Respiratory Flashcards
1
Q
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
What features show it is more likely a patient has COPD than Asthma?
A
1) Onset >35
2) Smoking/pollution related
3) Chronic Dyspnoea
4) Sputum production
2
Q
What is Chronic Bronchitis?
A
- Cough and sputum production for 3+ months in 2 consecutive years
- Permanent narrowing of the airways
3
Q
What are the causes of Chronic bronchitis?
A
- mucous gland hypertrophy and hyperplasia
- bronchial wall inflammation and mucosal oedema
4
Q
How would a patient appear if they had Chronic Bronchitis?
A
’ Blue Bloaters’
- Overnight
- Peripheral Oedema
- Cyanosed
- Low PaO2 and high PaCO2
5
Q
why should we be careful when giving O2 therapy to someone with Chronic bronchitis?
A
They rely on their hypoxic drive to breath as their respiratory centres are insensitive to CO2. If we take their hypoxic drive away by giving O2 this could be fatal to the patient
6
Q
What is Emphysema?
A
Dilation and destruction of alveolar walls distal to terminal bronchioles
7
Q
What does dilation and destruction of alveolar walls lead to?
A
1) Decreased elastic recoil (keeps airways open during expiration)
2) Increased air trapping = increased dead space
8
Q
How does a patient with Emphysema appear?
A
‘Pink Puffer’
- thin
- hyperinflated chest
9
Q
How is Respiration driven?
A
an increase in PaCO2
10
Q
Pathology of Cigarette smoke and what it causes
A
1) - Mucous gland hypertrophy
- increase in immune cells (neutrophils, macrophages, lymphocytes)
- release of inflammatory mediators (elastases, proteases, IL-1, TNF-8)
2) This increase in inflammation breaks down the lung parenchyma
11
Q
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Signs and Symptoms?
A
symptoms
1) Chronic productive cough
2) Wheeze
3) Dyspnoea
signs
1) Breathless
2) Tachypnoea
3) Prolonged expiration
4) hyperinflated chest
5) Decreased lung expansion
6) Use of accessory muscles
7) wheeze
12
Q
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Diagnosis?
A
1) FEV1/FVC= <0.7
2) INCREASED TLC and RV
13
Q
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
What can be seen on bloods, CXR and ABG
A
bloods= increased packed cell volume
CXR= hyperinflated lungs and flat diaphragm
ABG= decreased PaO2
14
Q
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Stages of COPD?
A
stage 1= <80% FEV1 - predicted
stage 2= 50-79% FEV1
stage 3= 30-49% FEV1
stage 4= <30% or <50% FEV1 if respiratory failure
15
Q
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
What must all diagnosed patients receive
A
Steroid Trial:
Oral prednisolone for 2 weeks and if FEV1 rises by >15% COPD is steroid responsive
therefore they may benefit from long term inhaled corticosteroids
16
Q
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Treatment?
A
- cessation of smoking and BMI control
- SAB2A and LAB2A if persists
- short acting antimuscarinic (ipratropium) may be enough for mild
17
Q
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
treatment of severe?
A
1) LAB2A
2) Corticosteroids
3) Long term oxygen therapy
18
Q
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
What is an acute exacerbation?
A
respiratory failure/ 2/3 of: 1) Worsening dyspnoea 2) Worsening wheeze 3) Increased coughing
19
Q
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
treatment of an acute exacerbation?
A
Low conc 02 through venturi mask (SaO2 88-92%)
Abx if infective
- salbutamol
- prednisolone
- ipratropium
20
Q
ASTHMA
Characteristics?
A
1) bronchial muscle contraction - triggered by stimuli
2) Mucosal swelling and inflammation - mast degranulation = mediator and histamine release
3) Increased mucous production
21
Q
ASTHMA
Classifications?
A
Eosinophilic- Extrinsic (atopic) - allergens proven by +ve skin prick reactions
& Intrinsic
Non- eosinophilic
22
Q
ASTHMA
Aetiology?
A
- Individuals who readily develop IgE against common allergens
23
Q
ASTHMA
Genetic Cause?
A
IL-4 clusters on chromosome 5. this produces IL-3,4,5 &13
24
Q
ASTHMA
Environmental cause?
A
childhood exposure to allergens (hygiene hypothesis)
if you grow up in a clean area your risk is increased
25
ASTHMA
Pathology of the inflammation?
- Mast cells, eosinophils, T-lymphocytes and dendritic cells increased in bronchial wall
1) T- cells release IL-3,4,5 &13
2) IL-4 &13 produce IgE instead of B-cells/ antibodies
3) IgE attaches to mast cell= degranulation when inhaled allergens are encountered
4) Inflammatory mediator and histamine released
26
ASTHMA
Pathological changes to the airway
- Bronchial Smooth muscle undergoes hypertrophy and hyperplasia
- airway wall thickened by deposition of collagen below the basement membrane
- metaplasia of respiratory epithelium
27
ASTHMA
How many people suffer in the U.K?
5-8%(more in developed countries (hygiene hypothesis)
28
ASTHMA
Precipitants?
- fumes
- exercise
- viral infections
- cold air
- Beta blockers
- NSAIDS
- smoking
- stress
29
ASTHMA
Clinical features?
1) Wheeze
2) Dyspnoea
3) Tight chest
4) tachypnoea
these all vary diurnally (daily)
30
ASTHMA
what jobs may increase your chance of developing or worsening asthma?
- animal handlers
- food processors
- paint sprayers
31
ASTHMA
Diagnosis?
2 week peak flow diary - 3 each morning and 3 each night- best score
32
ASTHMA
Non medical treatment?
- stop smoking
- avoid allergens
- avoid beta blockers/ NSAIDs
33
ASTHMA
| Step by step treatment?
can move up and down the steps accordingly
1) Short acting beta 2 agonist (salbutamol- BASELINE)
2) Inhaled corticosteroids (ICS)
3) Add LTRA
4) Add long acting beta2 agonist + - LTRA
5) Increased dose of ICS, SAB2A, LAB2A +- LTRA
6) Trial addition of theophylline / muscarinic receptor antagonist
- Refer to asthma clinic and specialist may recommend PO prednisolone
34
ASTHMA
What is an LTRA?
leukotriene receptor agonist
35
ASTHMA
Features of an acute attack?
1) Pulse <110bpm
2) Respiratory rate >25
3) Cant complete sentences
4) PEF 35-50% predicted
36
ASTHMA
When may an attack be life threatening / fatal?
- cyanosis
- silent chest
- bradycardic
- PEF <33% predicted
37
ASTHMA
Treatment of an acute attack?
- nebulised salbutamol and ipratropium
- prednisolone
- O2 through venturi (24%)
38
ASTHMA
When can someone be discharged after a severe attack?
- PEF >75%
- Diurnal variation <25%
- Stable for 24 hrs +
- once discharged give PO prednisolone to be taken OD
39
LUNG CANCER
What are 95% of all lung tumours?
Bronchial Carcinoma's
40
LUNG CANCER
Risk Factors?
- smoking
- asbestos
- radiation (radon)
- arsenic
41
LUNG CANCER
Types?
Small cell and non-small cell
42
LUNG CANCER
Subtypes of Non-small cell?
Squamous
Adenocarcinoma
Large Cell
Small Cell
43
LUNG CANCER
What does Squamous Lung Cancer present as?
It presents AS an obstructive lesion leading to infection
44
LUNG CANCER
What is Adenocarcinoma associated with?
asbestos and non smokers. occurs peripherally
45
LUNG CANCER
WHat is LArge Cell?
poorly differentiated tumour that metastasizes early
46
LUNG CANCER
What is small cell?
it arises from endocrine cells and secretes polypeptide hormones
also metastases early so a poor prognosis
47
LUNG CANCER
Epidemiology?
`19% of all cancers. 27% of all cancer deaths. poor prognosis
48
LUNG CANCER
Local Effects?
- cough
- dyspnoea
- haemoptysis
- chest pain
- slowly resolving/ recurrent pneumonia
- weight loss/ anorexia
49
LUNG CANCER
Invasive Effects?
1) Arm pain (brachial plexus)
2) Facial plethora
3) Horner's Syndrome (stellate ganglion)
4) Hoarseness (Left recurrent laryngeal)
5) Pleural effusion (pleura)
50
LUNG CANCER
Common sites for Mets?
- bone
- brain
- liver
- pleura
- lymph nodes
51
LUNG CANCER
Commonly secreted hormones from the tumour and their effects?
```
ACTH = Cushing's
PTH = Hypercalcaemia
ADH = SIADH
```
52
LUNG CANCER
| 3 steps to an Investigation?
1) Confirm diagnosis
2) Assess spread
3) Stage the tumour
53
LUNG CANCER
Investigations?
1st = CXR then CT of chest to stage it, then PET scan to check for Mets
54
LUNG CANCER
Staging?
```
primary tumour (T0-T4)
regional nodes (N0-N3)
distant mets (M0-M1)
```
```
T0
T1
T2
T3
T4
N0
N1
N2
N3
M0
M1
```
55
LUNG CANCER
Describe the 4 numbered stages
Stage 1= T1/T2, N0, MO
Stage 2= T1, T2, N1 OR T3
Stage 3= T3, N1, M0 OR T1-T3, N2
Stage 4= T1-T4, N0-N3, M1 (instant stage 4 if distant metastases)
56
LUNG CANCER
Treatment of non-small T1/T2
Curative surgery or curative radiotherapy
57
LUNG CANCER
What occurs before any surgery occurs?
WHO Performance status: ECG&PFTs to assess if they are fit enough to actually have the surgery and recover
58
LUNG CANCER
What happens post op?
radio/chemo therapy
59
LUNG CANCER
How is radiotherapy given?
3x every day for 12 days.
60
LUNG CANCER
Treatment of Stage 3/4?
palliative radio/chemo
61
LUNG CANCER
WHat is palliative radiotherapy good for?
local symptoms such as bone pain and haemoptysis
62
LUNG CANCER
What is palliative chemo good for
Systemic symptoms and maintaining quality of life right up until death
63
LUNG CANCER
Side effects of Chemo?
- alopecia
- nausea + vomiting
- Peripheral neuropathies
- Bone marrow suppression
64
LUNG CANCER
Side effects of Radiotherapy?
- Fatigue
- Anorexia
- cough
- oesophagitis
65
treatment for small cell LUNG CANCER?
palliative chemo/ radio
66
PNEUMONIA
Which groups are at risk?
- old people
- IVDU
- alcoholics
- diabetics
- immunocompromised (AIDs)
67
PNEUMONIA
Aetiology? (typical and hospital acquired)
TYPICAL:
- S.aureus
- H.influenzae
- S.pneumoniae
- Klebsiella pneumoniae
HOSPITAL:
S.aureus
-ve enterobacteria
68
PNEUMONIA
Epidemiology and what is the mortality rate in hospital?
5-11 per 1000 people
21% mortality
69
PNEUMONIA
Symptoms?
1) fever
2) Sweats
3) pleuritic pain
4) Purulent cough
5) weakness
6) Dyspnoea
70
PNEUMONIA
Signs?
1) Confusion
2) Tachycardia
3) Tachypnoea
4) Lung consolidation features e.g. ( crackles, dull percussion and bronchial breathing)
71
PNEUMONIA
Tests?
CXR- to see for consolidation (follow up to check for cancer/complications)
Bloods ( increased WCC and CRP)
Sputum test for MC&S
Green swab for flu
72
PNEUMONIA
How is the severity determined?
CURB-65 1 point each for:
- confusion
- urea >7mmol/L
- resp rate >30
- Age >65
- BP <90 systolic/ <60 diastolic
73
PNEUMONIA
For the CURB-65 what do the different scores represent?
```
0-1= home treatment
2= hospital treatment
3-5= severe/ ITU/ Mortality is 15-40%
```
74
PNEUMONIA
Type 1 respiratory failure is common after pneumonia. what is the cycle of draining an infected pleural effusion
pneumonia causes a pleural effusion, exudate produced and this needs to be drained
signs of infection =
if exudate is yellow, smelly, acidic
75
PNEUMONIA
Treatment of Mild, moderate and severe?
mild= PO amoxicillin
moderate= PO amoxicillin + PO clarithromycin
severe= IV cefuroxime and IV clarithromycin
76
PNEUMONIA
Who is eligible for Vaccine?
- age over 65
- people with chronic conditions (heart and lung e.g.)
- Diabetes Mellitus
- Immunosuppressed (AIDS)
- People on Chemo
77
TUBERCULOSIS
| Epidemiology?
- in UK African and indian immigrants are common
- Biggest killer of a single infectious disease in the world. 2 million deaths a year
- biggest cause of death for people with HIV
78
TUBERCULOSIS
Cause?
mycobacterium tuberculosis =primary tuberculosis that is spread by aerosols
79
TUBERCULOSIS
Pathophysiology?
1) Bacteria ingested by macrophages become granulomas which are the primary focus (these are recognised by exudation and neutrophil infiltration)
2) Also occurs in mediastinal lymph node (primary complex)
3) Typical Granulomatous LEsions form
4) They are calcified/ walled off = bacteria remains latent?
80
TUBERCULOSIS
What is Dissemination and where is it likely to spread after dissemination?
When the bacteria fails to stay contained
Spreads into lungs, CNS, Bone, abdomen , Commonly= lymphadenopathy
81
TUBERCULOSIS
What is Dissemination to the lungs and CNS called?
lung: Miliary TB
| CNS= TB meningitis
82
TUBERCULOSIS
Most people present with post-primary TB, what symptoms may they have?
- weight loss
- night sweats
Pulmonary:
- Over 3 week cough
- Haemoptysis
- Dyspnoea
- chest pain
Takes 4-8 weeks to develop
83
TUBERCULOSIS
Complications?
1) Pleural effusion
2) Pericardial effusion
3) Lung collapse
4) Lung consolidation (becomes solid)
84
TUBERCULOSIS
Investigations?
1st CXR = see cavitating lesion in upper lobes + loss of volume
Sputum test by coughing or broncho-alveolar lavage
85
TUBERCULOSIS
What is the name of the sputum test and what culture medium is used?
Zeihl-Neeson Test with a Lowenstein Jenson culture medium
86
TUBERCULOSIS
Latent TB tests?
1) Mantoux test
| 2) Interferon- Gamma testing
87
TUBERCULOSIS
Treatment of latent TB?
Isoniazid for 6 months
88
TUBERCULOSIS
Treatment of Non Drug resistant TB?
First 2 months:
1) Rifampicin
2) Isoniazid
3) Pyrazinamide
4) Ethambutol
then another 4 months with:
1) Rifampicin
2) Isoniazid
89
TUBERCULOSIS
Side effects of Rifampicin?
pink urine, low platelets, induces CYP450, Flu symptoms
90
TUBERCULOSIS
Side effects of Isoniazid?
neuropathy, low WCC, inhibits CYP450
91
TUBERCULOSIS
Side effects of Pyrazinamide?
rash and arthralgia
92
TUBERCULOSIS
Side effects of Ethambutol
Optic Neuritis
93
PULMONARY EMBOLISM
Pathophysiology?
1) Embolism obstructs ventricular outflow tract
2) Increased in pulmonary vascular resistance
3) Right heart failure
4) Lung tissue is ventilated but not perfused - impaired gas exchange
94
PULMONARY EMBOLISM
Risk factors?
1) Recent flight
2) Recent surgery / immobilization
3) Recent fracture
4) Pregnant or the pill
5) Cancer
6) Heart failure
95
PULMONARY EMBOLISM
Features?
Small-medium: Tachycardia, tachypnoea, pleuritic chest pain, breathlessness, syncope
Large: SAME but also cyanosis, pale and sweaty and distended/ increased JVP
96
PULMONARY EMBOLISM
What is the Name of the pre test probability test?
wells score
97
PULMONARY EMBOLISM
| Diagnostic tests?
cxr- normal or decreased vascular markings
ECG- inverted T IN v1-v4, tachycardia, RBBB
ABG- type 1 respiratory failure
98
PULMONARY EMBOLISM
Gold standard imaging?
CTPA= CT pulmonary angiography
99
PULMONARY EMBOLISM
| what is given to people of low risk and high risk of PE?
low risk = d-dimer
high risk = LMWH (low molecular weight heparin)
100
PULMONARY EMBOLISM
Treatment of small?
1st - D-dimer test
if that is positive do a CTPA
if that is positive give warfarin/ NOAC
101
PULMONARY EMBOLISM
Treatment of medium?
and what should be given if they're compromised?
LMWH
+ O2, morphine and fluids if they're compromised
102
PULMONARY EMBOLISM
Treatment of large?
Thrombolysis (alteplase)
103
PULMONARY EMBOLISM
How long is treatment?
Normally 3 months, 6 months if idiopathic
maybe lifelong if they're recurrent
104
RESPIRATORY FAILURE
How is type 1 defined?
PaO2<8kPa
105
RESPIRATORY FAILURE
How is type 2 defined?
PaO2<8kPa
| PaCO2>6kPa
106
RESPIRATORY FAILURE
Cause of Type 1?
Ventilation- perfusion mismatch
may be due to Asthma, COPD, Pulmonary oedema, Pneumonia, Pulmonary Fibrosis
107
RESPIRATORY FAILURE
Cause of Type 2?
Alveolar Hypoventilation
1) Pulmonary (Fibrosis, COPD, Asthma)
2) Reduced respiratory flow (trauma, opiates)
3) Neuromuscular (Myasthenia Gravis, Guillan Barre)
4) Thoracic wall disease (kyphoscoliosis)
108
RESPIRATORY FAILURE
Investigations? (ABG already done)
CXR, FBC, U+E, Spirometry, CRP
109
RESPIRATORY FAILURE
Treatment of type 1?
treat underlying cause + high saturated O2 through venturi 35-60%
110
RESPIRATORY FAILURE
Treatment of type 2?
treat hypoxia first as patient can rely on the respiratory drive to breathe if they have hypoxia
24% O2 through venture then ABG every 20 mins to check if its working, Titrate O2 up slowly
111
RESPIRATORY FAILURE
There are two types of severe treatment. Name them
Type 1: Continuous Positive Airways Pressure (CPAP)
Type 2: Bilevel Positive Airways Pressure (BiPAP)
112
URT INFECTIONS
Causes of Sinusitis?
Bacteria: H influenzae, S pneumoniae
Virus: Rhinovirus, Coronavirus
113
URT INFECTIONS
Symptoms of Sinusitis?
Headache, frontal pain, Nasal discharge
114
URT INFECTIONS
Pharyngitis causes?
S.aureus, H.influenzae, S,pyogenes, S.pneumoniae
virus: EBV and Adenoviruses
115
What is EBV?
Epstein-Barr Virus
116
URT INFECTIONS
Criteria for Pharyngitis?
1) Tonsillar exudate
2) No cough
3) Fever
117
URT INFECTIONS
What is Croup?
Laryngo tracheobronchitis
118
URT INFECTIONS
What is Laryngo Tracheobronchitis caused by and how is it treated?
Parainfluenza viruses and steroids with O2 therapy
119
INFLUENZA
WHat are the two proteins found on the influenza virus?
Haemagglutinin (H)
| Neuraminidase (N)
120
What is the function of Haemagglutinin?
Sticking onto the host respiratory cell/ epithelium
121
what is the function of Neuraminidase?
Lysis of host cell so the virus can be released
122
Why is Influenza A worse than B?
it has less robust genetics so mutates much more frequently
123
What is Antigenic Drift?
Small mutations so only small changes made to the virus so small infection
124
What is Antigenic Shift?
Complete change in the proteins H&N so it is unrecognisable to the immune system = infection
125
INFLUENZA
How is it transmitted?
Aerosols and droplets
126
INFLUENZA
Symptoms?
1) Myalgia
2) Fever
3) Tired
4) Headache
5) Sore throat
6) Dry cough
127
INFLUENZA
Diagnosed?
by green swab
128
INFLUENZA
Treatment?
Paracetamol, bed rest and fluids
129
INFLUENZA
When does Antigenic Drift happen a lot?
Seasonally e.g. every year new vaccine needs to be made
130
INFLUENZA
What would cause a viral pandemic?
when Antigenic Shift occurs
131
What is Alpha- 1 antitrypsin?
Alpha1 - antitrypsin is a protease inhibitor inactivated by cigarette smoke.
132
BRONCHIECTASIS
What is it?
• Chronic infection of the bronchi and bronchioles
133
BRONCHIECTASIS
What is bronchiectasis a result of, and give 5 causes for this.
A result of chronic inflammation
```
CAUSES
genetic conditions (CF, immotile cilia),
childhood infections (Pertussis),
chronic lung infections (TB),
idiopathic
immunodeficiency.
```
134
BRONCHIECTASIS
Give 4 symptoms and 2 signs a person with bronchiectasis may have.
```
Chronic purulent cough,
dyspnoea,
wheeze,
recurrent chest infections,
haemoptysis.
```
Signs are clubbing and crackles.
135
BRONCHIECTASIS
What is gold standard investigation and what would spirometry likely show?
CT chest is gold standard (CXR can be used too). obstructive
136
BRONCHIECTASIS
Give 3 organisms commonly causing acute exacerbations
S aureus, H influenzae, P aeruginosa
137
BRONCHIECTASIS
Give 3 non-pharmacological and 3 pharmacological rx.
Non-drug:
flu + pneumococcal vaccines
physiotherapy
stop smoking.
Drugs:
mucolytics,
Abx,
SABAs.
138
HYPERSENSITIVITY PNEUMONITIS
What is it?
Inhalation of allergens (fungal spores or avian proteins) provokes a hypersensitivity reaction
139
HYPERSENSITIVITY PNEUMONITIS
Causes?
- Farmers lung
- malt workers lung
- mushroom workers lung
- cheese washers lung
- wine makers lung
140
HYPERSENSITIVITY PNEUMONITIS
Acute phase?
alveoli are infiltrated with acute inflammatory cells
141
HYPERSENSITIVITY PNEUMONITIS
Chronic exposure?
- granuloma formation
| - obliterative bronchiolitis
142
HYPERSENSITIVITY PNEUMONITIS
treatment of acute and chronic?
Acute
• Remove allergen and give O2
• Oral prednisolone
Chronic
• Avoid exposure – facemask
• Long-term steroids often achieve CXR and physiological improvement
• Compensation may be payable
143
HYPERSENSITIVITY PNEUMONITIS
Investigations? Acute and chronic
Acute
• Bloods – FBC , raised ESR, ABGs
• CXR – upper-zone consolidation
• Lung function tests
Chronic
• Blood tests
• CXR – upper zone fibrosis; honeycomb lung
144
HYPERSENSITIVITY PNEUMONITIS
Acute clinical presentation?
```
• 4-6h post exposure
o Fevers
o Rigors
o Myalgia
o Dry cough
o Dyspnoea
o Crackles (no wheeze)
```
145
HYPERSENSITIVITY PNEUMONITIS
Chronic clinical presentation?
```
• Chronic
o Increasing dyspnoea
o Weight loss
o Exertional dyspnoea
o Type I respiratory failure
o Cor pulmonale
```
146
CYSTIC FIBROSIS
Epidemiology?
1/20 caucasians carry, 1/2000 affected.
147
CYSTIC FIBROSIS
| Where is the genetic problem?
Deletion mutation in a gene on chromosome 7 that encodes the CF transmembrane conductance regulator (CFTR) protein
148
CYSTIC FIBROSIS
Pathophysiology of the gene defect?
Mutations affect the cystic fibrosis transmembrane conductance regulator (CFTR).
Lead to impaired Cl- and H2O transport across cell membranes
leading to viscosity of secretions.
149
CYSTIC FIBROSIS
Give 4 places CFTR is found
Lungs, pancreas, GIT, reproductive tract.
150
CYSTIC FIBROSIS
Common presenting features?
Recurrent respiratory infections
small intestine obstruction in the young
failure to thrive
cough
haemoptysis
wheeze
Bilateral coarse crackles
151
CYSTIC FIBROSIS
Give 2 pancreatic symptoms and one reproductive.
Pancreatic: DM and steatorrhoea.
Reproductive: infertility
152
CYSTIC FIBROSIS
Investigations?
Sweat test – sweat sodium and chloride >60mmol/L; chloride > sodium
Genetics – screen for known common CF mutations – family screening + counselling
Faecal elastase – screens for pancreatic dysfunction
153
CYSTIC FIBROSIS
Treatment?
```
Chest
• Regular physiotherapy
o Postural drainage
o Active cycle breathing techniques
o Forced expiratory techniques
• Abx for acute infective exacerbations
• Bronchodilators
```
```
GI
• Pancreatic enzyme replacement
• Fat soluble vitamin supplements
• Ursodeoxycholic acid – for impaired liver function
• Cirrhosis = liver transplant
```
```
Other
• Treat CF-related diabetes
• Screen for/treat osteoporosis
• Treat arthritis, sinusitis, vasculitis
• Fertility and genetic counselling
```
154
SARCIODOSIS
What is it?
A multisystem granulomatous disorder of unknown cause.
155
SARCIODOSIS
What group are affected more frequently and more severely?
afro-caribbeans
156
SARCIODOSIS
What is the most common way it presents?
Symptomless found incidentally on a CXR with bilateral hilar
lymphadenopathy, ± fibrosis and pulmonary infiltrates (latter 2 less common early on).
157
SARCIODOSIS
Give 2 lung symptoms, 1 skin, 2 eye, 1 bone, 1 cardiac.
Lung: Dyspnoea, dry cough. Skin: Erythema nodosum. Eye: Uveitis, conjunctivitis. Bone: Polyarthralgia.
Heart: Bundle branch block.
158
SARCIODOSIS
What is the diagnostic test and what is found? What are 2 other blood tests you would look for? What will lung function tests show?
Biopsy is diagnostic: non-caseating granuloma. Look for increased ACE and hypercalcaemia (due to granulomas). Lung function tests can show a restrictive defect.
159
SARCIODOSIS
When is treatment indicated and what is given?
Parenchymal lung disease on CXR, ocular, cardiac or neurologcal involvement, or hypercalcaemia. Treated with prednisolone.
160
SARCIODOSIS
Prognosis?
60% resolve in 2 years
161
3 holistic lung tests?
6 minute walking test. Incremental shuttle walking test. Cardio-respiratory exercise testing.
162
What is Mesothelioma?
Tumour of mesothelial cells that usually occur in the pleura, caused by asbestos exposure
163
Mesothelioma clinical presentation, investigation and treatment?
- chest pain
- dyspnoea
- weight loss
CXR/CT
Chemo
164
PLEURAL EFFUSIONS
What is it?
excessive fluid in pleural space
165
PLEURAL EFFUSIONS
How is Transudates and exudates defined?
Transudates : <25g/L protein
Exudates : >35g/L
166
PLEURAL EFFUSIONS
what do you call blood in the pleura?
what do you call pus in the pleura?
Haemothorax
Empyema
167
PLEURAL EFFUSIONS
Cause of Transudates?
1) Increase venous pressure e.g.g HF
2) Hypalbuminaemia
3) Hypothyroidism
168
PLEURAL EFFUSIONS
Cause of exudates?
1) TRauma
2) Cancer
3) Infection (TB, Pneumonia, SLE)
169
PLEURAL EFFUSIONS
Signs and symptoms?
```
Breathless
Reduced breath sounds
Dull percussion
Reduced chest wall movement
Tracheal deviation
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170
PLEURAL EFFUSIONS
Diagnostic tests?
1st CXR- dense shadows with blunt angles
2nd- aspiration of fluid, send for cytology, bacteriology, protein, glucose, pH
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PLEURAL EFFUSIONS
treatment?
Transudates- treat cause
Exudates = Drain
Drain if symptomatic and surgery if persistent
172
PNEUMOTHORAX
What is it?
Air in pleural space = collapsed lung
173
What is a Tension Pneumothorax?
pleural tear acts as a one way valve so air can go in but not out
174
How does a tension pneumothorax cause a cardiac arrest?
Unilateral increase in pleural pressure = increased respiratory distress = shock and cardiac arrest
175
Treatment of tension pneumothorax?
1st - needle decompression at 2nd intercostal space at midclavicular line
176
PNEUMOTHORAX
Difference between tension and normal?
Tracheal deviation away from side of pneumothorax in tension
177
PNEUMOTHORAX
Aetiology?
- COPD
- asthma
- Pneumonia
- TB
178
PNEUMOTHORAX
How may a spontaneous one occur?
thin young man - rupture of sub-pleural bulla
179
PNEUMOTHORAX
Clinical features?
1) Pleuritic chest pai
2) dyspnoea
3) Decreased breath sounds
4) Hyper- resonant percussion
5) Reduced expansion
180
PNEUMOTHORAX
Diagnostics?
CXR - pleural linings, no lung markings, shifted mediastinum
181
PNEUMOTHORAX
Treatment?
1st - Aspirate
2nd - chest drain
primary = >2cm + breathless = Aspirate
secondary = >2cm + breathless + over 50 = intercostal drain
182
PULMONARY HYPERTENSION
What is it?
- Pulmonary arterial pressure of over 25mmHg at rest and secondary RV failure
183
PULMONARY HYPERTENSION
What is the normal mean pulmonary arterial pressure and mean arterial pressure? (MPAP and MAP)
MPAP = 10-14mmHg
MAP= 90mmHg
184
PULMONARY HYPERTENSION
Aetiology?
Occurs due to increase in pulmonary vascular resistance or increase in pulmonary blood flow
185
PULMONARY HYPERTENSION
causes?
Drugs = methotrexate, amiodarone
HIV, portal HTN, autoimmune rheumatic e.g. RA
Heart - valvular heart disease, systolic/diastolic failure
Lung- COPD, fibrosis
186
PULMONARY HYPERTENSION
Symptoms?
initial - Exertional dyspnoea and fatigue
Proegresses to : RV failure, cor pulmonale = increased JVP, Hepatomegaly, peripheral oedema
187
PULMONARY HYPERTENSION
Signs?
Loud pulmonary 2nd sound, RV heave
188
PULMONARY HYPERTENSION
Diagnostic tests?
CXR- enlarged proximal pulmonary arteries
ECG- RVH, P pulmonale - peaked p waves
189
PULMONARY HYPERTENSION
Treatment?
1st
oxygen
warfarin
diuretics = oedema
oral CCBs = pulmonary vasodilators
190
What drugs will reduce pulmonary resistance?
Sildenafil
191
PULMONARY HYPERTENSION
Worst case scenario treatment?
Lung and heart transplant - unlikely
192
Name some lung consolidation features
Bronchial breathing, dull percussions, crackles
193
BRONCHIECTASIS
What does the inflammation lead to?
* Abnormal and permanent dilation of these airways
* Leads to impaired clearance of bronchial secretions
* Secondary bacterial infection
* May be localised to a lobe or generalized
194
Complications of TB (other organs)
Meningitis
Addison's
Hepatitis
