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What are the possible causal agents in pneumonia? [4]
Bacteria, virus, opportunistic organisms, chemical
Pneumonia - S+S [5]
Cough, +/- purulent sputum, fever, pleuritic chest pain, breathlessness
Describe the features of Mycoplasma pneumonia
Cold agglutinins in 50%, abnormal liver function, diarrhoea
Describe the features of Staphylococcus aureus pneumonia
Abcesses (in lung and elsewhere)
What are the features of Coxiella burnetii pneumonia?
Multiple lesions on X-ray
Describe the features of Strep. pneumoniae pneumonia? [2]
Rust coloured sputum, peri-oral HSV
Pneumonia - Ix [5]
Chest X-ray, ABG, So2, blood/sputum culture, serology for atypical organisms
Pneumonia - Rx [3]
Antibiotics (amoxycillin), oxygen, prevent dehydration
Pneumonia - Cx [3]
Respiratory failure (type I), lung abscess, empyema
Tuberculosis - P
Caseating granulomatous infection due to Mycobacterium tuberculosis in lung
What groups have an increased risk of contracting tuberculosis? [7]
Developing countries, immunosuppressed, HIV, steroids, malignancy, alcoholics, homeless
Tuberculosis - S+S
May be symptomless, malaise/lethargy, weight loss/anorexia, fever, cough, haemoptysis. Pleural effusion, pneumonia, fibrosis
Tuberculosis - Ix
CXR (esp. upper, +/- calcification/cavitation), sputum microscopy (Ziehl-Nielsen stain), broncoscopy and washings
Tuberculosis - Rx
6 months combination antibiotics: Isoniazid 300 mg + Rifampicin 600 mg od (Pyrazinamide for first 2 months)
How many deaths per year does bronchial carcinoma result in?
32,000
Bronchial carcinoma - cell types
Small cell, non-small cell (squamous, large cell, adenocarcinoma, alveolar cell)
Bronchial carcinoma - Ae
Smoking (squamous), urban > rural, occupational
Bronchial carcinoma - S+S
Often no clinical signs, cough, chest pain, haemoptysis, chest infection, malaise, breathlessness, clubbing, supraclavicular nodes (small cell). Pleural effusion/collapse, chest infection, chronic lung disease
Bronchial carcinoma - Ix
CXR, bloods (hyponatraemia, polycythaemia, anaemia), CT/MRI (staging), bronchoscopy
Bronchial carcinoma - Rx
Surgery (in 20%, for non-small), radiotherapy (esp. squamous), chemotherapy (esp. small cell)
Bronchial carcinoma - Px
6-8% 5 yr survival
Bronchial carcinoma - Cx
Metastatic spread (bones, liver, brain, adrenal glands), ectopic hormone production, neurological, HPOA, vascular/thrombotic/haematological, cutaneous
Asthma - P
Chronic inflammatory disease of airways (reversible airflow limitation, airway hyper-responsiveness to stimuli, bronchial inflammation)
Asthma - Ae
Atopy and allergy, increasing airway responsiveness, pollution, occupational, drugs (e.g. NSAIDs)
Asthma - S+S
Cough, wheeze, breathlessness, chest tightness
Asthma - Ix
CXR, lung function test, peak flow charts, skin testing for allergies
Asthma - Rx
Self-management plan, avoid precipitants, B2-agonists, anticholinergics, corticosteroids, leukotriene antagonists (selected cases)
COPD - P
Chronic bronchitis, emphysema, airways obstruction (esp. smokers)
COPD - Ae
Smoking (>40 pack yrs), rarely a1-antitrypsin deficiency
COPD - S+S
Cough and sputum, wheeze, breathlessness, tachypnoea (with prolonged expiration), use of accessory muscles, ic muscle recession on inspiration, pursed lips on expiration, reduced chest expansion, hyperinflation, cyanosis, RVF, CO2 retension
COPD - Ix [8]
Spirometry, CXR, BG, sputum exam, ECG, Hb + PCV, WCC, a1-antitrypsin levels
COPD - Rx [9]
Smoking cessation, flu/pneumococcal vaccines, b2-agonists, prompt antibiotics on infection, diuretics for RVF, ventilation (CPAP) in acute, home nebulizers, home oxygen, surgery (lung volume reduction)
COPD - Px
50% with severe breathlessness die within 5 yrs
Obstructive sleep apnoea - Epi
Overweight patients
Obstructive sleep apnoea - S+S
Snoring/nocturnal choking, daytime somnolence, poor sleep, morning headaches, reduced libido, ankle swellings
Obstructive sleep apnoea - Ix
Sleep study (measure oximetry, abdominal/thoracic movement, EEG)
Acute severe asthma - S+S [7]
Bradycardia, silent chest, tachypnoea, inability to speak in full sentences, confusion, SpO2 <92%, PEF <33%.
Acute severe asthma - Emergency Rx
High-flow oxygen and monitor oximetry, neb. salbutamol 5mg +/- ipratropium bromide 500 micrograms, iv steroids
Acute severe asthma - Ix
ABG, CXR (exclude pneumothorax)
Acute severe asthma - 2nd line Rx
iv aminophylline/salbutamol if unresponsive to repeated nebulizers, ventilation if approaching respiratory failure
Bronchiectasis - Ae
Abnormal and permanently dilated airways
Bronchiectasis - Ae
Congenital, mechanical obstruction, extrinsic (tumour), postinfective bronchial damage, granuloma and fibrosis, immunological over-response, immune deficiency, mucociliary clearance defects
Bronchiectasis - S+S [8]
Cough and excessive sputum, recurrent chest infection, halitosis, haemoptysis, clubbing, coarse crackles, hyperinflation
Bronchiectasis - Ix
CXR, high-res CT, sputum exam, immunoglobulins, sweat electrolytes for cystic fibrosis
Bronchiectasis - Rx
Postural drainage, antibiotics, bronchodilators if airflow limitation, steroids, heart/lung transplant
Bronchiectasis - life expectancy
around 55 yrs
Cystic fibrosis - Ae
Autosomal recessive mutation of cystic fibrosis transmembrane conductance regulator gene (CFTR) on chromosome 7, inducing low salt and chloride excretion into airways leading to increased viscosity of airway secretions
Cystic fibrosis - clinical features
Recurrent chest infections, clubbing, sinusitis, haemoptysis, nasal polyps, spontaneous pneumothorax, respiratory failure, RVF, GI symptoms (steatorrhoea, meconium ileus, gallstones, cirrhosis)
Cystic fibrosis - Ix
Sweat electrolyte test, DNA analysis for genotype
Cystic fibrosis - Rx
Antibiotics, pancreatic/nutritional supplements, CFTR gene therapy, lung transplant
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