Respiratory Flashcards
What are the physiological causes of pulmonary oedema?
Increased capillary permeability
Increased capillary pressure
Decreased oncotic pressure
Lymphatic obstruction
Symptoms of pulmonary oedema?
SOB - orthopnoea, exercise dyspnoea, paroxysmal nocturnal dyspnoea
Tachypnoea
Cough - pink frothy sputum
Investigations for pulmonary oedema?
Bloods - FBC, U+Es, BNP, blood gas
CXR
ECG
Lung function tests - restrictive pattern
How can you divide up the causes of pulmonary oedema?
Cardiogenic
Non-cardiogenic
What non-cariogenic conditions can cause pulmonary oedema?
Non-cardiogenic
- volume overload (increased cap pressure)
- renal - AKI, CKD, renal artery stenosis (increased cap pressure)
- ARDS (increased cap permeability)
- lung transplant (may cause lymphatic insufficiency)
What cardiogenic conditions can cause pulmonary oedema?
All cause increased capillary pressure:
- MI
- Valve problem - aortic regurg/stenosis, mitral regurg
- PE
- Cardiomyopathy
- Cardiac tamponade
Management of pulmonary oedema?
Varies with cause
1) Sit patient up + oxygen
2) Nitrates (vasodilators) if Syst BP >90
3) Furosemide
4) Opiates (not if heart failure) - decrease anxiety but may suppress respiratory drive
5) ?ACEi long term
RFs for a PE? (Name 5)
Post-surgery Long-haul flight cOCP Malignancy Pregnancy
What is the pathophysiology of CF?
Defects if the CFTR protein, who’s gene is on the long arm of Chr 7
Most commonly ∆508
Causes high conc of Na and low conc Cl in secretions
How do babies with CF normally present? (if not picked up of Guthrie screening)
Meconium ileus
Respiratory infections
Failure to thrive
Respiratory presentations of CF?
Recurrent infections esp with Pseudomonas
If aspergilloma, may have haemoptysis
Bronchiectasis
Nasal polyps
Pulmonary HTN + fibrosis may cause cor pulmonale
GI manifestations of CF?
Pancreatic insufficiency -> malabsorption, steatorrhoea, DM Thickening of bile -> portal HTN Liver cirrhosis/CLD -> gynaecomastia Gallstones, cholecystitis Acute pancreatitis Intussusception
Other manifestations of CF?
Infertility for males (failure of vas deferens and epididymis to develop)
DM
Ix for CF
Immunoreactive trypsinogen in heel prick
Sweat test - >Na, >Cl
Nasal potential difference testing
Genetic testing
Management of pulmonary manifestations in CF?
Vigorous daily physiotherapy - with manual percussion, forced expiratory manoeuvres and vibration
May also be a role for postural drainage - lying in various positions
Prophylactic or responsive abx
Management of nutrition in CF?
Enteric coated pancreatic enzymes
KADE vitamin replacement
120% normal diet intake - high calorie, high fat
Respiratory causes of clubbing?
Bronchus carcinoma, mesothelioma, bronchiectasis, abscess, empyema, fibrosing alveoli’s, CF
NOT COPD or asthma
Which abx treats MRSA?
Vancomycin
Which abx treats Legionella?
Clarithromycin
Which organs does sarcoidosis affect?
Lungs, eyes, skin
Heart, kidney, CNS
Investigations for sarcoidosis?
Bloods - Raised serum ACE, Ca, ESR and Ig
Urine - raised Ca
CXR/CT - hilar lymphadenopathy
Tissue biopsy - non-caseating granulomata with epithelioid cells
Management of sarcoidosis?
Bilateral hilar lymphadenopathy alone - no Tx needed
Acute - bed rest + NSAIDs
Consider prednisolone 6-12 months
What are the symptoms of idiopathic pulmonary fibrosis?
Dry cough, exertion dyspnoea, malaise, WL, arthralgia
What are the signs of IPF?
SOB/cyanosis, clubbing, fine end-inspiratory creps
Investigations for IPF?
Reduced transfer factor (TLCO)
ANA +ve in 30%
CXR - ground glass to honeycomb lung
CT - Ix of choice
Management for IPF?
Best supportive care - O2, pulmonary rehab, opiates, palliative care
How much does peak flow readings need to change by to diagnose asthma?
After bronchodilator reversibility test: improvement of FEV1 >12% and increase in volume of >200ml
What is the side effect of salbutamol?
Tremor
What is the side effect of ICS (beclometasone)?
stunted growth in
children
oral candida
Asthma treatment?
SABA (salbutamol) - for symptomatic relief, relaxes SM of the airways
If asthma not controlled/new Dx + symptoms ≥3 times/wk or night-time waking:
ICS (beclometasone) - taken every day regardless of symptoms
Add a LTRA, continue if responsive
LTRA (Montelukast) - oral
LABA (salmeterol) - taken every day regardless of symptoms
MART (maintenance + reliever therapy) is now an option for patients with poorly controlled asthma – contains ICS + LABA in a single inhaler
Main investigation for asthma after spirometry?
FeNO test
Examples of T1 and T2 respiratory failure?
T1: Pneumonia, Pulmonary Oedema, PE, Asthma, Emphysema, Pulmonary fibrosis
T2:
- Pulmonary disease – asthma, COPD, pneumonia, end-stage pulmonary fibrosis etc
- Reduced respiratory drive – sedative drugs, CNS tumour or trauma
- Neuromuscular disease – cervical cord lesion, myasthenia gravis, GBS
- Thoracic wall disease – flail chest, kyphoscoliosis
Symptoms of hypoxia?
SOB, agitation, central cyanosis, confusion
Symptoms of hypercapnia?
headache, peripheral vasodilatation, tachycardia, tremor/flap, papilloedema
Causes of pneumothorax?
Often spontaneous
Chronic disease - asthma, COPD, CF, Ca
Infectious - TB, pneumonia
Trauma
When might you need surgical advice for a pneumothorax?
If: •bilateral pneumothoraxes •Failure of IC drain insertion •2+ previous pneumothoraxes on same side •Hx of pneumothorax on the opposite side
What causes transudates in pleural effusions?
D/t increased hydrostatic pressure
Too much fluid - CCF, fluid overload
Hypoproteinaemia - cirrhosis, malabsorption
What causes exudates in pleural effusions?
The gap between the endothelial cells widen and fluids and proteins leak out, therefore there is a high protein content found in exudates e.g. caused by infection, Ca, PE, RA, SLE etc
