48 - cough / sputum, 49 - cyanosis, 50 - haemoptysis Flashcards
Which cells produce sputum
goblet
Dx of asthma
spirometry
diurnal variations in peak flow
What non pharmalogical mx of asthma
No smoking
annual flu and pneumonia vaccine
which class of drug contraindicated in asthma
b blockers
Acute asthma mx
Oxygen! Nebbed salbutamol Oral prednisolone Ipratropium bromide Magnesium Sulphate
Chronic asthma stepwise progression
SABA: salbutamol – important to assess technique if treatment has failed
Inhaled corticosteroid: beclomethasone
LABA: salmeterol.
Leukotriene receptor antagonist: monteleukast. Or theophylline
Oral steroids: prednisolone
FEV1 in COPD
<30%
causes of COPD
smoking
cooking fires
air pollution
genetic - alpha 1 antitrypsin deficiency
mx of COPD
Reduce risk factors.
May need oxygen, nebs or long term corticosteroids.
Salbutamol if breathless and exercise limited. Then to SABA or LAMA – tiotropium. Can add on aminophylline or theophylline, which improve lung function but not symptoms.
When to admit for acute COPD
breathless, confused, cyanosed, acopia, low sats
Mx acute COPD
Increase SABAs, pred, Abx if signs of pneumonia (amoxicillin 500mg TDS 5d)
Eg causes of cor pulmonale
COPD, CF, pulm HTN
Sx / signs of cor pulmonale
SOB, wheeze, cyanosis, ascites, jaundice, raised JVP, third heart sound.
is latent TB contagious
no
Dx of TB
CXRs and culture and microscopy in active disease (acid fast and Ziehl Neelsen stain)
Latent disease with tuberculin skin test.
What can activate latent TB
Silcosis, smoking, infection and malnutrition
Mx of TB
Arrange hospital admission
Notify public health authorities
RIPE therapy: 6/12 isoniazid and rifampicin, 2/12 pyrazinamide and ethambutol. Compliance is vital.
Contract tracing.
Side effects of 4 tb drugs
Rifampicin – orange bodily secretions, liver toxicity, flu-like symptoms
Isoniazid – peripheral neuropathy, elevated liver enzymes
Pyramidazine –joint pains, gout, hepatoxicity,
Ethambutol – optic neuritis, peripheral neuropathy, hepatoxicity
Lung Ca Sx
Coughing up blood, wheeze, SOB, weight loss, weakness, clubbing of fingers, hoarse voice, palmar wasting (Pancoast tumours),
Rfs for Lung ca
smoking, radon gas, asbestos, air pollution
which 2 paraneoplastic syndromes can happen in Lung Ca
Lambert-Eaton myasthenic syndrome
LEMS
->muscle weakness due to neuropathy
SIADH
organs affected in CF
lungs, pancreas, liver, kidneys, intestine, genitals
Sx of CF
Failure to thrive, dyspnoea, repeat lung infections, fatty stool, male infertility, finger clubbing, productive cough, diabetes.
Pathology of CF
AR
Mutations in cystic fibrosis transmembrane conductance regulator (CFTR) controls flow of chloride and water into mucus.
Dx of CF
Diagnose with sweat test and genetic screening. Heel prick testing (trypsinogen levels).
Mx of CF
No cure,
Creon for pancreatic enzyme replacement,
physiotherapy
fat soluble vitamin replacement (ADEK).
Lung transplant may become necessary.
Long term Abx therapy.
Ix in pneumonia
CXR, CRP, sputum culture to identify cause
Abx mx of pneumonia
amoxicillin 500mg TDS for 5d. If no improvement after 3d, extend tx to 7-10d.
If CRB score 1-2 then add clarithromycin
Parts of CURB65 ? What does it do?
Confusion
Urea (blood 7mmol/l)
Respiratory rate of 30 breaths per minute
Blood Pressure less than 90 systolic or 60 diastolic
65 or older
Evaluates death risk and is the basis for treatment and admission
What is pulm oedema
Fluid accumulation in the lungs. Impairs gas exchange and leads to respiratory failure.
Associations with pulm oedema
CHF
fluid overload
Sx /signs of pulm oedema
Pink frothy sputum, dyspnoea, sweating, orthopnea, PND, raised JVP, third heart sound.
low SaO2, CXR
Mx of cardiogenic pulm oedema? non cardiogenic?
If cardiogenic, furosemide, position upright, oxygen, GTN, morphine,
Consider NIV.
non cardiogenic
treat underlying cause and provide oxygen.
preventitive anticoagulation following PE?
monitoring?
other Ix?
3 months of heparin at least, however longer if risk factors remain.
Target INR 2.5 (2.0-3.0)
Investigate for undiagnosed cancer if PE unprovoked.
What is bronchiectasis? obstructive / restirctive?
Permanent airway dilation (obstructive lung disease
Sx of bronchiectasis?
Chronic cough (productive, haemoptysis), SOB, wheezing, clubbing, frequent infection.
Cause of bronchiectasis?
Can result from CF and lung infections.
May also be congenital
Dx of bronchiectasis?
CT / cultures
prevention of bronchiectasis?
immunisations / sno smoking
Mitral stenosis sx?
Chest pain, palpitations, haemoptysis, weakness, malar flash and fatigue
Dx of MS
Echocardiography
Mx of MS
Treat if symptomatic: valve replacement/balloon dilation. Manage symptoms (i.e. angina with GTN etc.)
Common cause of MS
Rheumatic fever
What is goodpastures? 2 key organs
Autoimmune disease attacking basement membrane in kidneys and lungs.
Produces haemoptysis and renal failure.
Sx of good pastures bar lung / renal
usual autoimmune symptoms of weakness, fatigue, fever and joint aches.
Dx for goodpastures?
Anti-GBM antibodies
Mx goodpastures
steroids
cyclophosphamide and plasmapheresis.
Damage to organs may necessitate transplant
Association with goodpastures
HLA-DR2
What is sarcoidosis?
Inflammatory disease producing diffuse granulomas in all organs
Sarcoidosis sx
Dry cough, wheezing and chest pain if there is lung involvement. Lungs, skin and lymph nodes usually present first
you can basically get any sx as it affects everything
Whats seen on CXR of sarcoid ? bloods?
CXR shows hilar lymphadenopathy and basal nodularity.
Bloods show hypercalcaemia with normal PTH.
Raised ACE in circulation.
Mx of sarcoid
depends on severity anything from ibuprofen to DMARDS
2 bleeding disorders that could -> haemoptysis
haemophilia A/B
VW disease
haemophilia A vs B
A is a Factor VIII deficiency.
B is a Factor IX deficiency.
Complications of haemophilia
haemarthrosis, internal bleeding, CVA, blood infections.
What is von willirand factor
Von Willibran Factor is a blood glycoprotein aiding clotting.
It is present normally in the epithelium basement membrane and its exposure is a sign of tissue injury.
It binds to clotting factors and platelets, holding them to the site of the injury.
