Respiratory Flashcards
Complications of COPD
Cor pulmonale Lung cancer IHD Recurrent pneumonia Pneumothorax Respiratory failure
COPD Definition
Preventable and treatable disease characterised by progressive airflow limitation that is not fully reversible and is associated with an abnormal inflammatory response to noxious particles or gases. Both emphysema and chronic bronchitis.
COPD BODE index
BMI (<19 high risk)
Obstruction FEV1
Dyspnoea MRC score
Exercise capacity 6min walk test
COPD investigations
Spirometry Pulse oximetry ABG CXR FBC ECG
Causes of upper lobe fibrosis
Aspergillosis ABPA Pneumoconiosis: coal, silica Extrinsic allergic alveolitis Negative, sero-arthropathy TB Previous radiotherapy Ank spon Sarcoidosis
Causes of lower pulmonary fibrosis
Sarcoidosis Toxins (amiodarone, methotrexate) Asbestosis Idiopathic pulmonary fibrosis Rheum: RA, SLE, SS, Sjögrens, PM/DM
Pulmonary fibrosis investigations
PEFR, ECG FBC, ABG, ESR, CRP, ANA, RF, C3/C4, ACE, Ca CXR, HRCT Spirometry Echo BAL, lung biopsy
Bronchiectasis causes
Congenital: CF, PCD, Young's, Low Abs Chronic lung disease (COPD) Post-infectious: pertussis, TB, measles Obstruction: tumour, foreign body Chemical damage (acid reflux aspiration) Associated: RA, IBD, ABPA
Bronchiectasis treatment
MDT: GP, resp, physio, dietician, immunologist
Medical: Abx (prophylactic), bronchodilators
Treat underlying cause: CF (DNAase, Creon, ADEK vits), ABPA (Steroids), Immune deficiency (IVIg)
Vaccination: flu, pneumococcus
Surgical: severe localised disease or obstruction
Kartagener’s Syndrome
Situs inversus
Chronic sinusitis
Bonchiectasis
Young’s Syndrome
Bronchiectasis
Rhinosinusitis
Azoospermia
Hypogammaglobulinaemia causes
Bruton’s X-linked Agammablobulinaemia (no B cells)
Common Variable Immunodeficiency (only IgM)
Specific Antibody Deficiency
Yellow Nail Syndrome
Very rare Yellow dystrophic nails Pleural effusions Lymphoedema: lymphatic hypoplasia Bronchiectasis
Pleural Effusion causes
- Transudate: CCF, CLD, Nephrotic syn, hypothyroidism, peritoneal dialysis
- Exudate: Infection, Malignancy, PE, AI (RA, SLE), pancreatitis, drugs, post CABG, trauma, oesophageal rupture!
Pleural Effusion investigations
Sputum Bloods: FBC, U+Es, LFTs, TFTs, ESR, Ca Imaging: CXR, US, CT Diagnostic pleurocentesis: MC+S, cytology, chemistry Pleural biopsy
Indications for lobectomy
Lung cancer (90%) Brochiectasis COPD lung reduction surgery Chronic lung abscess TB Benign tumours Fungal infections (Aspergillus) Congenital abnormalities
Thoracotomy scar causes
Pneumonectomy Lobectomy Oesophageal surgery Diaphragmatic repair Heart valve replacement Thoracic aortic aneurysm repair Anterior spinal tumour excision Latissimus dorsi flaps
Lung cancer complications
Local: nerve palsies, Horner’s, SVCO
Paraneoplastic: Endo (ADH, ACTH, PRHrP, 5-HT), DM/PM, Neuro (cerebellar, peripheral neuropathy), Derm (acanthosis nigricans)
Metastatic: #’s, liver failure, neurology, Addisons
SIRS
Inflam response to a variety of insults manifest by ≥ 2 of:
Temperature: >38°C or 90
Respiratory rate: >20 or PaCO2 12x109/L or 10% bands
Complications of pneumonia
Parapneumonic effusion Empyema Lung abscess Respiratory failure Severe sepsis/septic shock
TB treatment and side effects
Rifampicin: hepatitis, orange urine, enzyme induction
Isoniazid: peripheral sensory neuropathy
Pyrazinamide: hepatitis, arthralgia (CI: gout, porphyria)
Ethambutol: optic neuritis → loss of colour vision first
TB surgery
Artificial pneumothorax Phrenic nerve crush Thoracoplasty (rib removal) Plombage (insertion of polystyrene balls) Lobectomy/pneumonectomy
Cor pulmonale
Cardiovascular consequence of chronic respiratory failure:
- pulmonary hypertension
- peripheral vasodilation and oedma from hypercapnia
- salt and water retention from renal hypoxia
Does not = RVF but can lead to it. RVF has low output state from dilated ventricle, CorP has normal output from hypertrophied ventricle
