Flashcards in Respiratory Medicine 1 Deck (55):
What is the FEV1/FVC ratio in obstructive lung disease?
Markedly reduced -
What are the features of an obstructive lung disease?
Poorly recoiling lung tissue (floppy) so quick to inflate but poor deflation
So TLC is normal or high but FVC is reduced and FEV1 is markedly reduced
What defines severity in obstructive lung disease spirometry?
FEV1 % of expected
0.8-0.5 = mild
0.3-0.5 = moderate
3 examples of obstructive lung disease?
COPD, asthma, Bronchiectasis
What is a restrictive lung disease?
'Stiff' lungs which are difficult to inflate but quick to deflate
FVC and FEV1 are both reduced
What happens to the FEV1/FVC ratio in restrictive lung disease?
2 examples of restrictive lung disease?
What is the pathophysiological background of bronchiectasis?
Irreversible dilatation of the bronchi with wall thickening
Increased mucus production, poor trachebronchial clearance and resultant chronic airway infection
What sort of things can predispose to bronchiectasis? (4)
Severe childhood asthma
Chronic congenital condition linked with Bronchiectasis?
Enzyme deficiency often implicated in respiratory disease?
a1 antitrypsin deficiency
Immunodeficiency syndrome linked to bronchiectasis?
Describe the sputum associated with bronchiectasis?
Chronic sputum production in large amounts
May be purulent, often dark or green
May be bloodstained
2 upper airway conditions linked with bronchiectasis?
Management strategies for bronchiectasis?
Bronchodilators, O2, nutritional support
Chest physio - active cycle breathing
Long term azithromycin
What Abx can be given long term in bronchiectasis?
Surgical management options for bronchiectasis?
Massive haemoptysis - bronchial artery embolization
Abx for bronchiectasis (and generally infection) confirmed to be with pseudomonas aeruginosa?
Abx for general bronchiectasis management or those colonised with h. Influenzae?
Amoxicillin or clarithromycin
3 subtypes of bronchiectasis?
Cystic - worst, associated with CF
What underlying condition should be considered in bronchiectasis patient with no identifiable pre-infection and/or unusual colonisations?
CAPT Kangaroo has Mounier Kuhn of bronchiectasis causes?
Congenital - CF, connective tissue disorders,
Allergic bronchopulmonary aspergillosis
Post-infection - Measles, pneumonia, RSV (bronch), pertussis, flu
TB and other granulomatous disease
Kartagener's disease (PCD)
Mounier-Kuhn syndrome (tracheobronchomegaly)
What is Williams-Campbell syndrome?
Bronchial cartilage deficiency -> congenital cystic bronchiectasis
Deficiency typically from 4th-6th order bronchial cartilage
Common findings on auscultation for bronchiectasis?
Course early-inspiratory crackles
Large airway rhonchi (low pitched snore)
Gold standard Ix for diagnosing bronchiectasis?
What is the definition of pneumonia?
Infection of the lung parenchyma with airway consolidation
What is the role of air bronchograms in pneumonia CXR?
If present, suggestive of a pneumonia type consolidation. If absent, indicates more likely a blockage or solid something restricting the airway (e.g. Tumour)
In addition to a high CURB65, what other clinical features may make you consider escalation of care in a pneumonia patient?
Number of lobes involved
What organ abnormality predisposes to pneumococcal pneumonia as well as other capsulated bacterial infection?
Lobar vs bronchopneumonia on CXR?
Lobar is consolidation confined to a lobe
Bronchopneumonia is often consolidation of lung bases
3 common bacterial causes of atypical pneumonia syndromes?
What does coxiella burnettii cause?
Apart from the 3 main bacterial causes what are some other causes of atypical pneumoniae?
Coxiella burnettii - Q fever
Viruses - adenovirus, influenza, RSV etc.
Main differentiating factors of mycoplasma pneumonia from pneumococcal pneumonia?
Non-productive, hacking cough
Systemic features - erythema multiforme etc.
Neurological features - Guillain-Barre, cerebellar ataxia
Haematological features - cold agglutinin disease -> haemolytic anaemia
GI features - diarrhoea, abdo pain etc.
Which is the most severe atypical pneumonia and what is outbreaks of it often associated with?
Air conditioning system failure or poor maintenance
Rx for atypical pneumonia?
Start on amoxicillin as per typical CAP
Can also use macrolides
Legionella may require Rifampicin
3 criteria for diagnosing pneumonia without CXR?
Cough and at least 1 other LRTI Sx or fever
New focal signs on chest exam
No other better explanation for illness
3 criteria for diagnosing pneumonia with CXR?
Cough and at least 1 other LRTI Sx or fever
New radiographic infiltrates
No better explanation for illness
What Ix are required to identify atypical pneumoniae?
Serology (paired sera - Ab and Ag)
Rx for CAP of unknown causative organism?
Amoxicillin and clarithromycin - covers pneumococcus as well as atypicals
Ix for pulmonary embolism?
WELLS score for probability.
Low risk -> D dimer (very sensitive but non-specific)
High risk -> V/Q scan and CTPA
What does a COPD rescue pack consist of?
Oral corticosteroids (7-14 days)
Antibiotics if sputum is purulent
First line management of COPD?
SABA or SAMA
What 2 inhaled drugs can't be taken together in COPD long term management?
SAMA and LAMA
Which type of lung cancer typically causes clubbing?
If a lung cancer occurs in a non-smoker what type is it likely to be?
NSCLC - adenocarcinoma
What type of lung cancer typically presents with metastasis having already occurred?
4 most common symptoms of lung cancer?
What constitutes a transudate?
Low protein content (
3 causes of a transudative pleural effusion?
What constitutes an exudate?
High protein content (>30g/L)
3 causes of exudative pleural effusion?
3 places to send off pleural tap?
Chemistry (transudate vs exudate)
What type of pleural effusions need drainage?