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CP3 Medicine > RESPIRATORY - Bronchiectasis, CF and pneumonia > Flashcards

RESPIRATORY - Bronchiectasis, CF and pneumonia Flashcards

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1
Q

What is bronchiectasis

A

Chronic dilatation of airways –> chronic infection/inflamm

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2
Q

Sx bronchiectasis (5)

A 
Recurrent cough --> copious infected sputum 
Int haemoptysis 
Persistent hallitosis 
Dyspnoea 
Recurrent febrile eps/eps pneumonia
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3
Q

Signs bronchiectasis (4)

A

Clubbing
Coarse insp crackles over infected areas
Wheeze
Low body habitus

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4
Q

What is bronchiectasis’ most common differential

A

COPD

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5
Q

Most common cause bronchiectasis

A

No cause

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6
Q

Other causes bronchiectasis

A 
Post infective 
CF
Obstruction - tumour/FB
Allergic broncho-pulmonary aspergillosis 
Ciliary Dyskinetic syndromes 
immune deficiency 
CT disease
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7
Q

Pathology bronchiectasis

A

Airways become dilated w/ purulent secretions + chronic inflamm b/c of inflamm granulomatous tissue
Granulomatous tissue can bleed –> haemoptysis
Repeated exaccerbations –> fibrous scarring –> resp failure

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8
Q

Ix bronchiectasis (4)

A

Sputum culture
CXR
CT
Spirometry

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9
Q

CXR findings bronchiectassis

A

cystic shadowing

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10
Q

CT findings bronchiectasis

A

Dilated airways w/ signet ring sign

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11
Q

What type of respiratory pattern does bronchiectasis have

A

Obstructive

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12
Q

Mx bronchiectasis

A 
Assess for Tx'able causes 
Stop smoking 
physio 
postural drainage 
ABx for exacc 
Imms 
Bronchodilators 
Surgery (rare)
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13
Q

Complications bronchiectasis (6)

A 
pneumonia 
pneumothorax 
empyema 
lung abscess 
haematogenous spread of infection 
Severe life threatening haemoptysis
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14
Q

CF genetics

A

Autosomal recessive

mutation CFTR gene chromo 7 post 508

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15
Q

What % of CF is ID’d by genetic screening

A

90%

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16
Q

What does the mutation in CF usually code for

A

cAMP regulated Cl- channels

Which are predominantly in resp tract and pancreas

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17
Q

Pulmonary features CF

A 
Recurrent resp infections 
FTT
Later in life - breathless, haemoptysis --> bronchiectasis 
chronic sinusitis + nasal polyps 
resp failure + cor pulmonale
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18
Q

GI features GF (4)

A

Mec ileus
Steatorrhoea + malabsorption
Incr gallstones + peptic ulcers
Cirrhosis

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19
Q

Other features (Non GI/pulm) of CF (4)

A

Clubbing
Infertilty - m + subfertility f
DM
Rickets/osteomalacia

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20
Q

early pathogens CF

A

S aureus

H influ

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21
Q

late pathogen CF

A

Pseudomonas

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22
Q

Def pneumonia

A

Infection of pulmonary parenchyma + shadowing cxr

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23
Q

Who most commonly gets pneumonia

A

elderly
male
smoker
alcoholics

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24
Q

SOCRATES - pneumonia

A 
S - chest pain 
O - progressive 
C - pleuritic 
R - shoulder/ant abdo wall
A - systemic illness, dry/painful cough --> productive mucopurulent. Dyspnoea 
T 0 days --> w 
S - moderate
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25
O/E - pneumonia
``` tachypnoea Decr chest expansion Dull to percuss Coarse crackles/pleural rub Bronchial breathing Increased vocal resonance Upper abdo tenderness - LL pneumonia ```
26
Define HAP
Develops at least 48hrs after admission to hospital w/ no signs of incubation on admission Or in someone that has been hospitalised in the last 10 days
27
Causes of CAP
Conventional bacteria = 70% Atypical bacteria = 20% Viruses = 10%
28
Who gets S. pnuemonia
People without COPD
29
How is S pneumonia prevented?
Vaccine
30
Who gets S pneumonia vaccine
Immunosuppresed pt
31
Classical PS S pneumonia
lobar pneumonia | Rust coloured sputum
32
Who gets H influenza pneumonia
pt w/ COPD
33
Who gets M pneumonia
Young pt | Epidemics
34
PS M pneumonia
Hx illness + prominent extrapulmonary features Patchy consolidation across multiple lobes
35
extrapulmonary features M pneumonia
``` Rash Hepatitis D + V Pericarditis Meningoencephalitis ```
36
Tx M pneumonia
2 w erythromycyin
37
Who gets L pneumonia
Smokers who have returned from holidays
38
PS L pneumonia
``` Severe disease + SIADH + neuro involvement - CN palsy Proteinuria/haematuria Affects both lung bases ```
39
Tx L pneumonia
Erythromycin
40
Who gets C pneumonia
Infants | Elderly
41
What organism causes CAP during an influenza outbreak
S aureus
42
Mx CAP caused by S aureus
Fluclox added to standard regimens
43
Ix pneumonia
``` Obs/O2 Bloods - FBC, CRP, U+E, LFT Blood cultures CXR Sputum Urine - legionella/pneucoccal antigen Se mycoplasma IgM Throat swab (viral) ```
44
How to determine severity pneumonia
CURB 65 score
45
CURB 65 scoring
``` +1 point for each C - confusion (MMS <8) U - urea >7 RR >30 BP <90 or <60 diast +65 y/o ```
46
Mx Non-severe CAP
PO amox | or PO doxy if pen allergic
47
Mx moderately severe CAP
PO clarithroycin + amox PO doxy if pen allergic Admit pt
48
Mx severe CAP
IV clarithromycin + co-amoxiclav Iv levofloxacin + vancomycin if MRSA/pen allergic Tx at least 10 days
49
If in CAP you suspect aspiration - what is Mx?
Add metronidazole | + PT to encourage effective coughing
50
Bronchopneumonia on XR
patchy consolidation
51
Who gets bronchopneumonia
Extremes of age
52
Lesions in bronchopneumonia
Initially focal and involve one or > lobules
53
If left untreated, what can happen in bronchopneumonia?
Can come confluent and involve whole lobe
54
Who gets acute lobar pneummonia
Young fit people
55
Causative organisms acute lobar pneumonia
H influ Strep pneumoniae Staph
56
What part of lung is affected in acute lobar pneumonia
Distal air spaces | --> whole lobe affected
57
Phase 1 acute lobar pneumonia
Congestion Lungs dark and red first couple of days
58
Phase 2 acute lobar pneumonia
Red hepatisation Days 2-4 Lungs solidify - deep red and dry
59
Phase 3 acute lobar pneumonia
Grey hepatisation Lungs solid and grey B/c decr RBC in alveoli + incr neutrophils + dense fibrin
60
Phase 4 acute lobar pneumonia
Resolution @8-10days Restoration to normal fct Uniform consolidation entire lobe
61
Complications pneumonia (9)
``` RF HoTN AF Pleural effusion Empyema Lung abscess Septicaemia Pericarditis/myocarditis Jaundice ```

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