Respiratory Flashcards
Recall the 3 different clinical pictures that can be produced by aspergillus spore inhalation
Aspergilloma
Allergic bronchopulmonary Aspergillosis
Invasive aspergillosis
What is aspergilloma?
Growth of A. fumigatus in pre-existing lung cavity
In which demographic is ABPA most commonly seen?
Asthmatics
Recall the pathophysiology of ABPA
Regulated by IgG and IgE
Leads to bronchiectasis
In which demographic is invasive aspergillosis most common?
Immunosuppressed
What is invasive aspergillosis?
Infection and fungal dissemination of aspergillus
Recall the symptoms of aspergilloma
Usually asymptomatic but may produce haemoptysis
How does ABPA present?
Like a difficult-to-control asthma: irecurrent episodes of pneumonia with wheeze, cough and fever
Describe the presentation of invasive aspergillosis
Dyspnoea with rapid deterioration and a septic picture
Which form of aspergillus lung disease will produce a wheeze?
ABPA
What would be found upon percussion in aspergillus lung disease?
Dullness
Where in the lungs does aspergilloma normally form?
Upper lobes
How would aspergilloma appear on CXR?
Round mass with crescent of air around it
What is the first choice of imaging for each different form of suspected aspergillus lung disease?
Aspergilloma: CXR
ABPA: CXR and CT/MRI
Invasive aspergillosis: CT/MRI
What features on imaging are indicative of ABPA?
Looks similar to bronchiectasis
Transient and patchy shadows/ consolidation
Describe the wheeze that is heard upon auscultation in asthmatics?
Polyphonic expiratory wheeze
How does HR differ in severe vs life-threatening asthma attacks?
Severe: >110
Life-threatening: bradycardia
What would be abnormal on FBC in asthma?
Eosinophilia
Recall the 6 steps of chronic asthma management
- Inhaled SABA PRN (salbutamol)
- Add low-dose inhaled steroid (beclomethasone)
- Add LABA (salmetarol)
- Increase steroid dose
- Try a different drug eg leukotriene receptor antagonist
- Add prednisolone
Recall the acute management of asthma
- High flow oxygen
- Nebulised salbutamol and ipratroprium
- IV hydrocortisone
- Continue steriod treatment orally
- If no improvement: IV magnesium or IV aminophylline
Recall the triad of pathologies that characterise bronchiectasis
- Chronically dilated airways
- Bacterial infections
- Decreased mucociliary clearance
What % of cases of bronchiectasis are idiopathic?
50%
When in the lifecourse does bronchiectasis usually arise?
Childhood
Describe the symptoms of bronchiectasis
Productive cough with copious purulent sputum and intermittent haemoptysis
What would be heard upon auscultation in bronchiectasis?
Coarse inspiratory crepitations that shift when coughing
What would be seen upon general inspection in bronchiectasis?
Clubbing
Recall 2 approaches for medical management in bronchiectasis
Antibiotics for recurrent infection
Bronchodilator
Which 2 conditions does COPD comprise?
Emphysema
Chronic bronchitis
What would be found upon percussion in COPD?
Resonant percussion notes
What would be heard upon auscultation in COPD?
Polyphonic wheeze; crepitations