resp DPD Flashcards
A 45 year old patient complains that they cough up a pot of purulent sputum every day. Examination reveals course crackles. What is the likely diagnosis?
bronchiectasis (bronchi dilation)
Congenital causes of bronchiectasis
Cystic fibrosis Young's syndrome Primary ciliary dyskinesia Kartagner's syndrome Ig deficiency
Acquired causes of bronchiectasis
Infection (pertussis, bronchiolitis, pneumonia, ABPA, post-measles, rarely TB and HIV)
Bronchial obstruction (tumours, foreign bodies)
Inflammation (RhA, UC)
Hypogammaglobulinaemia
Low PO2 <8kPa, normal PCO2 suggests
Type I resp failure - hypoxaemic
Caused by V/Q mismatch including pneumonia, pulmonary oedema, PE
Low PO2 <8kPa, high PCO2 suggests
Type II resp failure - hypercapnic
Caused by alveolar hypoventilation ±V/Q mismatch in pulmonary disease e.g. COPD, drug overdose, severe asthma, NMJ disorders.
Isoniazid used in pulmonary TB can lead to peripheral neuropathy because…
it depletes vitamin B12
ACEi electrolyte side effect
Hyperkalaemia
Salbutamol electrolyte side effect
Hypokalaemia
COPD step wise treatment
- SABA
- SABA + LABA or only LAMA
- SABA + LABA + ICS or only LAMA
- All
Mucolytic therapy e.g. carbocysteine can be given to…
COPD patients with chronic productive coughs
Oxygen therapy is given to those with…
PaO2 <7.3kPa on room air during clinical stability OR
PaO2 7.3-8kPa and one of: nocturnal hypoxaemia polycthaemia peripheral oedema pulmonary HTN
Exacerbation of COPD, what is the most appropriate initial test?
ABG
Cavitating lung lesion on CXR could be…
Infection (TB, staph, Klebsiella in alcoholics)
Inflammation (WG, RA)
Infarction (PE)
Malignancy
Acute onset SOB (secs) DDx
Pneumothorax (alveoli)
PE (venous)
Foreign body (airway)
Anxiety
Sub-acute onset SOB (mins-hours) DDx
Airways (inflammation/obs)
Infection (pus)
Acute heart failure (fluid)
Chronic onset SOB (days/weeks) DDx includes acute/sub-acute onset recurrences and also…
Interstitial lung disease Malignancy Large pleural effusions NMJ e.g. GBS Anaemia Thyrotoxicosis
Pulmonary embolism Rx
Haemodynamically stable: LMWH (tinziparin), then confirm diagnosis with CTPA, add warfarin until INR 2-3.
Haemodynamically unstable:
Thrombolysis
Pulmonary embolism CXR sign
Wastemarker’s sign
A darker area - pulmonary oligemia.
50yr old female with progressive SOB has a dry cough and clubbing. Her FEV1/FVC ratio is >70%. What are the DDx?
Idiopathic fibrosing alveolitis
Connective tissue disease
Asbestosis
(FEV1/FVC ratio shows restrictive disease)
Restrictive disease Clubbing Dry cough Bibasal fine late inspiratory creps Raised JVP Likely diagnosis?
Interstitial fibrosis
n.b. may present with raised JVP due to pulmonary hypertension but the diagnosis will not be CCF.
Which causative organisms of pneumonia will be detected on a URINE ANTIGEN test?
Legionella pneumoniae Strep pneumoniae (this sometimes presents on blood cultures)
Erythema multiforme can be caused by which organism
Mycoplasma pneumonia
Erythema multiforme = target lesions
Primary pneumothorax Rx
<2cm - conservatively
>2cm - aspiration (±chest drain)
ANALGESIA
Secondary pneumothorax Rx
<2cm - aspiration
>2cm - chest drain
ANALGESIA
Tuberculosis Rx
6 month Abx course Rifampicin - 8 wks + 16wks Isoniazid - 8 wks + 16wks Pyraminazide - 8wks Ethanmbutol - 8wks Give pyridoxine throughout
Rifampicin (TB medication given for 8+16weeks) side effects
Orange body fluids
Hepatotoxicity
Fever
ENZYME INDUCER
Isoniazid (TB medication given for 8+16weeks) side effects
Hepatotoxicity
Peripheral neuropathy (vit B def)
Sideroblastic anaemia
Pyraminazide (TB medication give for 8weeks) side effects
Hepatotoxicity
Increased urate/arthralgia
Pruritis
Sideroblastic anaemia
Ethambutol (TB medication given for 8weeks) side effects
Optic neuritis
Peripheral neuropathy
Red-green colour blindness
Vertical nystagmus
