Respiratory Flashcards
Features of Bronchiectasis?
Clubbing Suspected COPD but smoking Hx less than 10yrs History of TB or recurrent pneumonia Disadvantaged childhood Unusual organisms on sputum
Causes of bronchiectasis?
Cystic fibrosis Primary ciliary dyskinesia Congenital hypogammaglobulinaemia Infections on childhood Localised disease - bronchial adenoma, TB, FB ABPA RA and sjorgens syndrome COPD Recurrent aspiration ILD Idiopathic
Investigations for bronchiectasis?
CXR - infection, cystic lesions, tram tracking Sputum MCS Immunoglobulin FBC ? eosinophilia CF testing Lung function tests ABG HRCT
Treatment of bronchiectasis?
Physiotherapy Inhaled steroids Antibiotics during exacerbations Vaccinations Treatment of heart failure IVIG if hypogamma Haemoptysis - bronchial artery embolisation Smoking cessation Home oxygen Surgery Lung transplant
Investigation of potential lung carcinoma?
CXR and CT chest
Bronchoscopy and biopsies or transthoracic biopsy
Pleural effusion = thoracocentesis and pleural biopsy
FBC, EUCs, Calcium and LFTs
CT CAP
Lung function tests ? resection
Causes of COPD?
Smoking Wood, charcoal, coal smokes Grain dust Nitrogen dioxide Dusts - organic and mining Plastic, textile and rubber manufacturing Leather and food manufacturing Alpha-1 anti-trysin deficiency
Investigations of COPD?
Lung function tests - FEV1 CXR - hyperinflation ABG - ? hypoxia or hypercapnia FBC ?polycythaemia Sputum MCS ECG Alpha-1 anti-trypsin level
Treatment of COPD?
LABA and LAMA ICS if severe COPD or acute exacerbation Vaccinations Pulmonary rehab programs O2 therapy CPAP Treat HF Replace Alpha-1 antitrypsin Lung transplant
Assessment of Sleep apnoea?
Obesity - BMI BP ? HTN Epsworth sleepiness scale Sleep study for AHI TFTs ECG ?arrhythmias CPAP assessment
Why treat OSA?
Reduces daytime sleepiness
Reduces motor accidents
Improves HTN
Improves cognition
Classifications of ILD?
- ILD with known association:
- Drugs
- Occupational exposure
- Connective tissue disease - SLE, RA, S. Sclerosis, PM and DM, Sjogrens - Granulomatous:
- Hypersensitivity pnuemonitis
- Sarcoidosis - Idiopathic:
- IPF
- NSIP
- Respiratory bronchiolitis ILD - Other ILD:
- Lyphoangioleiomyomatosis
- Pulmonary langerhans cell hystiocytosis
Investigations for ILD?
CXR HRCT Lung function tests and DLCO ABG FBC ?Eosinophilia Bronchoscopy and biopsy
Treatment for ILD?
Stop smoking Steroids Treat GORD Treat infections Treat OP Treat OSA Treat pulmonary HTN Home O2 Lung transplant
Diagnosis of Pulm HTN?
PAP >25
Lung causes = PCWP <15
Heart causes = PCWP >15
Classifications of pulmonary HTN?
- Idiopathic
- 2ndary to Left heart disease
- 2ndary to lung disease
- Chronic thromboembolic pulm HTN
- Miscellaneous
Investigations of Pulmonary HTN?
CXR - enlarged central and peripherally pruned pulmonary vessels Lung function tests and DLCO ECG - right heart strain ABG - hypoxia V/Q scan HRCT 6 minute walk test TTE - measure pulm artery pressures Right heart cath
Investigations for sarcoidosis?
FBC - lymphopenia and eosinophilia ESR - raised Ace level - raised CXR - bilateral hilar lymphadenopathy Bronchoscopy
Treatment of sarcoidosis?
Prednisone
Steroid sparing agents - AZA or MTX
Infliximab
History of CF?
Age at diagnosis Method of diagnosis Presenting symptoms Pulmonary symptoms - cough, haemopytsis, pnuemothorax Nasal polyps and sinusitis GIT symptoms - Weight loss, pancreatic malabsorption, diarrhoea and steatorrhoea, constipation and obstruction Heat exhaustion Liver disease - PBC and portal HTN DM Cardiac symptoms Fertility Family history Treatment - PT, mucolytic drugs, antibiotics, pancreatic supplements Number of admissions in 12 months Social supports
Management of CF?
PT Immunization Nebulised antibiotics Pancreatic enzymes Vitamin ADEK replacement Diabetes - insulin only Human recombinant DNAase Double lung transplant
History for lung transplantation?
How long ago?
Double or single?
Heart and lung?
Original lung disease?
Rejection episodes?
Failure?
Bronchiolitis Obliterans?
Lung transplant complications - bronchial stenosis
Medications - Tacrolimus or cyclosporine, mycophenolate or azathiopurine and steroids
Transplant Complications - OP, DM, Infections, Cancer
Effect on life?
Infections from immunosuppression?
Invasive fungal infections CMV PCP Influenza Adenovirus --> Valgancyclovir Bactrim
