Resp Theory Flashcards
Common variable immunodeficiency (CVID)
-about
-complications
.recurrent infection
.chronic lung disease
.autoimmune disease
.gastrointestinal disease
.increased malignancy risk
-investigations
.bloods
.lungs
.gastro
.CNS
ABOUT.
Impaired B-cell -> impaired immunoglobulin production
Genetic
20-45yo
COMPLICATIONS.
-recurrent infections (Hib, strep, staph, moraxella but rarely, PJP, mycoplasma pneumoniae).
. sinopulmonary infection (lead to bronchiectasis)
. otitis
. bacterial meningitis
. sepsis
. septic arthritis
. skin infections
-chronic lung disease
. restrictive (interstitial pneumonitis or organising pneumonia)
. obstructive (bronchiectasis)
. granulomatous disease (ground-glass)
. primary malignancy (lymphoma) or mets
-autoimmune disease
. immune thrombocytopenia
. autoimmune hemolytic anaemia
. RA (negative Ab)
. SLE
. Sicca syndrome
. Sjogren’s syndrome
. autoimmune thyroiditis
. vitiligo
-gastrointestinal disease
. infective / inflammatory diarrhoea
. gastric ca
. liver dx
. hepato/splenomegaly
. lymphadenopathy
-increased risk of malignancy
INVESTIGATIONS.
-bloods (FBE, coombs, BM bx/b2 microglobulin, immunoglobulins, flow cytometry, vaccination response)
-lungs (sputum, PFT with spirometry, gas transfer and lung volumes, ABG, CXR, HRCT, echo, bronchoscopy, CT pan scan and lymph node bx for ?lymphoma)
-gastro (upper endoscope ?h.pylori, gastric ca and lower endoscope).
-CNS (MRB, CSF)
Tuberculosis
Diagnosis
Risk factors: immigration, immunosuppression (HIV, alcohol, malnutrition)
Progress
Investigations
-sputum bronchoscopy
-quantiferon
-CXR
-mantoux
-fasting BSL
-HIV test
Management
-public health
-meds: isoniazid, rifampicin, ethambutol, pyrazinamide
-SE of meds: hepatitis, vision/hearing impairment.
Complications
-lungs
-lymphadenopathy
-genitourinary tract
-bones
-pericarditis
-abdominal TB
Sarcoidosis.
-about
-complications
-dx
-tx
About:
20-40yo
Exaggerated T-helper response
Granuloma and fibrosis
Lymphadenopathy
Constitutional symptoms, facial nerve palsy, parotid enlargement, anterior uveitis, hypercalcemia, arrythmias, arthralgia, erythema nodosum.
Complications:
Skin
ILD: PFTs
Eye (uveitis, sicca)
Nasal
Larynx (hoarse voice, stridor)
Renal (stones)
Neurological: facial n palsy, psychiatric
Arthralgia
Cardiac conduction: MRI/PET
Pregnancy
GI dysphagia (hilar lymphadenopathy), hepatosplenomegaly
Dx: CT, LN/lung bx, ACE level, ESR, hyperglobulinemia, CXR
Tx: steroids, steroid-sparin (MTX, AZA, chlorambucil, HCQ), infliximab.
Pulmonary hypertension
mean PAP >25
PAW < 15 (not left sided)
PVR >3 wood units
Bloods: FBC, UnE, LFT, BNP
HIV, ANA, eNA
Echo: dilated RV, TR, RVSP >40
HRCT, PFT, VQ scan
6MWT, echo
RHC +/- vasodilator challenge
Classification:
1. pulmonary arterial hypertension
2. left heart disease
3. lung disease or hypoxia
4. arterial obstruction: (surgery = pulmonary thromboendarterectomy OR balloon pulmonary angioplasty, transplant, lifelong anticoagulation) or PVOD
5. unclear / multifactorial
Tx:
Vasoreactive -> CCB.
Non-vasoreactive.
-phosphodiesterase 5 inhibitor (sildenafil)
-endothelin receptor antagonists (bosentan, ambrisentan)
-prostacyclin agonist (iloprost, epoprostenol)
Avoid pregnancy.
- high risk
- contraception
- abortion
- stop ERA and warfarin
- pre-term delivery, medicalised pregnancy
Oral anticoagulation.
O2 and diuretics.
Anaemia / iron deficiency.
Pulmonary rehabilitation.
Immunisation.
Epidural anaesthesia.
Surgery (PEA and BPA) for CTEPH.
Lung transplant.
BODE index
Body mass index
Obstruction (FEV1)
Dyspnoea scale (mMRC)
Exercise tolerance (6MWT)
mMRC scale
Modified Medical Research Council
0 - only on strenuous exercise
1- hurrying UP a hill
2- slower than other people same age
3- stops after 100m or few min
4- too breathless to leave home
WHO functional class
1 symptom free
2 sx with normal activity
3 sx limiting normal activity
4 sx at rest
Obesity hypoventilation
CO2 elevated during or immediately after sleep
BMI >35
CPAP or BiPAP
