Block 31 Week 7 Flashcards
(216 cards)
1
Q
CAP causes
A
2
Q
CFs of pneumonia?
A
- fever
- cough
- chest pain
- increased resp rate
- crackles
- tachycardia
3
Q
Ix for pneumonia?
A
- CXR - to confirm diagnosis/ look for complications e.g. effusions
- moderate/ severe:
- blood cultures
- viral swabs
4
Q
supportive management of pneumonia?
A
- Analgesia
- IV fluids
- Oxygen as needed
- Prophylaxis for DVT / PE
5
Q
pneumonia management - drainage?
A
- Drainage of effusion if empyema or severe symptoms
6
Q
Tx of mild pneumonia?
A
- 1st line: amoxicillin
- alt: clarithromycin
- alt: doxycycline
7
Q
moderate pneumonia - oral/ IV?
A
- 1st line: amoxicillin + clarithromycin
- alt: doxycyline
8
Q
What can be used instead of clarithromycin or doxycycline in moderate pneumonia?
A
Moxifloxacin / Levofloxacin
9
Q
severe pneumonia drugs are given?
A
IV
10
Q
Severe CAP first line?
A
- 1st line: Co-amoxiclav + Clarithromycin
11
Q
severe CAP alternatives?
A
- 1st line: Co-amoxiclav + Clarithromycin
- alt: Cefuroxime + Clarithromycin
- alt: Benzylpenicillin + Levofloxacin
12
Q
transmission of COVID-19?
A
- Major route is respiratory droplets, generated by coughing, sneezing, talking
- Other routes include aerosols, contact with contaminated surfaces
13
Q
CFs of Covid?
A
- Classical URTI symptoms, may progress to severe disease around day 10 of illness
14
Q
moderate-severe Covid?
A
- Pronounced inflammatory / pro thrombotic state in critical cases
- Often little to find on examination
- cough, fever, SOB, fatigue, chest pain, muscle aches
15
Q
Ix for Covid?
A
- Low lymphocytes / platelets
- AKI
- Higher d-dimer
16
Q
RF for mortality from Covid?
A
- For invasively ventilated patients mortality is around 50%
- Age is the most consistent and largest risk
- Men have worse outcomes
- Ethnicity appears to be a marked risk
17
Q
CXR for covid?
A
- clasically there is bilateral interstitial shadowing typical of viral pneumonia
- takes a long time to resolve - may have persistent shadowing/ fibrosis
18
Q
supportive care in the management of Covid-19?
A
*Oxygen for hypoxia
*IV fluids
*VTE prevention
*Analgesia
19
Q
Targeted treatment of covid-19?
A
*Anti viral - Remdesivir
*Anti inflammatory - Dexamethasone
20
Q
primary TB?
A
- Typically mild or asymptomatic
- Mid/lower zone infiltrates, hilar adenopathy, pleural effusion
21
Q
Secondary TB?
A
- Tuberculin skin test positive (confounded by BCG)
- IGRA testing
- No evidence of active disease
22
Q
Post-primary TB?
A
- Active disease; cough, presence of AFB in sputum, fever ~50%, haemoptysis, malaise, anorexia, weight loss, breathlessness
- Signs of parenchymal disease uncommon until disease advanced
23
Q
high incidence TB countries?
A
- india
- indonesia
- pakistan
- china
24
Q
RF for TB?
A
- Place of birth
- HIV
- Prison inmates/staff,
- nursing homes
- homeless shelters,
- health care workers,
- substance abuse,
- immigrant centres & migrant workers camps
25
medical factors inc TB risk?
- under nutrition
- smoking
- cancer
- HIV
- taking illicit drugs
- alcoholism
26
social factors increasing risk of TB?
Single/widowed men, immigration, incarceration, homelessness
27
CXR of pulmonary TB?
* Upper lobes tend to be affected
* irregular shadowing
* cavitation
* thick irregular walls
28
microbiological diagnosis of TB?
* positive cultures for M.TB confirm the diagnosis of TB
* CEPHAID test - detects DNA specific to TB and rifampicin. Results obtained within 90 mins
29
Mdr-TB means TB resistant to?
isoniazid and rifampicin
30
contact tracing in TB?
* idenficiation of contacts of TB positive individuals
* national target is for 90% of people with infectious TB to have at least 5 contacts traced
* pre-entry screening programme for testing of active pulmonary TB in migrants from high incidence countries who apply for visas which reduces importation of active TB
31
INF-gamma tests?
* quantiferon TB gold - used in place of TB testing for previous infection
* not confounded by prior BCG vaccine
* main role is screening for latent disease
32
what does the INF-G test measure?
* measures cell mediated immune response by looking at INF-g released by T cells in response to TB antigens
33
TB drugs?
*Isoniazid
*Rifampin
*Pyrazinamide
*Ethambutol
RIPE
34
TB drug regimen?
* Rifampicin, +Isoniazid, +Pyrazinamide, +Ethambutol for 2 months
* Rifampicin/Isoniazid for 4 months
35
isoniazid mechanism?
* bactericidal
* blocks mycolic acid synthesis
36
isoniazid needs to be taken?
* absorption decreased by fatty acids: needs to be taken 4 hours after food and 1 hour before
37
Adverse effects of isoniazid?
* hepatitis
* neuropathy, reduced risk with pyroxidine (vit B6) supplements
38
rifampicin mechanism?
* bactericidal, inhbitis DNA-dependent RNA polymerase
39
which drug reduces abs or rifampicin?
pyrazinamide
40
adverse effects of rifampicin ?
* induction of P450 enzymes - increases breakdown of many drugs
* hepatitis
41
Pyrazinamide - ? is intrinsically resistant?
M bovis
42
Adverse events of pyrazinamide?
* GI upset and arthralgia - raised uric acid
* hepatotoxicity
43
ethambutol?
* weak bacteriostatic drug
* antacids affect absorption
44
Adverse effects of ethambutol?
Optic neuritis (increased risk with pre-existing eye disease and higher doses than standard regimen)
45
Adherence to drug Tx - RF?
* social risk factors
* previous TB
* MDR
46
TB drugs that require monitoring?
* rifampicin
* 2nd line are commonly monitored to avoid toxicity e.g. amikacin, cycloserine
47
Where are the highest TB rates?
* highest rates of TB in the most deprived groups
* london has the highest number of TB cases in England followed by the South of England
48
Tb is concentrated in the following groups:
* the urban poor
* alcoholics
* iV drug users
* homeless
* prison inmates
49
how is TB spread?
* inhalation of droplets
* Infectious particles aerosolized by coughing, sneezing or talking
* fomites not important
50
TB - when the antigen load is small?
* granuloma forms
51
TB - when antigen load is high?
* lymphcoytes, macrophages and granulocytes present is a less organized fashion
* tissue necrosis may be present - exudative reaction
52
pathogenesis of TB?
* caseating necrosis is unstable so it tends to liquify and discharge through the bronchial tree producing a TB cavity
* infectious materal from a cavity results in new exudative foci in other parts of the lung - bronchogenic spread
53
symtoms of PTB?
* include a productive, prolonged cough (duration of >= 3 weeks),
* chest pain,
* hemoptysis.
54
Systemic symptoms of TB
* Fever, chills, night sweats, appetite loss, weight loss, and easy fatigability
55
In primary TB, there's rapid
destruction of bactera so the only remaining evidence of infection would be a postive skin test
56
57
What happens in post-primary TB?
* Immune deficiency including disease, drugs, old age, malnutrition, alcohol etc
* Reactivation as macrophage/granuloma break up
* Causes bronchial spread as necrosis occurs
58
EP TB - metastatic spread to any organ:
* Abdomen
* Bone
* Brain
* Muscle
* Retina
* Lymph Node
59
TB of the spine and kidney?
* TB of the spine may cause pain in the back
* TB of the kidney may cause blood in the urine.
60
when should EP TB be considered?
* Extrapulmonary TB should be considered in the differential diagnosis of ill persons who have systemic symptoms and who are at high risk for TB.
61
sputum collection in TB?
* 3 early morning specimens of sputum on 3 consecutive days
62
what else can be done to obtain TB specimens?
* bronchoscopy can be done if there's suspicion of TB and the patient can't cough up sputum
* Gastric aspiration can also be used to obtain specimens of swallowed sputum
63
other tests for TB patients?
* Testing for HIV
* hep B and C serologic tests if risks present
64
tests to do when TB Tx is initiated?
* AST
* ALT
* bilirubin
* ALP
* serum creatinine
* platelet count
* Visual acuity and color vision tests (when EMB used)
65
drug interactions with rifampicin
66
MDR-TB is more likely in:
* people who have a history of Tx with TB drugs
* contacts of ppl known to have drug resistant TB
* people from countries where prev of MDR TB is high
* Persons whose smears or cultures remain positive despite 2 months of therapy with TB drugs;
* Persons receiving inadequate treatment regimens for > 2 weeks.
67
extensively drug resistant TB?
* XDR-TB is resistant to fluoroquinoline and at least 3 of the second line drugs (capreomycin, kanamycin, and amikacin), in addition to MDR-TB.
68
Summary table of the second line therapies in TB Tx
69
CAP =
* refers to pneumonia contracted outside the hospital setting and includes those developing the condition in a nursing home
70
typical CAP?
* productive cough, fever, pleuritic chest pain
* most commonly caused by streptococcus pneumoniae
* can also be caused by haemophilus influenzae
71
Most common causitive agent of CAP?
1) streptococcus pneumoniae
2) haemophilus B
72
atypical pneumonias?
* These tend to have a more insidious, subacute onset. They often present with a combination of pulmonary and extrapulmonary symptoms
73
pathogens causing atypical pneumonias?
* Mycoplasma pneumoniae, Legionella pneumophila, Chlamydophila pneumoniae
74
HAP =
* contracted >48 hrs after hospital admission
75
causes of HAP?
* Gram-negative bacilli (e.g. Pseudomonas aeruginosa)
* Staphylococcus aureus
* Legionella pneumophila
76
Aspiration of pneumonia?
* caused by inhalation of oropharhngeal or gastric contents
* typically seen in patients with reduced conciousness level, NM disorders, oesophageal conditions, mechanical interventions such as endotracheal tubes
77
IC - bacterial pneumonia?
typical pathogens and non-tuberculosis mycobacterium.
78
IC - fungal pathogens?
Pneumocystis jirovecii, Aspergillus fumigatus and Cryptococcus neoformans.
79
IC - viral pathogens?
such as varicella zoster virus and cytomegalovirus should be considered.
80
IC - parisitic pathogens?
parasitic pneumonias are very rare and seen almost exclusively in the immunocompromised.
81
streptococcus pneumonia typically produces a ? pattern of consolidation
lobar
82
# sputum
strep pneumonia typically gives?
* It classically gives rust coloured sputum and may be accompanied by the reactivation of cold sores.
* Urinary antigen tests may be used to diagnose the infection and is unaffected by antibiotics.
83
mycoplasma pneumoniae?
* lacks a cell wall
* tends to affect younger demographic
* occurs in cyclical epidemics
84
mycoplasma pneumonia causes pneumonia with a prolonged insidious onset that may exhibit EP features:
* Erythema multiforme
* Arthralgia
* Myocarditis, pericarditis
* Haemolytic anaemia
85
legionella pneumonia?
* gram negative
* may cause the atypical CAP (lobar) Legionnare's disease
86
legionella - exposure to?
* It is encountered in those exposed to contaminated cooling systems, humidifiers and showers.
87
presentation of legionalla pneumonia?
* Chest symptoms may be preceded by several days of myalgia, headache and fever.
88
Legionnaire's disease - classical finding?
* hyponatreaemia secondary to SIADH is a classical finding but not always present
89
pseudomonas aeruginosa?
* gram negative bacillus - typically causes HAP
* In patients with bronchiectasis (e.g. cystic fibrosis) is may cause CAP.
* opportunistic - rarely causes disease in a healthy person
90
pseudomonas aeruginosa typically causes pneumonia in?
* typically causes pneumonia in IC patients and those with chronic lung disease
* can lead to bacteraemia
91
pseudomonas aeruginosa - sputum is characteristically?
green
92
klebsiella?
* gram negative
* classically causes CAP classically seen in alcoholics
93
klebsiella produces a?
* fast moving lobar pneumonia
94
appearance of sputum with klebsiella pneumonia?
* Sputum may have the characteristic ‘red-currant jelly’ appearance.
95
what is klebsiella resistant to?
* resistant to beta lactams
* Beta-lactamase stable beta-lactams, cephalosporins and aminoglycosides may be used to treat the infection.
96
Pneumocystis jirovecii?
* fungi
* aids defining illness that can cause life threatening penumonia
97
Pneumocystis jirovecii causes?
* It causes fever, cough (frequently non-productive) and exertional dyspnoea.
* Hypoxia and a raised LDH are also common findings.
98
how is Pneumocystis jirovecii pneumonia treated?
* does not respond to antifungals and is instead treated with co-trimoxazole (trimethoprim-sulfamethoxazole).
99
pneumonia is characterised by?
cough, SOB and signs of consolidation
100
symptoms of pneumonia?
* Fever
* Malaise
* Cough (purulent sputum)
* Dyspnoea
* Pleuritic pain
101
respiratory signs of pneumonia?
* Dull percussion note
* Reduced breath sounds
* Bronchial breathing (transmission of bronchial sounds to peripheries due to consolidation
* Coarse crepitations
* Increased vocal fremitus (increased transmission of ’99' through consolidated lung)
102
other signs of pneumonia?
* Tachycardia
* Hypotension
* Confusion
103
pulmonary complications of pneumonia?
* Parapneumonic effusion
* Pneumothorax
* Abscess
* Empyema
104
EP complications of pneumonia?
* Sepsis
* Atrial fibrillation
105
Bedside Ix of pneumonia?
* sputum sample
* urinary sample - urinary antigens: legionella and pneumoccal
* ECG
106
CURB-65
107
general management of pneumonia?
* O2
* IV fluids - ppts may be dehydrated
* analgesia - NSAIDs or opiods
108
Low severity pneumonia Tx?
* amoxicillin
* doxycycline or clarithromycin if penicillin allergy
* typical course is 5-7 days
109
intedmediate severity pneumonia?
* dual therapy with beta-lactam (e.g. amoxicillin) and a macrolide (e.g. clarithromycin).
* Doxycycline may be used as an alternative in those with a penicillin allergy.
110
Typical ab course for intermediate severity pneumonia?
7-10 days
111
high severity pneumonia Tx?
* IV beta-lactamase stable beta-lactam (e.g co-amoxiclav) and a macrolide (e.g. clarithromycin).
112
duration of Tx in high severity pneumonia?
* An antibiotic course of 7-10 days may be extended to 14 or 21 days depending on clinical circumstance.
113
HAP Tx?
* Co-amoxiclav 625mg orally TDS may be used in mild infections.
* Tazocin (piperacillin/tazobactam) 4.5g IV TDS may be used in severe infections.
114
follow up CXR after pneumonia?
- 11% of smokers over the age of 50 who have pneumonia have lung cancer.
- A CXR at 6-8 weeks post-event should be used to screen for underlying lung cancer
115
Streptococcus pneumoniae (pneumococcus)?
Accounts for 80% of cases
- Particularly associated with high fever, rapid onset and herpes labialis
- A vaccine to pneumococcus is available
116
Haemophilus influenzae?
- Particularly common in patients with COPD
117
staph aureus?
- Often occurs in patient following influenza infection
118
mycoplasma pneumoniae?
- One of the atypical pneumonias, which often present a dry cough and atypical chest signs/x-ray findings
- Autoimmune haemolytic anaemia and erythema multiforme may be seen
119
legionella pneuomia?
- Another one of the atypical pneumonias
- Hyponatraemia and lymphopenia common
120
Pneumocystitis jiroveci?
-Typically seen in patients with HIV
- Presents with a dry cough, exercise-induced desaturations and the absence of chest signs
121
latent vs active TB?
* latent: no active disease and not infectious
* active: symptomatic or progressive disease
122
types of mycobacterium?
* Mycobacterium tuberculosis: main cause of TB in humans
* Mycobacterium bovis: main cause of TB in cattle and other mammals, can cause human disease
123
post-primary TB?
- also termed reactivation TB. It occurs in patients with latent TB, frequently due to immunocompromise (e.g. AIDs).
- May be pulmonary (55%) or extra-pulmonary (45%).
124
What happens in primary TB?
* alveolar macrophages phagocytose bacilli which continue to proliferate
* the Ghon complex (mosy commonly seen in children) may develop which is made up of the ghon focus - a small caseating garnuloma and ipsilateral mediastinal lymph node
125
Cavitating TB on CXR
126
classic triad of pulmonary TB:
* Cough
* Fever
* Weight loss
127
lymph node TB?
* most common EP site
* most commonly affects cervical and supraclavicular nodes
128
Genitourinary TB?
* Sterile pyruria may be seen
* Other features include:
* Salpingitis
* Epididymo-orchitis
* Renal abscess
129
Miliary TB?
* Miliary TB is the disseminated haematogenous spread of the bacilli
130
CNS TB?
* TB meningitis
* TB meningitis tends to present with fever, malaise and headache.
131
TB meningitis CSF results?
* High protein
* Low glucose
* Lymphocytosis
132
vertebral TB (Pott's syndrome)?
* Fever
* Weight loss
* Back pain
* development of kyphosis common
133
Pericardial TB?
pericardial effusions or constrictive pericarditis
134
Adrenal TB?
TB is the leading cause of Addison's disease worldwide
135
GI TB?
terminal ileitis - peritoneal spread may lead to ascites
136
Mantoux test shows?
* false positive from BCG vaccine
137
Interferon-g is not affected by?
previous BCG vaccine
138
Ix for TB
* CXR +/- CT
* Bronchoscopy and pleural fluid taken for TB microscopcy and culture and cytology
139
Isoniazid mechanism?
* Isoniazid: mycolic acid synethesis inhibitir
140
isoniazid side effects?
* side effects: polyneuropathy (but given with pyroxidine to reduce this risk)
* may cause hepatotoxicity
141
isoniazid ? CYP450
inhibits
142
rifampicin?
* RNA polymerase inhibitor
* Stains secretions pink and may cause hepatotoxicity.
* It is an inducer of CYP450.
143
Pyrazinamide side effects?
* hepatotoxicity
* gout
144
ethambutol mechanism?
* inhibits arinosyl transferase needed for cell wall synthesis
145
hepatotoxicity from TB drugs?
* rifampicin, isoniazid and pyrazinamide all associated w hepatotoxicity
* LFT measurement and serial measurements
146
Tx of latent TB
* 6 months of isoniazid with pyridoxine (6H) or - preferred if interactions with other meds possible
* 3 months of isoniazid (with pyridoxine) and rifampicin (3HR) - preferred if patient is younger than 35 if hepatotoxicity is a concern.
147
Prevention of TB?
* Raising awareness - TB education programmes for those in contact with the general public
* MDT TB teams should raise awareness of TB among under-served and high risk groups and information on symptom recognition and the benefits of diagnosis and treatment
* national information for the public about TB like PHE and TB alert
148
TB prevention - BCG vaccine?
* improving uptake by identifying eligible groups in line with the DoH's green book
149
Active TB without CNS involvement drug regimen?
* isoniazid (with pyridoxine), rifampicin, pyrazinamide and ethambutol for 2 months then
* isoniazid (with pyridoxine) and rifampicin for a further 4 months.
150
active TB with CNS involvement drug regimen?
* isoniazid (with pyridoxine), rifampicin, pyrazinamide and ethambutol for 2 months then
* isoniazid (with pyridoxine) and rifampicin for a further 10 months
151
Approaches to controlling spread of TB
?
* improve vaccination uptake
* address TB in under-served populations
* improve access to services and ensure early diagnosis
* quarentine
* DOT - directly observed treatment when non-compliance suspected e.g. homeless, alcoholics
152
MDT TB teams should provide data to TB control boards on:
screening uptake, referrals and the number of active TB cases identified.
153
TB control boards should?
* control boards should develop TB prevention and control programmes working with commissioners, Public Health England and NHS England
* TB control boards should be responsible for developing a TB prevention and control programme based on the national strategy and evidence‑based models.
154
roles of the TB control boards?
* TB control boards should plan, oversee, support and monitor local TB control, including clinical and public health services and workforce planning.
155
bronchiectasis =
* abn and irreversible dilatation of the airways
156
bronchiectasis normally results from?
* It normally results from the inflammatory destruction of the elastic and muscular components of the airways.
* commonly occurs secondary to CF
157
who does bronchiectasis affect more?
* Female > male
* more common in older age groups especially 70+
158
immune deficiency & bronchiectasis?
* recurrent infective insults combined with poor host immune response increases risk
* Ig deficiency, panhypogammaglobulinaemia, HIV, malignancy
159
mechanical obstruction and bronchiectasis?
* Airway obstruction can lead to bronchiectasis.
* Foreign bodies (particularly in children), mucus plugging, stenosis, tumours or lymph nodes can all be responsible.
160
mucocilliary clearance dysfunctions and bronchiectasis?
- primary ciliary dyskinesia
- young syndrome
161
primary ciliary dyskinesia?
* autosomal recessive
* characterised by immotile cilia often resulting in recurrent infections and bronchiectasis.
162
primary ciliary dyskinesia is associated with?
* It is associated with early-onset of symptoms (in childhood/ teenage years), otitis media, rhinosinusitis and male infertility.
163
young syndrome?
* is a syndrome characterised by male infertility (obstructive azoospermia), sinusitis and bronchiectasis.
* relationship with mercury exposure
164
CF and bronchiectasis?
* causes dehydration and depletion of airway surface liquid which is key to normal function of cilia
165
congenital airway defects and bronchiectasis?
- williams-campbell syndrome
- Mounier-Kuhn syndrome: a
166
Williams–Campbell syndrome?
is a rare disease characterised by defective cartilage in the airways (fourth to sixth division) resulting in bronchiectasis.
167
Mounier-Kuhn syndrome?
also termed tracheobronchomegaly, it is a rare disease characterised by dilatation of the trachea itself as well as the bronchi.
168
other causes of bronchiectasis?
* RA
* ABPA - exaggerated immune response to Aspergillus, tends to occur in asthmatics and can lead to bronchiectasis.
* COPD - repeated infection can lead to bronchiectasis
* iBD
169
symptoms of bronchiectasis?
* Persistent sputum production - purulent
* Persistent cough
* Dyspnoea
* Haemoptysis
* Weight loss
170
sputum culture for ? is highly suspicious for bronchiectasis?
P aerguinosa
171
signs of bronchiectasis?
* Crackles
* High pitched inspiratory squeaks
* Wheeze
* Clubbing (rare)
172
Dx of bronchiectasis?
* first line: CXR - Typical changes include tram-track airways and ring shadows.
* CT: diagonistic modality of choice
173
CT scan of bronchiectasis?
* CT: diagonistic modality of choice
* dilated airways
* signet sign classicial
174
Bloods for bronchiectasis?
* FBC
* Renal function
* Serum immunoglobulins (and serum protein electrophoresis if elevated)
175
Aspergillus fumigatus Ix?
* Serum total IgE
* Sensitisation assessment (specific IgE or skin prick test)
176
management of bronchiectasis - airway clearance?
* techniques taught by resp physiotherapist
* active cycle of breathing techniques
177
Mx of B - mucoactives?
* help clearing mucus from airways
* Isotonic and hypertonic saline may be used and have been shown to improve quality of life
* oral carbocisteine
178
Mx of B - prophylactic ab?
* > 3 exacerbations per year
* colistin and gentamicin
* azithromycin and erythromycin
179
complications of bronchiectasis?
* Infective exacerbation
* Chronic respiratory failure
* Haemoptysis (may be massive and life-threatening)
* Cor pulmonale
* Pneumothorax
* Chest pain
=
180
CF =
* mutation in CFTR gene found on chromosome 7
* encodes chroride channels
* most common in those of white ethnicity
181
pathophys of CF?
* results in dehydration of airway surface fluid resulting in mucociliary dysfunction
* reduced mucus clearance, airway obstruction and predisposition to infection
* Recurrent infection leads to chronic bronchitis, damage to the bronchi and eventual bronchiectasis
182
Most common CF mutation?
* most common mutation is the delta-F508 (DF508) mutation
183
CF - pancreatic?
* Pancreatic insufficiency is common in patients with CF and patients can suffer with recurrent acute pancreatitis or chronic pancreatitis.
* Damage to pancreatic islets may result in CF-related diabetes. Liver impairment is common
184
CF screening?
heel prick blood test
185
respiratory symptoms of CF?
productive cough and recurrent chest infections
186
CF - pancreatic disease symptoms?
* pancreatic disease - insufficiency with fatty stools and malabsorption.
* In those with more severe pancreatic disease, autolysis destroys the pancreatic islets leading to CF-related diabetes.
187
CF and GI disease in infants?
* CF is the most common cause of meconium ileus in term infants
188
diagnosis of CF?
* Immuno-reactive trypsin test: the test used at newborn screening
* Sweat test: can be used in children of any age.
* Genetic testing: common mutations are screened for,
189
What should be done for pleural effusions?
diagnostic tap - diagnostic aspiration
190
What can be used to decide whether ppts w acute bronhitis need ab?
CRP > 100 CRP level can be used to guide whether patients with acute bronchitis require antibiotics
191
indications for ab?
- multiple comorbids
- becoming systemically very unwell
192
BRONCHITIS clinical pattern?
Bronchitis follows a clinical pattern of an initial dry cough over 3-4 days followed by a productive cough that usually resolves within 3 weeks.
193
Typical Sx of ARDS?
breathlessness, reduced oxygen saturations and auscultation of the chest showing bilateral crackles, is typical of acute respiratory distress syndrome.
194
Decrease in pO2/FiO2 in poorly patient with non-cardiorespiratory presentation ->
ARDS
195
Crackles vs wheeze?
Crackles on auscultation imply fluid whereas an asthma exacerbation creates a wheeze as the airways tighten.
196
CO2 retention->
CO2 renetion - resp acidosis
low O2
197
pleural plaques?
pleural plaques can occur following asbestos exposure and are benign - no follow up required
198
fine end inspiratory crepitations?
Fine end-inspiratory crepitations are a common finding in idiopathic pulmonary fibrosis causes by the sudden opening of small airways during inspiration that were held closed in the previous expiration.
199
what points at it being a viral infection?
clear sputum, no fever, normal CXR= probably viral infection
200
? is assoc w erthema multiforme
Mycoplasma is associated with erythema multiforme
201
which pathogen can cause desaturation on exercise?
Pneumocystis jiroveci pneumonia causes desaturation on exercise
202
cold sores ->
streptococcus
203
peritoneal dialysis peritonitis?
Coagulase-negative Staphylococcus is the most common cause of peritonitis secondary to peritoneal dialysis
204
klebsiella?
Klebsiella most commonly causes a cavitating pneumonia in the upper lobes, mainly in diabetics and alcoholics
205
Legionella CP?
- GI symptoms such as diarrhoea, abd painm dry cough, hyponatreamua
206
recent influenza infection->
staph a
207
mycoplasma pneumonia?
- young adults
- sore throat, headache, nausea, abd pain, diarrhoea
208
which 2 pathogens cause cavitating pneumonia?
staph a and klebsiella
209
Characteristic features of pneumococcal pneumonia
- rapid onset
- high fever
- pleuritic chest pain
- herpes labialis (cold sores)
210
hyponatreamia, headache and dry cough ->
legionella
211
recent flu ->
staphyLococcus
212
213
pneumocystitis jivorci pneumonia Tx?
Pneumocystis jiroveci penumonia is treated with co-trimoxazole, which is a mix of trimethoprim and sulfamethoxazole
214
which pathogen can cause cold haem anaemia
mycoplasma - pneumonia and CHA
215
which organism causes LRTI in CF?
Pseudomonas aeruginosa is an important organism causing LRTI in cystic fibrosis patients
216
