Respiratory Flashcards
Bronchiectasis - key features hx
chronic cough sputum production dyspnoea recurrent LRTI \+/- haemoptysis ?smoker pmhx recurrent LRTI as child
Bronchiectasis - key features ex
bibasal crackles chest auscultation
+/- wheeze
digital clubbing
SaO2 N or low
Bronchiectasis - single most useful Ix to diagnose
HRCT chest - abnormally dilated airways, bronchoarterial ratio>1
Bronchiectasis - initial Ix to rule out secondary causes
Initial:
FBC
Sputum MCS x 1 routine resp pathogens
Sputum MCS x 3 morning samples for atypical pathogens
TB serology/PCR quantiferon gold
Total IgE
spirometry - normal in early disease, variable mixed pattern, restrictive or obstructive
+/- Immunoglobulins IgG, IgA, IgM
+/- HIV/HTLV serology
+/- Aspergillus serology
+/- Cystic fibrosis screening - sweat test and CF transmembrane conductor regulator gene mutation
Bronchiectasis - Mx
Immediate:
Referral to resp physician at dx
Physio pulm rehab exercise program
Airway clearance - breathing, cough, neb normal saline, mycolytics
Vaccination - Pneumococcal and influenza
Early treatment of acute exacerbations with appropriate antibiotics
Aug DF bd or doxycycline 100mg bd for 10-14 days
Long term:
prophylactic poabx if 3 or more acute exacerbations in 1yr
+/- palliative care referral
+/- transplant surgery
Bronchiectasis - key features of acute exacerbation
2 or more of: increase cough increased SOB increase volume or purulence of sputum reduction of FEV1 >10% in <2/52
Bronchiectasis - indications for referral to respiratory physician
rapid progression of symptoms
severe symptoms
frequent exacerbations and POABx
haemoptysis
Pertussis/whooping cough - key features
persistent cough for ≥ 2/52 plus:
paroxysms of coughing
inspiratory whoop
post tussive vomiting
mild coryzal symptoms between coughing paroxysms
Pertussis/whooping cough - Ix and timing
Nasopharyngeal swab for PCR - < 2/52 since onset of symptoms. will be neg if >21/7 since onset or 5/7 poabx
Nasopharyngeal swab for MCS - less sensitive, positive after 2-4/52 catarrhal phase.
Pertussis serology (IgA) detectable after 2/5 of symptom onset
Pertussis/whooping cough - Mx
advise goal - prevent disease transmission, doesnt alter disease duration Avoid contact with others until had 5/7 POABx Contact Prophylaxis (same tx as index case) - kids <2yrs, pregnant women 3rd trimester household contacts if < 6/12 baby in household
Pertussis/whooping cough - Tx
azithromycin (10mg/kg, then 5mg/kg) 500mg po stat, 250mg po od for 4/7
Bactrim DS 160/800mg po bd for 7/7
Clarithromycin 500mg po bd for 5/7
Interstitial lung disease - causes “schart rasco”
Sarcoidosis Coal miners pneumoconiosis Histiocytosis Ankylosing spondylitis + Allergic aspergillosis Radiation Tuberculosis
Rheumatoid arthritis Asbestosis Scleroderma Cryptogenic fibrosing alveolitis Other - drugs: amiodarone, MTX, nitrofurantoin, hydralazine, bleomycin
Interstitial lung disease- key features hx
Indolent and progressive
SOB/dyspnoea
dry cough
Interstitial lung disease- key features ex
fine inspiratory crackles
reduced SaO2
digital clubbing
Interstitial lung disease - key Ix
- HRCT chest:
honey combing
ground glass and mosaicism opacity pattern
spirometry - restrictive ventilatory defect - CXR:
basal and peripheral reticulonodular opacities/interstitial opacities (network of lines that form nodules and ring shadows)
+/- medistinal ipsilateral displacement
Fibrocystic changes - Lung biopsy - gold standard for Dx cause of ILD
other to determine cause: spirometry ANA, Anti CCP, ANCA (autoimmune) FBC (infection, eosinophilia) LFT/UEC autoimmune, systemic vasculitis multiorgan involvement
Interstitial lung disease - Mx
prompt referral to respiratory physician
general measures:
stop smoking
identify and tx associated comorbidities:
GORD
pulm HTN
depression/anxiety
Patient education - poor prognosis, planned EOLC discussion
Referral to palliative care
Irretractable dyspnoea - opioids
Interstitial lung disease - Tx for symptom control
dyspnoea - opioids
GORD - PPI
hypoxaemia at rest - O2
acute flare - oral prednisolone 0.5mg/kg/day for 1/12, then maintenance dose 10-15mg od for 2yrs
Pleural effusion - causes
exudative (local disease):
transudative (systemic disease):
Pleural effusion - key features hx
dyspnoea
pleuritic chest pain
cough
Pleural effusion - key features CXR
meniscal edge (concave) of effusion homogenous shadowing/opacity \+/- contralateral mediastinal shift/tracheal displacement
Pleural effusion - key features Ex
tacchypnoea
SaO2 reduced
reduced chest expansion - ipsi or bilaterally
percussion dullness
reduced or absent breath sounds over fluid
reduced vocal resonance
+/- bronchial BS at upper border of effusion
+/- pleural friction rub above level of effusion
Pulmonary hypertension - causes
Cardiac: LV failure Left sided valvular HD (CCF) Intracardiac shunts(congenital VSD/ASD) Liver cirrhosis
Respiratory: COPD Chronic PE Idiopathic pulm arterial HTN from connective tissue disorders Interstitial lung disease OSA
Pulmonary hypertension - RF
Fhx Obesity Asbestis exposure High altitude living cocaine + amphetamine use
Pulmonary hypertension - key features Hx
SOB fatigue dizziness syncope chest pressure/pain ankle swelling/ascites cyanosis - lips and skin heart palpitations