Respiratory Flashcards
(35 cards)
Aetiology Bronchiectasis
Complications of Bronchiectasis
Cor Pulmonale
Pneumonia
Empyema
Lung abscess
AA Amyloidosis
Cerebral abscess
Investigations for Bronchiectasis
-HRCT -> Confirms diagnosis
-Sweat chloride / immotile cilia function in young adults
- Eosinophil level (ABPA)
- Immunoglobulin levels - Sptum MCS
- PFT (FEV 1 affected in severe disease)
- ABG
Management Bronchiectasis
- Treatment of infections
- Long term azithromycin
- Inhaled tobramycin
- Bronchodilators / ICS if bronchial reactivity
- Chest wall physio (postural drainage and PEEP)
- Vaccination
- Surgery for localised disease
- Transplant
MRC Breathlessness Scale
0 - Only with strenuous exercise
1- When hurrying or walking uphill
2- When walking at own pace
3- Walking ~100m
4- When undressing / too breathless to leave house
Radiographic Types of Emphysema
- Centrilobular (most common) involves proximal respiratory bronchioles in upper lobes
- Panlobular involves secondary bronchioles predominately lower lobes (seen in A1ATD)
- Paraseptal involves peripheral areas. Assoc with bullous emphysema / smoking
ECG findings COPD
1) Right ventricular hypertrophy ( Prominent R wave V1, TWI V1-2, RAD)
2) Multifocal atrial tachycardia
COPD and flying?
During flight equivalent Fi02 is ~15%
If patients Sats ate <95% supplemental oxygen will be needed.
If sats 88-95% then should have an altitude simulation test prior to flying.
Smoking Cessation
- Ask
- Assess motivation and nicotine dependance
- Advise to quit
- Assist with smoking cessation
-Ensure follow up
Treatments:
- Non-pharmacological using QUIT helpline, hypnotherapy, counselling
- Varenicicline (Champix) which acts as partial nicotine agonist.
S/E: mood changes and suicidal thoughts
- Nicotine replacement therapy
- Bupropion
S/E: seizures
COPD Criteria Lung transplant?
- FEV1 <25%
- PaCO2 >55
- Complications including cor pulmonate
- Age <65yoa
Sleep apnoea exam
-Pharyngeal crowding
-Raised BMI
-Signs of pulmonary hypertension (loud p2, parasternal heave)
-Signs of acromegaly / hypothyroidism
Benefits of CPAP in OSA
- Safe driving
- Reduced sleepiness
- Better QOL
- Better cognition
Methotrexate and lungs
- <5% of persons
- No correlation between dose and severity of condition
- Occur at any time during treatment
- Resolves with withdrawal
- May require steroids
Causes of idiopathic pulmonary hypertension
- Idiopathic
- Inherited (BMPR2)
- Assoc Connective tissues disease
- HIV
- Cirrhosis / portal hypertension related
- Chronic haemolytic anaemia
- Shchistosomiasis
Clinical signs of Pulmonary Hypertension
Loud P2
Palpable P2
Large A wave
Larve V wave (if Concurrent tricuspid regurgitation)
Parasternal impulse
Pulmonary Hypertension
CXR -> Large pulmonary arteries with pruning in periphery +/- Right ventricular hypertrophy
PFT -> Isolated low DLCO
ECG -> Right heart strain, P Pulmonale
Bood Gas ->
VQ -> Rule out CTEPH
HRCT -> Rule out IPD
TTE
Six minute walk test -> <330 metres confers poor prognosis
Clinical manifestations Sarcoid
- Asymptomatic hilar adenopathy
- Generalised symptoms: fever, lethargy, cough, dyspnoea
- Pulmonary fibrosis (upper zone predominant)
- Skin erythema nodosum
- Polyarthralgia
- Uveitis
- Hypopituitarism
- Cardiac conduction abnormalities (CHB and VT)
- Facial nerve palsy or Peripheral neuropathy
- Hypercalcaemia
Clinical signs Sarcoidosis
- Uveitis
- Parotitis
- Generalised lymphadenopathy
- Lupus pernio
- End inspiratory crackles
- Erythema nodosum
- Facial nerve palsy
- Hepato / Splenomegaly
Management of sarcoidosis
If evidence of detrimental end-organ involvement give prednisolone 1mg/Kg daily for 6 weeks then taper over 6 months.
Steroids sparing agents MTX, AZA
Physiotherapy treatment for Cystic Fibrosis
Postural drainage
Positive End Expiratory devices
Percussion
Deep breathing exercises
Pulmonary Rehabilitation
Clinical signs Cystic Fibrosis
Prolonged Forced Expiratory Time >6 seconds
Barrell chest
Clubbing
Wheeze, local crackles
Muscle wasting
Faecal loaded colon
Right heart failure secondary to pulmonary HTN
CF investigations
Sputum MCS
CXR
FBC -> May be anaemic
Fat soluble Vitamins (ADEK) due to concurrent pancreatic insufficiency
Spirometry: FEV1 <40% confers poor prognosis
Cystic Fibrosis management
- Ivacaftor / Tezacaftor
- Chest Physiotherapy **Very important
- Tune ups for IV antibiotics according to sputum MCS
- Azithromycin as anti-inflammatory
- Bronchodilators
- Home oxygen
- DNAse mucolytic
- Lung transplant
- ** Pancreatic enzyme replacement
- Regular aperients to avoid constipation
Tuberculosis Treatment
Active TB:
- 2 months RIPE
- 4 months RI
* Ensure smear negative at conclusion of treatment
Latent TB:
- Treat in high risk groups
> HIV
> Less than 35yo
> Contact with smear positive patient
> Health care worker
> About to receive immunosuppressive drugs
- Isoniazid 9 months
- 3 Months RI
- Rifampicin 4 months
