Respiratory Flashcards
Asthma & Pathophysio
Episodic, chronic inflammatory disorder of the airways.
- Narrowing of airway → Due to smooth muscle contraction, thickening of airway wall by cellular infiltration & inflammation & secretions in lumen.
Asthma Risks
- Cold air
- Emotion
- Allergens
- NSAIDs / Beta - Blockers
- Smoking
Asthma Signs & Symptoms
- Cough (worse at night & morning)
- Dyspnoea
- Wheeze/ Chest tightness
- Spit clear sputum
Asthma Investigations
Spirometry:
→ Obstructive defect (decreased FEV1/ FVC, increased residual volume)
→ >1% improvement in FEV1 after Beta-2 agonists.
Acute Asthma Management
- Short acting beta 2 agonist = Salbutamol
- Inhaled corticosteroid = Beclometasone
- Leukotriene receptor antagonist = Montelukast
- Long acting beta 2 agonist =Salmeterol
- Maintenance & Reliever Therapy
- Long acting muscarinic antagonist = Tiotropium
- Theophylline
Asthma long- term management
Children & Adults:
SABA → SABA + ICS → SABA + ICS + LTRA → SABA + ICS + LABA
COPD
Chronic bronchitis & emphysema
COPD Symptoms & Signs
→ Productive cough (Smoker’s cough)
→ Dyspnoea
→ wheeze
→ Severe RHF → Peripheral Oedema
COPD Investigations
- Obstructive Iung disease - FEV 1 / FVC < 0.7
- CXR - hyperinflation, bullae, flat hemidiaphragm, exclude malignancy
- Spirometry
- FBC - exclude polycythaemia
Acute COPD management
Bronchodilation & Oxygen
Oral Prednisolone or IV Hydrocortisone (if severe)
CPAP before intubation & ventilation
When to give Long- term Oxygen COPD
- FEV1< 30% Predicted
- Cyanosis
- Polycythaemia
- Raised JVP
- Peripheral oedema
Pneumothorax + Risks
Collapsed lung when air enters Pleural cavity.
Risks:
- COPD
- Smoking
- Trauma
- Genetics/ Fx
Pneumothorax Symptoms
- Dyspnoea
- Chest pain
- Tachycardia
- Tachypnoea
Pneumothorax Management
Primary
- <2cm Discharge
- Aspiration
- Chest Drain
Secondary
- <1cm O2 & admit
- 1-2 cm Aspirate
- > 2cm Chest drain
Tension Pneumothorax
Tx
- Compression of lung
- RHF
Tx = Chest drain
TB
Disease caused by mycobacterium - small rod shaped acid fast bacilli
(Has waxy coating which makes gram staining ineffective)
- Caseating Granulomas
→ Active TB: Active infection
→ Latent TB: Immune system stops progression of disease - this reactivates to become 2° TB.
TB
Sx
I×
Tx
Sx: Fever, Night sweats, Weightloss, cough with/out blood, Erythema nodosum
Ix:
- Ziehl- Neelsen
- Chest X-Ray= Ghon complex, hilar lymphadenopathy, Pleural effusion
- Mantoux test
Tx: Rifampicin, Isoniazid, Pyrazinamide, Ethambutol
Cystic Fibrosis
Autosomal Recessive
Defect in CFTR gene (which regulates movement of salts across epithelial cell membranes - this means secretions are thicker & stickier)
Cystic Fibrosis Symptoms
- Neonatal jaundice
- Recurrent chest infections → cough, fever
- Struggling to cough something up
- thick greasy stools
Cystic Fibrosis Investigations
- Newborn = Heel prick
- Older = Sweat test → High chloride
Cystic Fibrosis Management
- Chest drainage
- High calorie, high fat diet
- Minimise contact with infective patients
- Pancreatic supplementation
Bronchiectasis
Permanent dilation of airways.
Bronchiectasis Causes
→ Post-infection - after TB/ Pneumonia
→ Cystic Fibrosis
→ Immunodeficiency - AIDS
→ Airway obstruction
Bronchiectasis Symptoms
→ Dyspnoea
→ Cough
→ Hamoplysis
→ Recurrent chest infections
Bronchiectasis Investigations
- Chest X. Ray: Kerby B Lines
- Coarse crackles in inspiration, wheezing
- Sputum - H.influenzae (most common)
Bronchiectasis Management & Complications
→ Physiotherapy
→ Healthy diet
→ Prophylactic antibodies
Cx: Emphysema, Pneumothorax, Resp. failure
Lung Cancer Risks
- Cigarette smoking
- Asbestos, Arsenic, Iron oxide
- Pulmonary Fibrosis
- Genetic factors
Lung Cancer Types
Non-Small cell: → Adenocarcinoma → Squamous Cell carcinoma → Large cell & differentiated carcinoma → Carcinoid tumours
Small Cell
Adenocarcinoma Lung Cancer
- Primary Lung Cancer
- Most common cell type in non-smokers
- Originates from mucus- secreting glandular cells
Squamous cell carcinoma
Most common in smokers
Arises from epithelial cells typically in the central bronchus.
Carcinoid tumours & Small cell Lung canoers
Release neuroendocrine hormones ACTH → Paraneoplastic syndrome
Cancer that Spreads to lungs from:
→ Breast → Colon → Prostate → Sarcoma → Bladder
Common site of metastasis
→ Liver
→ Bone
→ Brain
→ Adrenal glands
Lung Cancer Symptoms
Local disease: → Persistant cough → Shortness of breath → Haemoptysis → Weight loss
Metastatic disease:
- Bone pain
- Abdo. pain
- Seizures, neuro deficit
Lung Cancer Paraneoplastic changes
- Increase PTH → Hyperparathyroidism → Hypercalcaemia → Stones, Bones, Groans, Psychic moans
- Increase ADH → SIADH → Hyponatraemia → Nausea+ Vomiting → Weakness, Cramps, Tremor, Confusion
- Increase ACTH → Cushing’s Syndrome → Mood changes, Moon face, Central fat, Buffalo hump, Proximal weakness
Lung cancer Extrapulmonary manifestations
- Recurrent laryngeal nerve palsy - hoarse voice
- Superior vena cava obstruction - facial swelling, Pemberton ‘s sign
- Horner ‘s syndrome - ptosis, miosis
Lung Cancer Investigations
CXR - Opacified lesion, hilar enlargement, pleural effusion
Percutaneous or Bronchoscopic biopsy + histology
CT chest abdo pelvis
PET - CT
Bronchoscopy
Lung Cancer Treatment
Surgery= lobectomy, segmentectomy, wedge resection
Radiotherapy
Chemotherapy
Palliative care - tracheal stenting or debulking
Pleural Effusion
Collection of fluid in the pleural cavity, the space between Parietal & visceral pleura.
Pleural effusion Pathophysiology
→ Exudative = High protein count (3g/L)
Related to inflammation, causes fluid + protein to leak out of capillaries into pleural space.
Cause: Lung cancer, Pneumonia, TB, RA
→ Transudative = Low protein count (3g/L)
Related to Fluid moving across into the pleural space.
Cause: Congestive HF, Fluid overload, Hypoalbuminemia
Pleural effusion Symptoms
- Dyspnoea
- Cough
- Stony duII percussion over effusion
- Reduced breath sounds
- Tracheal deviation away from effusion
Pleural effusion Investigations
CXR
- blunting of costophrenic angle
- fluid in lung fissures
- meniscus
- Tracheal & mediastinal deviation
Pleural effusion treatment
Fluid overload or Congestive HF - Diuretic
Infective - Antibiotics
large effusions - Aspiration or Drainage
Whooping Cough
Upper respiratory tract infection caused by Bordetella pertussis (Gram -ve).
Whooping Cough Symptoms
- Mild coryzal symptoms, low grade fever
- Paroxysmal cough - Sudden & recurrent attacks of coughing
- large, loud inspiratory whoop
- apnoeas (infants)
Whooping Cough Diagnosis
- Nasopharyngeal Or Nasal swab with PCR testing Or bacterial culture
- Anti - pertussis toxin immunoglobulin G
Whooping Cough Management
- Public health should be notified
- Macrolide antibiotics such as Azithromycin, Erythromycin & Clarithromycin
- Or Co - trimoxazole
- Give prophylactic antibiotics (for vulnerable group)
Bronchiolitis
Inflammation & infection in the bronchioles
Caused by Respiratory Syncytial Virus
(usually occurs in children under 1
Bronchiolitis Symptoms
Coryzal Symptoms : Snotty nose, Sneezing, Watery eyes, Mucus in throat
- Respiratory distress = high respiratory rate, use of accessory muscles
- Dyspnoea
- Tachypnoea
- Wheeze & crackles
Bronchiolitis Airway Noises
- Wheezing
- Grunting
- Stridor
Bronchiolitis Management
- IV / NG tube fluids
- Saline nasal drops & nasal suctioning
- Supplementary Oxygen
- Ventilatory Support
→ Palivizumab (monoclonal antibody that targets RSV
Interstitial Lung Disease (ILD)
Conditions that affect lung Parenchyma (Tissue) causing inflammation & Fibrosis.
Fibrosis = lung tissue replaced with scar tissue
ILD Diagnosis
High resolution CT scan of thorax
- shows ground glass appearance
Lung biopsy & histology
ILD Management
- Home Oxygen
- Stop smoking
- Physiotherapy & pulmonary rehab.
- Pneumococcal & flu vaccine
- Lung transplant
Sarcoidosis
Noncaseating Granulomatous inflammatory condition.
Granulomas are nodules of inflammation full of macrophages.
Sarcoidosis associated diseases
Mediastinal / bilateral hilary lymphadenopathy
TB
Hodgekin lymphoma
Heart failure
Sarcoidosis tests
Histology from biopsy
FBC:
- Raised serum ACE
- Hypercalcaemia
- Raised serum soluble interleukin-2 receptor
- Raised CRP
- Raised Ig
Imaging:
chest X- Ray → shows hilar lymphadenopathy
Sarcoidosis Management
Corticosteroids
Oxygen
Lung transplant
Hydroxychloroquine
Sarcoidosis Symptoms
Lofgren ‘s Triad:
→ Erythema Nodosum
→ Bilateral Hilar Lymphadenopathy
→ Polyarthritis (joint pain)
→ Uveitis
- Weight loss
Pulmonary Hypertension
Increased resistance & pressure of blood in the pulmonary arteries.
This causes strain on the right side of the heart, this causes back pressure of blood into systemic venous system.
Causes of Pulmonary Hypertension
1) Primary P.H or Connective tissue disease e.g. SLE
2) Left Heart Failure due to MI or systemic hypertension
3) COPD
4) Pulmonary Embolism
5) Miscellaneous - Sarcoidosis, Glycogen storage disease
Pulmonary hypertension Symptoms
Shortness of breath
- Syncope
- Tachycardia
- Raised JVP
- Hepatomegaly
- Peripheral oedema
Pulmonary hypertension Investigations
ECG Changes:
→ Right ventricular hypertrophy ( large r waves on V1-3 & S waves on V4-6 )
→ Right axis deviation
→ Right bundle branch block
CXR:
- Dilated pulmonary arteries
- Right ventricular hypertrophy
Pulmonary hypertension Management
- IV Prostanoids (e.g. Epoprostenol )
- Endothelin receptor antagonists (e.g. macitentan)
- Phosphodiesterase - 5 inhibitors (e.g. sildenafil)
Pancoast Tumour
Sx
Ix
Tx
Cancer at apex of lung.
Sx: Horner’s Syndrome - droopy eyelid, Pupil constriction, lack of sweat on left side of face. (Due to compression of sympathetic nerve Pathway.), Weakness, Shoulder blade pain
Ix: Imaging & biopsy
Tx: Chemo, Radio., Surgery
Haemophilus Influenza
- Gram -ve Coccobacillus
Sx: Cough up green phlegm, Fever, malaise
Ix: CURB - 65 (Confusion, Urea, Resp. rate, BP, Age > 65)
Tx: Co- amoxiclav, Doxycycline
Pleural Effusion & Pneumothorax
Diff. in Resp. exam & Hx
Resp. Exam:
- P.E= dullness on percussion
- Pneumo.= hyper - resonant on percussion
Hx:
- P.E= Slower onset, PMH of heart failure, cancer
- Pneumo.= Rapid onset, Hx. of trauma / Pneumothorax
