respiratory_week_4_20190518190116 Flashcards
(118 cards)
1
Q
what does TB look like on chest x-ray
A
dense consolidation in right upper lobe with cavity formationheals with calcification
2
Q
what are the main pathogens of TB
A
m. tuberculosis and m. bovis
3
Q
how is TB spread
A
airborne
4
Q
what is military TB
A
massive seeding of mycobacteria through bloodstream
5
Q
what is general symptoms of TB
A
weight loss, malaise and night sweats
6
Q
what is respiratory symptoms of TB
A
cough, haemoptysis, breathlessness and upper zone crackles
7
Q
what are meningeal symptoms of TB
A
headache, drowsy, fits
8
Q
what are GI symptoms of TB
A
pain, bowel, obstruction
9
Q
what is spinal symptoms of TB
A
pain, deformity, paraplegia
10
Q
what is other symptoms of TB
A
lymphadenopathy, cold access, pericardial tamponade, renal failure, septic arthritis and hypoadrenalism
11
Q
what are infections with opportunistic pathogens
A
virus (cytomegalovirus), bacterium (mycobacterium avian intracellulare), fungi (aspergillus, candida, pneumocystis) and protozoa (cryptosporidia, toxoplasma)
12
Q
how is TB diagnosed
A
Zn stain, AAFB, auramine stain, PCR
13
Q
what is the histology of TB
A
multinucleate giant cell granulomas, caseating necrosis and sometimes visible mycobacteria
14
Q
what drugs are used in the treatment of TB
A
two months of: rifampicin, isoniazid, pyrazinamide, ethambutol four months of: rifampicin, isoniazid
15
Q
what is side effect if rifampicin
A
colours urine and all body fluids orange, also potent inducer of cytochrome enzymes (breaks down steroid molecules)
16
Q
what is side effects of ethambutol
A
causes optic neuritis
17
Q
what is latent TB
A
symptom free and culture negative - history of TB prior to 1960, calcification on X ray and exposure to high prevalence area
18
Q
what is secondary TB
A
the reactivation of latent TB (due to age, coincident disease e.g. HIV, immunosuppressives)
19
Q
how is previous exposure of TB tested for
A
interferon gamma release assay (blood test)mantoux test (skin test) - also tests for BCG - can cause type 4 hypersensitivity reason
20
Q
what is treatment of latent TB
A
either treat or leave alonedrugs: 6 months of isoniazid or 3 month of rifampicin and isoniazid (both cause liver disturbance)
21
Q
what is BCG immunisation
A
attenuated strain of mycobacterium bovis, most effective in neonates of high risk families
22
Q
why should all TB cases be offering HIV test and vice versa
A
they go hand in hand
23
Q
when should you consider pleural infection
A
when patient not settling with 2-3 days antibiotics
24
Q
what can pleural infections rapidly coagulate and organise to form
A
fibrous peels even with antibiotics
25
what is risk factors for pleural infections
diabetes mellitus, immunosupression, gastro-oesophagel reflux, alcohol misuse, IV drug abuse
26
what is a complicated parapneumonic effusion
+ve stain, pH <7.2, low glucose, septations and loculations
27
what is pleural empyema
pus in pleural cavity
28
what is management of pleural infection
antibiotics and drainnutrition, VTE prophylaxis, fibrinolytic and reassess patients who do not improve
29
what are some gram positive upper respiratory tract colonisers
a-haemolytic streptococci: strep pneumoniaeb-haemolytic streptococci: strep pyogenes staphlyoccus aureus
30
what are some gram negative upper respiratory tract colonisers
haemophilus influenza moraxella catarrhalis
31
what bacteria could be responsible for acute exacerbation of COPD
haemophilus influenza, moraxella catarrhalis, streptococcus pneumoniae and others
32
which bacteria causes whooping cough
bordetella pertussis: gram negative coccobacillus
33
how is bordetella pertussis diagnosed
bacterial culture, PCR or serology
34
how is whooping cough treated in children under one month
clarythromycin
35
how is whooping cough treated in children over one month
clarythromycin / azithromycin
36
how is whooping cough treated in pregnancy
erthryromycin
37
what is cystic fibrosis
inherited disease which leads to abnormally viscous mucous - blockage of many tubular structures inc airways and lungs (repeated chest infection and chronic colonisation)
38
what bacteria most prominent in cystic fibrosis
pseudomonas aeruginosa and burkholderia cepacia
39
how is pneumonia caused
fluid (oedema) in alveolar airspaces causes swelling, leads to consolidation, thickened alveolar walls and congested capillaries
40
what is lobar pneumonia
only in specific lobe(s)
41
what is broncho pneumonia
infection starts in airway and spreads to lung (usually pre existing disease)
42
what is the most common bacteria in community acquired
streptococcus pneumoniae
43
what is used to assess severity of pneumonia
CURB65confusion urea >7resp rate >30/minblood pressure (<90/<60)65 or older add 10% if COPDscore 3 or greater severe
44
when is mycoplasma pneumoniae common and what is symptoms
older children and young adultsdry cough, autoimmune anaemia and erythema multiforme, atypical chest signs
45
what is used to treat mycoplasma pneumoniae
erythromycin / doxycycline resistant to beta lactams (penicillin etc)
46
what causes aspiration pneumonia
inhalation of foreign material into lungs
47
who is most likely to get PCP (pneumocystis carinii pneumonia/pneumocystis jirovecii) and what is signs
immunosuppressed patients (HIV, cancer, steroids) dry cough, no atypical chest signs
48
how is PCP treated
trimethoprim / sulfamethoxazole / co-trimoxazole
49
what is legionella pneumonia and what is signs
inhalation of bacteria in contaminated water GI symptoms, renal failure - low sodium and lymphocytes in returning traveller - gram negative bacteria
50
how is legionella pneumonia treated
clarithromycin, erythromycin and quinolones (levofloxacin)
51
what is chlamydia trachomitis
STI that causes infantile pneumonia
52
what is chlamydia pneumoniae
transferred person to person, causes mild respiratory tract infection
53
what is staphylococcus aureus
recent influenza infection, IV drug user
54
what is gram negative enterobacteria
alcoholic, usually from achalasia - vomiting
55
what is fungal (aspergillus) pneumonia and how is it treated
fungal infection that result in pneumonia, breathlessness - treat with surgery, voriconazole, amphorericin B
56
what is the treatment for severe hospital acquired pneumonia
IV amoxicillin + metronidazole + gentamicin allergic: co-trimoxazole + metronidazole + gentamicin
57
what is haemophilus influenzae (hospital acquired)
bacteria, "atypical pneumonia", nursery workers, people with COPD
58
what is coxiella burnetti (hospital acquired)
Q fever - sheep, goats, cattle, farms culture negative endocarditis responds to tetracylline, macrolides
59
what is chlamydophilia psittaci (hospital acquired)
caught from pet birds, presents as pneumonia
60
what is klebsiella pneumoniae (hospital acquired)
gram negative anaerobe, caviating, alcoholism, diabetes, chronic lung diseasetreat with crabapenems (resistant to b lactams)
61
general symptoms of pneumonia
malaise, anorexia, sweats, rigor, myalgia, arthralgia, headache, confusion, cough, pleurisy, haemoptysis, dyspnoea, preceding URTI, abdominal pain, diarrhoea
62
general signs of pneumonia
dull to percuss, bronchial breathing (differentiated from PE), crackles, rub heard, cyanosis, hypotension, can reactivate mouth herpes, tachypnoea (rapid breathing)
63
what are severity markers of pneumonia
temperature less than 35 or greater than 40 cyanosis PaO2 < 8kPawhite blood count <4 or >30multi-lobar involvement
64
what investigations take place in diagnosis of pneumonia
blood culture (WCC and CRP), serology, PCR, arterial gases, full blood count, urea, liver function, CXR (consolidation)
65
what are the complications of pneumonia
organisation (scarring), abscess/cavitation, metastatic lung infection, bronchiectasis, respiratory/ARDS/multi-organ failure, pleural / paraneumonic effusion, empyema, death
66
what increases the risks of pneumonia
smoking, heart failure, diabetes, COPD/asthma, flu, steroids, proton pump inhibitors
67
what is clinical features of phagocyte deficiencies
recurrent infection
68
what organisms cause phagocyte deficiencies
common bacteria (staphylococcus aureus) unusual bacteria (burkholderia cepacia) mycobacteria (both TB and atypical) and fungi (candida, aspergillus)
69
what does failure of neutrophil differentiation cause
severe congenital neutropenia and cyclic neutropenia = shortage of neutrophils - recurrent infection
70
what does failure to express leukocyte adhesion markers cause
leukocyte adhesion deficiencies = recurrent infection
71
what does any antibody or complement deficiency cause
failure of opsonisation
72
what does failure of oxidative killing cause
chronic granulomatous disease
73
what does failure of cytokine production cause
IFNy and IL-12 deficiency
74
what is the life cycle of a T lymphocyte
arise from haematopoetic stem cells in bone marrow, exported as immature cells to thymus where undergo selection (10% survive), mature T lymphocyte enter circulation and reside in lymph nodes
75
what is a defect of haemopoetic stem cells
recticular dysgensis - failure of production of neutrophils, lymphocytes, monocyte/macropages and platelets
76
what does failure of lymphocyte precursors cause (T cell maturation)
severe combined immune deficiency
77
what does failure of thymic development cause (T cell maturation)
DiGeorge syndrome
78
what does failure of expression of HLA molecules cause (T cell maturation)
bare lymphocyte syndromes
79
what does failure of signalling, cytokine production and effector functions cause (T cell maturation)
IFNy deficiency, IL-12 deficiency
80
what does failure of normal apoptosis cause (T cell maturation)
autoimmune lymphopoliferative sundromes
81
what does failure of B cell maturation cause
X-linked agammaglobulinaemia = few B cells
82
what does failure of lymphocyte precursor cause (B cell maturation)
severe combined immune deficiency
83
what does failure of production of IgG antibodies cause (B cell maturation)
common variable immune deficiency and selective antibody deficiency
84
what does failure of IgA production cause (B cell maturation)
selective IgA deficiency
85
what is causes of stridor in children
infections (croup, epiglottis, diphtheria), foreign body, anaphylaxis / angioneurotic oedema
86
what is causes of stridor in adults
neoplasms of larynx, trachea and major bronchi, anaphylaxis, trauma (strangulation, burns)
87
what is the management of malignant airway obstruction
tumour removal: laser, photodynamic therapy, cryotherapy, diathermy, surgical resection tumour compression by intraluminal stent radiotherapy, chemotherapy & steroids
88
what is the treatment for anaphylxis
IM epinephrine (adrenaline)IV antihistamine or corticosteroids high flow O2nebulised bronchodilator endotracheal intubation
89
what is snoring
relaxation of pharyngeal dilator muscles during sleep - upper airflow narrowing, turbulent airflow and vibration of palate and tongue base
90
what is sleep apnoea
intermittent upper airway collapse
91
what are risk factors for sleep apnoea
enlarged tonsils, obesity, retrognathia, hypothyroidism, oropharyngeal deformity, neurological issues, drugs, and post op period
92
what is the consequences of sleep apnoea
daytime sleepiness, personality, cognitive impairment, increase RTA risk, hypertension, raised CRP, impaired endothelial function and glucose tolerance
93
how to diagnose sleep apnoea
snoring, raised EDS score (normal <12/24), overnight sleep study and full polysmnography
94
what is treatment of sleep apnoea
remove underlying cause, CPAP (continuous positive airway pressure)others: mandibular advancement device (snoring) and surgery (UPPP, laser Rx)
95
what are the abnormal host responses which are risk factors for chronic pulmonary infection
immunodeficiency (IgA most common)immunosuppression (steroids, chemo etc)
96
what are the abnormal innate host defences which are risk factors for chronic pulmonary infection
damaged bronchial mucosa (smoking, pneumonia, malignant)abnormal cilli (kartenagers or youngs syndrome)abnormal secretion (CF or channelopathies)
97
what are the repeated insults which are risk factors for chronic pulmonary infection
aspiration (NG feeding, poor swallow)indwelling material (NG tube in wrong place, chest drain, inhaled foreign body)
98
what is symptoms of pulmonary abscess
weight loss, lethargy, tiredness, weaknesscough, sputum high mortality usually a preceding illness e.g. pneumonic infectionflu-> staph pneumonia -> cavitating pneumonia -> abscess
99
what pathogens cause pulmonary abscess
streptococcus, staphylococcus (post flu) E-coli, gram negatives and aspergillus
100
what is a simple parapneumonic effusion
clear fluid, pH>7.2, LDH<1000, glucose>2.2
101
simple can lead to complicated parapneumonic effusion - what is this?
pH<7.2, LDH>1000, glucose<2.2 - requires drainage
102
complicated effusion can progress to empyema - what is this?
frank pus, look for D on CXR, aerobic organisms more frequently
103
what gram positive organisms can cause empyema
Steph milleri or staph aureus (usually post op or nosocomial)
104
what gram negative organisms can cause empyema
e-coli, pseudomonas, haemophilus influenza, kelbsiellae
105
what is the treatment of empyema
drain, IV antibiotics (amoxicillin and metronidazole) or oral antibiotics
106
what is bronchiectasis
localised, irreversible dilation of bronchial tree
107
what is clinical presentation of bronchiectasis
recurrent chest infections, recurrent antibiotics with no/short lived response, persistent sputum production
108
what is treatment of brochiectasis
stop smoking, flu vaccine, reactive antibiotics e.g. nebulised gentamicin or colomycin anti-inflammatory: clarithromycin or azithromycin
109
how to tell difference between bronchiectasis and chronic bronchial sepsis
sepsis has all hallmarks of bronchiectasis but not on HRCTconfirmed positive sputum results often young / involved in childcare or old with COPD
110
what are complications of cystic fibrosis
bronchiectasis, sputum, biliary obstruction, pancreatic dysfunction, infertility for males, psychological, salty sweat, recurrent lung infection, filled sinuses, gallbladder/liver disease
111
what are health problems associated with cystic fibrosis
sinus problems, nose polyps, enlarged heart, trouble breathing, gallstones, trouble digesting food, fatty BMs
112
how is cystic fibrosis formed
chloride channel CFTR (pushes chloride out of cell) is dysfunction - more Na moves into cell and this causes dry sputum
113
what does the management of cystic fibrosis need to include
treatment for pancreas, bowels and liver
114
what is given for pancreas
exocrine failure (slugged up ducts) -CREON endocrine (destruction of pancreatic cells) - annual OGTT, CGMS
115
what is given for bowels
DIOS - mucus blocks intestines - gastrograffin, laxido, fluids
116
what is given for liver
slugged up hepatic ducts and portal hypertension - TIPSS (reduced anastomoses and bleeding risk)
117
what is the G55ID gene mutation in cystic fibrosis
type III mutation, normal CFTR, non functional channeltreatment - ivacafactor (improves chlorine flow)
118
what is given for F508del mutation in cystic fibrosis
lumacftor
