal vaccine
Pulmonary rehab (for those functionally disabled by COPD)

25
Q

What is the first line treatment of COPD?

A

SABA or SAMA

26
Q

What determines the second line treatment of COPD?

A

Whether patient has asthmatic features or not

27
Q

If a patient has asthmatic features what is the second line treatment of COPD?

A

LABA + ICS

28
Q

What is third line treatment for someone with asthmatic features and COPD?

A

Triple therapy - LABA, LAMA, ICS

29
Q

What is the second line treatment of COPD without asthmatic features?

A

LABA + LAMA

30
Q

What features are suggestive of asthmatic features/steroid responsiveness in COPD?

A

Any prev. diagnosis of asthma/atopy
Those with a higher blood eosinophil count
Substantial variation in FEV1 over time (at least 400ml)
Substantial diurnal variation in peak expiratory flow (at least 20%)

31
Q

What patients may be treated with theophylline for COPD?

A

After trials of short and long acting bronchodilators or to those who can’t use inhaled therapies

32
Q

What antibiotic is recommended in some patients with COPD?

A

Azithromycin prophylaxis

33
Q

What COPD patients may get azithromycin prophylaxis?

A

Those who don’t smoke, have optimised standard treaments, and continue to have exacerbations

Must have bronchiectasis ruled out with CT thorax and have sputum culture done to rule out atypical infections + TB

RESP - 1 (27 decks)

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