Respiratory Flashcards
COPD symptoms and ix findings
Chronic productive cough Hyperinflated barrel chest JVP Central cyanosis Weight loss Pursed lip breathing SOBOE Cor pulmonale FEV1:FVC < 0.7 is OBSTRUCTION Cxr: Hyperinflation and increased pulmonary vasculature
Causes of COPD
Smoking Air pollution Low birthweight and socioeconomic class Dust exposure Alpha1 antitripsyn
Triggers for flare if COPD
Bacterial and viral infection
Smoking
Pathophysiology of COPD
Trigger- inflammatory response narrow airways Increased goblet cells Mucous production increases Blood vessels change Leads to- damanged elastin, broken alveolar, increased obstruction due to mucus and goblet cells and ciliary dysfunction
Exacerbation of COPD SX
Increases SOB
Increased cough and sputum
Chest tightness
Acute confusion
Ddx for copd
Heart failure Asthma Bronchiectasis Cancer ILD
Mantoux testing
screening tool for patients w/o BCG vaxx
skin rx >15mm in diameter ==> ACTIVE TB
skin rx 6-15mm in diametter ==> refer for cxr
Latent TB
positive mantoux + normal cxr + no clinical findings
tx; 6 months of isoniazid + pyridoxine OR 3 months or isoniazid + rifampicin
BCG vaxx
given to Mantoux neg patients
- not received vaxx yet
- 35yr and younger
- 36yr and older and healthcare/lab worker
Types of TB
primary : no immunity to tb
post primary : bacterial spread by blood + reactivation of primary tb
miliary: widespread infection via blood steam
RF of TB
low income homeless alcohol HIV + immigrants from areas with high tb DM vit D defiency
Causes of TB
BACTERIA: mycobaterium tuberculosis
Pathophysiology of PRIMARY TB
GHON complex: a single tubercli in macrophage focus found in the middle/lower zones of lungs
some bacilli travel via the lymphatics to the drainage lymph nodes which undergo caseation
GHON complex and lymph nodes calcify
specific immunity develosp ==> MANTOUX positive
Pathophysiology of Post-primary TB
found in LUNGS, BONES, LYMPH NODES
reactivation due reduced host immunity
Pathophysiology and sx of Miliary TB
Bacilli travel via blood stream and affect whole body
Usual symptoms + hepatosplenomegaly + choiroidal tubercules
Symptoms of TB
persistent cough blood in sputum pneumonia weight loss night sweats lymphadenopathy meningitis cold abscess
Sx of TB in CHILDREN
non-specific : fatigue, poor weight gained, persistent fever
DX of TB
CXR: bilateral patchy shadow in upper zones, volume loss, cavitation, fibrosis
3 respiratory samples:
1. AAFB using Ziel neelson/ auramain stain and smear
2. lowenstein jensen medium culture for 6 weeks
3. PCR for tuberculosis DNA
bronchoscopy and lavage
X-rays/US/ECHO/CT/
Aspiration: pleural effusion/
Biopsy: LN/liver
Screening of TB
contact with active laryngeal/pulmonary TB
immunocompromised
NHS employees
New entrance to UK from high risk countries
Ptx starting on ant-tumour necrosis -alpha
TESTS: mantoux, IGFR assay
Mx of TB -
RIPE Rifampicin x 6 Isoniazid x 6 Pyrazinamide x2 Ethambutol x 2 second line agents: ethionamde, propionamde, streptomucine, cycloserine DOT if poor compliance
