RESPIRATORY - Bronchiectasis, CF and pneumonia Flashcards
What is bronchiectasis
Chronic dilatation of airways –> chronic infection/inflamm
Sx bronchiectasis (5)
Recurrent cough --> copious infected sputum Int haemoptysis Persistent hallitosis Dyspnoea Recurrent febrile eps/eps pneumonia
Signs bronchiectasis (4)
Clubbing
Coarse insp crackles over infected areas
Wheeze
Low body habitus
What is bronchiectasis’ most common differential
COPD
Most common cause bronchiectasis
No cause
Other causes bronchiectasis
Post infective CF Obstruction - tumour/FB Allergic broncho-pulmonary aspergillosis Ciliary Dyskinetic syndromes immune deficiency CT disease
Pathology bronchiectasis
Airways become dilated w/ purulent secretions + chronic inflamm b/c of inflamm granulomatous tissue
Granulomatous tissue can bleed –> haemoptysis
Repeated exaccerbations –> fibrous scarring –> resp failure
Ix bronchiectasis (4)
Sputum culture
CXR
CT
Spirometry
CXR findings bronchiectassis
cystic shadowing
CT findings bronchiectasis
Dilated airways w/ signet ring sign
What type of respiratory pattern does bronchiectasis have
Obstructive
Mx bronchiectasis
Assess for Tx'able causes Stop smoking physio postural drainage ABx for exacc Imms Bronchodilators Surgery (rare)
Complications bronchiectasis (6)
pneumonia pneumothorax empyema lung abscess haematogenous spread of infection Severe life threatening haemoptysis
CF genetics
Autosomal recessive
mutation CFTR gene chromo 7 post 508
What % of CF is ID’d by genetic screening
90%
What does the mutation in CF usually code for
cAMP regulated Cl- channels
Which are predominantly in resp tract and pancreas
Pulmonary features CF
Recurrent resp infections FTT Later in life - breathless, haemoptysis --> bronchiectasis chronic sinusitis + nasal polyps resp failure + cor pulmonale
GI features GF (4)
Mec ileus
Steatorrhoea + malabsorption
Incr gallstones + peptic ulcers
Cirrhosis
Other features (Non GI/pulm) of CF (4)
Clubbing
Infertilty - m + subfertility f
DM
Rickets/osteomalacia
early pathogens CF
S aureus
H influ
late pathogen CF
Pseudomonas
Def pneumonia
Infection of pulmonary parenchyma + shadowing cxr
Who most commonly gets pneumonia
elderly
male
smoker
alcoholics
SOCRATES - pneumonia
S - chest pain O - progressive C - pleuritic R - shoulder/ant abdo wall A - systemic illness, dry/painful cough --> productive mucopurulent. Dyspnoea T 0 days --> w S - moderate