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
Member this!
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
Extrapulmonary TB
CNS= TB meningitis, Tuberculoma Pericadial TB Pott's disease in spine GI TB Bladder TB or prostatistis Scrofula- LNs Miliary TB
Causes of Pleural effusion
Transudate- CHF ESRF Cirrhosis Meig's syndrome Hypoalbuminaemia Hypothyroidism
Exudate- Infection Malignancy Inflammation Trauma Infarction (PE)
Drugs- in drug induced lupus (hydralazine, procainamide)
Methotrexate
Nitrofurantoin
Bromocriptine
Complications of draining effusions
Pneumothorax
Haemothorax
Intravascular collapse or re-expansion pulmonary oedema if drained too quickly.
Light’s critera
If protein >35 = exudate
<25 = transudate
In between apply lights criteria. If one of the below reached then is an exudate
Fluid albumin:serum albumin >0.5
Fluid LDH: Serum LDH= >0.6
Fluid LDH is >2/3rds of upper limit of serum LDH
OSA and pickwickian syndrome
OSA= presence of an increased number of breathing cessations (apnoeas) and reduction in tidal volume)
Pickwickian syndrome is this plus hypercapnea and a restrictive defect in PFTS
Investigations
Use Epworth sleeping scale to score severity of symptoms
Overnight polsomnography (Sleep study) is gold standard which assesses EEG, Resp effort, pulse oximetry and ECG
Diagnosis is made by measureing severity of sleep disordered breathing which is Respiratory disturbance index (RDI)
Number of events occuring per hour of sleep.
>5= abnormal
5-15= MILD
15-30 moderte
30+=severe
Then do concurrent CPAP to set suitable settings
Also baseline tests of FBC (for polycythaemia) TFTs Morning ABG CXR ECG Echo
Managment of OSA
Weight loss Stop smoking and ETOH consumption CPAP- 1st line treatment LTOT if indicated Oral appliances to alter position of jaw and palate Surgery but rarely needed
Complications of OSA
Arrhythmias HTN MI Stroke Obesity hypoventilation syndrome Pulomanry Hypotension
Lung Cancer Paraneoplastic syndromes
MSK= -Hypertrophic pulomonary osteoarthropathy- clubbing plus paina nd swelling at wrists and ankles. Mainly with Squamous cell and adenocarinoma
-Polymyositis
Neurological- Lambert Eaton Myasthenic syndrome- Slowly progressive weakness. Improves with exercise.
- Proximal myopathy
- Peripheral neuropathy
- Cerebellar syndrome
Endocrine- Hypercalcaemia with squamous cell carcinoma producing PTHrP
- SIADH- SCLC
- ectopic ACTH secretion
- HCG secreting tumour= gynaecomastia
Dermatoliglcal- Thrombopplebitis migrans
-Dermatomyositis.
Common sites for lung cancer mets
Liver
Bone
Brain
Adrenal glands
Difference in NSCLC and SCLC
Non small cell lung cancer can be managed surgically if caught at an early enough stage and in a patient with good lung function (FEV >2L)
Use Radical radiotherapy and chemotherapy
In Small cell lung cancer- treat with radiotherapy and chemotherapy as always too widespread to manage surgically.
Causes of SVC obstruction
1) Lung cancer
2) Lymphoma
3) THymoma
4) Large LNs mets
5) THombosis due to central lines and such
6) Post radiation fibrosis
Causes of cor pulmonale
COPD Interstitial Lung disease OSA Hypoventilation disorders Recurrent small VTE
Can also be split into; 1) Pulmonary arterial HTN (aka idopathic pul htn)
2) Pul venous HTN due to Left sided heart disease
3) Pul HTN due to hypoxamia
4) Pul HTN due to chornic VTE
5) Pul HTN due to miscallaenous disorders (e.g sarcoid)
