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
Recall 2 signs of CO2 retention that may be seen in COPD
Asterixis
Bounding pulse
What are “pink puffers” and “blue bloaters”?
“Pink puffers” = emphysema dominates
“Blue bloaters” = bronchitis dominates
Recall 3 aspects that can differentiate between pink puffers and blue bloaters
Alveolar ventilation: increased in PPs and decreased in BBs
Build: PPs are thin with hyperinflation, BBs are stocky
Complications: PPs get resp failure, BBs get cor pulmonale
What would be seen on FBC in COPD?
Polycythaemia
How can you identify hyperinflation on CXR?
> 6 anterior ribs seen
What is cor pulmonale?
Enlargement of right hand side of heart due to lung disease
What sort of drug is ipratropium?
Anti-cholinergic
What is extrinsic allergic alveolitis?
Interstitial inflammation of distal parts of lung
What would be heard upon auscultation in hypersensitivity pneumonitis?
Fine inspiratory crepitations
To what group of diseases do farmer’s and pigeon-fancier’s lung belong?
Hypersensitivity pneumonitis/ EAA
Describe the symptoms, signs and prognosis of idiopathic pulmonary fibrosis
Symptoms: Exertional dyspnoea and dry cough with NO WHEEZE
Signs: Clubbing
Prognosis: very poor
Recall the management of idiopathic pulmonary fibrosis
Azothioprine
Glucocorticoids
What are the 2 most important blood tests to do in suspected obstructive sleep apnoea?
TFTs
ABG
What is pneumoconiasis?
Group of obstructive lung diseases related to occupation
Give 2 examples of pneumoconiasis
Silicosis
Asbestosis
Recall 2 signs of pneumoconiasis on CXR
Infiltrative patches
“Honeycombing” (cystic radiolucency)
What are the most commonly-implicated pathogens in hospital-acquired pneumonia?
Klebsiella
Pseudomonas
What are the most commonly-implicated pathogens in community-acquired pneumonia?
Streptococcus pneumoniae: 70%
H. influenzae (COPD)
S.aureus (IVDUs)
Legionella (air-con)
Which pneumonia-causing pathogens may be detected in urine?
Pneumococcus
Legionella
What is pneumocystis carinii?
Type of life-threatening fungal pneumonia
Recall the medical management of mild, moderate and severe pneumonia
Mild: oral amoxicillin
Moderate: amoxicillin + erythromycin
Severe: Erythromycin + co-amoxiclav
What is co-amoxiclav a combo of?
Amoxicillin
Clavulanic acid
Recall 3 signs that could be identified from chest examination in pneumonia
Reduced expansion
Increased tactile vocal fremitus
Dull percussion
When would metronidazole be added to pneumonia medication?
If abscess or empyema is suspected
What is empyema?
A collection of pus in the pleural cavity caused by microorganisms, usually bacteria
Recall the CURB 65 scoring system
Confusion Urea >7 Resp rate >30 BP <90/60 >65 years
Recall some causes of secondary pneumothorax
Pre-existing lung disease like asthma/ COPD/ lung Ca
When would pneumothorax cause tracheal deviation?
Tension pneumothorax
What is the management of tension pneumothorax?
Max O2
Large bore needle into 2nd ICS at MCL
What size of pneumothorax is considered small?
<2cm
How is a moderate pneumothorax aspirated?
Using a large bore needle with a 3-way cannula
If a large-bore needle with a 3-way tap fails to resolve a pneumothorax, how should it be managaed?
Chest drain with water seal
Recall 3 symptoms of pulmonary embolism
Sudden onset dyspnoea
Pleuritic chest pain
Cough with haemoptysis
How is pulmonary embolism scored?
Well’s score
What investigation should be carried out in low-probability pulmonary embolism?
D-dimer
What investigation should be done in high-probability pulmonary embolism?
CTPA + CXR
Differentiate the medical management of pulmonary embolism whether the pt is haemodynamically stable or unstable
Stable: LMWH and warfarinise
Unstable: alteplase
Recall the 3 types of TB infection
Primary: first infection, either pulmonary or occasionally GI
Miliary: when there is haematogenous dissemination
Post-primary: caused by reinfection/reactivation
What damage does mycobacterium do to the lungs?
Causes necrosis and caseating granulomas
Recall the symptoms of post-primary TB
Drenching night sweats
Fevers
Haemoptysis
Cough
What disease does mycobacterium tuberculosis cause in the heart?
Constrictive pericarditis
What would be seen on CXR in TB?
Bilateral hilar lymphadenopathy, upper lobe shadowing, potential pleural effusion
In which demographic does non-pulmonary TB usually present?
Immunocomprimised
Recall one highly specific test for latent TB
Interferon gamma
How long should antibiotic therapy be continued in pulmonary TB?
6 months
Recall the 4 antibiotics that are combined to treat TB
Rifampicin
Isoniazid
Ethambutol
Pyrazinamide
