RESPIRATORIO Flashcards
COP.
Chronic Bronchitis definition:
cough for 3 months in each of 2 consecutive years
Enphysema and bronchitis x ray findings
hyperinflated lungs
flattened hemi-diaphragms **
Diagnosis of COPD is confirmed by:
spirometry
FEV1/FVC ratio < 0.7 and not reversible after admnistration of bronchodilator
COPD
Managment of stable COPD =
general + drugs
- smoking cessation
- regular excersise
- pulmonary rehabilitation
- pneumococal vacc and anual influenza vacc
- SABA
2.SABA + LABA OR LAMA - SABA + LABA + ICS
Most important intervention to prevent and limit lung damage in COPD
stop smoking
Comorbilities of COPD ( 6)
COACHD
cardiovascular
osteoporosis
anxiety disorders
Cor pulomanle ( common)
HTP
diabetes
indications for hospitalizacion for COPD
Is sputum culture recomended for exacerbations of COPD? why?
NO, positive is not indicative of infection. 50% are colonixed by HI , MC, SP/
COPD EXACERBATION MANAGEMENT - drugs
1) SABA
o
1) terbutaline
o
IPATROPIUM CONTRAINDICATED IF TAKES A LAMA
if doesnt respond 5 DAY COURSE SYSTEMIC CORICOSESTORIDS.
COPD EXACERBATION MANAGEMENT - oxygen
administrar oxigeno para mantener O2 88-92%
si no funciona non invasive ventilation
COPD EXACERBATION MANAGEMENT + signs of infection - drugs
amoxciilina
o
doxiciclina
TRIADA DE SAMSTERS
ASTHMA
ASPIRINA SENSIVITY
NASAL POLIPOS
TRIADA DE ATOPIA
ASTHMA
RINITIS ALERGICA
ATOPIC DERMATITIS
ASTHMA - espirometria dx valores de reversivilidad
FEV1 > 200ml o 12% de baseline
ASTHMA - best dx test
spirometry
fev1/fv reduced
ASTHMA - guidelines spacer in sever asthma:
<35kg <6 anos
6 puff salbutamol
2 patropium
> 6 anos
12 puff salbutamol
4 ipatropium
Cystic Fibrosis- inheritance
autosomal recessive inheritance
25% affected
50% carrier
25% unaffected
cystic fibrisis clinic - respiratory, GIT, reproductive, general
Cystic Fibrosis- dx ?
Cystic Fibrosis- most important test? gold standar
heel prick test (screening after birth)
sweat chloride test (>60 sodium chloride)
Cystic Fibrosis- managment
Bronchiectasis - image
When to suspect bronchiectasis
Bronchiectasisas - gold standar?
.
high resolution CT
Bronchiectasisas - MX - cuando dar ATB?
if >3 exacerbtions a year
Bronchiectasisas - MX
Bronchiectasisas - empirical ABX exacerbation
Non severe
- amoxicilina
severe - P aureginosa
- ceftriazona
-cefotaxime
-amoxicilina _ clavunato IV
severe + P aureginosa
- ceftazidime IV
- pip taz IV
-gentamicina IV
-tobramycina IV
-ILD investigation
ILD symptoms
INSPIRATORY CREPITATION
clubbing fingers
ILD MX
supportive
corticosteroids
lung transplantation
ILD - most common IPF (idiopatic pulmonary fibrosis)
no therapy
SARCOIDOSIS what is it? diffentiate with what from TB
abnormal nodules, granulomas appears in body tissue.
Manoux test
Sarcoidosis symptoms:
GRUELING nemotecnia
sob, chest pain, wheeze, fever, cough, malaise, arthitis, night sweats. SIMILAR TB
Sarcoidosis FEATURES MNEMOTECNIC GRUELING
IMAGE
Sarcoidosis TX
Usually spontaneous resolution
if not or worst or EYE , SNC involvement =
prednisolona
Sarcoidosis 2 types
extrinsic allergic alveolitis
extrinsic allergic alveolitis
extrinsic allergic alveolitis -question
allergic bronchopulmonary aspergillosis - predomintaly in pts with ?
asthma 1-2%
CF 10-20 %
allergic bronchopulmonary aspergillosis - dx
+ve skin test for aspergillus
blood: ige levels, eosinophilia
allergic bronchopulmonary aspergillosis - complication
bronquiectasia
allergic bronchopulmonary aspergillosis - question
DRUG INDUCED ILD
most common pathogen
in comunity , pte has been in hospital <48 horas
S P
atypical microorganisms
mycoplasman pneumonie
hamofilus influenza
legionella
chlamydophilia
CAP symptoms and signs
hospital admision red flags CAP
CRB-65 AND CURB 65
CAP dx
acute respiratory symptoms + fever + new infiltrate on C-XR (dx)
CAP TX en caso de hipersensibilidad a penicilina?
moxifloxacina 400 mg orally, and
iv whenre high severity tx
Empirical rx for Pseudo. A. in CAP
cefepime ‘O’ pip taz
+
azotrimicina IV
(shock SEPTICO)=
+ gentamicina IV
CAP TREATMENT
CAP - pneumonia in children hospitalizacion :
CAP - Neonatos etiologia ?
primeras 72 horas:
>72 h:
>1 mes :
1) maternal flora, streptococus grupo B and E choli
2) haemophilus influenzae
3) 70% viral. (30% streptococ pneumonie and mycoplasma pneumoniae=school aged*)
CAP children TX - mild and severe
mild to moderate
- amoxicilina 25mg/kg
+
azitromicina/ claritromicina / doxiciclina si (atypical bacteria sospecha)
severe
- cefotaxime IV / ceftriaxona IV
atypical pneumonia -mycoplasma dx
serum mycoplasma AG
atypical pneumonia -LEGIONELLA dx
ac cooling systems
sputum culture GOLD STANDAR
hiponatrmia
urine - alternative, rapido al dia siguiente de los sintomas detectbale x semanas
atypical pneuumonia tx
legionella question
Hospital acquired pneumonia definition?
hospital> 48 horas
Hospital acquired pneumonia most common patogen
s. pneumoniae
Hospital acquired pneumonia investigations
blood and sputum samples
- uncomon pathogens in inmunocompromised
CXR
HAP EMPIRICAL TX
LOW MODERATE
-AMOXI+CLAV orally
- - Hipersensibilidad penicilinas (moxifloxacino)
HIGH SEVERETY HAP
- PIP TAX
- Hipersensibilidad penicilinas (ciprofloxacino IV) + vancomicina
o meropenem
Lung abscess - most comon cause adults and children
adults: oral bacteria (periodontal, paranasal sinusitus, swealling disordes, GER , vomiting frecuunetly from alcohol abuse. anaeorobic bacteria and microanarophilici streptocco
children: neumonia stafilicocos o s aureus
Lung abscess- INVestigations
Blood culture - 3 sets before ATB
sputum gram stain and culture - Blood culture - before ATB
CT
images chest xray and CT scan
lung abscess - pte does not improve in 7 or 10 days ->
may need drainage procedure or surgery.
Empyema is a collection of pus in pleural cavity . most comon causative organism:
DM/alcohol abuse/ GORD : gram negative bacteria
lung abscess TX ATB
Empyema images - CT mos ideal for DX an TX
Empyema tx
ATB mismos que CAP/HAP
DRENAJE = tube thoracostomy (confirm with rx o CT)
(thoractomia last resource)
Tb. most common cause of PUO. investigations and gold test?
1) sputum testing
microscopia AFB stain (rapido)
cultivo (semanas)
2) IGRA - quantiferon GOLD TEST
3) mantoux test (false positve in BCG vacc)
TB. IGRA advantage and disadvantage
advantage: unaffected by previous BCG vacc
disadvantage: not < 2 years, prefered TST to detect it
( - cannot exclude TB ,
+ is suggestive)
TB- mantoux test - PPD . AREAS values
TB- most comon finding in RX?
cavity infiltrate upper lobbe
hiv upper or lower lobes
image TB
algoritmo TB- manejo
TB tratamiento antibiotico
COPD ESPIROMETRIA IMAGEN
ASSESING SEVERITY ACUTE ASHTMA IN CLINICAL SETTINGS
ASTHMA MANAGMENT ACCORDING TO EPISODES TABLE
CYSTIC FIBROSIS SUMMARY
Pulmonary HTN definition
Pulmonary HTN is when the mean arterial pressure >25 mmHg(Normal = 15 mmHg)
Pulmonary HTN & Cor pulmonale SIGNS
RHF signs:
*Raised JVP
*Positive hepato-jugular reflux
*Peripheral edema
*Hepatomegaly
*Loud P2 (Pulmonary HTN)
*Flow murmur –holosystolic murmur of tricuspid insufficiency
*S4
*Parasternal heave
Pulmonary HTN/ Cor pulmonale -Investigations & Rx:
Normal pH
7.35-7.45
Normal PaCO2
35-45 mmHg
Normal HCO3
22-26 meq/L
Unprocessed raw cotton + bacterial endotoxin
Byssinosis
doesn’t cause COPD
FEV1/FVC ratio
0.75-0.85
List of restrictive diseases
- pulmonary fibrosis
- pneumothorax
FEV1/FVC ratio > 0.85
Restrictive airway disease
FEV1/FVC ratio < 0.75
Obstructive airway disease
Residual lung volume increased :
obstructive disease
Residual lung volume decreased
restrictive disease
CURB-65 Score
– Confusion of new onset.
– Urea greater than 7 mmol/l.
– Respiratory rate of 30 breaths per minute or higher.
– Blood pressure less than 90 mmHg systolic or diastolic blood pressure 60 mmHg
or less.
– Age 65 or older
CURB-65 score equal or >3, an
inpatient treatment for community acquired pneumonia is necessary.
Difference between crackles associated with alveolar fluid vs interstitial lung disease .
Egophony
Crackles (or rales) are predominantly heard during inspiration and are considered a sign of alveolar or interstitial lung disease. A variety of diseases cause crackles including pneumonia, pulmonary edema, and any cause of interstitial lung fibrosis. Some clinicians attempt to distinguish between the “wet” crackles of pulmonary edema or pneumonia compared to the “dry” crackles of interstitial lung disease. However, this is not a reliable finding. A better way to differentiate between the alveolar and interstitial causes of crackles is to test for the presence of egophony. When alveolar filling is present, the “EEE” sound will be heard as a “AH” sound; however, in interstitial lung disease the “EEE” sound will be preserved. Whispered pectoriloquy will also be intensified in alveolar filling processes, but not interstitial lung disease.
The lack of breath sounds is important to note, but can be caused by many factors including severe bullous lung disease, emphysema, pneumothorax, or pleural effusion.
Primary spontaneous pneumothorax CRITERIA
*No respiratory finding on exam except those related to the pneumothorax
*There is no history of lung disease
*Thereisnochest- Xrayfind ingotherthanthoserelatedtothe pneumothorax
*The patient is young<or=50
*There is no significant history of smoking
PNEUMOTHORAX
Diagnostic testing: WHICH IS BEST INITIAL AND MOST ACCURATE TEST?
Chest radiograp –> Bestinitial test
Computed tomography(CT) ->MOST ACCURATE
PNEUMOTHORAX
The differential diagnoses of pleuritic pain include the following 5Ps:
1Pulmonary embolism
2Pericarditis
3Pneumonia
4Pneumothorax
5Pneumomediastinum
