Resp 2 Flashcards
define COPD
chronic inflammatory airway disease characterised by FIXED AIRWAY OBSTRCTION
Classical COPD hx
SOB, wheeze
decreased exercise tolerance
chronic cough wiht clear phlegm
smoking +++
classing COPD findings on O/E
inspection: barrel chest, tar stained fingers, cyanosis, pursed lips
ascultation: wheeze, ronchi
summary of COPD mx
- conservative: smoking cessation (with nicotine replpacement), pulmonary rehab, vaccines (annual flu vaccine, one-off pneumococcal
- medical: bronchodilator therapy, mucolytuic, rescue pack, prophylactic abs, LTOT
- surgical
what mucolytic do you give in COPD
carbocysteine
whyddo you give a rescue pak in COPD
in case they become unwell, so they can start tx at home
what does a COPD rescue pack contain
antibiotics + steroid
what surgical mx of COPD
bullectomy
lung reduction surgery
lung transplant (if they stopped smoking, FEV1 <20% predicted, cor pulmonale, pulmonary HTTN)
what criteria do you use for COPD prognosis
BODE critera
Body mass high (obese)
Obstruction (low FEV1)
Dyspnoea a
Exercise capacity low (test on 6min walk)
what does FEV1/FVC need to be to dx COPD
<0.7
FEV1 % criteria for COPD category
FEV1 >80 = mild
FEV1 50-79% = moderate
FEV1 30-49% = severe
<30% = very severe
sx of asthma
dry cough
wheeze (worse at night / morning9
triggers
findings of asthma on inspection
findings of atopy e.g. eczema, nnasal polyp
ascultation of asthma
audible polyphonic wheeze (due to different diameters)
clear chest if well
asthma ix
spirometry with bronchodilator reversiibility
peak flow
FeNO (marker of airway inflammation, >40)
allergy testing (total IgE, specific IgE RAST, skin prick, eosinophil count)
holistic asthma management
conservative:
- teach / check inhaler technique
– avoid triggers (teach to identify and avoid
- monitor peak flow
- educate
- give personalised asthma action plan
- flu vaccines
medical:
- bronchodilator therapy
if very allergic > antihistamine
what is atelectasis
A POST OP COMPLICATION
BASAL alveolar collapse, causing respiratory difficulty (as the airway becomes obstructed by bronchial secretions)
how do you manage atelectasis
chest physio + deep breathing
what is ABPA
T1 hypesensisivity to aspergillys
O/E ABPA
wheeze
coarse creps
Ix ABPA
raised eosinophils, total IgE, aspergillus +ve
CXR, HR-CT (bronchiectasis)
how do you manage ABPA
chest physio
oral glucocorticoids
consdier itraconazole
what channel type does CFTR mutation in CF affect? explain what this causes
Chlorride channel - which usually excretes chloride into secretions, pulling water with it > loosening the secretions
when chloride channel is mutated > no chloride movement > limited water movement > secretions are all thick
which and when do pneumonia pts need a follow up CXR
6-12 weeks later
to ensure resolution and exclude underlying pathology
what paraneoplastic hormone productions does SCLC cause
SIADH
ACTH
LEMS
what paraneoplastic hormone production does SCC cause
PTH
ectopic TSH
what is the difference between obstructive and restrictive lung disease
obstructive = difficult to exhale
restrictive = difficult to inhale (difficulty expanding the chest, due to stiffness of lung tissue)
causes of obstructive lung disease
COPD
asthma
bronchiecasis
causes of restrictive lung disease
interstitial lung disease
scoliiosis
obestiy
neuromusk
what are the TWO requirements to diagnose asthma in an adult
FeNO test + spirometry with bronchodilator reversibility
where is aspiration pneumonia most likely to occur
Right lung base
why is aspiration pneumonia commonest in Right lung base
because the right bronchus is straightest
RF for aspiration pneumonia
swallowing dysfunctiono
reduced consciousnesss
altered neuro status
what is unusual about obs that should make you suspect an aspiration pneumonia
TEMPERATURE - they will be APYREXIC
what do you need to give to a patient with IE COPD after discharge?
5 days pred
what do you give when discharging asthma pt if no admission
QUADRUPLE inhaled ICS (instead if PO pred)
most common causative organism of infecton in BRONCHIECTASIUS
Haemophilius influenza
how do you differentiate mesothelioma from SCC lung cancer on CXR
Mesothelioma is PERIPHERAL
SCC more likely CENTRAL
how does mesothelioma appear on CXR
pleural effusion, pleural thickening
peripheral pleural plaques and peripherla mass
what is a restrictive pattern on sppirometry
FEV1/FVC >70 (increased)
TLCO (gas exchange) low
which respsiratory condition presents with a restrictive picture
pulmonary fibrosis
what makes an asthma attack near fatal
if pCO2 is RAISED
2 requirements to diagnose asthma in 5-16 yo
spirometry with broncodilator reversibility +- FeNO testing (FeNO necessary if uncertainty)
Requirements for asthma dx in adult
FeNO test > spirometri with broncodilator reversibility (may also use, PFV, BC, specialist inoput)
what is Meig’s syndorme
OPA
Ovarian tumour
pleural effusion
ascites
what is TLCO
Transfer factor of the
Lung for
Carbon
monOxide
what does TLCO essentially indicate
the amount of carbon monoxide in the blood > reflects how much oxygen is taken up by RBC
causes of raised TLCO
INCREASED PERFUSION OR DIFFUSION
e.g. exercise, polycythaemia, asthma
how do you investigate a mesothelioma
CXR > CT chest
if pleural effusion: tap, drain (MCS, buochem, cytology)
mx of mesothelioma
symptomatic tx
industrial compensation
chemotherapy or surgery where possible
POOR PROGNOSISS 12 months
mx pulmonary fibrosis
conservative: educate, pulmonary rehab, smoking cessation
medical: LTOT, anti-tussives, pirferidone, immunosuppressants
surgical: lung transplant
mx sarcoid:
NSAID
steroid
steroid sparing (methotrexate, hydroxychloroquine)
mx bronchiectasis
correct underlying cause if possible e.g. ABPA = oral glucocorticoids
conservative: physio, pulm reab
smoking cessation
prophylactic rescue packs
broncodilators
immunisatin
surgical options for COPD
- bullectomy
- lung reduction surgery
- endobronchial valve placement
- lung transplant
what can you give for smoking cessation
nicotinic replacrement therapy (ok in pregnancy)
bupropion
varencycline
when is bupropion contraindicated
in epileptics
because it may cause seizure
why is intubation a RF for aspiration
- Use of neuromuscular agents may lead to an impaired swallow
- Intubation itself can cause regurgitation
- Intubation may cause damage to the trachea/airway that can inadvertently increase the risk of gastric contents aspirating into the lung
why does a tension pneumothorax cause low BP
becuase it causes OUTFLOW OBSTRUCTION
what is acute bronchitis
inflammation of trachea + major bronchi
sx of bronchitis
cough
no sputum or sputum
sore throat, rhinorrhoea, wheeze
what findings do you have on exam for bronchitis
may have NO FINDINGS on exam
incl on ascultation of lungs
how do you manage bronchitis
fluids
analgesia
DOXYCYCLINE if:
- crp >100
consider if
- crp 20-100
- systemically unwell
- pre existing comorbidities
what is the most common organism in infective exacerbations of COPD
H influenza
typical atibiotic for atypiical pneumonia
clarythromycin or doxy
mycoplasma pneumoiae pneumonia presentation
joint pain
cold aglutinin test
erythema multiforme
SJS AIHA
legionella pnneumoniae presentation
air travel, air condiitionin, hhepatitis,
hyponatraemia, urinary angigen
