respiratory Flashcards
define chronic with regards to chronic bronchitis
- potential DDx for chronic cough?
a productive cough for 3 consecutive months across 2 consecutive years
DDx - bronchiectasis
COPD: causes?
smoking!!
alpha-1-antitrypsin (inhibits neutrophil elastases)
other: 4 Cs
Cadmium (used in smelting)
Coal
Cotton
Cement
what could be the potential cause in a young pt presenting with features of COPD
alpha-1-antitrypsin deficiency
describe how COPD can lead to cor pulmonale
- Chronic hypoxia causes vasocontriction of pulmonary arteries
- This leads to elevated pulmonary arterial pressure.
- The chronic elevation of pulmonary arterial pressure subsequently leads to right heart failure
How does Cor pulmonale present
This presents with classical features including raised JVP, cyanosis, ankle (peripheral) oedema, left parasternal heave due to RV hypertrophy and hepatomegaly
signs of COPD
tachypnoea
barrel chest
coarse crackles
hyperresonance on percussion
pursed lip breathing
loss of cardiac dullness
tar staining
peripheral cyanosis
symptoms of COPD
cough (often productive)
dyspnoea (on exertion)
wheeze
general management of COPD
smoking cessation
ANNUAL influenza vaccine + ONE OFF pneumococcal vaccine
pulmonary rehabilitation (> MRC grade 3 - “functionally disabled” )
what are the asbestos-related lung diseases (5)
pleural plaques
pleural thickening
mesothelioma
asbestosis
lung cancer
pleural plauques
-benign/malignant
-latent period
benign and DO NOT undergo malignant change
latent period 20-40 yrs
seen as discrete circumscribed areas of fibrosis on the parietal pleura
almost always asymptomatic
do not impair lung function
pleural thickening
diffuse pleural fibrosis that follows the pattern of haemothorax or empyema
mesothelioma
- where does it metastasise to
Malignant disease of the pleurathat commonly metastasises to the contralateral lung and peritoneum, affecting the RIGHT LUNG more than the left
does mesothelioma develop with long/short term exposure
short term (around 40 yrs)
management of mesothelioma
palliative chemo
mesothelioma - features
progressive dyspnoea
chest pain
pleural effusions
asbestosis
-which lung lobes are affected
- latent period
- presentation
-treatment
LOWER lobes (opposites - ceiling)
15-30 yrs
dyspnoea, reduced exercise tolerance
conservative
what is the relationship between asbestos and cancer
Asbestos exposure is a risk factor for lung cancer and also has a synergistic effect with cigarette smoke.
what is Lofgren’s syndrome
acute form of the disease characterised by bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia
features of acute sarcoidosis
swinging fever
polyarthralgia
erythema nodosum
features of insidious sarcoidosis
cough (non-productive)
fatigue
dyspnoea
Sx of sarcoidosis
- cough (non-productive)
- dyspnoea (gradual onset)
- polyarthritis
- uveitis
- red eye
- photophobia
- constitutional symptoms
- swinging fever
- fatigue
- weight loss
signs of sarcoidosis
cervical and submandibular lymphadenopathy
erythema nodosum
lupus pernio
what is sarcoidosis
Sarcoidosis is a multisystem disorder of unknown aetiology characterised by non-caseating granulomas.
What is Heerfodt’s syndrome
Heerfordt’s syndrome: causes facial nerve palsy, fever, uveitis and parotitis
Indication for steroids in Sarcoidosis
stage 2/3 x-ray stage AND symptomatic
ACE levels in sarcoidosis
elevated (used to monitor disease)
Ca levels in sarcoidosis
HYPERCALCAEMIA (macrophages have 1 alpha hydroxylase activity which converts vit D to its active form)
respiratory complications of sarcoidosis
pulmonary HTN
resp failure
UPPER zone fibrosis
cardiovascular complications of sarcoidosis
cor pulmonale
heart block
CNS complications of sarcoidosis
cranial nerve palsies e.g. facial nerve, meningeal disease
occular complications of sarcoidosis
keratoconjunctivitis sicca, uveitis
symptoms of bronchiectasis
productive cough - often producing copious amounts of sputum
dyspnoea
haemoptysis
signs of bronchiectasis
clubbing
auscultation
coarse crackles on inspiration
high-pitched squeaking on inspiration
rhonchi (snoring like low pitch)
infectious causes of bronchiectasis
TB, whooping cough, measles, pneumonia
congenital causes of bronchiectasis
CF, Kartagener’s syndrome, Young’s syndrome, Yellow nail syndrome
allergic and inflammatory causes of bronchiectasis
RA, IBD, ABPA, Sjogren syndrome
most common cause of bronchiectasis
idiopathic
what is the gold standard Ix for bronchiectasis and what does it show
HRCT - shows tram track lines and signet ring pattern
first line management of bronchiectasis
identify the underyling cause
chest physiotherapy (draining mucus) - e.g. inspiratory muscle training
annual flu vaccine
Abx for acute exacerbations + long-term rotating antibiotics in severe cases
*AA Abx - Amoxicillin (acute like pneumonia) → Azithromycin (longer name - long-term for recurrent episodes)
2nd line Mx of bronchiectasis
mucolytics e.g. Carbocystine
bronchodilators
saline
LTOT
surgery
what are the 4 most common bacteria that are isolated from pts with bronchiectasis
Most common organisms isolated from patients with bronchiectasis:
Haemophilus influenzae (most common)
Pseudomonas aeruginosa
Klebsiella spp.
Streptococcus pneumoniae
when (after) is the follow up x-ray for pneumonia and what is it for
X-ray after 6 weeks to look for any residual consolidation (esp in the elderly) to look for any underlying malignancy
signs of pneumonia
reduced breath sounds
dull percussion
bronchial breathing (high pitch)
pyrexia
hypoxia
tachycardia
symptoms of pneumonia
productive cough
dyspnoea
fever
pleuritic chest pain
pneumonia Ix
CXR
FBC
Us+Es
ABG
Sputum cultures
what is the discharge criteria for pneumonia
As per NICE, do not discharge patients with CAP if in the last 24 hours they have had 2 or more of the following:
Temperature > 37.5°C
RR ≥ 24
HR ≥ 100
SBP ≤ 90 mmHg
SpO2 ≤ 90% on room air
Abnormal mental status
Inability to eat without assistance
CURB score mortality %
0-1: > 3%
2: 3-15%
3+: < 15%
0 = 0.7
1 = 2.1
2 = 9.2
3 = 14.5
4 = 40
5 = 57
pneumonia complications
ARDS
empyema
sepsis
lung abcesses (Klebsiella, Staph Aureus)
What are the symptoms of PHT
- progressive breathlessness
- Exertional dizziness
- Fatigue
- Hemoptysis (chronic thromboembolic PHT)
What are the signs of PHT
- right parasternal heave
- loud second heart sound
- tricuspid/ pulmonary regurgitation
- raised JVP
- signs of an underling conditions
What are the 5 different categories for the causes of PHT
- PHT due to left heart disease
- PHT due to chronic conditions/hypoxia
- PHT due to obstruction of the pulmonary artery
- PAH (pulmonary arterial)
- PHT due to miscellaneous causes
