resp stuff to memorise Flashcards by a forbes

define bronchiolitis and extra info

inflam of bronchioles, RSV, common in winter, infants under 1

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coryzal symptoms ? (bronchiolitis)

runny/snotty nose
sneezing
mucus in throat
watery eyes

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how to monitor resp distress

capill blood gas (arterial to look at blood gas)

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manage bronchiolitis

supportive
adequate intake - nasogastric tube, orally, IV fluids
saline nasal drops to clear way for feeding
suppl oxygen
ventilation if severe

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what you’d hear from chest in bronchiolitis

whistling due to airway narrowing

wheeze, crackles, harsh breath sounds

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what causes grunting and stridor

grunting - exhaling with glottis closed

stridor - high pitch inspiration due to upper airway obstruction

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prophylaxis for bronchiolitis

monthly injection of palivizumab - monoclonal antib targets RSV - passive protection (doesnt stim immune sys like a vaccine would)

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3 brackets of causes of bronchiectasis - 2 causes of each

chronic inflam:
- CF auto recess - mucus too sticky/hard to move
- prim ciliary dyskinesia auto recess - cilia move abnormally
airway obstruct:
- tumour
- lodged foreign object
infection:
- TB
- haemophilius influenzae
- staph aureus

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define bronchiectasis

chronic inflam and dilation of bronchioles = destruction of airways
damage to mucocilliary ‘elevator’ = mucus and bacteria accumulate - excessive mucus production

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how is mucus normally cleared

mucocilliary ‘elevator’ moves it up and out of resp tract via cilia
cl- channels pump out ions which attracts water = keeps them lubricated/moving

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sign of long term hypoxia

finger clubbing

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signs/symptoms of bronchiectasis

wheeze
prod cough
fouls smelling mucus
haemoptysis
dyspnea
recurrent pneumonia
basilar crackles

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diag bronchiectasis

CT scan - will show dilation
CXR
sputum culture
spirometry - reduced ratio aka obstruction

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treat bronchiectasis

bronchodilator eg. beta 2 agonist
inhaled corticosteroid
atib for pneumonia
percussion/postural drainage

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pleural effusion?

collection of fluid in pleural cavity (between lung and chest wall)

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exudative?

high protein count above 3g

protein moves out of tiss into pleural space

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transudative?

low protein count below 3g

fluid moving across pleural space

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pres of pleural effusion

SOB, dullness to percussion (no air), reduced breath sounds, tracheal deviation - fluid has pushed mediastinum

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investigate pleural effusion

CXR - blunting of costophrenic angle, mediastinal and tracheal deviation
pleural fluid aspiration/chest drain - can check protein

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small vs large pleural effusions managements

conservative if small

if large: aspirate (needle thru chest wall which may need to be repeated) or drain (prevent reoccurence)

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empyema - what is it, investig, treat?

infected pleural effusion eg patient has improving pneumonia but ongoing fever
aspirate would show pus, low ph, low gluc, high LDH
treat w chest drain and beta lactam with beta lactamase inhib eg. amoxicillin and Clavulanic acid

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3 key conseq of CF

thick pancreatic and biliary secretions - lack of digestive enzymes eg. pancreatic lipase due to blockage of ducts
low volume thick airway secretions - reduced airway clearance, bacteria colonisation, susceptible to airway infections
congenital bilateral absence of vas deferens in men - sperm cannot get into ejaculate so infertility

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lack of pancreatic lipase presence in CF leads to…

malabsorption = weight loss, short AKA FTT, loose greasy stool

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clinical signs of CF

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nasal polyps, finger clubbing, crackles, wheezes, abdo distention

microbes that colonise in CF

staph aureus, haemophilus influenzae, pseudonomas

prophylactic treatment in CF

flucloxacillin for staph aureus

CF patients screened for which linked conditions

DM, osteoporosis, vit D def, liver failure

avg life expectancy for CF

manage CF

``` chest physiotherap exercise high cal diet CREON tablets for pancreatic insuff nebulised DNAse salbutamol ```

sarcoidosis?

granulomatous (macrophages) inflam condition

typical sarcoidosis patient

``` young adult OR 60 black woman dry cough SOB nodules on skin ```

tests in sarcoidosis

screening test - serum ACE Raised serum soluble interleukin-2 receptor raised calcium raised CRP raised immunoglob CXR - bilateral hilar lymph GOLD histo biopsy showing non-caseating granulomas with epithelioid cells

fatal comp of sarcoidosis

arrythmias | CNS disorder

manage/treat sarcoidosis

no symp = no treat 1st oral steroids and bisphos 2nd immunosupp eg. methotrexate severe - lung trans

right ventricular hypertroph on ecg

r.axis deviation rbbb s waves large r waves

causes of pul hypertension

``` SLE LHF COPD pul emobolism sarcoidosis ```

primary treatement for pul hypertension

IV prostanoids endothelin receptor anatgonists phosphodiesterase-5-inhib

treat pneumothorax

``` >2cm/SOB = aspiration (if fails twice then chest drain) tension = large bore cannula into 2nd intercostal space at midclavicular line ```

tension pneumothorax

one way valve - air gets in but not out, increasing pressure, mediastinal deviation, cardioresp arrest

investig pneumothorax

erect CXR 1st | CT thorax GOLD

most common place for TB

lungs bc high o2 supply

vaccine for TB

BCG - intradermal, live attenuated protection against severe & complicated TB less effective against pul TB

test before TB vaccine

Mantoux needs to be neg, text for hiv, eliminate live vaccine risk

at risk ppl for tb

neonate w/ fam hist or in area unvacc older kids or have arrived from tb country healthcare worker

latent tb treat

isoniazid | rifampicin

active/acute tb treat

``` rifampicin isoniazid pyrazinamide ethambutol +pyridoxine vit b6 to reduce periph neurop ```

asbestos is...

oncogenic fibrogenic = adenocarcinoma, mesothelioma, lung fibrosis

high res CT thorax of ILD would show

ground glass appearance

invest for hypersen penumonitis

broncheolar lavage - bronchoscopy washing up airways with fluid = high lymphocytes and mast cells

treat whooping cough

ezithromycin (or cotrimoxazole if not)

cause of whooping cough

bordetella pertussis

pneumonia on CXR

consolidation

treat pneumonia

amoxicillin | clarithromycin

auscultation of pneumonia

bronchial breath sounds focal coarse crackles dullness to percussion

fungal pneumonia treatment

co-trimoxazole

2 red flag symp for lung cancer

finger clubbing | lymphadenopathy =urgent CXR

cxr in lung cancer

hila enlargement peripheral opacity pleural effusion

invest lung cancer

urgent cxr then staging contrast enhanced CT then bronchoscopy and biopsy for diag

resp stuff to memorise Flashcards

(58 cards)