- cough (non-productive) - dyspnoea (gradual onset) - polyarthritis - uveitis - red eye - photophobia - constitutional symptoms - swinging fever - fatigue - weight loss

respiratory Flashcards by Mithila Thasan

define chronic with regards to chronic bronchitis

potential DDx for chronic cough?

a productive cough for 3 consecutive months across 2 consecutive years

DDx - bronchiectasis

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COPD: causes?

smoking!!
alpha-1-antitrypsin (inhibits neutrophil elastases)

other: 4 Cs
Cadmium (used in smelting)
Coal
Cotton
Cement

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what could be the potential cause in a young pt presenting with features of COPD

alpha-1-antitrypsin deficiency

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describe how COPD can lead to cor pulmonale

Chronic hypoxia causes vasocontriction of pulmonary arteries
This leads to elevated pulmonary arterial pressure.
The chronic elevation of pulmonary arterial pressure subsequently leads to right heart failure

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How does Cor pulmonale present

This presents with classical features including raised JVP, cyanosis, ankle (peripheral) oedema, left parasternal heave due to RV hypertrophy and hepatomegaly

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signs of COPD

tachypnoea
barrel chest
coarse crackles
hyperresonance on percussion
pursed lip breathing
loss of cardiac dullness
tar staining
peripheral cyanosis

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symptoms of COPD

cough (often productive)
dyspnoea (on exertion)
wheeze

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general management of COPD

smoking cessation
ANNUAL influenza vaccine + ONE OFF pneumococcal vaccine
pulmonary rehabilitation (> MRC grade 3 - “functionally disabled” )

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what are the asbestos-related lung diseases (5)

pleural plaques
pleural thickening
mesothelioma
asbestosis
lung cancer

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pleural plauques
-benign/malignant
-latent period

benign and DO NOT undergo malignant change
latent period 20-40 yrs
seen as discrete circumscribed areas of fibrosis on the parietal pleura

almost always asymptomatic
do not impair lung function

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pleural thickening

diffuse pleural fibrosis that follows the pattern of haemothorax or empyema

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mesothelioma
- where does it metastasise to

Malignant disease of the pleurathat commonly metastasises to the contralateral lung and peritoneum, affecting the RIGHT LUNG more than the left

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does mesothelioma develop with long/short term exposure

short term (around 40 yrs)

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management of mesothelioma

palliative chemo

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mesothelioma - features

progressive dyspnoea
chest pain
pleural effusions

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asbestosis
-which lung lobes are affected
- latent period
- presentation
-treatment

LOWER lobes (opposites - ceiling)
15-30 yrs
dyspnoea, reduced exercise tolerance
conservative

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what is the relationship between asbestos and cancer

Asbestos exposure is a risk factor for lung cancer and also has a synergistic effect with cigarette smoke.

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what is Lofgren’s syndrome

acute form of the disease characterised by bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia

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features of acute sarcoidosis

swinging fever
polyarthralgia
erythema nodosum

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features of insidious sarcoidosis

cough (non-productive)
fatigue
dyspnoea

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Sx of sarcoidosis

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cough (non-productive)
dyspnoea (gradual onset)
polyarthritis
uveitis
- red eye
- photophobia
constitutional symptoms
- swinging fever
- fatigue
- weight loss

signs of sarcoidosis

Study These Flashcards

cervical and submandibular lymphadenopathy
erythema nodosum
lupus pernio

what is sarcoidosis

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Sarcoidosis is a multisystem disorder of unknown aetiology characterised by non-caseating granulomas.

What is Heerfodt’s syndrome

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Heerfordt’s syndrome: causes facial nerve palsy, fever, uveitis and parotitis

Indication for steroids in Sarcoidosis

stage 2/3 x-ray stage AND symptomatic

ACE levels in sarcoidosis

elevated (used to monitor disease)

Ca levels in sarcoidosis

HYPERCALCAEMIA (macrophages have 1 alpha hydroxylase activity which converts vit D to its active form)

respiratory complications of sarcoidosis

pulmonary HTN resp failure UPPER zone fibrosis

cardiovascular complications of sarcoidosis

cor pulmonale heart block

CNS complications of sarcoidosis

cranial nerve palsies e.g. facial nerve, meningeal disease

occular complications of sarcoidosis

keratoconjunctivitis sicca, uveitis

symptoms of bronchiectasis

productive cough - often producing copious amounts of sputum dyspnoea haemoptysis

signs of bronchiectasis

clubbing auscultation coarse crackles on inspiration high-pitched squeaking on inspiration rhonchi (snoring like low pitch)

infectious causes of bronchiectasis

TB, whooping cough, measles, pneumonia

congenital causes of bronchiectasis

CF, Kartagener's syndrome, Young's syndrome, Yellow nail syndrome

allergic and inflammatory causes of bronchiectasis

RA, IBD, ABPA, Sjogren syndrome

most common cause of bronchiectasis

idiopathic

what is the gold standard Ix for bronchiectasis and what does it show

HRCT - shows tram track lines and signet ring pattern

first line management of bronchiectasis

identify the underyling cause chest physiotherapy (draining mucus) - e.g. inspiratory muscle training annual flu vaccine Abx for acute exacerbations + long-term rotating antibiotics in severe cases *AA Abx - Amoxicillin (acute like pneumonia) → Azithromycin (longer name - long-term for recurrent episodes)

2nd line Mx of bronchiectasis

mucolytics e.g. Carbocystine bronchodilators saline LTOT surgery

what are the 4 most common bacteria that are isolated from pts with bronchiectasis

Most common organisms isolated from patients with bronchiectasis: Haemophilus influenzae (most common) Pseudomonas aeruginosa Klebsiella spp. Streptococcus pneumoniae

when (after) is the follow up x-ray for pneumonia and what is it for

X-ray after 6 weeks to look for any residual consolidation (esp in the elderly) to look for any underlying malignancy

signs of pneumonia

reduced breath sounds dull percussion bronchial breathing (high pitch) pyrexia hypoxia tachycardia

symptoms of pneumonia

productive cough dyspnoea fever pleuritic chest pain

pneumonia Ix

CXR FBC Us+Es ABG Sputum cultures

what is the discharge criteria for pneumonia

As per NICE, do not discharge patients with CAP if in the last 24 hours they have had 2 or more of the following: Temperature > 37.5°C RR ≥ 24 HR ≥ 100 SBP ≤ 90 mmHg SpO2 ≤ 90% on room air Abnormal mental status Inability to eat without assistance

CURB score mortality %

0-1: > 3% 2: 3-15% 3+: < 15% 0 = 0.7 1 = 2.1 2 = 9.2 3 = 14.5 4 = 40 5 = 57

pneumonia complications

ARDS empyema sepsis lung abcesses (Klebsiella, Staph Aureus)

What are the symptoms of PHT

- progressive breathlessness - Exertional dizziness - Fatigue - Hemoptysis (chronic thromboembolic PHT)

What are the signs of PHT

- right parasternal heave - loud second heart sound - tricuspid/ pulmonary regurgitation - raised JVP - signs of an underling conditions

What are the 5 different categories for the causes of PHT

- PHT due to left heart disease - PHT due to chronic conditions/hypoxia - PHT due to obstruction of the pulmonary artery - PAH (pulmonary arterial) - PHT due to miscellaneous causes

respiratory Flashcards

(51 cards)