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Flashcards in Respiratory Medicine Deck (10):
1

Physical Signs of Bronchiectasis

  • Coarse inspiratory crackles altered in quality by coughing
  • Cx
    • Cor Pulmonale [RHF =↑JVP, Peripheral oedema, Parasternal heave]
    • Respiratory failure [distress]

2

Causes of Bronchiectasis

[5 Groups]

Mostly idiopathic

  1. Recurrent/Persistent infections – TB, Pneumonia, Fungal (ABPA)
  2. Rheumatological – SLE, RA
  3. Immunodeficiency - Hypogammaglobulinaemia
  4. Fibrotic Lung Disease [→ Traction bronchiectasis] – Fibrosing alveolitis
  5. 1o Ciliary Dysfunction – Kartagener’s Syndrome

3

What are the diseases associated with Bronchiectasis?

  • Chronic Sinusitis [60%]
  • Asthma [10%], COPD
  • GERD

4

Investigations for Bronchiectasis

  • Imaging – CXR, HRCT
  • Spirometry [Obstructive Pattern]
  • Sputum smear and culture [inc. AFB]
  • Sputum cytology
  • XR Sinuses
  • Saccharine Test and Ciliary studies
  • If resp. failure → SaO2, ABG

5

Physical Signs of COPD

  • Respiratory distress [tachypnoea, accessory muscles]
  • Hyperinflated chest [‘Barrel-chest’]
  • Breath sounds
    • with prolonged expiratory phase
    • Added soundsEnd-expiratory ronchi & inspiratory crackles
  • Features of Cor Pulmonale [in Blue Bloaters]
    • Displaced apex, Parasternal heave, ↑JVP, Oedema, Central Cyanosis

6

CXR Features of COPD

  • Hyperinflation & Bullae
  • Cx of COPD – Pneumothorax, Infections [Consolidation], Cardiomegaly [Cor Pulmonale], Pulmonary congestion [PHTN]
  • Associated – Lung CA

7

Causes of Interstitial Lung Disease

[5 Groups]

  1. Idiopathic
  2. Exposure
    • Pneumoconiosis Asbestosis, Silicosis, Berylliosis
    • Hypersensitivity pneumonitis
    • ABPA
  3. Drug-inducedAmiodarone, Chemotherapy, RT
  4. Collagen vascular diseaseScleroderma, RA, SLE, Vasculitis
  5. Sarcoidosis

8

Investigations for Interstitial Lung Disease

  • Imaging – CXR, HRCT
  • Lung Function – Spirometry
  • Resp. Failure – SaO, ABG
  • Autoimmune Markers – ANA, RF
  • Confirm Ddx – Lung biopsy

9

Light’s Criteria

PE is exudate if it meets one of following criteria

  • Pleural Fluid protein >0.5 of serum protein
  • Pleural Fluid LDH > 0.6 of serum LDH
  • Pleural Fluid LDH >2/3 of ULN of serum

10

Causes of PE in ILD patients

  1. Malignant Effusion [IPF is a RF for CA Lung]
  2. Parapneumonic [Steroids for IPF → Immunosuppression]
  3. Pleurisy [e.g. RA patients]
  4. Pulmonary Embolism [immobile ∵Respiratory failure]