important! Flashcards
Why will we hear crackles at the beginning of inspiration in patient with chronic bronchitis?
Due to opening of small collapsed airways
Hypoxia effect on vessels
vasoconstriction
Hypoxic vasoconstriction in lungs will lead to
Increase pulmonary vascular resistance and pulmonary HTN
Types of emphysema
Centriacinar- Smoking
Panacinar- a1-AT deficiency
Paraseptal
Chronic bronchitis definition
Productive cough on most days of the week for at least 3 months with total duration of 2 years
mMRC measures
Breathless scale 0-4
3 steps of combined COPD asessment
Spirometry to confirm diagnosis
Assessment of airflow limitation
Assessment of symp./risk of exacerbations
COPD non-pharmacological treatment
Smokin cessation Smoke prevention Regular exercise Rehabilitation Oxygen therapy NIV (CPAP) Lung Volume Reduction Therapy LuTx
Oxygent therapy- How long per day and what is the indication?
minimum 15h/d
PaO2 < 60 mmHg and <88% O2 saturation
COPD pharmacological treatment other than LABA LAMA ICS..
Influenza vaccine
Mucolytics
AB
Define COPD exacerbation
Acute worsening of respiratory symp. that result in need of additional therapy
How to assess the severity of an exacerbation?
Arterial blood gass
CXR (for alternative diagnosis)
ECG
WBC count
Systemic corticosteroids- What will we give, how much and for how long?
Prednisone
40 mg
5 days
Asthma severity classification
Mild intermittent
Mild persistent
Moderate persistent
Severe persistent
Special feature of PEF?
Daily variability > 20%
Anti IgE drug
Omalizumab
Clinical features of asthma exacerbation
Too breathless
Respiratory rate > 25/min
HR > 110 BPM
PEF < 50% of predicted normal or best
PEF value in life threatening situations
< 33%
Immediate management of asthma exacerbation
Oxygen
High dose Albuterol+Ipratropium
High dose systemic steroids
asthma exacerbation respiratory medicine lecture notes what to add
Nebulized ipratropium
IV MgSO4
IV bronchodilators
Classification of pneumonia (pathology)
Bronchopneumonia
Lobar
Interstitial
Stages of pneumonia (4)
- Congestion
- Red hepatization
- Grey hepatization
- Resolution
Grey hepatization is due to
Break down of RBC
Auscultation of pneumonia
Bronchial breathing sounds
Tectile fermitus is pneumonia
Increased due to lungs being filled with fluids
Bronchopneumonia on CXR
Patchy areas spread throughout the lung
Interstitial pneumonia on CXR
Spread pattern throughout, especially concentrated in the perihilar regions
Pneumonia specific pathogen - How can we recognise it?
Sputum culture Blood culture Pleural fluid Antigen detection Serological test
Which AB can we start if we suspect interstitial pneumonia?
Macrolides - Clarythromicine
Hospital Aquired Pneumonia definition
Pneumonia that developes 48h post hospital admission
Lung abscess are caused mainly by which bacterias?
Fusobacterium Prevotella Strep Staph Klebsiella
When can we say that a patient is free of TB infection?
3 sputum samples are negative
Treatment for TB lasts
6-24 months
ILD of known etiology caused by exposure is devided into 2
Organic- Hypersensitivity pneumonitis
Inorganic- Silicosis, Asbestosis
Inorganic substances
Silicosis
Asbestosis
Berylliosis
Coal worker’s lung
IIP is devided into
Idiopathic Pulmonary Fibrosis
Usual Interstitial Pneumonia
Acute Interstitial Pneumonia
CXR in ILD
Reticular
Diffuse / Nodular bronchovascular
Reticulonodular or infiltrative pattern
In IIP which is the most common?
IPF
IPF drug
Nintedanib
Sarcoidosis is most common in which populatons?
African american
Scandinevian
Sarcoisosis symptoms
Hypoxemia
Heart blocks
Bells palsy
Erythema nodosum
Sarcoidosis on HRCT
Ground glass appearance
OSA definition
Total cessation of airflow > 10 sec
Hypopnea=
shallow breathing or an abnormally low respiratory rate
Apnea-Hypopnea Index is used to
Indicate the severity of sleep apnea
AHI values
Normal: AHI<5
Mild sleep apnea: 5≤AHI<15
Moderate sleep apnea: 15≤AHI<30
Severe sleep apnea: AHI≥30
Causes for OSA
Obesity Short neck Alcohol Diabetes Tonsillitis Macroglossia Large uvula Chronic URI
Name of an intra-oral device that is given to OSA patients
Mandibular Advancement Device
Why give CPAP/BPAP in OSA?
Airflow can prevent pharyngeal collapse
