Respiratory Flashcards by Aureliah K

Give 4 sx of COPD

Productive cough
SOB
Wheeze
recurrent infections

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How is SOB measured in COPD

MRC Dyspnoea scale

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Signs of COPD

Use of accessory muscles
asterixis
Pursed lip breathing
Tachypnoea
Hyperinflation - barrel chest
decreased cricosternal distance
reduced chest expansion
hyperesonant - percussion
decreased breath sounds
wheeze

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How does smoking cause COPD

Stimulates neutrophil elastase leading to destruction

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Ix COPD

CXR
FBC
ABG
ECG
Spirometry

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CXR findings in COPD

Hyperinflation
bullae
flat hemidiaphragm

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Conservative management of COPD

Smoking cessation
pulmonary rehab
vaccination

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signs of asthma

tachypnoea
chest hyperexpansion
hyper resonant
wheeze - polyphonic
Harrisons sulci

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Investigations for asthma

Spirometry with BDR

FeNO >40ppb - eosinophilic airway inflammation

Peak flow variability >20%

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Asthma triggers

Animals
infection
meds
cold weather
dust / mould
emotions

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conservative asthma management

Education
smoking cessation
annual r/v
decrease weight
annual influenza
decrease exposure to triggers

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sx of asthma exacerbation

worsening SOB
Use of accessory muscles
worsenign wheeze
tachpnoea
reduced air entry

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investigations for asthma exacerbation

Bloods - FBC / CRP
PEFR
ABG - T2RF
CXR

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Signs of life threatneing asthma exacerbation

33 92
Cyanosis
Hypotension
Exhaustion
Silent chest
Tachycardia

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requirements for hospital discharge following exacerbation

PEF > 75% Predicted
inhaler technique checked
stable on meds for 12-24 hours

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community management of asthma - adult

4 puffs

2 puffs every 2 mins
max 10 puffs

rpt every 20 mins

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community management of asthma exacerbation - child

1 puff every 30-60s

max 10 puffs

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Bronchiectasis causes

pneumonia
CF
Idiopathic
TB
Lung cancer

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Bronchiectasis features

Productive cough
Sputum
dyspnoea
haemoptysis

clubbing
coarse inspiratory crackles
wheeze

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Investigations for bronchiectasis

CXR - Thickened bronchial walls

Sputum culture + bloods

Spirometry - obstructive

High resolution CT - Diagnostic
Dilated airway and signet rings

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Bronchiectasis management

smoking cessation
physiotherapy
education

Abx - azithromycin
Bronchodilators - wheeze / sob

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RF for lung cancer

smoking
silica
coal
asbestos
radiation
HIV

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Features of lung cancer

cough
SOB
Haemotysis
hoarse voice
fever

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Squamous cell carcinoma paraneoplastic syndrome

PTH-rp –> Hypercalcaemia

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2ww referral criteria for lung cancer

CXR suspicious findings >40 + unexplained haemoptysis

Causative organisms for CAP

Step penumoniae H influenzae Moraxella catrhalis

causative organisms for a HAP

Psudomonas aeruginosa Staph aureus

Features of mycoplasma penumonia

cold AIHA Erythema multiforme

Features of legionella pneumophilia

SIADH - low sodium Lymphocytes

Features of penumocystisis jivorecci

HIV Excercise induced dyspnoea Dry cough

causative organisms of aspiration pneumonia

strep penumoniae H influenzae

RF for aspiration penumoniae

stroke MG Alcoholics post-ictal mechnaical intubation

features of pneumoniae

productive cough pleuretic chest pain haemoptysis fever dyspnoea

classification of pneumothorax

spontaneous - primary: young tall thin men - secondary: Asthma COPD TB Penuminae Lung cancer Traumatic

what is sarcoidosis

multisystem disease characterised by inflammation and granuloma formation

What is the classical presentation / syndrome of sarcoidosis

Lofgrens syndrome - erythema nodosum - BHL - Polyarthralgia

Features of sarcoidosis - lungs - heart - liver - kidneys - PNS / CNS - Eyes - Derm

BHL Pulmonary fibrosis BBB/HB Cirrhosis / cholestasis Renal stones Bells palsy Diabetes insipidus Uveitis Lupus pernio

causes of BHL

Sarcoidosis TB Lymphoma bronchial carcinoma

haemoptysis differentials

PE Cancer TB Pneumoniae Bronchiectasis Goodpastures

Investigations for sarcoidosis

Bloods - FBC / U+E / CRP / ACE / Ca2+ Urien dipstick ECG / Spirometry CXR Bronchoscopy + biopsy + histology

histological finding of sarcoidosis

Non caseating granuloma with epithelioid cells

Clincial features of sarcoidosis

fever weight loss SOB Dry cough

What is TB

Chronic granulomatous disease caused by mycobacterium TB

Causes of re-activation of TB in latent disease

Immunosuppresion - steroids Immunodeficiency HIV / AIDS DM CKD Lymphoma

Who is the BCG vaccine offered to

Neonates born in areas of the UK with high rates of TB Neonates with relatives from countries with a high rate of TB Neonates with a family history of TB close contact with TB Unvaccinated children or young adults that recently arrived from a country with a high rate of TB Healthcare workers

features of TB

WEIGHT LOSS fever haemoptysis cough dyspnoea night sweats lymphadenopathy

TB investigations

Sputum sample and culture - 3 samples Blood and blood cultures CXR

Specialist tests for TB

Mantoux test Inteferon gamma release assay

Causes of exudative PE

PE / Pneumoniae Inflamm - SLE / R.A Neoplasm TB

Causes of transudative PE

HF Liver cirrhosis nephrotic syndrome CKD Hypoalbuminaemia Hypothyroid Meigs syndrome

features of PE

SOB Pleuretic CP Reduced exercise tolerance

signs of Pleural effusion

tachypnoeic tahcycradic tracheal deviation decreased chest exapnsion stoney dull percussion reduced breath sounds reduced TVF

Investigations for Pleural effusion

Bloods - FBC / U+E / LFT - albumin / AST/ALT CXR Pleural aspiration and fluid analysis

what is measured in a pleural aspirate

LDH Protein pH Gram stain MC&S Glucose WCC

Outline the lights criteria

fluid : serum protein >0.5 fluid : serum LDH > 0.6 Pleural fluid LDH >2/3 upper limit of normal for serum

when do you suspect an empeyema

improving penumonia but ongoing fever

causes of interstitial fibrosis

coal / dust / silica IPF Medications lung damage - penumonia / TB alpha 1 antitrypsin R.A SLE Sjogrens syndrome

Medications causing pulmonary fibrosis

amiodarone MXT Nitrofuranotin

features of pulmonary fibrosis

dry cough SOB Fatigue clubbing

CT chnages of IPF

Ground glass Reticualr opacities

Management of IPF

Smoking cessation Pulmonary rehab Physio Advanced care plan O2 therapy Pirfenidone Lung transplant

consequences of asbestos exposure

fibrinogenic - lung fibrosis - lower lobes - pleural plaques carcinogenic - adenocarcinoma - mesothelioma

causes of hypersenitivity pneumonitis

farmers lung mushroom workers lung malt workers lung bird fanciers lung