Respiratory Flashcards
Features and stages of clubbing
1) Bogginess / fluctuance of nail bed
2) Loss of concave nail fold angle
3) ↑ longitudinal and transverse curvature
4) Soft tissue expansion at distal phalanx (drumstick)
Respiratory causes of clubbing
Carcinoma
- Bronchial
- Mesothelioma
Chronic lung suppuration
- Empyema, abcess
- Bronchiectasis, CF
Fibrosis
- Idiopathic pulmonary fibrosis / CFA
- TB
Cardiac causes of clubbing
- Infective endocarditis
- Congenital cyanotic heart disease
- Atrial myxoma
GI causes of clubbing
- Cirrhosis
- Crohn’s, UC
- Coeliac
- Cancer - GI lymphoma
Definition of cyanosis
- Blue discolouration of mucosal membranes or skin
- Deoxygenated Hb >5g/dl
Respiratory causes of cyanosis
- Hypoventilation - COPD, musc
- ↓ diffusion: pulm oedema, fibrosing alveolitis
- V/Q mismatch: PE, AVM (e.g. HHT)
Cardiac causes of cyanosis
Congenital - Fallot’s, TGA
↓ CO: MS, systolic LVF
Vascular: Raynaud’s, DVT
CURB 65 score
Assessing severity of asthma
Confusion - AMT<8 Urea - >7 Resp rate - >30 BP - <90/60 65 yo or older
Score
0-1 -> home treatment
2 -> hospital treatment
3 -> ?ITU
Empirical abx treatment for mild/mod/severe CAP
Mild - amox 500mg TDS for 5 days or clari 500mg BD for 7 days
Moderate - both as above for 7 days unless pen allergy, consider IV
Severe - co-amoxiclav 1.2g TDS IV / cefuroxime 1.5g TDS IV
AND clari 500MG BD IV for 7-10 days. Add fluclox if staph suspected.
Empirical therapy for atypical CAPs
Chlamydia - tetracycline
PCP - Co-trimoxazole
Legionella - clari and rifampacin
Empirical abx therapy for HAP
Mild / <5 days - co-amox 625mg PO TDS for 7 days
Severe / >5 days - Tazocin +/- Vanc +/- Gent for 7 days
Definition of type 1 and type 2 respiratory failure
Both - PaO2 <8
Type 1 - PaCO2 <6
Type 2 - PaCO2 >6
Causes of lung abscess
- Aspiration
- Bronchial obstruction: tumour, foreign body
- Septic emboli: sepsis, IVDU, RH endocarditis
- Pulmonary infarction
- Subphrenic / hepatic abscess
Features of lung abscess
- Swinging fever
- Cough, foul purulent sputum, haemoptysis
- Malaise, wt. loss
- Pleuritic pain
- Clubbing
- Empyema (pus in the plural cavity)
Systemic Inflammatory Response Syndrome
Inflammatory response to a variety of insults manifested by 2 or more of:
- Temp >38 or <36
- HR >90
- RR > 20 or PaCO2 <4.6
- WCC >12 or <4 or >10% bands
Pathophysiology of bronchiectasis
Chronic infection of bronchi/bronchioles -> permenent dilatation
Retained inflammatory secretions and microbes -> airway damage and recurrent infection
Common organisms of infection in bronchiectasis
H. influenza
Pneumococcus
S. aureus
Pseudomonas
Congenital causes of bronchiectasis
CF (mainly upper lobe inflitration)
Kartagener’s / Primary Ciliary Dyskinesia
Young’s syndrome (azoospermia + bronchiectasis)
Causes of post-infectious bronchiectasis
Measles Pertussis Pneumonia TB Bronchiolitis
Immunodeficiency causes of bronchiectasis
Bruton’s X-linked agammaglobinaemia
Common Variable Immunodeficiency
IgG subclass deficiency IgA deficiency
signs and symptoms of bronchiectasis
- Persistent cough with purulent sputum
- Haemoptysis
- Fever and weight loss
- Clubbing
- Coarse inspiratory creps
Complications of bronchiesctasis
Pneumonia Pleural effusion Pneumothorax Pulmonary HTN Massive haemoptysis Cerebral abcess Amyloidosis
Pathogenesis of CF
Mutation in CFTR gene on Chromosome 7 (commonly ∆F508)
↓ luminal Cl secretion and ↑ Na reabsorption → viscous secretions.
In sweat glands, ↓ Cl and Na reabsorption → salty sweat
Clinical features of CF in neonates
Failure to thrive
Meconium ileus
Rectal prolapse
Clinical features of CF in children and young adults
Nose: nasal polyps, sinusitis
Resp: cough, wheeze, infections, bronchiectasis, haemoptysis, pneumothorax, cor pulmonale
GI: Pancreatic insufficiency (DM and steatorrhoea), Distal Intestinal Obstruction Syndrome, Gallstones, Cirrhosis
Male infertility, osteoporosis, vasculitis
Types of lung cancer
Small-cell and non-small-cell (squamous cell carcinoma, adenocarcinoma, large-cell)
Lung squamous cell carcinoma
35% of lung cancer
M>F
Smokers
Radon gas
Centrally located
Keratinisation
Locally invasive
Metastasise late via LN
PTH releasing -> ↑Ca
Lung adenocarcinoma
25% of lung cancer
Females
Non-smokers
Far East
Peripherally located
Glandualar differentiation
Extrathoracic mets common and early -> 80% present with mets
Large cell lung cancer
10% of lung cancer
Peripheral or central
Large, poorly differentiated cells
Poor prognosis
Small-cell lung carcinoma
20% of lung cancer
Smokers
Central location, near bronchi
Small, poorly differentiated cells
80% present with advanced disease
v. chemo sensitive but poor prognosis
Ectopic hormone secretion
Clinical features of ARDS
Tachypnoea
Cyanosis
Bilateral fine creps
SIRS
Pulmonary causes of ARDS
Pneumonia
Aspiration
Inhalation injury
Contusion
Systemic causes of ARDS
Shock Sepsis Trauma Haemhorrage and multiple transfusions Pancreatitis Acute liver failure DIC
Definintion of chronic asthma
Episodic, reversible airway obstruction due to bronchial hyper-reactivity to a variety of stimuli.
Definition of COPD
- Airway obstruction: FEV1 <80%, FEV1:FVC <0.70
- Chronic bronchitis: cough and sputum production on most days for 3mo of 2 successive years.
- Emphysema: histological diagnosis of enlarged air spaces distal to terminal bronchioles c¯ destruction of
alveolar walls.
