Respiratory Flashcards
Fev1/Fvc <75%
Obstructive
Asthma, COPD, bronchiectasis, bronchiolitis obliterans
Fev 1 /Fvc normal/raised
restrictive
PF, asbestosis, sarcoidosis
ARDS, kyphoscoliosis, neuromuscular disorders
HAP -most common bacteria type
Gram negative anaerobes
Most common organism CAP
Strep pneumonia
HI
Mycoplasma
Aspiration microbes
Anaerobes
Pneumococcal
Most common
Fever, pleurisy, herpes labialis
Lobar consolidation
rust coloured sputum
Staphylococcal
Complicates flu
Young, old, IVDU
Bilateral cavitating pneumonia
Klebsiella
Rare Old, DM Upper lobe cavitating Drug resistance often red current jelly sputum
Pseudonomas - who gets it?
Bronchiectasis
CF
Mycoplasma
Epidemics 4 yrs Flu symptoms > dry cough cold agglutinins CXR reticular nodular shadowing patches >autoimmune hemolytic anaemia >erythema multiform, Stephen Johnsons, GBS
Legionella
Flu like > dry cough D&V, renal failure CXR Bilateral consolidation Lymphopenia Hyponatraemia Deranged LFTs
RSV
Bronchiolitis
Parainfluenza virus
Croup
Rhinovirus
Common cold
Haemophilus Influenzae
CAP
Most common for bronchiectasis exacerbations
Acute epiglottitis
Pneumocystis Jiroveci
HIV
Few chest signs
Exertional dyspnoea
Tonsitilits
group B haemolytic strep
Pseudomembranous croup
staph A
q fever
corxiella burnetti
cattle sheep goats
flu like + GI symp
>ARDS, endocarditis
chlamydia psittaci
bird fanciers lung
systemic prodrome
rising titre complement fixing antibody
Exudate
protein > 30
Inflammatory, cancer
Transudate
<30
HF, cirrhosis etc
Positive BDR testing
Improvement of FEV1 of 12% or more and increase in volume of 200 ml or more
In children just 12%
Diagnosis Asthma
Spirometry and BDR test
Should have FeNO test
FeNO results
Children > 35 parts/ billion
Adults > 40
g
jyg
LAMA examples
glycopyronium
tiotropium
Theophylline
Phosphodiesterase inhibitor
Increases cAMP ….. > decrease leukotrienes
How to step down asthma therapy.
If stable reduce ICS by 25-30% every 3 months
Spirometry grade severity COPD
FEV1: FVC ration < 70 AND FEV1: >80 - - mild (stage 1) 50 - mod 30 - severe <30 v severe (stage 4)
Most common viral cause of COPD
Human rhinovirus
First line abx for exacerbation of COPD
Amox, clari, doxy
Asthma Adult management
SABA \+ low ICS \+LTRA \+LABA \+MART - low, medium > high seperate ICS + LABA \+ LAMA/ theophylline/ expert
Asthma management 5-16
As per adults - changes:
Stop LTRA if not working
High dose MART available
SABA \+ low ICS \+ LTRA - stop if not working \+ LABA > MART - low, med, high.
Trial theophylline
Asthma management in children <5
SABA
Trial 8 moderate ICS
> back in 4/52 - low ICS
> >4/52 - retrial 8 weeks
+ LTRA
Stop, refer paeds
COPD management
SABA/ SAMA
Then.. is there asthma features?
Yes - LABA + ICS (then + LAMA)
No - LABA + LAMA
Theophylline Oral abx - macrolide - azith (should not smoke), needs CT thorax, sputum cultures LFTs/ QT hearing loss tinnitus
Prophylactic antibiotics in COPD
Macrolide - azith
(should not smoke), needs CT thorax, sputum cultures
LFTs/ QT
hearing loss tinnitus
Example LABA
Salmeterol
Example LAMA
Tiotropium
What is theophylline
Phosphodiesterase inhibitor..
relaxes smooth muscle
