Respiratory important Flashcards by Jenny Griffiths

What bacteria are responsible for TB?

Mycobacterium tuberculosis

M. bovis (“bovine TB”)

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How is TB transmitted?

From “open” TB coughing/sneezing
Remain airborne for long periods of time
Bovine - through infected cow’s milk

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What can indicate post primary pulmonary TB?

Diabetes
Immunosupressive diseases/drugs
Previous TB
Alochol
Imigrants from high incident areas
Poor social circumstances

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How do you diagnose TB?

3 sputum specimins on successive days
>Sputum smear
>Sputum culture
>Sputum PCR potentially

Chest xray
CT if above positive

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What do you see on an Xray for TB?

Patchy shadowing 
Often of Apices/apexes of lower zones
Often bilateral
Cavitation in advanced disease
May be calcified if chronic/healed

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How do you treat TB?

Rifampicin 6 months
Isoniazid  6 months
Ethambutol 2 months
Pyrazinamide 2 months
Must also notify comission

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What are the side effects of rifampicin?

Orange ‘Irn Bru’ urine, tears 
Induces liver enzymes, >prednisolone, 
>anticonvulsants
>Oral contraceptive pill ineffective
Hepatitis

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What are the side effects of isoniazid?

Hepatitis

Peripheral neuropathy

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What are the side effects of ethambutol?

Optic neuropathy

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What are the side effects of pyrazinamide?

Gout

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Why does CF lead to recurrent pulmonary infections?

Decreased mucociliary clearance
Increase bacterial adherance
Decrease endocytosis of bacteria
Leads to increased colonisation

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Which bacteria reduce life expectancy dramatically in CF?

Pseudomonas aeruginosa
Burkholderia cepacia
Stenotrophomonas maltophilia?

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How do you treat CF infections?

Early and aggressively with antibiotics
Oral antibiotics for Staph, Haemophilus, Pneumococcus
IV antibiotics for Pseudomonas, Stenotrophomonas, Burkholderia
Two antibiotics (-lactam + aminoglycoside)
Two week course

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What are the indications for lung transplant with CF?

(Done as double lung)
Rapidly deteriorating lung function
FEV1 < 30% predicted
Life threatening exacerbations
Estimated survival <2 years

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What is Ivacaftor?

Drug addressing primary defect in CF
Currently too expensive
However only helps in some patients

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How does CF affect fertility?

No effect on sexual function
Affects fertility in men
Females fertile, however poor nutritional state may affect chances of conception

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What are the contraindications to transplant in CF?

Other organ failure
Malignancy within 5 years
Significant peripheral vascular disease
Drug, nicotine, alcohol dependency
Active systemic infection
Microbiological issues (eg. M. abscessus)

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What is the defect in CF?

A defect in the Cystic fibrosis transmembrane conductance regulator (CFTR)
Without it, cilia collapse
And excessive inflammation

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What is the CFTR?

Active transport channel for chlorine

>Regulates liquid volume on epithelial surface through chloride emission

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How do you screen for CF?

Guthrie test - heel blood prick day 5
Intially immuno-reactive trypsinogen
If positive then analysis of mutation

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What are the features of pancreatic insufficiency (in CF)?

Abnormal stools (steatorrhea)
Failure to thrive

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How do you treat pancreatic insufficiency?

Enteric coated enzyme pellets
High energy diet
Fat soluble vitamins/mineral supplements
PPIs

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What are the main features of CF?

Recurrent bronchopulmonary infection

Pancreatic insufficiency

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What are the respiratory organisms in CF?

Common organisms
>Staphylococcus aureus and >Haemophilus influenzae in early years
>Pseudomonas aeruginosa later

Less common organisms
>Burkholderia cepacia
>Stenotrophomonas maltophilia
>Alcaligenes xylosoxidans
>Atypical mycobacteria e.g. M abscessus

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What are the common occupational interstitial lung diseases?

Extrinsic allergic alveolitis Coal workers’ pneumoconiosis Silicosis Asbestosis

What can cause occupational COPD?

Coal mining Hard rock mining Cadmium fume Organic dusts

What is occupational asthma?

A substance is considered to cause occupational asthma if, as a result of exposures in the workplace, it both: produces the biological change known as the hypersensitive state in the airways and triggers a subsequent reaction in those airways”

How do you diagnose occupational asthma?

Work related symptoms Working with occupational sensitiser Symptoms better when not at work Symptoms may be worst after shift

What causes farmer's lung?

Thermophillic actinomyectes

What is silicosis?

Caused by inhalation of silicon dioxide - miners, stomemasons etc Rarely fatal Can cause silicoTB

What is asbestos?

Mineral used often for insulation etc Commonly foundin building materials Highly toxic (Increased cancer risk)

What is asbestos related disease?

``` Pleural plaques (benign) Benign asbestos pleurisy Pleural fibrosis Asbestosis (progressive pulmonary fibrosis) Lung cancer Mesothelioma (malignant pleural tumour) ```

What are pleural plaques?

Asymptomatic No affect on lung function Not premalignant

What is benign asbesto pleurisy?

Presents with pleural effusion Often blood stained May lead to DPT

What is asbestosis?

Latency of 20+ years Progressive breathlessness Cough Signs Crackles Clubbing Restrictive lung function Interstitial fibrosis on radiology

What is mesothelioma?

Pleural malignancy Can occur in peritoneum Presents with SOB + chest wall pain Usualy unilateral pleural thickening

What are the symptoms of COPD?

``` SOB Cough/recurrent chest infection Loss of muscle mass/weight loss Cardiac disease Depression ```

What are the examination signs of COPD?

``` Reduced chest expansion Prolonged expiration/wheeze Hyperinflated chest Respiratory failure >Tachypneoa, cyanosis, accessory muscles etc ```

How do you manage COPD?

Smoking cessation Inhalers for SOB + exacerbation Long term oxygen (if not smoker)

What drugs are used in COPD?

SABAs LABAs Short/long acting antimuscarinis (SAMA/LAMA) Inhaled corticosteroids

What are the signs/symptoms of an exacerbation of COPD?

``` Increased SOB Cough Sputum volume/purulence increase Wheeze worsens Chest tightness ```

What is the presentation of lung cancer>?

``` Haemoptysis Recurrent bronchopulmonary infection Cough, increasing breathlessness Chest or other pain Weight loss Lump ```

What are the signs of lung cancer?

``` Finger clubbing Reduced expansion/dull percussion etc Cervical lymphadenopathy Horner's syndrom Hepatomegally ```

What are the treatment options of lung cancer?

Surgery Radiotherapy Chemotherapy

What are the types of lung cancer?

``` Non small cell >Squamous >Adenocarcinoma Small cell Mesothelioma ```

How do you treat malignant pleural effusion?

Drain + send fluid to cytology + microbiology | Follow up with chemo/radio dependent on stage

What is the interstitium?

Connective tissue space around airways, vessels and space around basement membrane of alveolar walls

What are the trends in restrictive lung disease?

FEV normal or low FVC very down Ratio above 70%

What are the trends in obstructive lung disease?

FEV massively down FVC normal Ratio below 70%

What is sarcoidosis?

``` Multisystem disorder More common in temperate climates Acute arthralgia Erythema nodosum Bilateral hilar lymphadenopathy ```

How do you diagnose sarcoidosis?

Clinical/imaging findings | Serum calcium and ACE up

What can cause restriction?

``` Interstitial lung disease Pleural effusions Pneumothorax Pleural thickening Skeletal causes Muscle causes (eg ALS) Obesity/pregnancy ```

What are the main intersitial lung diseases?

Sarcoidosis Idiopathic pulmonary fibrosis Hypersensitivity pneumoniitis

How do you treat sarcoidosis?

No treatment if mild NSAIDs in arthralgia Topical steroids Systemic steroids

What is the presentation of idiopathic pulmonary fibrosis?

Chronic SOB + cough Often older men Clubbing Crackles

How do you diagnose asthma?

S&S Peak flow Spirometry

What are the steps for treating asthma?

``` Inhaled SABA Inhaled corticosteroids Inhaled LABA 4th step - increase or new drug 5th corticosteroids oral ```

What are the examples of SABA?

Salbutamol | Terbutaline

What new drugs can be considered in the 4th step?

Leukotrine receptor antagonists Beta2 agonist tablet Theophylline

How do you treat mild acute asthma?

Oral steroids for 7 days SABA frequently Assess within 24 hours

How do you treat a severe asthma attack?

Oral/IV steroids Nebulised bronchodilators IV magnesium sulphate if no response Antibiotics if infection

Respiratory important Flashcards

(61 cards)