Respiratory Flashcards
list the bedside tests in respiratory?
Sputum examination
Peak Expiratory Flow
Pulse oximetry
ABG
Spirometry
what happens to the FEV1/FVC in restrictive and obstructive airway disease?
Normal, 75-80%
>70% normal
<70% predicted
pneumonia can be classified as what?
Community aqcuired
Hospital acquired
Aspiration
immunocomprimised pt
clinical features of pneumonia?
Symptoms: fever, rigor, malaise, anorexia, dyspnoea, cough, purulent sputum, pleuritic chest pain
Signs: pyrexia, cyanosis, tachyponeic, tachycardic, signs of consolidation, pleural rub
how is severity assessed in pneumonia?
CURB65
Confusion
Urea
Resp rate >30/min
BP <90 systolic +/- 60 diastolic
>65yrs of age
how many points does each element of CURB65 score?
1pt for each
0-1, antibiotic/ home treatment
2, hospital therapy
3, severe pneumonia consider ITU
complications of pneumonia?
respiratory failure, hypotension, atrial fibrillation, pleural effusion, empyema lung abscess, septiceamia, pericarditis/ myocarditis, jaundice
repeat CXR/CRP in thsoe not responding to treatment to look for complications/progression
which is the most common bacterial pneumonia?
pneumococcal pneumonia
which pneumonia occurs as an epidemic every 4yrs?
mycoplasma pneumonia- presents insidiously with flu like symtpoms followed by dry cough
complications include skin rash, stevens johnson syndrome,
which population goups are more likely to suffer klebsiella pneumonia?
diabetics, alcoholics, elderly
particularly affects upper lobes
which pneumonia causes a bilateral cavitating bronchopneumonia?
staphylococcal pneumonia: may complicate influenze infection or occur in elderly/young, IVDU, those with underlying disease
hwo is leionella pneumonia diagnosed?
urine antigen/ culture
which pneumonia colonizes in water <60C?
legionella pneumonia
(typical in pools/ air conditioning)
which respiratory illness is acquired from infected birds (typically parrots)?
chlamydial psittaci
headache, fever, dry cough, patchy consolidation on CXR
which pneumonia commonly presents in the imunocompromised patient?
pneumocystitis pneumonia
dry cough, fever, bilateral crepitations, exertional dyspnoea
which organsism is responsile for pneumocystis pneumonia?
pneumocystis jiroveci
what is empyema?
pus in the pleural space
suspect if a pt with resolving pneumonia presents with recurring fever
chronic inflammation of the bronchi and bronchioles resulting in permanent dilation and thinning fo these airways is known as?
bronchiectasis
what are the main organisms responsible for bronchiectasis?
H. influenzae, strep pneumoniae, staph aureus, pseudonmonas aeruginosa
clinical features of bronchiectasis?
symptoms: persistent cough, purulent sputum, intermittent haemoptysis
signs: figner clubbing, crepitations, wheeze,
how do you bronchiectasis?
airway clearance techniques: chest physiotherapy, mucolytics
Antibiotics (consider longterm if >3 exacerbations a year)
bronchodilators/ corticosteroids
what is seen on this CT?
Bronchiectasis
how many people carry a copy of the faulty gene for Cystic Fibrosis?
1:25 people
Cystic fibrosis is caused by a mutation in which gene?
CFTR gene on chromosome 7
(CF transmembrane conductance regulator)
causes defective chloride secretion and increased sodium absoprtion across the airway epithelium
CF features in neonates and young children
Neonates: failure to thrive, meconium ileus, rectal prolapse
young children: cough/wheeze, recurrent infections, pancreatic insufficiency (DM, steatorrhoea), dital intestinal obstruction syndrome,
how is CF diagnosed?
sweat test: sodium and chloride >60mmol/L
genetic screening
further tests include: FBC, LFTs, annual glucose tolerance test, sputum cultures, CXR, Abdo US, Spirometry
describe the management of CF?
Chest: physiotherapy, drainage, antibiotics, bronchodilatros, annual CXR
GI: look for any evidence of malabsoption, GORD, pancreatic dysfunction
what are some mutation specific therapies for CF?
Ivacaftor
Lumacaftor
symptoms of lung tumour?
cough, haemoptysis, dyspnoea, chest pain, lethargy, anorexia, wgt loss
how are lung tumours differentiated?
Small cell lung cancer (SCLC)
Non-small cell lung cancer (NSCLC): Squamous, adenocarcinoma, large cell
SCLC or NSCLC is more likely disseminated at presentation?
SCLC (70%) laready disseminated at presentation
complications of lung tumours?
recurrent laryngeal nerve palsy, phrenic nerve palsy, SVC obstruction, Horners syndrome,
metastases to brain, bone, liver, adrenals
describe a bronchial adenoma
rare, slow growing, 90% are carcinoid tumours
treat w surgery
lung malignancy asocc w asbestos exposure?
mesothelioma: occurs in pleura
latent period of up to 45yrs fro time of exposure
how is mesothelioma diagnosed?
Pleural thickening, effusion on CXR/CT
diagnosed with hisotology
how is mesothelioma managed?
pemtrexed + cisplatin therapy can improve survival
pleurodesis/ indwelling intra pleural drain may help
(overall poor prognosis <2yrs)
differential dagnoses of lung nodule on CXR?
malignancy primary/secondary, abscess, granuloma, carcinoid tumour, AVM, cyst
if surgery is being considered with curative intent in lung cancer what should be carried out beforehand?
PET-CT
treatment options for NSCLC and SCLC?
NSCLC: lobectomy for localised disease with curative intent. Radical radiotherapy for stage I,II,III. Chemo +/- Radiotherapy for more advanced disease i.e. cetuximab
SCLC: surgery if limited stage disease, Chemo +/- Radiotherapy if well enough, palliative radiotherapy/ drainage/drug therapy
list the 5 ways aspergillus fungi affects the lungs?
- Asthma (Type I hypersensitivity)
- Allergic bronchopulmonary aspergillosis (ABPA, Type I +II hypersensitivity
- Aspergilloma (mycetoma), fungus ball within pre-existing cavity (i.e. TB/sarcoidosis)
- Invasive aspergillosis
- Extrinsic allergic alveolitis
what three factors contribute to the airway narrowing seen in asthma?
bronchial muscle contraction, mucosal swelling/inflammation, inc musous production
what symtpoms pattern is seen inasthma?
diurnal variation: symtpoms vary throughout the day
mornign dip of peak flow is common
what are the treatment steps in asthma?
