Ash Flashcards
Types
Cystic Saccular Cylindrical Fusiform Tractional
Congenital causes
Cf Kartaneger Pcd Yellow nail Young syndrome LUNG SEQUESTRATION
Infective
Obstruction
Post infectious- aspiration, tb. Pneumonia
Fb, mucous impaction,bronchial adenoma
Syndromes ass
Kartaneger Pcd Yellow nail Young Lady windermere Mounier khun
Stabdard tests
Cbc Ige and specific ige Ig g , igm Soecific ab levels against pneumococcus- if less vaccine Cf- early onset, male infertility, abd symptoms Pcd- neonatal distress, childhood , infertility, otitus media Sputum culture Ctd Aat - basal panacinar emphysema Bronch Serum electrophoresis Hiv1 Aspiration- flouroscopr, endoscopy
What are the tests you fo in cf
Staph aureus Sweat nacl 60 30-60 - border line Chromosme 7 , delta 508 Cftr mutation
What are the symptoms u see in pcd
Ultrastructural defects in cilia affecting normal motility Recurrent urti and lrti Otitis media Sinusuistis Bronchiecrasis Male infertility Situs incersus Kartengere syndrome- sinusitis , infertility , situs
Investigations in pcd
Nasal bitric oxide- low
Daccharin taste test
High speed video microscopy analysis
Transmission electron microscopy
Young syndrome
Primary azoospermia
Bronchiectasis
Sinsusits
Severity scoring
Faced
Stable state treat
Twice daily acapella
Bronchopulmonary hygiene od- imrpoves cough related qol.airway clearance technoque- teached by physio
Airway clearnace techniques
Acbt- active cycle of reathing technique
Postural/ modified pos/
Manual tech- percussion, vibration
Postural drainage- by gravity
Modified- dec symptoms of gerd
Pep
Oscillatiry pep- acapella Insp muscle training- High frequency chest wall oscillation- vest Intrapulmknary percussive ventilation I/m bipap
Recommend physio
Acbt/ acapella
Pd - modified pd- sitting
Rest if these are not working
Exercise plus fet huff for airway clearance
During exacerbation
Fatigue
Acapella,+ pd are safe
Manual
Niv safe durimg exacerbation
How often
Min 10 min , max 30
After this 2 huff or cough or until pt is fatigued
Long term anti inflammatory
Ics proven role in asthma/copd
Abpa , ibd also
Decreases sputum volume , increases exacerbation
Indometgacin
Long term abx ix
Pseudo rx
3 or more exacerbation per year 1st- colistin- ectasis and pseudo 2nd- genta 3rd- azee ir erythro If high exacerbation- inhaled to oral
Non pseudomonas
1st- azee
2nd- genta
3rd- doxy if macro intolerant
When do u do tx
Less than 65
Fev1ess than 30 with significant clinical instability
Rapid progression/ detoriation drspite optimal treatment
Earler- massive hemo , phtn, icu need , rf needing niv
Hiw do u treat respiratory failure
Long term o2 therapy
Same as copd.
Niv with Humidifier
When do u do eradication therapy
1st isolation or regrowth in followup
1st-ciplox for 2 weeks
Iv antipseud bl+_ ag for 2 wks
F/b 3 months Neb Colistin, genta, tobra
Before starting rx
Dose of azee
Choice
Review
Ntm, hearing loss- azee Crcl , heaing - ag Challenge test before inhaled abx As per sens, tolerance. Regular c/s
Bd
In copd , asthma
Rehab
Mmrc more than 1
6mwt/iswt- evaluate pre and post capacity
Insp muscle training in conjunction with conventional pulmonary rehab
Ig g therapy
Cvid and xlinked agammaglobulinemia In iga/ig g subclass def
Lack of Pneumococcal ab
Sinopulmonary infection and progressive disease despite apo mx
