Overview of conditions Flashcards
COPD, asthma, pneumothorax, pleural effusion, empyema, resp failure, mesothelioma, pneumonia, pulmonary oedema
What does COPD stand for?
Chronic obstructive pulmonary disease
What is COPD?
A (potentially partially reversible) condition where airflow progressively reduces over time, especially in expiration (there is greater resistance).
Who gets COPD?
Smokers, people in industrialised countries (air pollution)
How do patients with COPD present?
Breathlessness - that has developed over time
Productive cough
(Wheeze)
How do patients with COPD and chronic bronchitis present?
Productive cough
Infections with purulent sputum
Increasing breathlessness
Wheeze
What is the treatment for mild COPD?
SAMA = ipratropium
What is the treatment for moderate COPD?
LABA/LAMA combo
What are the complications/types of COPD?
Emphysema
Chronic bronchitis
What is the prognosis of COPD?
It is SOMETIMES partially reversible but is mainly palliative
How do you diagnose COPD?
CXR Arterial blood gas Spirometry Pulmonary function test CT scan
What is a pleural effusion?
an abnormal collection of fluid in the pleural space
How do you diagnose pleural effusion?
Examination - dull percussion
CXR, CT scan
Pleural aspirate/biopsy - allowing biochem and cytology and culture
How do you treat a pleural effusion that isn’t malignant?
Drainage, if infectious then antibiotics and may need surgery
What is mesothelioma?
an uncommon, malignant tumour of the lining of the lung, causing pleural thickening causing the lung to shrink
Who gets it mesothelioma?
People who have been exposed to asbestos
How do patients with mesothelioma present?
Breathlessness Chest pain Weight loss Fever Sweating Cough
How do you diagnose mesothelioma?
Imaging
Pleural fluid aspiration
Biopsy
What is the treatment for mesothelioma?
Palliative: - radiotherapy - chemotherapy - pleurodese effusions Can do surgery but only in clinical trials.
What is the prognosis for mesothelioma?
Palliative
What is the treatment for malignant mesothelioma?
Drain, pleurodesis, long term pleural catheter (Palliate symptoms Repeated pleural taps Talc slurry Pleurodesis Long term pleural catheters Surgical options: abrasion, pleurectomy)
What is a pneumothorax?
Air in the pleural space
Who gets pneumothorax/more common in?
Tall thin men, smokers, cannabis users, underlying lung disease patients
How do patients with pneumothorax present?
Acute onset of pleuritic chest pain
SOB
Hypoxia
What are the signs that a patient has a pneumothorax?
Tachycardia Hyper-resonant percussion (extra hollow) Reduced expansion Quiet breath sounds on auscultation Hamman's sign (click)
How do you diagnose someone with pneumothorax?
CXR
sometimes CT as well
What is the treatment for a pneumothorax?
NO treatment if no symptoms (asymptomatic) and small OTHERWISE Oxygen Aspiration in the 2nd intercostal space if not enough time then...chest drain MAY NEED suction or surgical intervention
What is a tension pneumothorax?
When a pneumothorax is so large that it causes the lung to collapse and shift to the other side, displacing the trachea and heart
How do you diagnose a tension pneumothorax?
No breath sounds Tracheal deviation Hypotension (low BP) Raised JVP (jugular venous pressure) Reduced air entry on the affected side
What is the treatment for a tension pneumothorax?
Needle decompressions (2nd intercostal space (for emergency) vs the safety triangle)
What is empyema?
A pleural effusion but pus instead of liquid
What is the treatment for empyema?
Antibiotics (6 wks, co-amoxiclav)
Drain as needed
If doesn’t go away then surgeons remove it all and wash out the lung.
What is asthma?
A recurrent and reversible (in the short term) obstruction to the airways in response to a substance that isn’t necessarily noxious and doesn’t normally affect non-asthmatic subjects.
What is the asthma triad?
Reversible airflow obstruction
Airway hyperresponsiveness
Airway hyperinflammation
Where does asthma affect?
BOTH the large and small airways
What are the steps of the dynamic evolution of asthma?
Bronchoconstriction
Chronic airway inflammation
Airway remodelling
Inflammatory cascade
What is the initial response in asthma?
Constriction of the bronchioles = bronchospasm
What is the secondary response to asthma?
The immune response
What permanent changes can asthma cause as a result of long standing inflammation?
Thickening of smooth muscle in bronchioles
Increased secretion of mucus
Accumulation of interstitial fluid
Epithelial damage, exposing sensory nerve endings
Sub-epithelial fibrosis
Who gets asthma?
5-10% of the Population in industrialised countries.
Can be genetically predisposed
Non-smokers
Could be genetically predisposed
How do asthmatics present?
Wheezing (on expiration) Struggling to breathe Tight chest Cough Diurnal variability (bad at night and worse in the mornings)
How is asthma diagnosed?
Challenge tests
Spirometry
Peak flow (how much can blow out)
Exercise testing
What is the first line treatment for asthma?
SABA (salbutamol - blue inhaler) with an inhaled steroid (glucocorticoid - brown inhaler)
If a SABA and an ICS doesn’t work for asthma what do you add in?
A LABA (salmeterol)
If SABA, ICS and LABA doesn’t work for asthma what do you do?
Increase the dose of the ICS ADD: CysLT1 (LTRA) (Montelukast) LAMA triple therapy (tiotropium) xanthines (theophylline) cromones (cromoglycate) Anti-IgE (omalizumab) Anti-IL-5 (mepolizumab) Anti-IL4a (duplimab)
What is the difference between restrictive and obstructive lung disease, give examples?
Obstructive have problems with expiration (COPD, asthma)
Restrictive have problems with inspiration (pulmonary fibrosis)
what is the treatment for chronic asthma?
Avoid triggers
ICS
+/- non-steroidal anti-inflammatory (eg: theophylline, anti-leukotriene)
+/- LABA/LAMA to stabilise smooth muscle
what is the treatment for acute asthma?
Oral prednisolone Nebulised high dose salbutamol \+/- neb ipratropium, IV aminophylline At least 60% O2 Assisted ventilation if failing PaO2 and rising PaCO2
what is the treatment for COPD as it progresses?
LABA/LAMA combo ICS/LABA/LAMA combo PDE4 inhibitor (roflumilast Mucolytic (carbocisteine) Antibiotics (azithromycin)
treatment of acute COPD?
Nebulised high dose salbutamol + ipratropium
Oral prednisolone
Antibiotic if infectious exacerbation (amoxycillin/doxycycline)
24-28% O2
Non invasive ventilation
how do you distinguish between type 1 and 2 respiratory failure?
Type 1 is hypoxic with normal or low CO2
Type 2 is hypoxic and hypercapnic (high CO2)
what is pneumonia?
inflammation of the lung, normally due to infection, resulting in consolidation on a CXR
what are the types of pneumonia?
community acquired hospital acquired aspiration pneumonia legionella atypical/walking pneumonia
stages of lobar pneumonia?
congestion
red hepatization
grey hepatization
resolution
what are the common causes of pneumonia? (3)
strep pneumonia
haem influenzae
staph aureus
what are common community acquired pneumoniae?
mycoplasma pneumoniae
coxiella burnetiid
chlamydia psittaci
legionella pneumophilia
what type of pneumonia is more common in alcoholics?
klebsiella
what would you find when examining someone with pneumonia?
late inspiratory crackles
dull percussion
what investigations would you do for pneumonia?
CXR blood culture serology PCR ABGs Bloods Sputum
what does the CURB65 mean and what is it used for?
used to assess severity of community acquired pneumonia.
Confusion Urea (>7) Resp rate (>30) Bp (systolic <90, dia <61) 65 - age
what is pneumothorax?
air in the pleural cavity
what is pleural effusion?
fluid in the pleural cavities
what is pulmonary oedema?
fluid in the alveolar spaces
what is the general treatment for pneumonia?
amoxicillin or doxycycline if allergic
oxygen
fluids
bed rest
why can’t you use penicillin for mycoplasma pneumonia?
it has no cell wall so is resistant
what is the treatment for community acquired pneumonia?
tetracycline and macrolides
what is the treatment for hospital acquired pneumonia?
amoxicillin and gentamicin
what is the treatment for aspiration pneumonia and why>
amoxicillin and metronidazole (as need anaerobic cover as came from stomach)
what is the treatment for legionella pneumoniae?
levofloxacin
