MedEd cough Flashcards
(130 cards)
1
Q
What is the most common cause of bacterial CAP?
A
Strep pneumoniae
2
Q
What atypical pneumonia organism is associated with air conditioning systems?
A
Legionella pneumophilia
3
Q
What scoring system is used to assess CAP severity?
A
CURB 65
4
Q
What is pneumonia?
A
Infection of the lung parenchyma
5
Q
What are risk factors for pneumonia?
A
Old age Aspiration Smoking Travel Chronic lung condition Immunosupression
6
Q
What area of the lung is infected in pneumonia?
A
Parenchyma
7
Q
What is hospital pneumonia by definition?
A
Pneumonia that occurs 48 hrs after admission into hospital
8
Q
What organism is also known as pneumococcus?
A
Strep pneumoniae
9
Q
Who is haemophilius influenzae as a causative agent of pneumonia more common in?
A
Those with chronic lung conditions eg bronchiectasis and COPD
10
Q
Who is staph aureus as a causative agent of pneumonia more common in?
A
IV drug users
11
Q
What is staph aureus as a causative agent of pnuemonia associated with on chest x ray?
A
Cavitating lesions
Abscess
12
Q
Who is klebsiella as a causative agent of pneumonia more common in?
A
Chronic alcoholics
13
Q
What is klebsiella as a causative agent of pnuemonia associated with on chest x ray?
A
Cavitating lesions
14
Q
What are the typical cuasative organisms of CAP?
A
Strep pneumoniae/pnuemococcus
Heamophilius influenza B
Staph aureus
Klebsiella pneumonia
15
Q
What are the atypical cuasative organisms of CAP?
A
Mycoplasma pneumoniae Legionella pneumophilia Chlamydia psittaci Chlamydia pneumoniae Coxiella burnetii PCP (pneumocystis jirovecii)
16
Q
Who is mycoplasma pneumoniae as a causative agent of pneumonia more common in?
A
Young patients
Patients who got pneumonia due to close contact
17
Q
What is mycoplasma pnuemoniae as a causative agent of pnuemonia associated with?
A
Erythema multiforme, transverse myelitis
18
Q
What is legionella pneumophilia as a causative agent of pneumonia associated with?
A
Faulty a/c
Causes hyponatraemia and deranged LFTS
19
Q
If legionella pneumophilia is the causative agent of a pneumonia what will you see on bloods?
A
Hyponatraemia
Deranged LFTs
20
Q
What is chlamydia psittaci as a causative agent of pneumonia associated with?
A
Have to be immunocompromised to get it eg HIV
Associated with birds and parrot fever
21
Q
What is PCP as a causative agent of pneumonia associated with?
A
You must check if they have HIV and AIDs
Check for Kaposi’s sarcoma
22
Q
What is commonly seen in kaposi’s sarcoma?
A
A purple patch on the nose
23
Q
What organism causes aspiration pnuemonia?
A
Anerobes from the gut flora
24
Q
What acronym can be used to remember causes of a cavitating lung lesion and what does it stand for?
A
CAVITY: cancer autoimmune vascular infective ty??
25
What will a cavitating lung lesion look like on CXR?
A circle shaped lesion with a white border, will be grey inside and may have a fluid in it which will be white. You will be able to see the fluid level line clearly
26
What 2 pneumonia organisms can cause cavitating lung lesions?
Staph aureus
| Klebsiella
27
What type of bacteria is strep pneumoniae?
Gram positive cocci
| Usually as diplococci and can be isolated or in a chain
28
What type of bacteria is staph aureus?
gram positive cocci
29
What causative agents of pneumonia are gram negative?
```
haemophilius influenza
klebsiella pneumoniae
pseudomonas aeruginosa
legionella pneumophilia
moraxella catarrhalis
```
30
What are the symptoms of pneumonia?
```
Productive cough commonly with green sputum
Fever
SOB
Pleuritic chest pain
Confusion (often in elderly people)
```
31
What are the causes of pleuritic chest pain?
```
Pneumothorax
Pneumonia
PE
Pericarditis
Pleural effusion
```
32
What are the symptoms of atypical pneumonia?
```
Dry cough
Fever
Headache
Diarrhoea
Myalgia
Hepatitis
```
33
Why is there a dry cough in atypical pneumonia?
Because the alveoli are spared so mucus is not produced
34
What are clinical signs of pneumonia?
```
Respiratory distress
Cyanosis
Reduced chest expansion/ asymetrical chest expansion on palpation
Dullness to percussion
Basal crepitation ie coarse crackles
Bronchial breathing
Increased vocal resonance
```
35
What type of crackles do you get in pnuemonia?
Coarse
36
What makes crackles coarse?
Fluid in the alveoli
| When you breath in and the alveoli open the fluid makes them pop which makes
37
Is there clubbing in pneumonia?
No
38
What is the most likely cause of pneumonia in all patients?
Strep pneumonia
39
What investigations are done for pneumonia? What will you see
```
Sputum sample
Urinary antigens
FBC- raised WCC
UEs
CRP- raised
ESR- raised
LFTs
ABG
Culture- if sepsis is suspected
CXR to image- may have pleural fluid in MCS
```
40
What pneumonia organism can be tested for using bedside urinary antigen test?
Legionella
| Strep pneumoniae
41
What will you see on CXR in pneumonia?
An area of consolidation in one or more lung zones (appears as a white opacification)
CAB: consolidation, alveolar opacification, (air) bronchograms
42
What acronym is used to remember features of pneumonia on CXR and what does it stand for?
CAB:
consolidation
alveolar opacification
consolidation
43
What might you see on CXR when there is an atypical pnuemonia? Which one specifically
Diffuse patchy infiltrates bilaterally- especially PCP
44
What severity scoring system is used for pneumonia and what does it stand for? Include the numerical values needed to gain a point for each one
```
CURB 65:
Confusion (AMTS <8)
Urea (>7 mmol/L)
Resp rate (>30/min)
BP(<90 systolic or <60 diastolic)
Over 65 in age
```
45
How is CURB 65 used to decide the course of care for pnuemonia?
Score 0-1= treat as an outpatient
Score 2 or higher= consider hospital admission
Score 3 or higher= consider ITU admission
46
What might be used instead of CURB 65 and how do scores determine treatment?
CRB 65- this is done if primary care or urea are unavailable
| If the patient scores 1 or over hospitalisation is recommended
47
What abx are used for treatment for CAP? Describe what each does
ACD:
amoxicillin- typical cover
clarithromycin- atypical cover and if allergic to penicillin
doxycycline- if allergic to penicillin
48
What type of abx is amoxicillin?
Penicillin
49
What abx are used to treat penicillin based off CURB 65 score? Include where the patient will be treated
0 or 1 = treat at home with amoxicillin
2 = treat in hospital with amoxicillin and clarithromycin
3 = treat in hospital/ITU with co amoxiclav and clorthiromycin
50
If CURB 65 is 0/1 what abx are given and where is the patient treated?
Amoxicillin is given at home
51
If CURB 65 is 2 what abx are given and where is the patient treated?
Amoxicillin and clarithromycin are given in hospital
52
If CURB 65 is 3 what abx are given and where is the patient treated?
Co amoxiclav and clarithromycin are given in hospital
53
What does co amoxiclav contain that amoxicillin doesnt? How does this help
A bacteria lactulose inhibitor which helps combat more resistant organisms
54
What abx is given to pregnant women with pneumonia?
Erythromycin
55
What is the first line abx for HAP?
Co amoxiclav
56
What is given in HAP if its MRSA resistant?
IV vancomycin
57
What abx are given for HAP due to pseudomonas?
IV tazocin and gentamicin
58
What is given for aspiration pneumonia?
Amoxicillin and metronidazole
59
What abx is given for pneumonia caused by staph aureus?
Flucloxacillin
60
What abx is given for PCP?
co-trimoxazole
61
What is A-E for pneumonia?
```
Airway- make sure its patent
Breathing- give oxygen if needed and sit the patient up, CPAP if needed
Circulation- give IV fluids if BP is low
Disability- check if they are ok
E- give IV painkillers and abx
```
62
What is bronchiectasis?
A chronic lung condition where this is abnormal, irreversible dilation of the bronchi and bronchioles
63
What are the most common causes of bronchiectasis in the world vs the western world?
In the world= most commonly caused by TB
| Western world= most commonly caused by cystic fibrosis
64
What are some causes of bronchiectasis?
```
Post infection eg TB
Immunodeficiency
Chronic aspiration eg GORD, dysphagia
Chronic inflammation eg RA, IBD
Chronic airway obstruction eg asthma, COPD, cancer
Congenital eg cystic fibrosis
```
65
What is the triad for Kartagener's syndrome?
Bronchiectasis
Sinusitis
Situs inversus- everything in the body is on the opposite side to normal anatomy
66
How will bronchiectasis present?
```
Chronic daily productive cough with large amounts of sputum (foul smelling, pus, can be green or yellow otherwise mucoid, is rust coloured due ot flecks of blood)
Haemoptysis
SOB
Fever
Weight loss
Non pleuritic chest pain
Recurrent pneumonia or chest pain
```
67
What are the 7 respiratory causes of clubbing?
```
Lung cancer
ILD
Cystic fibrosis
Bronchiectasis
Lung abscess
Emphysema
TB
```
68
What are the 7 respiratory causes of clubbing?
```
Lung cancer
Bronchiectasis
Cystic fibrosis
ILD
Lung abscess
TB
Emphysema
```
69
What is heard on ausculatation in bronchiectasis?
Coarse crackles in the lower lung zones
70
Describe the sputum in bronchiectasis?
Large volumes
Mucopurulent- white, can be yellow/green if there is infection
Haemoptysis- makes sputum rust coloured because it is flecked with blood
71
What investigations are done for bronchiectasis? What will they show
Sputum culture
Bloods: FBC has WCC raised, CRP raised, do UEs, LFTs, ABG, culture if sepsis is suspected
CXR- may see tram tracking
HRCT is gold standard
72
What are causative agents of brinchiectasis?
Most common= haemophilius influenzae
pseudomonas aerunginosa
Strep pneumonia
73
What is the gold standard investigation for imaging in bronchiectasis?
High resolution CT
74
What might you see on CXR in someone with bronchiectasis?
Tram tracking
75
When should you suspect allergic bronchopulmonary aspergillosis?
When someone has bronchiectasis with IgE and eosinophils
76
What sign might be seen on HRCT in bronchiectasis?
Signet ring sign
77
How is bronchiectasis managed?
Airway clearance by chest physiotherapy first line
```
Conservative= exercise, good diet, stop smoking, vaccinations, airway clearance
Pharmacological= steroids/ bronchodilators, IV abx if theres an acute exacerbation, oral abx
Surgery= rare, only done if a localised part of the lung is damaged
```
78
What causative agent of bronchiectasis acute exacerbation is potentially deadly? How is it treated?
Pseudomonas
| Treat with ciprofloxacin (oral)
79
What is tuberculosis?
A chronic infective disease affecting multiple organs, caused by mycobacterium tuberculosis
80
What lobes does TB most commonly affect?
Upper lobes
81
What happens to the virus in latent TB?
TB is contained in caseating granulomas
82
What are some RF for TB?
Immunocompromised
Overcrowding
Travel to sub saharan africa/ india/ bangladesh
83
What are signs and symptoms for TB?
```
Poductive cough
SOB
Haemoptysis
Pleural effusion
FLAWS- low grade fever, gradual weight loss
Lymphadenopathy
Erythema nodosum
```
84
What are causes of erythema nodosum?
TB
IBD
Sarcoidosis
85
What are some things TB can cause? What do they mean?
```
LRTI/pnuemonia
Meningitis
Erythema nodosum
Clubbing
Pott's disease- osteomyelitis of the spine
Addison's disease
Pyuria
```
86
What is the most common cause of Addison's disease worldwide?
TB
87
What are some investigations for TB? What will you see?
Sputum MCS- 3 samples one in early morning, for microscopy use AFB stain (zeihl neelsen), culture takes 6-8 weeks
FBC- high WCC, anaemia, high CRP, ABG, HIV screen
Chest x ray- bilateral lymphadenopathy
Lymph node biopsy- will show caseating granulomas
88
How is sputum culture done in TB?
3 samples are taken, one in the early morning
On microscopy use AFB stain (zeihl neelsen)
Culture will take 6-8 weeks
89
What is seen on CXR in active TB?
Bilateral hilar lymphadenopathy
90
What disease cause non caseating vs caseating granulomas?
Non caseating= Crohn's disease and sarcoidosis
| Caseating= TB
91
How do you test for latent TB? When might you do these tests? What do you do if they are positive?
Mantoux test- tuberculin protein is injected into the skin and if the skin reacts (over a certain sized bump appears) then it means you have been exposed to TB before
Interferon gamma assay- blood sample is tested for how much interferon gamma is released
Do them to trace contacts
If they are positive do a chest x ray
92
How do you test for latent vs active TB?
You can't tell it apart, you need to differentiate using the clinical picture and things like CXR
Can do a mantoux test or interferon gamma assay to see if they have been exposed to TB before
93
What is the mantoux test for?
To check if someone has been exposed to TB before
94
What is interferon gamma assay for?
To check if someone has been exposed to TB before
95
Which test for latent TB is difficult to interpret if they have had a previous BCG vaccine?
Mantoux test
96
What is seen on CXR in TB?
```
Consolidation which is patchy and heterogeneous
Bi hilar lymphadenopathy
Upper lobe scarring
Cavitating lesions
Pleural effusion
```
97
What is miliary TB? What does it signify
nodular shadowing on CXR
| It signifys that the TB has gotten really bad- lymphohaematogenous dissemination of TB throughout the body
98
What acronym is used to remember the drugs for TB? What does it stand for?
```
RIPE:
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
```
99
What are side effects of the abx used for TB?
Rifampicin- causes red/orange secretions (pee)
Isoniazid- causes peripheral neuropathy and vitamin B6 deficiency so give pyridoxine
Pyrazinamide- causes hyperuricaemia (gout)
Ethambutol- causes optic neuritis (remember e for eye) which results in reversible red green colour blindness
100
What side effects must you warn the patient about when giving drugs for TB?
Red/orange secretions
Peripheral neuropathy and vit B6 deficiency- this can be comabtted by giving pyridoxine
Hyperuricaemia (gout)
Optic neuritis
101
What is given alongside TB drugs to prevent the side affect of peripheral neuropathy and vit B6 deficiency
Pyridoxine
102
What is the difference between primary and secondary lung cancer?
```
Primary= from the lung
Secondary= metastasised from somewhere else
```
103
What are the types of lung cancer?
Small cell lung cancer
| Non small cell lung cancer- consists of adenocarcinoma, squamous cell carcinoma and large cell carcinoma
104
What 3 things might small cell lung cancer cause?
SIADH
Ectopic ACTH
Lamber eaton syndrome
105
What cells does small cell lung cancer arise from?
Endocrine cells
106
What cells does lung adenocarcinoma arise from?
Goblet cells
107
What part of the lung is SMLC found in?
Central
108
What part of the lung is adenocarcinoma found in?
Peripheral parts of the lung
109
What cells does squamous cell carcinoma of the lung originate from?
Squamous epithelial cells
110
What part of the lung is squamous cell carcinoma found in?
Central parts of the lung
111
What is squamous cell carcinoma of the lung associated with releasing? What effect does this have?
Releases PTH related peptide
| Has the same affects as PTH
112
What cells does large cell lung carcinoma originate from?
Goblet cells
113
What 2 types of lung cancer are similar and why? How are they differentiated?
Small cell lung cancer and large cell lung cancer
They are similar to each other as they both arise from goblet cells
Large cell lung cancer is just less differentiated and so less aggressive
114
What are risk factors for lung cancer?
Smoking
Increasing age
Asbestos exposure
115
What are symptoms of lung cancer?
```
Cough (can be dry or productive)
Haemoptysis
SOB
Weight loss
Anorexia
Night sweats
```
116
What are signs of lung cancer?
Clubbing
Tar staining
Lymphadenopathy
Dull to percussion, stony dull if theres pleural effusion
Auscultation you'll hear crepitations and increased vocal resonance
117
Where does lung cancer metastasise to? What symptoms might this cause?
Bone- bone pain, fractures
Brain- headaches, blurry vision
Liver- hepatomegaly
118
What is a complication of lung cancer that would cause eye symptoms?
Horner's syndrome
119
What is the triad for Horner's syndrome?
Miosis
Partial ptosis
Anhydrosis
120
What is the physiology behind Horner's syndrome?
Compression of the sympathetic trunk
121
What type of cancer causes Horner's syndrome?
Pancoast tumor
122
What is an atypical type of lung cancer to know?
Pancoast tumor
123
What are the 4 components of pancoast syndrome?
Horner's syndrome- miosis, partial ptosis, anhydrosis
Compression of the brachial plexus- shoulder/arm pain, parasthesia
Compression of the recurrent laryngeal nerve- hoarse voice and bovine cough
Compression of the vena cava- pemberton's sign (patient lifts their arm and gets facial flushing and swelling- this occurs when the tumor is in the right lung apex
124
Where is pancoast's tumor loacted?
apices of the lung
125
In aspiration pneumonia what lobe are gastric contents most likely to fall into?
The right lower and middle lobes
126
How many lobes do the right and left lungs have?
```
Right= 3 lobes
Left= 2 lobes
```
127
In someone with sarcoidosis what will be raised in the serum?
ACE and calcium
128
What symptoms will someone with sarcoidosis present with?
```
Fever
Weight loss
SOB
May have bone pains
Erythema nodosum
Bilateral hilar lymohadenopathy
```
129
What 2 features of a question make a diagnosis of sarcoidosis likely?
Bilateral hilar lymphadenopathy
| Erythema nodosum
130
How can you differentiate between TB and sarcoidosis in a question?
TB question will have something about recent travel to an endemic country
Other than this the 2 have very similar signs and symptoms
