Respiratory Flashcards
Acute Asthma:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - progressive worsening of asthma symptoms, hyper responsiveness of airways
Epidemiology - 9% of population, more common in children
Pathogenesis - extrinsic - allergens, Intrinsic - starts middle aged no common cause, mast cells release histamine causing hyperresponsiveness
Presentation - dyspnoea, tachypnoea, accessory muscle use, symmetrical expiratory wheeze
Investigations - Respiratory Examination, peak flow, O2 sats, ABG, CXR, spirometry
Differentials - benign or malignant tumours, thyroid lumps
Risk Factors - atopic history, tobacco exposure, obesity
Treatment -
O - oxygen
S - salbutamol 5mg nebulised - b2b up to 20mg
H - hydrocortisone 100mg IV
I - Ipritropium muscarinic antagonist
T - theophylline - narrow therapeutic range
M - magnesium
E - ITU
COPD:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - Non reversible long term deterioration in airflow through lungs - emphysema or chronic bronchitis
Epidemiology - more common in males
Pathogenesis - hypertrophy, hyperplasia of mucus secreting glands of bronchial tree
Alpha 1 antitrypsin deficiency - elastase excess
Presentation - SOB on exertion, chronic productive cough, accessory muscle use
Investigations - respiratory examination, O2 sats, ABG, CXR
Differentials - asthma, benign or malignant tumours, thyroid lumps, aneurysm
Risk Factors - smoking, occupational exposure, genetics
Treatment - Bronchodilators: short and long acting beta 2 agonist
Corticosteroids- prednisolone 30mg for reversibility assessment, LAMA, LABA, SAMA
Oxygen: if < 7.3KPa
Bronchial Carcinoma:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - cancer originating from the respiratory system
Epidemiology - 3rd most common cause of death
Pathogenesis - Non small cell: Squamous 40% obstructive lesion, central large airways, smokers
Large cell 25% - anapaestic poor prognosis
Adenocarcinoma - common lung cancer, asbestos exposure, glandular epithelium
Small Cell 20-30% - arise from endocrine cells, secretes polypeptide hormones, central bronchial
Presentation - cough, chest pain, SOB, haemoptysis
Investigations - respiratory examination, FBC - hypercalcaemia, CXR, CT, PET-CT, histology, broncoscopy, pleural fluid cytology
Differentials - benign tumour
Risk Factors - smoking, urban areas, passive smoking, arsenic, chromium, iron oxides
Treatment -
NSCLC: surgery +neoadjuvant chemotherapy cisplatin
SCLC: combined chemo + radiotherapy - surgery not useful as late presentation
Pneumothorax:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - air accumulation in the plural space
tension - trauma to chest wall creates one way valve
Epidemiology - young, tall males
Pathogenesis - Primary:occurs without trauma
Secondary: spontaneous complication of underlying disease
Traumatic: iatrogenic, penetrating trauma
Presentation - chest pain, dyspnoea, reduced chest expansion
Tension: tachycardia, tackypnoea + hypotension
Investigations - respiratory examination, ABG, CXR, CT, ultrasound, bronchoscopy
Differentials - asthma, COPD, PE, myocardial ischaemia
Risk Factors - smoking, Fx, tall and slender body build, chest trauma
Treatment -
Tension: large bore cannula into 2nd intercostal space mid-clavicular line - chest drain in triangle of safety
Acute: primary spontaneous - O2 + observations
- chest drain/aspiration
Pleural Effusion:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - fluid build up between parietal + visceral pleura
Epidemiology - coronary heart failure + pneumonia
Pathogenesis:
Exudate unilateral: infective TB, inflammatory, malignancy, PE, Meigs syndrome
Transudate Bilateral: heart failure, hypoalbuminaemia, hypothyroidism
Presentation - dyspnoea, pleuritic chest pain, stony dullness, reduced breath sounds, tracheal deviation, cough
Investigations - respiratory examination, FBC, CRP, CXR-PA+Lateral, pleural fluids biochemistry
Differentials - pleural thickening, pneumothorax, elevated hemidiaphragm
Risk Factors - CHF, pneumonia, malignancy, recent CABG
Treatment - Infective: empirical IV antibiotics
Chest drain/aspiration
Recurrent: pleurodsis
Community Acquired Pneumonia:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - Pneumonia acquired outside of hospital or healthcare
Epidemiology - 24.8 per 100,000 adults
Pathogenesis - strep pneumonia, H.Influenzae
Presentation - productive cough, fever, chills, dyspnoea, pleuritic chest pain
Investigations - Respiratory Examination, BG may be elevated, sputum MCS, High neutrophils = bacterial, H lymphocytes =viral
Differentials - acute bronchitis, CHF, COPD, bronchiectssis, TB, empyema
Risk Factors - age, smoking, alcohol, poor oral hygiene, use of antacids
Treatment - 1st line: amoxicillin, if MRSA add vancomycin or linezoid
Inpatient = fluroquinolone
Hospital Acquired Pneumonia:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - acute LRTI
Epidemiology - common presentation in malignancy
Pathogenesis - aerobic gram negative bacilli - pseudomonas aerginosa, e.coli, klebsiella pneumonia, acinetobacter species
Presentation - dyspnoea, productive cough, fever, chest pain, tachycardia
Investigations - Respiratory Examination, BG may be elevated, sputum MCS, High neutrophils = bacterial, High lymphocytes = viral, FBC, U&E, ABG, CRP, CT chest, CXR
Differentials - cariogenic pulmonary oedema, ARDS, pleural effusion, PE, lung cancer, pulmonary haemorrhage
Risk Factors - poor infection control, intubation/ventilation, H2 agonist and antacid use
Treatment - empirical antibiotic therapy before culture sample back - co-amoxiclav then antibiotic targeted towards culture sample
Atypical Pneumonia:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - caused by atypical organisms
Epidemiology -
Pathogenesis - Mycoplasma pneumonia, chiamydiphila pneumonia, legionella pneumonia (watersources - air con abroad)
Presentation - persistent cough, long duration of symptoms
Investigations - Respiratory Examination, BG may be elevated, sputum MCS, High neutrophils = bacterial, High lymphocytes = viral, FBC, U&E, ABG, CRP, CT chest, CXR
Differentials - typical bacterial pneumonia, viral pneumonia, TB, fungal pneumonia, PE
Risk Factors - close community settings, immune suppression,travel, male
Treatment - Macrolide - azithromycin, doxycycline for zoonotic atypical pathogens
What is CURB-65?
C - confusion - mental test -<8
U - urea - >7
R - RR >30
B - BP<90 systolic <60 diastolic
65 >age
0-1 = antibiotic + home
2 = hospital admission
2-5 = ITU involvement
What is the treatment plan for general pneumonia?
Oxygen >94%
IV fluids
Analgesia for pleuritic chest pain
Oral Antibiotics - IV if severe
Mild - amoxicillin 5 days
Moderate - amoxicillin + clarithromycin
Severe - co amoxiclav + clarithromycin (erythromycin if pregnant)
Pulmonary Embolus:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - thrombus formation in deep vein travelling to lungs - virchows triad
Epidemiology - elderly + bed ridden
Pathogenesis - venous stasis, hyper coagulability and endothelial damage, DVT
Presentation - pleuritic chest pain, dyspnoea, raised JVP, cyanosis, tachypnoea, bed rest>5 days
Triad - sudden dyspnoea, pleuritic chest pain and cough/haemoptysis
Investigations - respiratory examination - sternal heave, raised JVP and hypotension, U&E, creatinine, coagulation studies, FBC, LFT, ABG, CXR, CTPA or VQ scan if pregnant, D-dimer (non specific) Assess wells criteria
Differentials - angina, MI, pneumonia, bronchitis, COPD, asthma
Risk Factors - increased age, DVT, surgery within last 2 months, >5 days of bed rest, protein c+s deficiency
Treatment - Treat as soon as suspected
1st line: O2, fluids, vasoactive agents, anticoagulant - LMWH
DOAC
Recurrent - IVC filter
Anticoagulant contraindication - surgical: thrombolise
Identifiable cause - treat for 3 months
Unidentifiable cause - treat for 6 months
Pulmonary Fibrosis:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - fibrotic lung disease leading to interstitial lung damage + fibrosis
Epidemiology - presents late 60’s, more common in males
Pathogenesis - lung damage: infarction, TB, Pneumonia, irritants, smoking, extrinsic alveolitis, connective tissue disease
Presentation - dyspnoea on exertion, cough, crackles, clubbing
Investigations - respiratory examination, RF, ANA, CRP, CXR, CT, spirometry
Differentials - non specific interstitial pneumonia, cryptogenic pneumonia, asbestosis, connective tissue disease associated ILD
Risk Factors - increased age, male, smoking
Treatment - Modify risk factors, pulmonary rehabilitation, antifibrocytic drugs - pirfenidone, high dose corticosteroid, lung transplant = only cure
Prognosis = 3-4 years
Bronchiectasis:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - permanent dilation of bronchioles causing scaring and lung architecture changes
Epidemiology -
Pathogenesis - H.Influenza, obstruction
Presentation - productive chronic cough, haemoptysis, clubbing, wheeze, purulent sputum
Investigations - respiratory examination, sputum culture, FBC, LFT, U&E, CRP, CXR (Tram track lines), CT
Differentials
Risk Factors - previous pneumonia, cystic fibrosis, TB, measles
Treatment - chronic condition - cannot reduce or reverse scarring, antibiotics if needed, chest physiotherapy, bronchodilators, treatment of underlying cause
