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Flashcards in Respiratory Deck (23):
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COPD Definition

Preventable and treatable disease characterised by progressive airflow limitation that is not fully reversible and is associated with an abnormal inflammatory response to noxious particles or gases. Both emphysema and chronic bronchitis.

1

Complications of COPD

Cor pulmonale
Lung cancer
IHD
Recurrent pneumonia
Pneumothorax
Respiratory failure

2

COPD BODE index

BMI (<19 high risk)
Obstruction FEV1
Dyspnoea MRC score
Exercise capacity 6min walk test

3

COPD investigations

Spirometry
Pulse oximetry
ABG
CXR
FBC
ECG

4

Causes of upper lobe fibrosis

Aspergillosis ABPA
Pneumoconiosis: coal, silica
Extrinsic allergic alveolitis
Negative, sero-arthropathy
TB
Previous radiotherapy
Ank spon
Sarcoidosis

5

Causes of lower pulmonary fibrosis

Sarcoidosis
Toxins (amiodarone, methotrexate)
Asbestosis
Idiopathic pulmonary fibrosis
Rheum: RA, SLE, SS, Sjögrens, PM/DM

6

Pulmonary fibrosis investigations

PEFR, ECG
FBC, ABG, ESR, CRP, ANA, RF, C3/C4, ACE, Ca
CXR, HRCT
Spirometry
Echo
BAL, lung biopsy

8

Bronchiectasis causes

Congenital: CF, PCD, Young's, Low Abs
Chronic lung disease (COPD)
Post-infectious: pertussis, TB, measles
Obstruction: tumour, foreign body
Chemical damage (acid reflux aspiration)
Associated: RA, IBD, ABPA

9

Bronchiectasis treatment

MDT: GP, resp, physio, dietician, immunologist
Medical: Abx (prophylactic), bronchodilators
Treat underlying cause: CF (DNAase, Creon, ADEK vits), ABPA (Steroids), Immune deficiency (IVIg)
Vaccination: flu, pneumococcus
Surgical: severe localised disease or obstruction

10

Kartagener’s Syndrome

Situs inversus
Chronic sinusitis
Bonchiectasis

11

Young’s Syndrome

Bronchiectasis
Rhinosinusitis
Azoospermia

12

Hypogammaglobulinaemia causes

Bruton’s X-linked Agammablobulinaemia (no B cells)
Common Variable Immunodeficiency (only IgM)
Specific Antibody Deficiency

13

Yellow Nail Syndrome

Very rare
Yellow dystrophic nails
Pleural effusions
Lymphoedema: lymphatic hypoplasia
Bronchiectasis

14

Pleural Effusion causes

- Transudate: CCF, CLD, Nephrotic syn, hypothyroidism, peritoneal dialysis
- Exudate: Infection, Malignancy, PE, AI (RA, SLE), pancreatitis, drugs, post CABG, trauma, oesophageal rupture!

15

Pleural Effusion investigations

Sputum
Bloods: FBC, U+Es, LFTs, TFTs, ESR, Ca
Imaging: CXR, US, CT
Diagnostic pleurocentesis: MC+S, cytology, chemistry
Pleural biopsy

16

Indications for lobectomy

Lung cancer (90%)
Brochiectasis
COPD lung reduction surgery
Chronic lung abscess
TB
Benign tumours
Fungal infections (Aspergillus)
Congenital abnormalities

17

Thoracotomy scar causes

Pneumonectomy
Lobectomy
Oesophageal surgery
Diaphragmatic repair
Heart valve replacement
Thoracic aortic aneurysm repair
Anterior spinal tumour excision
Latissimus dorsi flaps

18

Lung cancer complications

Local: nerve palsies, Horner's, SVCO
Paraneoplastic: Endo (ADH, ACTH, PRHrP, 5-HT), DM/PM, Neuro (cerebellar, peripheral neuropathy), Derm (acanthosis nigricans)
Metastatic: #'s, liver failure, neurology, Addisons

19

SIRS

Inflam response to a variety of insults manifest by ≥ 2 of:
Temperature: >38°C or 90
Respiratory rate: >20 or PaCO2 12x109/L or 10% bands

20

Complications of pneumonia

Parapneumonic effusion
Empyema
Lung abscess
Respiratory failure
Severe sepsis/septic shock

21

TB treatment and side effects

Rifampicin: hepatitis, orange urine, enzyme induction
Isoniazid: peripheral sensory neuropathy
Pyrazinamide: hepatitis, arthralgia (CI: gout, porphyria)
Ethambutol: optic neuritis → loss of colour vision first

22

TB surgery

Artificial pneumothorax
Phrenic nerve crush
Thoracoplasty (rib removal)
Plombage (insertion of polystyrene balls)
Lobectomy/pneumonectomy

23

Cor pulmonale

Cardiovascular consequence of chronic respiratory failure:
- pulmonary hypertension
- peripheral vasodilation and oedma from hypercapnia
- salt and water retention from renal hypoxia
Does not = RVF but can lead to it. RVF has low output state from dilated ventricle, CorP has normal output from hypertrophied ventricle