respiratory pathology 4

Question 1

acute bronchitis

Answer 1

temporary inflammation of the bronchi (3 weeks)

Question 2

symptoms of acute bronchitis

Answer 2

Inflammation of bronchi
* Temporary <3 weeks
* Cough and sputum
* Usually viral

Question 3

management of acute bronchitis

Answer 3

paracetamol
drinking of fluids

Question 4

exacerbation of COPD

Answer 4

changes in the colour of the sputum
fevers
increased breathlessness
cough
wheeze

Question 5

yellow purulent sputum

Answer 5

bacterial infection

Question 6

treatment of COPD management

Answer 6

steroids
antibiotics - amoxicillin
- doxycycline
- co-trimoxazole
- clarithromycin

Question 7

organisms that cause the exacerbation of COPD

Answer 7

Streptococcus pneumoniae
* Haemophilus influenzae
* Moraxella catarrhalis
* Viral

Question 8

pneumonia

Answer 8

inflammation of the lung parenchyma that is the lung cells

Question 9

risk factors for pneumonia

Answer 9

smoking and alcohol intake
age extremes
viral illness
pre -existent lung disease
chronic illness
immunocompromised
hospitalisation
Intravenous drug users

Question 10

types of pneumonia

Answer 10

bronchopneumonia
lobar pneumonia
interstitial pneumonia

Question 11

symptoms of pneumonia

Answer 11

.Fever, rigors, myalgia
* Cough and sputum
* Chest pain (pleuritic)
* Dyspnoea
* Haemoptysis

Question 12

rusty brown sputum

Answer 12

pneumonia

Question 13

signs of pneumonia

Answer 13

Tachypnoea
* Tachycardia- increased heart beat
* Reduced expansion- there is solidification of the alveoli fluid filled alveoli
* Dull percussion- more solid because of the consolidation of matter
* Bronchial breathing- listen over the trachea to check for this
* Crepitations
Rusty brown sputum * Vocal resonance

Question 14

investigations of pneumonia in primary care setting

Answer 14

chest x ray

Question 15

investigations of pneumonia in the hospital

Answer 15

Bloods – serum biochemistry, FBC, CRP
Blood cultures
CXR
Sputum culture, viral throat swab
Legionella urinary antigen

Question 16

differential diagnosis of pneumonia

Answer 16

• Tuberculosis
• Lung cancer
• Pulmonary embolism
• Pulmonary oedema
• Pulmonary vasculitis (Wegners granulomatosis)

Question 17

causative agents of pneumonia

Answer 17

Strep Pneumoniae 39%
* H. Influenzae 5.2%
* Legionella 3.6%
* Staph aureus 1.9%
* Moxarella catarrhalis 1.9%
* Mycoplasma pneumoniae 10.8%
* Chlamydophila pneumoniae 13.1%
* Chlamydophyla psittaci 2.6%
* Coxiella burnetii 1.2%
* All viruses

Question 18

classification of pneumonia

Answer 18

community acquired
hospital acquired

Question 19

community acquired pneumonia

Answer 19

typical- cause the normal signs of pneumonia
atypical -present with different ( not normal) symptoms of pneumonia

Question 20

typical pneumonia causing bacteria

Answer 20

Streptococcus pneumoniae
* Haemophilus influenzae
* Mycoplasma pneumoniae

Question 21

atypical pneumonia causing bacteria

Answer 21

Legionella pneumophilia- fresh water
* Chlamydia pneumoniae- sexually acquired
* Chlamydia psittaci- birds
* Coxiella burnetti- farm animals
* Moraxella catarrhalis- causes COPD
* Viruses- influenza , varicella , SARS

Question 22

nosocomial bacteria

Answer 22

acquired by staying in the hospital for more than 48 hours

Question 23

examples of nosocomial bacteria

Answer 23

Enterobacteria
* Staphylococcus aureus
* Pseudomonas aerigunosa
* Klebsiella pneumoniae

Question 24

organisms that cause a cavitation pneumonia

Answer 24

MRSA
Klebsiella pneumoniae
TB

Question 25

severity test for pneumonia

Answer 25

CURB 65

Question 26

negatives of CURB 65 score

Answer 26

Young people - Hypoxia - Multi-lobar consolidation

Question 27

score of pneumonia

Answer 27

* 0-1 low risk - could be treated in community < 3% * 2 moderate risk - hospital treatment usually required 9% * 3-5 high risk of death and need for ITU

Question 28

complications of pneumonia

Answer 28

* Sepsis * Acute Kidney Injury * Adult Respiratory Distress Syndrome * Parapneumonic effusion * Empyema * Lung Abscess * Disseminated infection

Question 29

lung abscess

Answer 29

More likely with Staph aureus, pseudomonas, anaerobes… * Purulent sputum, haemoptysis * Screen for TB * CT scan +/- bronchoscopy * Prolonged antibiotics minimal of 4 weeks

Question 30

empyema

Answer 30

Thoracic ultrasound +/- aspirate * Fluid parameters: * Simple pH > 7.2 * Complicated pH < 7.2 * Empyema pus/Culture +ve * May need drain + prolonged abx * Surgery / intrapleural tPA + DNAse

Question 31

recovery period for pneumonia

Answer 31

* Repeat CXR 6 weeks if >50yrs, smokers this is to check whether the infection has resolved * Smoking cessation

Question 32

recurrent pneumonia

Answer 32

HIV cancer bronchiectasis aspiration pneumonia

Question 33

bronchiectasis

Answer 33

signet ring appearance

Question 34

causes of bronchiectasis

Answer 34

Idiopathic * Childhood infection * CF * Ciliary dyskinesia * Hypogammaglobulinaemia * Allergic BronchoPulmonary Aspergillosis (ABPA)

Question 35

symptoms of bronchiectasis

Answer 35

Chronic productive cough * Breathlessness * Recurrent LRTI * Haemoptysis * Finger clubbing * Crepitations (coarse) * Wheeze * Obstructive spirometry