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. What would you like to do?
- Airflow obstruction that is not fully revesible
- includes Chronic bronchitis + Emphysema
Give 3 symptoms + 2 signs of COPD?
- barrel chested
- use of accessory muscles
What would suggest a severe exacerbation of COPD?
- Pulse >110
- Inability to talk in sentences
Which nebs would you use for COPD and how do they work?
Salbutamol -> Short acting B2 agonist
Ipratropium -> antimuscarinic, decreases airway tone A/E; dry mouth, Acute angle closure glaucoma
Theophylline -> Inhibit PDE4; bronchodilate, ^^mucocilliary clearance A/E; low therapeutic index
Reversible airway narrowing [FEV change of >15%] with diurnal variation
Age <5yo = viral wheeze
What are the features of a severe asthma attack?
- PEFR <50%
- Pulse >110
- Inability to speak in sentences
What are the features of life threatening asthma?
What is the aim of asthma Mx?
Control of symptoms;
- no daytime symptoms
- no nighttime awakening
- no need for rescue medication
- no exacerbations
- no limitations on activity
- minimal side effects
Outline the stepwise Mx of Asthma in adults
1 - SABA [Salbutamol]
2 - SABA + steroid
3 - SABA + STEROID +LABA
4 - increase steroid or trial leukotriene receptor antagonist
5 -Daily PO steroid
What are the different types of Pneumonia?
Lobar -> spread via inflammatory oedema red hepatisation -> grey hepatisation -> resolution
Bronchopneumonia -> lower lobes, centered on bronchioles -> patchy consolidation
Name 3 typical causative organisms for Pneumonia?
- Strep Pneumoniae
- H. Influenzae
- Pseudomonas Aeruginosa in CF
- Chlamydia Psitacci
- Chalmydia Pneumoniae
- Coxiella burnetti
- Mycoplasma Pneumonia
- Legionella Pneumophila
Assess severity of Pneumonia?
- Urea >7
- RR >30
- BP -> Sys <90, dia <60
Define bronchiectasis + give 2 causes;
Permanent dilation of the bronchi + bronchioles usually assoc with chronic infection
Congenital; CF, youngs syndrome
Acquired; Infection [measles, pertussis, pneumonia, MTB] Tumour, RA
What are the 4 types of Lung malignancy?
Adenocarcinoma -> most common, peripheral incidetaloma
Squamous CC -> localised central mass, cavitating lesions [retention pneumonia + collapse] -> Smokers
Small cell carcinoma -> most aggressive -> late Pc, early mets -> smokers
Large Cell -> Dx of exclusion -> central poorly differentiated tumour
What are the CF indicating LungCa?
- Chest pain
- Effects of Mets [SIADH, patho #]
- retention Pneumonia
- weight loss
Give 5 causes of clubbing?
- Lung Ca
- Suppurative lung disease [abscess, empyema, CF]
- Hypoxic congenital conditions
- cyanotic heart disease
- subacute infective endocarditis
- atrial myxoma
Give 2 causes for pneumothorax?
- Tall thin males
What are the symptoms + 3 signs of PTx?
- Acute onset pleuritic CP
- Tachpnoea, tachycardia
- ipsilateral decreased chest expansion
- decreased breath sounds
- hyper-resonant to percussion
- <20% -> resolve spontaneously
- Chest drain 5th intercostal mid axillary line, above rib approach
- Tension -> venflon, 2nd intercostal
Features of Tension PTx?
- Respiratory distress
- Tracheal deviation
Give 4 CF of PTE?
- Pleuritic CP
- leg pain
RF for PTE?
- Age >65
- Surgery/# within 1 month
- PMH - DVT/PTE
Mx of PTE?
Anticoagulate -> LMWH [Dalteparin] then warfarinise [until therapeutic INR]
Thrombolysis if peri-arrest/PEA/RVOT obstruction
Define transudative pleural effusion and give 2 causes?
alteration of systemic factors the produce pleural fluid. Protein <25g/dL
- Nephrotic Syndrome
Define Exudative Pleural effusion and give 2 causes?
Increase in permeability
of pulmonary capillaries/Poor lymphatic drainage
- Infection -> parapneumonic, empyema
- Malignancy -> Lung Ca, Lymphoma, Met
- Inflammatory -> RA/SLE
- Trauma -> Chylothorax/Haemothorax
What are the CXR features of pleural effusion?
Only if >200ml [PA]
- dense opacification
- loss of costophrenic angle
- loss of costomediastinal margin
How would you Ix a PE?
Microscopy, C+S, Grams stain
Cytology -> Malignancy
Analysis; Protein + LDH
For Sarcoidosis give;
- 2 Ix
Idiopathic multi-system non-caseating granulomas
CF - arythmia, ant uveitis, erythema nodosum [on shins] arthralgia
Ix - CXR [bulky hilum], serum ACE, Biopsy
Outline the genetic features of CF?
- most common ingerited of caucasian
- AR inherit of Mt CFTR gene - faulty chloride ion channel
What are the CF of Cystic fibrosis?
Paeds - late maecomnuim, frequent chest infections, failure to thrive
Bronchiectasis - S. Aureus, Pseudomonas aureginosa
males = infertile
Define Idiopathic pulmonary fibrosis?
Pregressive scarring of lung parenchyma that is ultimateley fatal
HR-CT shows preated episodes of focal damage to alveolar epithel consistant w autoimmune process
CF of pulmonary fibrosis?
- insiduous progressive dyspnoea
- non-productive cough
- Bi-basal fine insp crackles
What would you like to do?
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