Bronchiectasis, ARDS

Question 1

Bronchiectasis def

Answer 1

Chronic infection of the bronchi and bronchioles

Permanent dilatation of airways

Question 2

Main orgnaisms of bronchiectasis

Answer 2

H influenza

Strep pneumonia

Staph

Psuedomonas aeroginosa

Question 3

Causes of bronchiectasis

Answer 3

Congenital; eg CF

Post-infection: eg measles

Bronchial obstruction

Aspergillosis

UC

Question 4

Bronchiectasis sx

Answer 4

persistent cough

copious purulent sputum

intermittent haemoptysis

Question 5

CXR result of bronchiectasis

Answer 5

cystic shadows

thickened bronchial walls (tramline and ring shadows)

Question 6

Rx of bronchiectaisis

Answer 6

postural drainage 2x daily

Abx (if>3 episodes/yr = long term)

Bronchidilators (neb salbutamol)

Prednisolone for aspergillos

Surgery (if severe haemoptysis and localised)

Question 7

Acute respiratory distress syndrome (ARDS) def

Answer 7

acute lung injury caused by direct injury or systemic illness

increased capillary permeability and pulmondary oedema

Question 8

Causes of ARDS

Answer 8

Infection eg Pneumonia

Gastric aspiration

other forms of trauma

Question 9

ARDS sx

Answer 9

Cyanosis

tachypnoea

tachycardia

peripheral vasodilatation

bilateral fine inspiratory crackles

Question 10

Dx of ARDS

Answer 10

ALL 4 OF:

1 Acute onset.

2. CXR: bilateral infiltrates.
3. Pulmonary capillary wedge pressure (PCWP) <19mmHg or a lack of clinical CCF
4. Refractory hypoxaemia with PaO2 : FiO2 <200 for ARDS.

(Others include total thoracic compliance <30mL/cmH2O)

Question 11

Mx of ARDS

Answer 11

ITU

Supportive therapy (Respiratory/circulatory support)

Question 12

Obstructive sleep apnoea def

Answer 12

intermittent closure/collapse of the pharyngeal air- way causing apnoeic episodes during sleep.

These are terminated by partial arousal

Question 13

Obstructive sleep apnoea sx

Answer 13

Loud snoring

Daytime somnolence (sleepiness)

Morning headache

Decreased libido

Question 14

Complications of sleep apnoea

Answer 14

Pulmonary HTN

Type II resp failure

HTN

Question 15

Ix for sleep apnoea

Answer 15

Polysomnography (monitoring during sleep, diagnostic)

• SpaO2
• airflow at nose/mouth

ECG

EMG chest/abdo muscle

Question 16

Severe sleep apnoea def

Answer 16

15 or more episodes of apnoea or hypoapnoea durign 1 hr of sleep

Question 17

Rx of sleep apnoea

Answer 17

Wt loss

Stop alcohol/tobacco

Nasal CPAP during sleep (mod to severe disease)

Surgery

Question 18

Surgeries for sleep apnoea

Answer 18

tonsillectomy

uvulopalatopharyngoplasty,

tracheostomy

(to relieve obstruction for severe disease)