Respiritory Flashcards
Type 1 resp failure
Hypoxia
Low O2 , Low or Normal Co2
Fluid in alveoli
Diffusion defect: CO2 can be redirected to normal lung to be removed but O2 still cant get in as well.
IBASE: ILD, Bacterial infection, ARDs, Shunt, Emphysema, Pulm embolism
Type 2 resp failure
Hypercapnia
Air unable to enter lung - all of lungs
can be problem with brain stem, phrenic nerve, neuromuscular junction
O2 low and CO2 high
Ventilation defect
Causes: COPD: Central cause- brain injury, meningitis, drugs, alcohol
Obstruction- foreign body, tumor
Pump- GBS, MND,myasthenia gravis, Ankylosing spondylitis, polio
Diaphragm involvement - obesity , Palsy
Severe Asthma attack
COPD
Chronic bronchitis Type 2 RF
Emphysema type 1 RF
CPAP vs BiPAP
CPAP: 1 pressure, resistance breathing out, obstructive sleep apnea, Acute type 1 RF- pulmonary Edema, cardiogenic edema
BiPAP: 2 pressures, muscle/ nerve problems, Type 2 RF, COPD exacerbation, weaning from tracheal tube
Contradictions: vomiting, confusion, bowel obstruction, facial burns, pneumothorax
Small cell lung cancer
20%
Aggressive, often central airways, usually mets, surgery inappropriate
Paraneoplastic syndrome: Produce peptides: SIADH secreting- Increase water reabsorption, decreased serum osmolality. - hyponatraemia
Ectopic ACTH- Cushing’s syndrome
Tx: radio/ chemo
Squamous cell cancer
Smoking
Metaplastic epithelium glandular
Associated with ectopic parathyroid hormone (PTH) - hypercalcemia
central and cavitation
presents late - obstruction
Adenocarcinoma
peripheral and glandular
Arises from bronchial mucosa
Slow growing
Diagnosis : CXR, CT, MRI, bronchoscopy, sputum culture
Screening: 55-75 yo smokers
Surgery: lobectomy (SCLC), segmentectomy, Sleeve resection
Mesothelioma
Primary pleural malignancy
99% asbestos fibres
Very low level exposure needed
Long latency - 20 years
12month prognosis
Plaques strangle lungs
Increase pneumonia
Lung cancer staging
Tumor, Nod, Mets,
T0-4 (>7cm or >1 lobe)
N0-2 (1: ipsilateral / hilar nodes, 2: mediastinal 3: contralateral )
M1abc
Sarcoidosis
RF: afro-american female, prior TB infection
Sx and signs: general- fatigue, fever , weight loss. Specific- tender leg nodules, vision changes, SoB and cough.
Lung lymphadenopathy - Hilary granulomas - NONCASEATING (no tissue necrosis unlike TB)
Erythema nodosum - red hard painful fat in skin
Uveitis - inflamed cornea and sclera
Heart arrhythmias
Macrophages can fuse- Langhans giant cells, Schaumann bodies, asteroid bodies
Diagnosis: CXR or CT, Bloods: Ca high from increase Vit D, high ACE from T cells.
Bronchoalveolar lavage
Biopsy = GOLD
Tx: severe sarcoidosis = steroids
Churg- Strauss syndrome
Asthma, peripheral and tissue eosinophilia, extravascular granuloma formation and vasculitis of multiple organ systems.
Necrosis of small and medium vessels
Sx: none specific manifestations - fever, malaise, anorexia, weight loss
Pulmonary infiltrates
Painful peripheral neuropathy
Allergic rhinitis and sinusitis
Skin purpura and nodules
Elevates ESR, fibrinogen, alpha 2 globulins.
ARDs
Severe SoB
Rapid shallow breathing
Tiredness, drowsy
Feeling faint
Life threatening , usually complication of condition
Tx: ICU
Drugs that damage lungs
Methotrexate
Heart meds: amiodarone
Abs: nitrofurantoin Ir ethambutol
Anti inflammatory : rituximab, sulfasalazine
Sx: persistent cough
Night Sweats
Fever
Fatigue
TB
Can spread outside lungs- swollen glands, abdo pain, confusion, fits.
Immunocompramised May develop Millary TB
Apex of lung, reactivation
Tx: rifampicin , pyrazinamide, isoniazid, ethambutol
Causes of mediastinal lymphadenopathy
Acute Lymphoblastic leukaemia
Anthracosis
COPD
CF
Coccidiodomycosis
Espohageal cancer
Histoplasmosis
TB
Sarcoidosis
Lung cancer causes
Asbestos, nickel, arsenic
Power plants, fires
Genetics
Radiotherapy
Radon - radioactive odourless gas
COPD and pulmonary fibrosis is RF
Pneumonia in elderly and alcoholics
Klebsiella
CXR : cavitation pneumonia
Pseudomonas pneumonia
Common in Bronchiectasis and CF
Water tanks and recent travel pneumonia
Legionella / legionaries disease
Swimming pools hot tubs
Air conditioning units
Bloods: hyponatraemia
Lymphopenia
Diagnosis by urinary antigen
Tx: clarithromycin
Pneumonia in immunocompromised patients
HIV
Pneumocystis jirovecci
Exertion also dyspnoea and low sats
Inhibits folate
Minimal CXR findings
Dry cough
Tx: co- trimoxazole
Acute asthma management
OSHIT
Oxygen 15L
Salbutamol
Hydrocortisone
Ipratropium - muscarinic antagonist
Theophylline - only by anaesthetist
Strawberry tongue
Kawasaki disease
Whooping cough
Pertussis
Vaccine in 6-1 and 4-1
Barking cough
Croup
Causes: rhinovirus, parainfluenza, adenovirus, RSV
Tx: rest and O2 in hospital
