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Flashcards in Respiratory Deck (22):
1

Features of Bronchiectasis?

Clubbing
Suspected COPD but smoking Hx less than 10yrs
History of TB or recurrent pneumonia
Disadvantaged childhood
Unusual organisms on sputum

2

Causes of bronchiectasis?

Cystic fibrosis
Primary ciliary dyskinesia
Congenital hypogammaglobulinaemia
Infections on childhood
Localised disease - bronchial adenoma, TB, FB
ABPA
RA and sjorgens syndrome
COPD
Recurrent aspiration
ILD
Idiopathic

3

Investigations for bronchiectasis?

CXR - infection, cystic lesions, tram tracking
Sputum MCS
Immunoglobulin
FBC ? eosinophilia
CF testing
Lung function tests
ABG
HRCT

4

Treatment of bronchiectasis?

Physiotherapy
Inhaled steroids
Antibiotics during exacerbations
Vaccinations
Treatment of heart failure
IVIG if hypogamma
Haemoptysis - bronchial artery embolisation
Smoking cessation
Home oxygen
Surgery
Lung transplant

5

Investigation of potential lung carcinoma?

CXR and CT chest
Bronchoscopy and biopsies or transthoracic biopsy
Pleural effusion = thoracocentesis and pleural biopsy
FBC, EUCs, Calcium and LFTs
CT CAP
Lung function tests ? resection

6

Causes of COPD?

Smoking
Wood, charcoal, coal smokes
Grain dust
Nitrogen dioxide
Dusts - organic and mining
Plastic, textile and rubber manufacturing
Leather and food manufacturing
Alpha-1 anti-trysin deficiency

7

Investigations of COPD?

Lung function tests - FEV1
CXR - hyperinflation
ABG - ? hypoxia or hypercapnia
FBC ?polycythaemia
Sputum MCS
ECG
Alpha-1 anti-trypsin level

8

Treatment of COPD?

LABA and LAMA
ICS if severe COPD or acute exacerbation
Vaccinations
Pulmonary rehab programs
O2 therapy
CPAP
Treat HF
Replace Alpha-1 antitrypsin
Lung transplant

9

Assessment of Sleep apnoea?

Obesity - BMI
BP ? HTN
Epsworth sleepiness scale
Sleep study for AHI
TFTs
ECG ?arrhythmias
CPAP assessment

10

Why treat OSA?

Reduces daytime sleepiness
Reduces motor accidents
Improves HTN
Improves cognition

11

Classifications of ILD?

1. ILD with known association:
- Drugs
- Occupational exposure
- Connective tissue disease - SLE, RA, S. Sclerosis, PM and DM, Sjogrens
2. Granulomatous:
- Hypersensitivity pnuemonitis
- Sarcoidosis
3. Idiopathic:
- IPF
- NSIP
- Respiratory bronchiolitis ILD
4. Other ILD:
- Lyphoangioleiomyomatosis
- Pulmonary langerhans cell hystiocytosis

12

Investigations for ILD?

CXR
HRCT
Lung function tests and DLCO
ABG
FBC ?Eosinophilia
Bronchoscopy and biopsy

13

Treatment for ILD?

Stop smoking
Steroids
Treat GORD
Treat infections
Treat OP
Treat OSA
Treat pulmonary HTN
Home O2
Lung transplant

14

Diagnosis of Pulm HTN?

PAP >25
Lung causes = PCWP <15
Heart causes = PCWP >15

15

Classifications of pulmonary HTN?

1. Idiopathic
2. 2ndary to Left heart disease
3. 2ndary to lung disease
4. Chronic thromboembolic pulm HTN
5. Miscellaneous

16

Investigations of Pulmonary HTN?

CXR - enlarged central and peripherally pruned pulmonary vessels
Lung function tests and DLCO
ECG - right heart strain
ABG - hypoxia
V/Q scan
HRCT
6 minute walk test
TTE - measure pulm artery pressures
Right heart cath

17

Investigations for sarcoidosis?

FBC - lymphopenia and eosinophilia
ESR - raised
Ace level - raised
CXR - bilateral hilar lymphadenopathy
Bronchoscopy

18

Treatment of sarcoidosis?

Prednisone
Steroid sparing agents - AZA or MTX
Infliximab

19

History of CF?

Age at diagnosis
Method of diagnosis
Presenting symptoms
Pulmonary symptoms - cough, haemopytsis, pnuemothorax
Nasal polyps and sinusitis
GIT symptoms - Weight loss, pancreatic malabsorption, diarrhoea and steatorrhoea, constipation and obstruction
Heat exhaustion
Liver disease - PBC and portal HTN
DM
Cardiac symptoms
Fertility
Family history
Treatment - PT, mucolytic drugs, antibiotics, pancreatic supplements
Number of admissions in 12 months
Social supports

20

Management of CF?

PT
Immunization
Nebulised antibiotics
Pancreatic enzymes
Vitamin ADEK replacement
Diabetes - insulin only
Human recombinant DNAase
Double lung transplant

21

History for lung transplantation?

How long ago?
Double or single?
Heart and lung?
Original lung disease?
Rejection episodes?
Failure?
Bronchiolitis Obliterans?
Lung transplant complications - bronchial stenosis
Medications - Tacrolimus or cyclosporine, mycophenolate or azathiopurine and steroids
Transplant Complications - OP, DM, Infections, Cancer
Effect on life?

22

Infections from immunosuppression?

Invasive fungal infections
CMV
PCP
Influenza
Adenovirus
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Valgancyclovir
Bactrim