resp stuff to memorise Flashcards
define bronchiolitis and extra info
inflam of bronchioles, RSV, common in winter, infants under 1
coryzal symptoms ? (bronchiolitis)
runny/snotty nose
sneezing
mucus in throat
watery eyes
how to monitor resp distress
capill blood gas (arterial to look at blood gas)
manage bronchiolitis
supportive
adequate intake - nasogastric tube, orally, IV fluids
saline nasal drops to clear way for feeding
suppl oxygen
ventilation if severe
what you’d hear from chest in bronchiolitis
whistling due to airway narrowing
wheeze, crackles, harsh breath sounds
what causes grunting and stridor
grunting - exhaling with glottis closed
stridor - high pitch inspiration due to upper airway obstruction
prophylaxis for bronchiolitis
monthly injection of palivizumab - monoclonal antib targets RSV - passive protection (doesnt stim immune sys like a vaccine would)
3 brackets of causes of bronchiectasis - 2 causes of each
chronic inflam: - CF auto recess - mucus too sticky/hard to move - prim ciliary dyskinesia auto recess - cilia move abnormally airway obstruct: - tumour - lodged foreign object infection: - TB - haemophilius influenzae - staph aureus
define bronchiectasis
chronic inflam and dilation of bronchioles = destruction of airways
damage to mucocilliary ‘elevator’ = mucus and bacteria accumulate - excessive mucus production
how is mucus normally cleared
mucocilliary ‘elevator’ moves it up and out of resp tract via cilia
cl- channels pump out ions which attracts water = keeps them lubricated/moving
sign of long term hypoxia
finger clubbing
signs/symptoms of bronchiectasis
wheeze prod cough fouls smelling mucus haemoptysis dyspnea recurrent pneumonia basilar crackles
diag bronchiectasis
CT scan - will show dilation
CXR
sputum culture
spirometry - reduced ratio aka obstruction
treat bronchiectasis
bronchodilator eg. beta 2 agonist
inhaled corticosteroid
atib for pneumonia
percussion/postural drainage
pleural effusion?
collection of fluid in pleural cavity (between lung and chest wall)
exudative?
high protein count above 3g
protein moves out of tiss into pleural space
transudative?
low protein count below 3g
fluid moving across pleural space
pres of pleural effusion
SOB, dullness to percussion (no air), reduced breath sounds, tracheal deviation - fluid has pushed mediastinum
investigate pleural effusion
CXR - blunting of costophrenic angle, mediastinal and tracheal deviation
pleural fluid aspiration/chest drain - can check protein
small vs large pleural effusions managements
conservative if small
if large: aspirate (needle thru chest wall which may need to be repeated) or drain (prevent reoccurence)
empyema - what is it, investig, treat?
infected pleural effusion eg patient has improving pneumonia but ongoing fever
aspirate would show pus, low ph, low gluc, high LDH
treat w chest drain and beta lactam with beta lactamase inhib eg. amoxicillin and Clavulanic acid
3 key conseq of CF
thick pancreatic and biliary secretions - lack of digestive enzymes eg. pancreatic lipase due to blockage of ducts
low volume thick airway secretions - reduced airway clearance, bacteria colonisation, susceptible to airway infections
congenital bilateral absence of vas deferens in men - sperm cannot get into ejaculate so infertility
lack of pancreatic lipase presence in CF leads to…
malabsorption = weight loss, short AKA FTT, loose greasy stool
clinical signs of CF
nasal polyps, finger clubbing, crackles, wheezes, abdo distention
microbes that colonise in CF
staph aureus, haemophilus influenzae, pseudonomas
prophylactic treatment in CF
flucloxacillin for staph aureus
CF patients screened for which linked conditions
DM, osteoporosis, vit D def, liver failure
avg life expectancy for CF
47
manage CF
chest physiotherap exercise high cal diet CREON tablets for pancreatic insuff nebulised DNAse salbutamol
sarcoidosis?
granulomatous (macrophages) inflam condition
typical sarcoidosis patient
young adult OR 60 black woman dry cough SOB nodules on skin
tests in sarcoidosis
screening test - serum ACE
Raised serum soluble interleukin-2 receptor
raised calcium
raised CRP
raised immunoglob
CXR - bilateral hilar lymph
GOLD histo biopsy showing non-caseating granulomas with epithelioid cells
fatal comp of sarcoidosis
arrythmias
CNS disorder
manage/treat sarcoidosis
no symp = no treat
1st oral steroids and bisphos
2nd immunosupp eg. methotrexate
severe - lung trans
right ventricular hypertroph on ecg
r.axis deviation
rbbb
s waves
large r waves
causes of pul hypertension
SLE LHF COPD pul emobolism sarcoidosis
primary treatement for pul hypertension
IV prostanoids
endothelin receptor anatgonists
phosphodiesterase-5-inhib
treat pneumothorax
>2cm/SOB = aspiration (if fails twice then chest drain) tension = large bore cannula into 2nd intercostal space at midclavicular line
tension pneumothorax
one way valve - air gets in but not out, increasing pressure, mediastinal deviation, cardioresp arrest
investig pneumothorax
erect CXR 1st
CT thorax GOLD
most common place for TB
lungs bc high o2 supply
vaccine for TB
BCG - intradermal, live attenuated
protection against severe & complicated TB
less effective against pul TB
test before TB vaccine
Mantoux needs to be neg, text for hiv, eliminate live vaccine risk
at risk ppl for tb
neonate w/ fam hist or in area
unvacc older kids or have arrived from tb country
healthcare worker
latent tb treat
isoniazid
rifampicin
active/acute tb treat
rifampicin isoniazid pyrazinamide ethambutol \+pyridoxine vit b6 to reduce periph neurop
asbestos is…
oncogenic
fibrogenic
= adenocarcinoma, mesothelioma, lung fibrosis
high res CT thorax of ILD would show
ground glass appearance
invest for hypersen penumonitis
broncheolar lavage - bronchoscopy washing up airways with fluid = high lymphocytes and mast cells
treat whooping cough
ezithromycin (or cotrimoxazole if not)
cause of whooping cough
bordetella pertussis
pneumonia on CXR
consolidation
treat pneumonia
amoxicillin
clarithromycin
auscultation of pneumonia
bronchial breath sounds
focal coarse crackles
dullness to percussion
fungal pneumonia treatment
co-trimoxazole
2 red flag symp for lung cancer
finger clubbing
lymphadenopathy =urgent CXR
cxr in lung cancer
hila enlargement
peripheral opacity
pleural effusion
invest lung cancer
urgent cxr
then staging contrast enhanced CT
then bronchoscopy and biopsy for diag
