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Flashcards in CORE CONDITIONS Deck (58):
1

Asthma: Description

Inflammation of the bronchioles. Obstructive respiratory disease because inflamed bronchioles obstruct air flow.
Bronchial wall contracts, mucosal surfaces become inflamed and mucus production increases

2

Asthma: Epidemiology

5-8% prevalence. More common in children. Can, grow out of it, be lifelong or be adult-onset

3

Asthma: Aetiology and RFx

- Allergic asthma (ATOPIC) associated with eczema and hayfever
- Exercise induced
- Cold weather induced
- Drug induced (NSAIDs)
- Stress/emotion reduced
- RF: smoking, infection, Beta-blockers

Mast cells degranulate and release histamine and IgE. Basophils may also degranulate and levels rise.

4

Asthma: Presentations (signs and symptoms)

- Intermittent dyspnoea
- Wheeze on expiration
- Cough (often worse at night and evening)
- Sputum
- Tachypnoea
- Hyperinflated chest
- Hyper-resonant percussion

5

Asthma: Differentials

Pulmonary Oedema
COPD
Large airway obstruction
SVC obstruction
Pneumothorax
PE
Bronchiectasis

6

Asthma: Ix and Dx

- PEF, Sputum Culture,
- BLOODS: FBC, U&E and CRP, cultures for infection
- ABG (might show decreased PaCO2 and PaO2 - due to hyperventilation)
- Decreased FEV1 and FVC, Increased RV.
**There should be a >15% improvement in PEF after B2 agonists. ASTHMA IS REVERSIBLE

7

Asthma: Treatments

- Short-acting beta2 agonist (salbutamol)
- Steroid Inhalers (beclamethasone)
- Long-acting beta2 agonists (salmeterol)

8

COPD: Description

Progressive, obstructive disorder. Combination of chronic bronchitis and emphysematous change.

9

COPD: Types

Two types of presentation depending on whether bronchitis or emphysema is main problem:
- PINK-PUFFER: usually younger, less advanced. Bronchitis main problem
- BLUE-BLOATER: have much less alveolar ventilation, very lowPaO2 and PaCO2. Cyanosed. At risk of cor pulmonale

10

COPD: Epidemiology

10-20% of over 40%

11

COPD: Aetiology/Risk Factors

Almost always caused by smoking

12

COPD: Presentation (signs and symptoms)

-Persistent SOB worse on exertion
- Cough with sputum
- Wheeze
- Tachypnoea
- Accessory muscle use
- Hyperinflation
- Cyanosis
- Cor Pulmonale

13

COPD: Ix and Dx

FBC
CXR (hyperinflation, decreased vascular markings)
ECG: RVH (cor pulmonale)
ABG (reduced PaO2)
FEV1 <80% expected, increased TLC and RV
Spirometry with trial steroids

14

COPD: Treatments

Stop smoking, treat sx.
IRREVERSIBLE
Weight loss
Mucolytics
Inhalers (Beta2Ags and steroids)
Long term steroids: prednisolone PO or beclametasone Inhaled

15

Bronchial Carcinoma: Description

Mostly squamous cell tumours, some are adenocarcinomas.
SMALL CELL or LARGE CELL. Small cell more common

16

Bronchial Carcinoma: Epidemiology

19% of all cancers
27% of all deaths

17

Bronchial Carcinoma: Aetiology/Risk factors

Most often smoking
Asbestos, Chromium, arsenic, iron oxides and radiation also RFs

18

Bronchial Carcinoma: Presentation (Signs and Symptoms)

- Cough + Haemoptysis
- Weight loss
- Dyspnoea
- Chest Pain
- Recurrent or slowly resolving pneumonias
- Clubbing
- Anaemia
- Lymphadenopathy (supra-clavicular and axillary)
- Pleural effusions on CXR
- METS

19

Bronchial Carcinoma: Complications

Can be P/C
- Horner's Syndrome (apical tumours/Pancoast tumours compress sympathetic chain: ptosis, miosis, anhidrosis)
- Brain sx (mets)
- Bone pain (mets)
- Lambert-Eaton (AI attacking neuromuscular junction, proximal limb muscle weakness)

20

Bronchial Carcinoma: Differentials

- COPD +/- acute exacerbation
- Pneumonia
- TB

21

Bronchial Carcinoma: Ix and Dx

- CXR (consolidation and effusions and poss. visible tumour)
- Sputum sample
- CT to stage the tumour
- Aspiration for cytology
- Bronchoscopy

22

Bronchial Carcinoma: Treatment

Different depending on whether it is small cell or non-small cell. NSCLC less likely to be disseminated (spread throughout lungs) hence better for excision and chemo/radio

SCLC can be treated with chemo/radio but invariably relapse
- CYCLOPHOSPHAMIDE, VINCRISTINE

23

Bronchial Carcinoma: Prognosis

NSCLC: 505 2 year survival (without spread.
SCLC: median survival is 3 months to 1.5 years if treated

24

Pneumothorax: Description

Air in pleural space - one lung might collapse.
Tension pneumothorax is when puncture trauma creates a one-way valve through which air can enter pleural space but not leave

25

Pneumothorax: Aetiology and Risk Factors

Can be spontaneous (more common in thing young men)
Secondary to pathology:
- Asthma, COPD, TB, Pneumonia, Lung abscesses
- Connective Tissue disorders
- Recent Surgeries

26

Pneumothorax: Presentation (signs and symptoms)

- Sudden onset dyspnoea
- Pleuritic pain
- Hyper-resonant to percussion
- Lack of tactile or audible vocal fremitus
- Absent breath sounds
- Reduced expansion
- Sudden deterioration of COPD patients

27

Pneumothorax: IX and Dx

- CXR will show it (actual pneumothorax, deviated trachea ONLY IN TENSION)

28

Pneumothorax: Treatment

Don't wait for CXR to commence treatment. Chest drain (4-6th IC space mid-axillary line). Risk of damaging lymph and long thoracic nerve - winged scapula)

29

Pleural Effusion: Description

Collection of fluid in pleural cavity. Can impact expansion of lung and hence ventilation. Can be in isolation or as part of other conditions (trauma, heart failure, thoracic cancers)

30

Pleural Effusion: Types

TRANSUDATES: watery, <25g/dL protein)
EXUDATES: >35g/dL protein

31

Pleural Effusion: Aetiology/ RFs

Can be a sign of other pathology:
- Congestive heart failure
- Bronchial Carcinomas or other cancers
- Chest trauma

TRANSUDATE more likely when there is high pressure in pulmonary venous system (congestive HF, constrictive pericarditis and fluid overload, hypoproteinaemia and hypothyroidism)

EXUDATE more likely secondary to infection, inflammation or mass (Pneumonia, TB, RA, SLE, Lymphoma, mesothelioma, carcinoma)

32

Pleural Effusion: Presentation (signs and symptoms)

Small ones are usually found incidentally. But sx are...
- Dyspnoea
- Pleuritic chest pain
- Absent breath sounds
- STONY Dull percussion
- Decreases expansion
- Decreased tactile vocal fremitus and resonance
- May show tracheal dev. AWAY and bronchial breathing above effusion

33

Pleural Effusion: IX and Dx

Clinical diagnosis: Stony dullness and absent breath sounds
- CXR shows opacity at lung bases (loss of costs-phrenic angle)
- Can aspirate effusion (identify exudate or transudate)

34

Pleural Effusion: Treatment

usually resolve self, can consider chest drain if very large
- Pleurodesis in recurrence with tetracycline, bleomycin or talc

35

Lobar Pneumonia: Description

Infection in lung usually confined to one lobe.

36

Lobar Pneumonia: Aetiology and Risk Factors

MOST COMMON CAUSATIVE ORGANISM: Streptococcus pneumoniae followed by haemophilus influenzae
ATYPICALS: legionella, chalmydia, mycoplasma

Spread via aerosolised mucus droplets, particularly at risk if you have another lung pathology (esp COPD and ASTHMA)

37

Lobar Pneumonia: Presentations (symptoms)

Fever, Rigors, Sweats, Malaise, Productive cough, Dyspnoea, Green sticky sputum, haemoptysis, Pleuritic chest pain

38

Lobar Pneumonia: Signs

- Cyanosis, bronchial breathing, tachypnoea, dull percussion, increased vocal fremitus/resonance, pleural rub

39

Lobar Pneumonia: Ix and Dx

CXR shows consolidation
O2 Sats <92 suggest severe
BLOODS: FBC, U&E, LFT, CRP, Cultures, ABG

40

Lobar Pneumonia (CAP): CURB65

- Confusion: AMTS <8 then 1 point
- Urea >7mmol/L 1 point
- Resp rate >30 1 point
- Blood Pressure <90/60mmHg 1 point
- >65yo 1 point

41

Lobar Pneumonia: Treatment and Management

CAP: Empirical Amoxicillin for 7-10 days
- Clarithromycin for atypical cover and penicillin allergy

Oxygen therapy

42

Pulmonary Embolus: Description

Clot or other mass lodges in pulmonary arteriole, partially or fully occluding it and restricting lung perfusion. There is then a V/Q mismatch and a decrease in gas exchange. usually acute or sub-acute

43

Pulmonary Embolus: Aetiology and RF

Most commonly comes from DVT. Clot forms due to haemostats (incompetent valves) travels up IVC into R side of heart and then into lungs.
Can also be caused by RA or RV thrombus due to AF or MI

RF: immobility, OCP, Long haul flight, obesity, diabetes, smoking, pregnancy, previous PE, malignancy

44

Pulmonary Embolus: Presentation (signs and symptoms)

Sudden onset SOB, syncope, pleuritic chest pain, haemoptysis.
Tachypnoea
Tachycardia
Hypotension
Raised JVP
Pleural rub
Pleural effusion

45

Pulmonary Embolus: Ix and Dx

CXR (usually normal might show small effusion or wedge shaped opacity)
CT Chest with contrast might be able to track pulmonary arteries
BLOODS: FBC, U&E, baseline clotting. D-DIMERS(negative D-Dimer excludes PE). ABG might show decr. PaO2 and PaCO2

46

Pulmonary Embolus: Differentials

Pneumonia
Pneumothorax
TB

47

Pulmonary Embolus: Treatment and Management

LMWH for anti-coag then start warfarin. Stop heparin when INR >2. Continue warfarin for minimum of three months and aim for INR of between 2-3.
- Thrombolyse massive PEs (alteplase)
- LMWH (tinza or dalteparin) goes to ALL immobile patients prophylactically

48

Interstitial Lung Disease: Description

Lung parenchyma becomes stiff and less elastic due to chronic inflammation and/or pulmonary fibrosis. Build up of scar tissue

49

Interstitial Lung Disease: Aetiology and RFs

THREE MAIN CATEGORIES:
Those of known cause:
- Occupational (cola workers, pigeon-fanciers, asbestosis)
- Drugs: nitrofurantoin, bleomycin, amiodarone
- Hypersensitivity: Extrinsic allergic alveoli's
- Infections: TB and recurrent pneumonia scarring
- GORD
Those of associated systemic disorder:
- Sarcoidosis
- SLE or RA
- UC, renal tubular acidosis, AI thyroid disease
Idiopathic

50

Interstitial Lung Disease: Presentation (signs and symptoms)

- Dyspnoea on exertion
- Non productive cough

- Tachypnoea
- Tachycardia
- Fine crackles
- Reduced expansion
- Restrictive spirometry

51

Interstitial Lung Disease: Ix and Dx

CXR

52

Interstitial Lung Disease: Treatment and management

Treat cause

53

Extrinsic Allergic Alveolitis: Description

Inhalation of allergens leading to hypersensitivity. If this is chronic then granuloma can form and there will be damage to the parenchyma
- Pigeon-fanciers lung is a type of EAA
- Farmers are also prone (due to hay)

54

Industrial Dust Diseases: Descriptions

Coal Workers' Pneumoconiosis (CWP): very common can cause chronic bronchitis and multiple round opacities
Progressive massive Fibrosis: progression of CWP causing progressive dyspnoea, fibrosis and cor pulmonate
Caplan's syndrome: pneumoconiosis-like nodules from RA
Silicosis: Caused by inhalation of silicone particles (metal miners or pottery). Increased risk of TB
Asbestosis: white asbestos is least fibrogenic and blue the mosts. Progressive dyspnoea, clubbing, fine-end resp crackles and pleural plaques
Malignant Mesothelioma: tumour of pleura caused by asbestos. treat with PEMETREXED

55

Type 1 Respiratory Failure

Resp Failure is when gaseous exchange is inadequate
Type 1 is Hypoxia (PaO2 <8kPa) with a NORMAL OR LOW PaCO2. Causes include:
- Pneumonia
- Pulmonary oedema
- PE
- Asthma
- Emphysema
- Pulmonary fibrosis
- ARDS

56

Type 2 Respiratory Failure

Hypoxia PaO2 <8kPa WITH HYPERCAPNIA
Usually caused when there is alveolar hypoventilation
- COPD and asthma (sometimes severe pneumonia)
- Reduced respiratory drive (sedative drugs or CNS tumour)
- Neuromuscular disease (cervical cord lesion, Guillain-Barré)

57

Respiratory failure symptoms

HYPOXIA: dyspnoea, restlessness, agitation, reduced consciousness, cyanosis
HYPERCAPNIA: headache, peripheral vasodilation, tachycardia, bounding pulse

58

Respiratory Failure: Treatment

ALWAYS GIVE O2 to type 1 and treat cause.
For those with type 2 respiration could be driven by hypoxia and so do NOT give O2 because it will depress breathing rate and worsen resp failure.