Resp Flashcards
MRC dyspnoea scale
0 Not troubled by breathlessness except on streneous exercise
1 Short of breath hurrying or slight hill
2 Walks slower on level ground or has to stop when walking at own pace
3 Stops for breath after 100m or few minutes on level gorund
4 Too breahtless to leave house or SOB when dressing
GOLD staging of COPD
Mild- FEV >80%
Moderate FEV 50-80%
sEVERE 30-50%
Very severe <30%
Baseline investigations for nearly any Resp disease
1) Baseline obs
2) Bloods- FBC for anaemia, U+E and LFT for other causes, CRP for udnerlying infection
If bronc or fibrosis then AI screen too
3) CXR +ECG
4) ABG if hypoxic
5) PFTs- for restrictive or obstructive picture
6) HRCT
Also sputum culture if producing sputum
Management breakdown for resp conditions
1) Conservative/supportive
2) Medical
3) Surgical
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COPD management
1) Supportive= Smoking cessation (Support, nicotine replacmeent, buproprion/vereniciline)
Pulmonary rehabilitation
Optomise nutrition
Vaccinate- Flu and strep
2) Pharm- Inhalers as per GOLD guidelines
Carbocistine if mucus/bronchitis picture
Oral steroids for flares
Prophylactic Azithromycin if raised eosinophils
LTOT
NIV at home
3) Surgery- Lung reduction surgery but select group
Bullectomy
GOLD COPD managment
Split by Symptoms/Exacerbations
Group A= Few/few= SABA
Group B More/Few= LABA
Group C= Few/More= LAMA
Group D= More/More= LABA+LAMA.
Escalate to ICS if high eosinophils and more eacerbations (2 in a year)/ one hospitalisation.
Causes of bronchiectasis
Congenital- CF, Young’s disease, yellow nails and Kartagener’s
Infective- CHildhood TB, pertussis, measles
Mechanical- Due to masses blocking airwaves, e.g cancers, lymph nodes, granulomas
Recurrent aspiration
Weakened immune system, e.g HIV or hypogammaglobulinaemia
30% of COPD patients concurrent.
Plus ABPA
Management of Bronchiectasis
As before Supportive Medical and surgical
1) Supportive- Add sputum clearance plus PT
2) Abx fror exacerbations- may need prophylactically
Bronchodilators and steroids
Mycolytics
3) Lobectomomy/ Bullectomy if isolated to specific lobe
Lung transplant
Treat underlying cause- e.g replace Ig in hypogammoglobinaemia
Cystic fibrosis
As per bronchiectasis notes
Autosomal recessive
Due to mutation in CFTR gene- transports chloride out of cells.
If mutated is unable to so chloride remains in cells
Thus sodium moves into cells to maintain homeostasis
This increases osmotic pressure for water to move into cells
This dehydrates and increases viscosity of mucus on surface of cells. Leading to prime environment for infection and blockage
Features of CF
Resp= Bronchiectasis
GI- Meconium ileus
Pancreatic insufficiency
T1DM
Fertility- Male infertility due to lack of sperm motility
Bone- Osteoporosis
ENT- nasal polyps and sinus disease
Complications of bronciectasis
Recurent infection
Haemoptysis
Empeyema
Cor pulmonale over time
Causes of Pulmonary fibrosis
Idiopathic
Drugs- Amiodarone, methotrexate, nitrofurantoin
Connective tissue disease- RA, SLE, Systemic sclerosis
Granulomatous- TB/Sarcoidosis
Radiation
Occupational- Coal workers Pneumoconniosis, Silicosis, asbestosis
Alevolitis- EAA
Management of idiopathic pulmonary fibrosis
Supportive- Smoking cessation
PT/OT input to support
Vaccinate
Symptom relief (morphine, fans etc)
Pharmacological- 2 drugs to slow PF
Pirfenidone
Nintedanib
Surgical- lung transplant.
TB signs to look for
In Old TB look for- visible chest deformity due to thoracoplasty or plombage
Scar in suprclavicular fossa from Phrenic nerve crush
Tracheal deviation to side of old TB in upper lobe Reduced expansion Dull perfussion FIne crepitations Bronchial breathing
Side effects of TB meds
Isoniazid- hepatitis, peripheral neuropathy (B6 def)
Rifampicin- activates p450, red secretions, GI disturbance
Pyazinamide- Gi disturbance, hepatic toxicity, peripheral neuropathy
Ethambutol- Optic neuritis
