Respiratory important Flashcards
What bacteria are responsible for TB?
Mycobacterium tuberculosis
M. bovis (“bovine TB”)
How is TB transmitted?
From “open” TB coughing/sneezing
Remain airborne for long periods of time
Bovine - through infected cow’s milk
What can indicate post primary pulmonary TB?
Diabetes Immunosupressive diseases/drugs Previous TB Alochol Imigrants from high incident areas Poor social circumstances
How do you diagnose TB?
3 sputum specimins on successive days
>Sputum smear
>Sputum culture
>Sputum PCR potentially
Chest xray
CT if above positive
What do you see on an Xray for TB?
Patchy shadowing Often of Apices/apexes of lower zones Often bilateral Cavitation in advanced disease May be calcified if chronic/healed
How do you treat TB?
Rifampicin 6 months Isoniazid 6 months Ethambutol 2 months Pyrazinamide 2 months Must also notify comission
What are the side effects of rifampicin?
Orange ‘Irn Bru’ urine, tears Induces liver enzymes, >prednisolone, >anticonvulsants >Oral contraceptive pill ineffective Hepatitis
What are the side effects of isoniazid?
Hepatitis
Peripheral neuropathy
What are the side effects of ethambutol?
Optic neuropathy
What are the side effects of pyrazinamide?
Gout
Why does CF lead to recurrent pulmonary infections?
Decreased mucociliary clearance
Increase bacterial adherance
Decrease endocytosis of bacteria
Leads to increased colonisation
Which bacteria reduce life expectancy dramatically in CF?
Pseudomonas aeruginosa
Burkholderia cepacia
Stenotrophomonas maltophilia?
How do you treat CF infections?
Early and aggressively with antibiotics
Oral antibiotics for Staph, Haemophilus, Pneumococcus
IV antibiotics for Pseudomonas, Stenotrophomonas, Burkholderia
Two antibiotics (-lactam + aminoglycoside)
Two week course
What are the indications for lung transplant with CF?
(Done as double lung) Rapidly deteriorating lung function FEV1 < 30% predicted Life threatening exacerbations Estimated survival <2 years
What is Ivacaftor?
Drug addressing primary defect in CF
Currently too expensive
However only helps in some patients
How does CF affect fertility?
No effect on sexual function
Affects fertility in men
Females fertile, however poor nutritional state may affect chances of conception
What are the contraindications to transplant in CF?
Other organ failure Malignancy within 5 years Significant peripheral vascular disease Drug, nicotine, alcohol dependency Active systemic infection Microbiological issues (eg. M. abscessus)
What is the defect in CF?
A defect in the Cystic fibrosis transmembrane conductance regulator (CFTR)
Without it, cilia collapse
And excessive inflammation
What is the CFTR?
Active transport channel for chlorine
>Regulates liquid volume on epithelial surface through chloride emission
How do you screen for CF?
Guthrie test - heel blood prick day 5
Intially immuno-reactive trypsinogen
If positive then analysis of mutation
What are the features of pancreatic insufficiency (in CF)?
Abnormal stools (steatorrhea) Failure to thrive
How do you treat pancreatic insufficiency?
Enteric coated enzyme pellets
High energy diet
Fat soluble vitamins/mineral supplements
PPIs
What are the main features of CF?
Recurrent bronchopulmonary infection
Pancreatic insufficiency
What are the respiratory organisms in CF?
Common organisms
>Staphylococcus aureus and >Haemophilus influenzae in early years
>Pseudomonas aeruginosa later
Less common organisms >Burkholderia cepacia >Stenotrophomonas maltophilia >Alcaligenes xylosoxidans >Atypical mycobacteria e.g. M abscessus
What are the common occupational interstitial lung diseases?
Extrinsic allergic alveolitis
Coal workers’ pneumoconiosis
Silicosis
Asbestosis
What can cause occupational COPD?
Coal mining
Hard rock mining
Cadmium fume
Organic dusts
What is occupational asthma?
A substance is considered to cause occupational asthma if, as a result of exposures in the workplace, it both:
produces the biological change known as the hypersensitive state in the airways and
triggers a subsequent reaction in those airways”
How do you diagnose occupational asthma?
Work related symptoms
Working with occupational sensitiser
Symptoms better when not at work
Symptoms may be worst after shift
What causes farmer’s lung?
Thermophillic actinomyectes
What is silicosis?
Caused by inhalation of silicon dioxide - miners, stomemasons etc
Rarely fatal
Can cause silicoTB
What is asbestos?
Mineral used often for insulation etc
Commonly foundin building materials
Highly toxic (Increased cancer risk)
What is asbestos related disease?
Pleural plaques (benign) Benign asbestos pleurisy Pleural fibrosis Asbestosis (progressive pulmonary fibrosis) Lung cancer Mesothelioma (malignant pleural tumour)
What are pleural plaques?
Asymptomatic
No affect on lung function
Not premalignant
What is benign asbesto pleurisy?
Presents with pleural effusion
Often blood stained
May lead to DPT
What is asbestosis?
Latency of 20+ years
Progressive breathlessness
Cough
Signs
Crackles
Clubbing
Restrictive lung function
Interstitial fibrosis on radiology
What is mesothelioma?
Pleural malignancy
Can occur in peritoneum
Presents with SOB + chest wall pain
Usualy unilateral pleural thickening
What are the symptoms of COPD?
SOB Cough/recurrent chest infection Loss of muscle mass/weight loss Cardiac disease Depression
What are the examination signs of COPD?
Reduced chest expansion Prolonged expiration/wheeze Hyperinflated chest Respiratory failure >Tachypneoa, cyanosis, accessory muscles etc
How do you manage COPD?
Smoking cessation
Inhalers for SOB + exacerbation
Long term oxygen (if not smoker)
What drugs are used in COPD?
SABAs
LABAs
Short/long acting antimuscarinis (SAMA/LAMA)
Inhaled corticosteroids
What are the signs/symptoms of an exacerbation of COPD?
Increased SOB Cough Sputum volume/purulence increase Wheeze worsens Chest tightness
What is the presentation of lung cancer>?
Haemoptysis Recurrent bronchopulmonary infection Cough, increasing breathlessness Chest or other pain Weight loss Lump
What are the signs of lung cancer?
Finger clubbing Reduced expansion/dull percussion etc Cervical lymphadenopathy Horner's syndrom Hepatomegally
What are the treatment options of lung cancer?
Surgery
Radiotherapy
Chemotherapy
What are the types of lung cancer?
Non small cell >Squamous >Adenocarcinoma Small cell Mesothelioma
How do you treat malignant pleural effusion?
Drain + send fluid to cytology + microbiology
Follow up with chemo/radio dependent on stage
What is the interstitium?
Connective tissue space around
airways,
vessels and
space around basement membrane of alveolar walls
What are the trends in restrictive lung disease?
FEV normal or low
FVC very down
Ratio above 70%
What are the trends in obstructive lung disease?
FEV massively down
FVC normal
Ratio below 70%
What is sarcoidosis?
Multisystem disorder More common in temperate climates Acute arthralgia Erythema nodosum Bilateral hilar lymphadenopathy
How do you diagnose sarcoidosis?
Clinical/imaging findings
Serum calcium and ACE up
What can cause restriction?
Interstitial lung disease Pleural effusions Pneumothorax Pleural thickening Skeletal causes Muscle causes (eg ALS) Obesity/pregnancy
What are the main intersitial lung diseases?
Sarcoidosis
Idiopathic pulmonary fibrosis
Hypersensitivity pneumoniitis
How do you treat sarcoidosis?
No treatment if mild
NSAIDs in arthralgia
Topical steroids
Systemic steroids
What is the presentation of idiopathic pulmonary fibrosis?
Chronic SOB + cough
Often older men
Clubbing
Crackles
How do you diagnose asthma?
S&S
Peak flow
Spirometry
What are the steps for treating asthma?
Inhaled SABA Inhaled corticosteroids Inhaled LABA 4th step - increase or new drug 5th corticosteroids oral
What are the examples of SABA?
Salbutamol
Terbutaline
What new drugs can be considered in the 4th step?
Leukotrine receptor antagonists
Beta2 agonist tablet
Theophylline
How do you treat mild acute asthma?
Oral steroids for 7 days
SABA frequently
Assess within 24 hours
How do you treat a severe asthma attack?
Oral/IV steroids
Nebulised bronchodilators
IV magnesium sulphate if no response
Antibiotics if infection
