Respiratory Flashcards
How is COPD investigated?
CXR:
- Hyperinflation, flat hemidiaphragm (also important to exclude lung cancer in this cohort of patients)
Lung function tests (spirometry):
- FEV1/FVC ratio < 0.7
- FEV1 may be normal or reduced
Describe the conservative management of COPD.
Smoking cessation
Describe the pharmacological management of COPD.
- 1st line = SABA, e.g. salbutamol AND LAMA (long acting muscarinic antagonist) e.g. tiotropium bromide
- 2nd line = Add LABA, e.g. salmeterol
- 3rd line = Add ICS (inhaled corticosteroid), e.g. beclomethasone
Which micro-organism causes tuberculosis?
Mycobacterium tuberculosis
What are the symptoms of tuberculosis?
- Cough
- Haemoptysis
- Pleuritic chest pain
- Fever/night sweats
- Fatigue
- Weight loss
How is TB investigated?
- Sputum test (3x)
- Mantoux skin test
Describe the pharmacological management of TB and give a side effect for each of the drugs used.
RIPE! R - rifampicin I - isoniazid P - pyrazinamide E - ethambutol
Side effects: Rifampicin = red urine Isoniazid = peripheral neuropathy Pyrazinamide = hepatitis Ethambutol = visual problems
What is bronchiectasis?
Permanent abnormal dilatation of the bronchi and bronchioles - this leads to a build-up of mucus that makes the lungs more susceptible to infection
What are the causes of bronchiectasis?
- Congenital, e.g. cystic fibrosis
- Infections, e.g. TB, pneumonia
- Bronchial obstruction, e.g. tumour
What are the clinical features of bronchiectasis?
- Cough
- Copious amounts of purulent sputum
- Intermittent haemoptysis
How is bronchiectasis investigated?
- Sputum culture
- Spirometry - obstructive pattern
- CXR shows cystic shadows and thickened bronchial walls
Describe the management of bronchiectasis.
- Sputum expectoration/mucus drainage
- Abx if necessary
- Bronchodilators
- Inhaled corticosteroids
What is a pneumothorax?
Build up of air in the pleural space
What are the symptoms and signs of pneumothorax?
Symptoms:
- Dyspnoea
- Acute, ONE SIDED pleuritic chest pain
Signs:
- Hypotension
- Hypoxaemia
- Diminshed breath sounds on affected side
What is the most common cause of pneumothorax?
Trauma
Describe the investigation of pneumothorax
CXR
Describe the management of pneumothorax
Small hole = may heal spontaneously
Chest drain
Surgery
What is the difference between a pneumothorax and a tension pneumothorax?
Pneumothorax = pleura allows air in and out
Tension pneumothorax = hole acts as one-way valve, allowing air in but not out
How could you tell if it is a pneumothorax/tension pneumothorax?
CXR - in tension peumothorax, trachea will deviate away form affected side
Describe the management of tension pneumothorax
MEDICAL EMERGENCY
Immediate chest drain and surgery
What is pleural effusion?
Build up of fluid in the pleural space
What are the symptoms and signs of pleural effusion?
Symptoms:
- Cough
- Dyspnoea
- Pleuritic chest pain
Signs: ALL ON AFFECTED SIDE
- Reduced chest expansion
- Diminished breath sounds
- Dull to percussion
What are the causes of pleural effusion?
Transudate vs. exudate
Transudate:
- Excessive production of pleural fluid/resorption reduced
- Increased hydrostatic pressure, e.g. heart failure
- Reduced oncotic pressure, e.g. cirrhosis, nephrotic syndrome
- Clear fluid, low protein/WCC
Exudate:
- Results from damaged pleura
- E.g. PE, pneumonia, TB, cancer
- Cloudy fluid, high protein/WCC
Describe the investigation of pleural effusion
- CXR
- Thoracocentensis to determine cause
Describe the management of pleural effusion
- Chest drain
- Treat underlying cause
Pulmonary hypertension is defined as a pressure over how many mmHg?
25 mmHg
Describe the signs of pulmonary hypertension on a CXR
ELEE
E - enlargement of pulmonary arteries
L - lucent lung fields
E - enlargement of right atrium
E - elevated cardiac apex due to RV hypertrophy
What is hypersensitivity pneumonitis/extrinsic allergic alveolitis?
Inflammation of the alveoli due to prolonged exposure to a particular allergen, e.g dust, animal proteins
Describe the management of hypersensitivity pneumonitis/extrinsic allergic alveolitis
- Avoid exposure to allergen
- Corticosteroids, e.g. prednisolone
Give 2 signs of TB on chest X ray
Ghon complex
Bihilar lymphadenopathy
Small cell lung cancers may present as a (…?) syndrome
Paraneoplastic syndrome
