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1
Q

Tx of acute asthma attack

A

OSHITME
Oxygen - oxygen driven nebs, back to backSalbutamol - 2.5-5mg back to backHydrocortisone IVIpatropium - 500mcg nebTheophyllineMagnesium sulphateEscalate care (intubation and ventilation)

TME given if needed with senior input

Do an ABG to assess O2 and CO2

Intensive care indications - requires ventilator, worsening acidosis/hypercapnia/hypoxia, exhaustion, drowsiness and confusion

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2
Q

Tx to settle exacerbation of asthma?

A

Oral pred for 5 days

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3
Q

Classify asthma severity

A 
Life Threatening (PEFR <33%) - 33,92 CHEST:
	• 33 - PEFR <33%
	• 92 - Sats <92%
	• Cyanosis
	• Hypotension
	• Exhaustion
	• Silent chest
	• Tachycardia
Severe (PEFR <50%) - cant complete sentences, RR >25, PR >110
Moderate (PEFR <75%)
Mild (PEFR >75%)
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4
Q

Discharge criteria for asthma

A
  1. Stable on prescribed meds for 24 hrs
    1. Peak flow is 75% of predicted
    2. Discharge with 5 days oral prednisolone and asthma management plan.
      Follow up with GP in 2 days. Follow up in 1 month in clinic.
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5
Q

Asthma LT tx guidelines. Pregnancy?

A

1st line SABA + ICS
2nd line + LABA (salmeterol)
3rd - Increase LABA (if good response) OR (if not good response) increase ICS or add 4th drug (theophylline or LAMA)
4th - Add 4th drug (theophylline, LAMA) OR increase ICS
5th line + oral corticosteroid

Use as usual during pregnancy

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6
Q

S&S that make asthma diagnosis likely?

A

• pt complains of >1 symptoms of :wheeze, SOB, cough, or chest tightness and if:
○ Worse at night and early morning
○ Worse in exercise, allergen or cold air
○ Worse after taking aspirin or beta blockers
• History of atopy
• Family history of atopy
Widespread wheeze on auscultation

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7
Q

S&S that make asthma unlikely?

A

• Prominent dizziness or peripheral tingling
• Chronic productive cough w/o wheeze or SOB
• Normal examination of chest when symptomatic
• Significant smoking history ie >20 pack yrs.
Cardiac disease

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8
Q

Qs to ascertain if asthma is unstable?

A

• Is there a nocturnal cough?
• Are you using the blue inhaler (rescue)?
Is your job impacted?

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9
Q

Ix for asthma?

A

Blood tests:
• Eosinophilia
• Increased IgE

Spirometry findings:
• Obstructive. Reversibility

PEFR - need more than one reading. Peak flow diary

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10
Q

Define occupational asthma

A

Symptoms improve at weekends or when away from work

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11
Q

Chemicals associated with occupational asthma

A

• Isocyanates - most common cause eg spray painting and foam moulding
• Flour
Epoxy resins

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12
Q

Tx of occupational asthma

A

• Serial measurements of PEFR at work and away

Referral to resp specialist for suspected occupational asthma

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13
Q

Tx of COPD exacerbation

A

Management - OSHIT
Oxygen - controlled oxygen (24-28% venturi) driven nebs, back to back. Do ABG after 15 mins to determine further therapy.SalbutamolHydrocortisoneIpatropiumTheophylline

Consider antibiotics and BiPAP if sats persist below 88%. IV abx if blood culture +ve

Intensive care indications - requires ventilator, worsening acidosis/hypercapnia/hypoxia, exhaustion, drowsiness and confusion

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14
Q

Tx for frequent exacerbation sof COPD?

A

Pts who have frequent exacerbations:
• Home supply of corticosteroids and abx eg prednisolone and amox.
• Abx only taken if sputum is purulent.
Contact you if exacerbation

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15
Q

NIV indications for COPD?

A

• COPD with resp acidosis pH 7.25-7.35
• T2RF secondary to chest wall deformity, neuromuscular disease, sleep apnoea
• Cardiogenic pulmonary oedema unresponsive to CPAP
Weaning from tracheal intubation

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16
Q

MOs causing exacerbations in COPD? Tx for each?

A
  • Haemophilus influenzae - most common - treat with amox and prednisolone
    • Strep pneumoniae
    • Moraxella catarrhalis
    • Resp viruses causes 30% with rhinovirus being most common.

To treat - increase bronchodilator use, give prednisolone oral. NO ABX unless sputum is purulent or clinical signs of pneumonia.

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17
Q

Bloods findings for COPD

A

FBC - Polycythemia in COPD pts due to reduced oxygen leading to increased erythropoietin and increased RBCs.

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18
Q

Diagnostic Ix for COPD

A

Spirometry - FEV/FVC ratio is <0.7. Deficit is not more than 15% reversible.

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19
Q

CXR findings for COPD

A 
• to exclude other diagnoses
	• Hyperinflation - >6 anterior ribs
	• Bullae
	• Flat diaphragm
Vertical orientation of heart
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20
Q

Classify severity of COPD

A 
Post-bronchodilator FEV1/FVC	FEV1 (of predicted)	Severity
< 0.7	> 80%	Stage 1 - Mild**
< 0.7	50-79%	Stage 2 - Moderate
< 0.7	30-49%	Stage 3 - Severe
< 0.7	< 30%	Stage 4 - Very severe
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21
Q

ECG findings on COPD? Why might you order an ECG for COPD pts?

A

• If considering LT azithromycin ensure no long QT syndrome as azithromycin causes it.
• Reduced amplitude of QRS complexes due to excess air between electrode and heart
• Cor pulmonale may be evident:
○ Rightward shift of P wave axis
Prominent P waves in inferior leads

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22
Q

Lt medical tx of COPD

A

FEV<50% :
1st line - SABA or SAMA
2nd line - LABA + ICS combo inhaler OR LAMA
3rd line - LABA + ICS combo inhaler + LAMA

FEV>50%:
1st line - SABA or SAMA
2nd line - LABA or LAMA
3rd line - switch LABA to LABA + ICS combo then + LAMA

cannot tolerate inhalers - oral theophylline
Chronic productive cough - mucolytics

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23
Q

General management of COPD

A 
• Smoking cessation
	• Pulmonary rehab
	• Annual influenza vaccine
	• One off pneumococcal vaccine
If 3+ infections a year - Consider prophylactic abx eg azithromycin or erythromycin at low doses (anti inflammatory)
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24
Q

Tx for cor pulmonale in COPD

A

• Use loop diuretic for oedema eg furosemide
• Consider LTOT (long term oxygen therapy)
ACEi, CCBs, alpha blockers not recommended.

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25
Indications for LTOT
Pt must have PaO2 of < 7.3 kPa under air when stable OR 7.3-8 kPa under air when stable AND: ○ Secondary polycythemia or ○ Nocturnal hypoxaemia or ○ Peripheral oedema or ○ Pulmonary hypertension • Assessment of PaO2 done on 2 separate occasions 3 weeks apart • 15 hours a day of oxygen minimum
26
S&S of COPD
``` • Exertional dyspnoea • Chronic cough - 3mths + • Regular sputum production • Regular winter bronchitis • Wheeze • Peripheral cyanosis • Clubbing Cor pulmonale ```
27
Causes of COPD
• Smoking • Pollution Alpha 1 antitrypsin deficiency
28
Questions to ask regarding SOB?
• How far can you walk? • How has SOB changed? • What were you like before SOB? Why are you here now? What has changed?
29
Resp Hx - SHx qs?
• Asbestos exposure? | Any contact with animals?
30
Qs about cough?
• Diurnal variation? | Is there a nocturnal cough?
31
Qs about sputum?
• Colour? | Always Blood - How much and how often?
32
What look for in eye son resp?
Horners sign could indicate Pancoast tumour (unilateral partial ptosis, miosis, anhydrosis)
33
What is stridor and wheeze?
Stridor - loud and harsh breath sound In inspiration. Large airway obstruction Wheeze - Small airway obstruction. Musical note heard on expiration.
34
Signs of SVCO and cause?
• SVCO - 90% caused by bronchogenic carcinoma: ○ Swelling of face, neck, arms Persistent cough and SOB
35
Crackles - early inspiratory, late or pan inspiratory, fine crackles, medium crackles, coarse crackles?
* Early inspiratory - COPD * Late or pan inspiratory - Alveolar disease * Fine 'velcro' crackles - Pulmonary fibrosis * Medium - left ventricular failure * Coarse - bronchiectasis
36
Causes of muffled breathing?
• Pleural effusion - Effusion is below lung, therefore decreased sounds. • Collapse Pneumothorax
37
Empyema vs consolidation - difference in bloods?
Empyema has v low grade inflammatory markers vs consolidation
38
Pleurisy causes?
1. Pneumonia or flu 2. RA PE or Lung cancer
39
Cause of increased vocal resonance/
Consolidation - Fluid actually in the lungs therefore increased resonance
40
Causes of dull, resonant and hyperresonance percussion?
Dull - Pleural effusion, Hepatic tissue, consolidation, pleural thickening Resonant - Normal lung Hyperresonance - Pneumothorax, COPD
41
Purulent sputum causes?
Pneumonia, bronchiectasis, abscess
42
White sputum causes?
COPD, asthma
43
Clear frothy sputum causes?
Pulmonary oedema
44
Blood sputum causes?
PE, malignancy, clotting disorder, infection, Granulomatosis with polyangiitis
45
Define massive haemoptysis
240ml in 24 hrs
46
Tx of haemoptysis
○ ABCDE ○ Lie on side of lesion ○ Tranexamic acid (antifibrinolytic) for 5 days Abx if RTI suspected
47
Type 1 resp failure and causes
Type 1 - hypoxia Ventilation/perfusion mismatch. e.g. PE, high altitude, pneumonia, shunts
48
Type 2 resp failure and causes
Type 2 - hypercapnia and hypoxia Inadequate alveolar ventilation. e.g. COPD, asthma, scoliosis, motor neurone disease
49
Causes of resp alkalosis
• Anxiety --> Hyperventilation • PE • Salicylate poisoning - resp alkalosis first then metabolic acidosis • CNS disorders - stroke, subarach hemorrhage, encephalitis • Alititude Pregnancy
50
Causes of acute cough with normal CXR
○ bacterial / viral RTI ○ Inhaled foreign body Irritation from fumes
51
Causes of acute cough with abnormal cxr
○ Pneumonia ○ Inhaled foreign body Extrinsic allergic Alveolitis
52
Causes of chronic cough with normal and abnormal CXR
``` • Normal CXR: ○ GORD ○ Asthma ○ ACEi - bradykinin • Abnormal CXR: ○ TB ○ Lung cancer ○ ILD Bronchiectasis ```
53
Classify upper and lower zone fibrosis ILD
``` Upper - APENT(house) • A - Aspergillosis • P - Pneumoconiosis • E - Extrinsic Allergic Alveolitis • N - Negative Seroarthopathy • T - TB ``` ``` Lower - STAIR BASEMENT • S - Sarcoidosis • T - Toxins - BASEMENT • A - Asbestosis • I - IPF • R - Rheumatological - RA, SLE ``` ``` Toxins subtype - BASEMENT • B - Bleomycin • A - Amiodarone • S - Sulfasalazine • ME - Methotrexate • NT - NitrofuranToin ```
54
Ix for pulmonary fibrosis
• Spirometry - restrictive picture, reduced transfer factor (TLCO) • CXR - bilateral interstitial shadowing (typically small, irregular, peripheral opacities - 'ground-glass' - later progressing to 'honeycombing') HRCT NEEDED FOR DIAGNOSIS
55
S&S of pulmonary fibrosis
• progressive exertional dyspnoea • bibasal crackles on auscultation • dry cough clubbing
56
Tx of Pulmonary fibrosis
``` • Perfenidone • Pulmonary rehab • Supplementary oxygen • Lung transplant 3-4 yr life expectancy ```
57
RFs of pulmonary fibrosis
RA and Methotrexate. Sulfasalazine
58
S&S of ILD
• Chronic dry cough • SOB gradual over 3+ months, getting worse • Multi systemic symptoms eg weight loss or malaise Eventual right HF. ``` • Tachypnoea • Clubbing • End inspiratory crackles - upper or lower? • Cyanosis, • T2F Cor pulmonale ```
59
RFs for ILD?
Connective tissue diseases - MS, SLE, RA • Amiodarone and methotrexate - biggest 2 • Sulfasalazine, bleiomycin and cylcophosphamide are others Nitrofurantoin leads to reversible fibrosis
60
Bloods for sarcoidosis?
Raised serum ACE
61
Blooods for hypersensitivity pneumonitis
Ab to antigen
62
Bloods for goodpastures
Anti-GBM Ab
63
Bloods for extrinsic alveolitis
NO eosinophilia
64
Pharm Tx for ILD
• Steroids in allergies • NAC Opioids
65
Non pharm Tx for ILD
• Pulmonary rehab • Cough syrups • Stop offending drugs Lung transplant last resort
66
Asbestos exposure diseases?
• Pleural plaques - non malignant. Most common • Pleural thickening • Asbestosis - Increasing severity with length of exposure. Lower lobe fibrosis. Mesothelioma - Malignancy of pleura. Crocidolite (blue) asbestos is most dangerous form.
67
TB bacteria
Mycobacterium tuberculosis, Mycobacterium bovis, africanum
68
S&S of TB
``` • Cough - productive or not • Weight loss* - rapid and dramatic • Fever • Night sweats* - drenching • Malaise *Are most important symptoms ``` If person with latent TB becomes immunocompromised, TB can occur.
69
Ix for TB
• Sputum • CXR - Upper lobe infection usually Biopsy - if TB in other organs
70
Tx for normal TB
Rifampicin + Isoniazid - 6 mths | Pyrazinimide + Ethanbutol - 2 mths
71
Tx for CNS and miliary TB
R+I - 12 mths P+E - 2 mths Steroids - 8 weeks
72
Tx for latent TB
R+I - 3 mths
73
ADRs of RIPE
R - P450 inducer, therefore double dose of steroids I ADR - optic neuritis, peripheral neuropathy (give B6 to counter) P ADR - v hepatotoxic E ADR - coloured vision problems
74
S&S suggesting legionella pneumonia
Recent travel, confusion, dry cough, flu like symptoms
75
Ix for legionella pneumonia?
Urinary antigen
76
Tx for legionella pneumonia
Erythromycin
77
CXR of legionella pneumonia
Patchy consolidaiton ofmid to lower zones
78
how to assess severity of pneumonia.
* Confusion = 1 * Urea > 7 = 1 * Respiratory rate > 30 breaths per minute= 1 * Systolic blood pressure < 90 mmHg / Diastolic < 60 mmHg = 1 * Age > 65 = 1
79
Community acquired MOs for pneumonia
• Streptococcus pneumoniae (accounts for around 80% of cases) • Haemophilus influenzae • Staphylococcus aureus: commonly after the 'flu • atypical pneumonias (e.g. Due to Mycoplasma pneumoniae) • Viruses Klebsiella pneumoniae in alcoholics
80
Define HAP
Onset of pneumonia symptoms 48 hrs after admission
81
Hospital acquired pneumonia organisms
• Gram negative enterobacteria • Staph aureus • Pseudomonas aeruginosa Clostridia
82
tx of pneumonia HAP and CAP
• Low/moderate severity - oral amoxicillin. Add macrolide if admitted to hospital • high severity CAP: intravenous co-amoxiclav + clarithromycin OR cefuroxime + clarithromycin HAP - Gentomycin IV and cephalosporin PT follow up with pneumococcal vaccine and flu vaccine with CXR 6 weeks later
83
Recovery time for pneumonia
• Week 1 - fever resolved • Week 4 - Chest pain and sputum reduced • Week 6 - Cough and SOB reduced • Month 3 - Symptoms resolved except tiredness Month 6 - Normal.
84
Complication sof pneumonia
``` • Resp failure • Sepsis • Pleural effusion • Empyema AF ```
85
Bacteria involved in aspiration pnuemonia
• Streptococcus pneumoniae • Staphylococcus aureus • Haemophilus influenzae Pseudomonas aeruginosa
86
RFs of aspiration pnuemonia
``` ○ Poor dental hygiene ○ Swallowing difficulties ○ Prolonged hospitalisation ○ Impaired consciousness Impaired mucociliary clearance ```
87
S&S of penumocystitis jivoreci pneumonia
``` • Desaturation on exertion • Affects immunocompromised pts - HIV • dyspnoea • dry cough • fever very few chest signs ```
88
Ix for pneumocystitits jivoreci pneumonia
• CXR - can be normal. Can have consolidation • Exercise induced desaturation BAL to show PCP
89
Tx of pneumocystitits jivoreci pneumonia
• Co-trimaxole • IV pentamidine if severe Steroids if hypoxic ie pO2 <9.3kPa
90
Censor criteria for URTI
THAT centor criteria T - presence of tonsillar exudate • H - history of fever • A - absence of cough T- Tender anterior cervical lymphadenopathy or lymphadenitis 3+ means sore throat likely due to bacteria.
91
Reasons for Tx non responsive pneumonia
CHAOS: • C - Complication, eg empyema, lung abscess • H - Host immunocompromised • A - Abx inadequate dose or poor absorption • O - Organism resistant or not covered by abx S - Second diagnosis eg PE, lung cancer etc
92
S&S of lung abscess
High swinging temp
93
What test used for heparin and warfarin
Warfarin - INR | Heparin - APTT
94
ADRs of heparin, clopidogrel, wafarin, aspirin
Heparin - hemorrhage, HIT Clopidogrel - hemorrhage Warfarin - hemorrhage, skin necrosis, teratogen Aspirin - Gi bleeding, Bronchospasm in asthmatics
95
MoA of digoxin
Increases force of myocardial contraction and reduces conductivity through AV node
96
ADR of digoxin
N&V, diarrhoea (sign of toxicity)
97
ADRs of beta blockers
bradycardia, hypotension, HF, bronchospasm, fatigue, peripheral vasoconstriction
98
ACEi ADRs
hypotension, renal impairment, persistent dry cough, hyperkalaemia, angioedema
99
examples of ARB
candesartan, losartan
100
Loop diuretics egs and ADRs
ADR - hypoK, hypotension | Furosemide, bumetanide
101
Aldost antag egs and ADRs
ADR - hyperK | Spironolactone
102
ADR of beta 2 agonist
fine tremor, headache, cramps, tachycardia, palpitations
103
SABA and LABA egs
• SABA - salbutamol, terbutaline | LABA - formoterol, salmeterol
104
Theophylline ADRs
N&V, gastric irritation, palpitations, tachycardia
105
Antimuscarinics ADRs
Dry everything | ADR - dry mouth, constipation, cough, headache, dizziness
106
Antimuscarinics short acting and long acting egs
• Short acting - ipratropium - nebs and inhaler | Long acting - tiotropium inhaler - COPD use
107
Steroids ADRs
``` CUSHINGOID C – Cataracts U – Ulcers S – Striae, Skin thinning H – Hypertension, Hirsutism I – Immunosuppression, Infections N – Necrosis of femoral heads G – Glucose elevation O – Osteoporosis, Obesity I – Impaired wound healing D – Depression/mood changes ```
108
Describing opacification
• Alveolar shadowing - poorly defined margins • Interstitial shadowing - Well defined margins Nodular shadowing - multiple, small opacities throughout lungs
109
Tx for pleural effusion
• Pleural aspiration using USS - 21G needle and 50ml syringe | Send fluid for pH, protein, LDH, cytology and microbiology.
110
Findings on pleural fluid
• Low glucose - RA, TB • Raised amylase - pancreatitis, oesophageal perforation Heavy blood staining - mesothelioma, PE, TB
111
Indications for prompt chest drain post pleural aspration
• Purulent (empyema) - prompt drainage • Presence of MOs on Gram staining pH of fluid is <7.2
112
define exudative and transudative fluid
• Exudative - >30g protein per litre | Transudative - <25g protein per litre
113
Signs of pulmonayr congestion on CXR?
``` ABCDE • Alveolar oedema (bat’s wings) • kerley B lines (interstitial oedema) • Cardiomegaly • Dilated prominent upper lobe vessels - upper lobe becomes more used so blood vessels dilate Effusion (pleural) ```
114
Ix for PE
CTPA (CT pulmonary angiography) Unless they have renal failure (contrast contraindicated) use V/Q scan.
115
ECG findings for PE
``` Sinus tachy (most common) and S1Q3T3: • Large S wave in lead I • Q wave in lead III • Inverted T wave in lead III RBBB, and right axis deviation also can be seen. ```
116
State Wells score for PE and how to use
``` Dont Die Tell The Team To Calculate Criteria Dont - DVT signs Die - Diagnosis most likely PE Tell - Tachycardia The Team - Three days immobilisation or surgery in past Thirty days To - Thromboembolism in past Calculate - Coughing up blood Criteria - Cancer ``` 2 or more signs = PE likely
117
Signs of PE on CTPA
Saddle embolus
118
S&S of PE
``` • Tachypnoea • Crackles • Tachycardia • Fever - low grade up to 38 SOB ``` 'Classic' presentation only 10% of cases: • Pleuritic chest pain • Haemoptysis dyspnoea
119
Tx of PE
Anticoagulant: • Enoxaparin used until the diagnosis confirmed Then switch to warfarin after INR in target range. There will be drug overlap.
120
How long to anticoag for PE?
• If PE precipitated by known event - 3 to 6 months • If due to unknown event - 6 months minimum. If due to malignancy - 6 month anticoag
121
Define Massive PE
Defined as haemodynamic compromise, ie: • Decreased BP - systolic below 90 or a 40+ mmHg fall • BP fall Sustained for 15+ mins Risk of sudden death
122
Tx of massive PE
• Thrombolysis eg alteplase • Aggressive resus - ABCDE Anticoagulate with enoxaparin
123
Tx of primary pneumothorax
• If rim of air is <2cm and pt is not SOB then discharge • Otherwise aspiration attempted If this fails - Chest drain inserted.
124
Tx of secondary pneumothorax
• Pt >50 age and rim of air is >2cm or pt is SOB then insert chest drain • If rim of air is <2cm aspiration. If aspiration fails insert chest drain. All pts admitted for 24 hrs.
125
S&S of tension pneumo
• Pt looks ill • Mediastinal shift Haemodynamic instability as tension compresses mediastinum
126
Tx of tension pneumo
• ABCDE | Immediate large bore cannula into 2nd ICS MCL.
127
S&S of wegners
• Rhinitis is first sign • Nose - pain, stuffiness, epistaxis, saddle nose deformity, crusting. LRT - dyspnoea, haemoptysis
128
Patho of wegners
Autoimmune attack by ANCAs (ant neutrophil cytoplasmic antibodies) against small and medium sized BVs. Affects upper, lower RTs, and kidneys.
129
Ix for wegners
• cANCA positive in >90% • CXR - wide variety presentations including cavitating lesions Renal biopsy - epithelial crescents in Bowmans capsule
130
Tx of wegners
• Steroids • Cyclophosphamide Plasma exchange
131
CXR of wegners
Cavitating pulmonary masses
132
Patho of goodpastures
Anti-GBM antibodies against type IV collagen.
133
S&S of goodpastures
• Pulmonary hemorrhage - haemoptysis and dyspnoea | Followed by rapidly progressive glomerulonephritis
134
Ix for goodpastures
• Negative ANCA - If positive more likely Granulomatosis with polyangiitis • Renal biopsy - Linear IgG deposits along BM Positive anti-GBM antibody
135
Tx of goodpastures
• Plasma exchange (plasmapharesis) • Steroids Cyclophosphamide - Immunosuppressive
136
Patho of bronchiectasis
Permanent dilatation of airways secondary to chronic infection or inflammation 1. Impaired mucociliary clearance 2. Chronic airways bacterial infection 3. Excessive inflammation 4. Persistent airways infection and inflammation 5. Bronchial wall inflammation and destruction 6. Cycle repeats
137
Causes of bronchiectasis
Post infective, CF, Ciliary dyskinetic syndrome
138
CF induced bronchiectasis MOs
1. H. influenzae 2. Staph aureus 3. Pseudomonas aeroginosa - Treat with ciprofloxacin Burkholderia cepacia
139
Complications of Bronchiectasis
``` • Deteriorating lung function • Empyema • Lung abscess • Pneumothorax • Resp failure Cor pulmonale ```
140
Ix for Bronchiectasis
HRCT Chest: Airways bigger than BVs indicates bronchiectasis ``` Investigation for cause: • CF - Chloride sweat test • HIV test • Immunoglobin panel (IgA, M, G) Test for ciliary dyskinesia if no other cause found ```
141
S&S of bronchiectasis
``` • Chronic, productive cough • Recurrent infections • History of severe resp infection as a child • Crackles on auscultation Wheeze ```
142
Tx of bronchiectasis
• Physical training eg inspiratory muscle training • Postural drainage • Immunisations - FLU • Maybe Surgery if disease is localised Abx for exacerbations + maybe prophylactic if repeated
143
CF gene and pattern of inheritance
• Autosomal recessive. • Carrier rate of 1 in 25. Mutation in delta F508
144
Ix for CF
Investigations: • Sweat test - Low Cl. Features on spirometry: • Restrictive lung disease • TF reduced due to incomplete alveolar expansion Transfer coefficient normal
145
Tx of CF
• Regular chest physio and postural drainage • High calorie high fat diet with pancreatic enzyme supplements • Vitamin supplementation Heart and Lung transplant
146
S&S of CF
Recurrent RTIs, DM, delayed puberty and short stature, malabsorption, failure to thrive
147
Kartagener syndrome S&S
• Dextrocardia or complete situs inversus • Bronchiectasis • Recurrent sinusitis Subfertility
148
Allergic bronchopulmonary aspergillosis patho
Results from an allergy to Aspergillus spores
149
S&S of Allergic bronchopulmonary aspergillosis
• Bronchoconstriction - wheeze, cough, dyspnoea Bronchiectasis ASTHMATICS
150
Ix for Allergic bronchopulmonary aspergillosis
``` • Eosinophilia • Flitting CXR changes • Positive radioallergosorbent (RAST) rest to aspergillus • Positive IgG precipitins Raised IgE ```
151
Tx for Allergic bronchopulmonary aspergillosis
• Steroids | Itracanzole second line
152
S&S of lung cancer
``` • Cough • Haemoptysis • Dyspnoea • Chest pain • Weight loss - cachexic • Anemia Clubbing (strongly associated with squamous cell cancer) ```
153
Lung cancer mets to
``` • Liver • Brain • Bone • Adrenal glands • Lymph nodes CAN PRESENT WITH THESE SYMPTOMS ```
154
RFs for lung cancer
• Smoking • COPD • Age Carcinogen exposure - coal is NOT carcinogen
155
Non small cell lung cancer types
• Adenocarcinoma • Squamous cell • Large cell Large cell Neuroendocrine
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S&S of squamous cell cancer lung
• Central • Associated with PTHrP therefore hypercalcemia • Finger clubbing Hypertrophic pulmonary oesteoarthropathy - pain in wrists and ankles.
157
Which lunch cancer most common in non smokers
adenocarcinoma
158
Ix for lung cancer
1. Xray 2. Contrast CT 3. USS guided biopsy PET Scan can be considered - Shows spread of non small cell cancers
159
When to refer urgently and 2 week for lung cancer?
Referral - 2 week waiting list if: • Have CXR that suggests lung cancer • Aged 40+ with unexplained haemoptysis ``` Urgent CXR within 2 weeks if 2 or more of following unexplained symptoms OR smoking + 1 of following: • Cough • Fatigue • SOB • Chest pain • Weight loss • Appetite loss ```
160
S&S of mesothelioma
• Progressive SOB • Chest pain • Pleural effusion Weight loss
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RFs for mesothelioma
STRONG correlation to asbestos exposure. 30 yrs latent period.
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Patho of mesothelioma
Malignancy of pleural cells
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Ix for mesothelioma
1. CXR - pleural effusion/thickening 2. CT pleura - shows pleural nodularity Image guided Pleural biopsy of nodularity to diagnose
164
Small cell cancer S&S
* Central * Associated with ectopic ADH, ACTH secretion, SIADH * ADH --> hyponatreamia * ACTH --> Cushings
165
SIADH Ix
* Plasma osmolarity low (hyponatremia) | * Urine osmolarity high
166
SIADH tx
• Fluid restriction | Replace sodium slowly

Z IPE (15 decks)

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