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Flashcards in Chest infections Deck (26):
1

Common organisms causing pneumonia (7)

Streptococcus pneumoniae: (80%) high fever, rapid onset, herpes labialis (cold sore)

Haemophilus influenza: Common in COPD
Staphylococcus aureus: Following influenza virus

Mycoplasma pneumoniae: Atypical, dry cough atypical chest signs/ x-rays. Autoimmune haemolytic anaemia and erythema multiforme may be seen.

Legionella pneumophilia: Atypical, Hyponatraemia, lymphopenia common

Klebsiella pneumoniae: Common in alcoholics

Pneumocystis jiroveci: Typically seen in patients with HIV. Presents with a dry cough, exercise-induced desaturations and the absence of chest signs

2

Upper zone fibrosis causes (7)

Extrinsic allergic alveolitis/hypersensitivity pneumotits
coal worker's pneumoconiosis, silicosis
sarcoidosis
ankylosing spondylitis (rare)
histiocytosis
tuberculosis

3

Lower zones fibrosis causes (4)

idiopathic pulmonary fibrosis
most connective tissue disorders (except ankylosing spondylitis)
drug-induced: amiodarone, bleomycin, methotrexate
asbestosis

4

What is hypersensitivity pneumonitis?

Inhalation of organic dust resulting in inflammation of the alveoli

5

Signs and symptoms of hypersensitivity pneumonitis

Dyspnoea
Cough
Fever/Chills
Malaise
Clubbing (Chronic HP)
Bibasalar or diffuse crackles

6

Risk factors for hypersensitivity pneumonitis (6)

Smoking

Exposure to:
Mould
Epoxy resin
Acid anhydride (paint finisher)
Metal working fluid
Nitrofurantoin, methotrexate, roxithromycin, and rituximab

7

Treatment for hypersensitivity pneumonitis

prednisolone: 0.5 to 1 mg/kg/day orally, taper dose by 5-10 mg/day every other day for 6 weeks

If chronic: prednisolone: 10 mg orally once daily on alternate days

8

What is pneumoconioses? (silicosis and coal workers' pneumoconiosis)

Interstitial lung disease due to inhalation of metals or minerals.
Interstitium is a collection of support tissues within the lung that includes the alveolar epithelium, pulmonary capillary endothelium, basement membrane, perivascular and perilymphatic tissues.

9

Pathophysiology of Silicosis

Silica which accesses the alveoli is ingested by macrophages, causing cytolysis of macrophages
Results in further inflammatory response

10

Signs and symptoms of pneumoconioses

Dyspnoea on exertion
Cough
Normal chest examination (at early stage)

Main diagnosis is history (ie exposure to silica, coal, beryllium)

11

Investigations for pneumoconioses

CXR: progressive upper zone non-calcified, small, rounded opacities, 'egg shell calcification' specific for silicosis
Spirometry: May show restrictive changes, obstructive or mixed.

12

Restrictive patterns on spirometry test

reduced FVC, normal FEV1/FVC ratio, reduced slow vital capacity, reduced total lung capacity (TLC), reduced lung diffusion capacity testing (DLCO).

13

Obstructive patterns in spirometry test

reduced FEV1, reduced FEV1/FVC ratio, increased residual volume/TLC ratio

14

Treatment for chronic pneumoconioses

Stop smoking, remove from occupational exposure
Prednisolone 40-70 mg initially
If hypoxic: oxygen supplement
If COPD: Bronchodilator
If end stage respiratory failure: Refer for lung transplant

15

What is sarcoidosis?

a chronic granulomatous disorder. Typically affects lungs and lymph nodes in >90% of cases. Can affect any part of the body

16

Granuloma

Collection of lymphocytes and macrophages

17

Sarcoidosis signs and symptoms

Cough
Dyspnoea
Chronic fatigue
Arthralgia
Wheezing
Auscultation: Rhonchi (low pitch rattling noise resembling snoring)
Enlarged and non tender lymph nodes (mainly cervical and sub-mandibular)
Photophobia
Blurred vision

18

Sarcoidosis risk factor

Age 20-40
FHx
Scandinavian origin

19

Investigation to order if sarcoidosis suspected

CXR: Hilar and/or paratracheal adenopathy
FBC: Anaemia?, leukopenia?
Serum Ca: Hypercalcaemia

Skin biopsy: non-caseating granulomas

20

Acute treatment of sarcoidosis

Unable to take oral: IV methylprednisolone (40 mg every 6 hrs)
Able to take oral: Prednisolone (40 mg OD)

21

Chronic treatment of sarcoidosis

Symptomatic Stage I with progressive adenopathy: Prednisolone 20-40 for 1-3 months, Inhaled budenoside

Symptomatic stage II, III, IV: Same as stage I,
DMARD (methotrexate, azathioprine, hydroxychloroquine)

22

Tuberculosis

Infectious disease caused by Mycobacterium tuberculosis. In many cases, M tuberculosis becomes dormant before it progresses to active TB

23

Tuberculosis. Signs and Symptoms

Cough
Fever
Weight Loss
Malaise

24

Investigations to order if TB suspected (5)

1. CXR: Fibronodular opacities in upper lobes with/without cavitation
Can be middle/lower lobes or in pleural effusion (atypical)
2. Sputum Acid Fast Bacilli smear (AFB smear): 3 tests 8 hours apart
3. Sputum culture: positive; no growth; or other mycobacteria
While on treatment patients should have sputum cultures done until two consecutive negative tests
4. FBC: Raised WBC in particular monocyte and eosinophil count.
5. Nucleic acid amplification test (NAAT): Positive for M tuberculosis
6. HIV test: HIV and Pulmonary TB is an AIDs defining diagnosis

25

Treatment for active TB in HIV negative, non pregnant.

Initial Phase (1st 2 months): Rifampin + Isoniazid + Pyrazinamide + Ethambutol (stopped if isolate sensitive to RIF and INH)

Continuous phase: Isoniazid + Rifampin for 4 months. 7 months if there are cavities on CXR.


26

Treatment for active TB in HIV positive

Initial phase (1st 2 months): Rifampin + Isoniazid + Pyrazinamide + Ethambutol (stopped if isolate sensitive to RIF and INH)

Continuous phase: Isoniazid + Rifampin for 7 months