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LCA - respiratory
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36
Medical
Undergraduate 4
06/19/2017

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Term
symptoms of COPD
Definition
exertional dyspnoea
chronic cough with sputum production
wheeze
Term
ix in COPD?
Definition
spirometry: FEV1 reduced, FVC normal. FEV1/FVC ratio < 0.7
CXR: hyperinflation, flat hemi diaphragms, black lesions; bulla, decreased lung markings, prominent hill
Term
what grades severity in COPD?
Definition
FEV1
Term
severity of COPD
Definition
FEV1

mild FEV1 > 80%
moderate FEV1 50-80%
severe FEV1 30-50%
very severe FEV1 < 30%
Term
mx of copd
Definition
1st: SABA or SAMA
2nd if FEV1< 50%: combined LABA & INH corticosteroid OR LAMA
2nd if FEV1 > 50%: LABA or LAMA

if on combined LABA and steroid and control is still bad then add LABA irregardless of what FEV1 is.
Term
summary of mx for copd
Definition
medication
pulmonary rehab
long term oxygen
bullectomy
lung transplant
Term
salmetarol and fluticasone?
Definition
seretide
Term
frometarol and budesonide?
Definition
symbicort
Term
whats in fostair?
Definition
formeterol and beclometasone


in symbicort: budesonide and formetarol
Term
inhalers used in COPD
tablets used in COPD
Definition
SABA, SAMA, LABA, LAMA, INH corticosteroid

Tablets: mucolytics, theophylline
Term
non pharmacological mx in COPD
Definition
smoking cessation
pulmonary rehab
O2 therapy
lung transplant
Term
define asthma
Definition
reversible airway obstruction due to bronchial hyperresponsiveness. there is bronco spasms and xs production of secretions blocking airways.
Term
risk factors to asthma
Definition
atophy
FHX
inner city or socio economic deprivation
obesity
prematurity and low birth weight
smoking
viral infections in early childhood
Term
features increasing likelihood of diagnosis of asthma
Definition
if worse on exertion, cold, post exercise
symptoms worse early in morning or late at night
worse after taking aspirin or beta blockers.
Term
expiratory to inspiratory phase ratio?
Definition
2:1

count one, two on expiration
count one on inspiration. this is a normal ratio
Term
ix in asthma
Definition
spirometry with bronchodilator reversibility
peak flow
Term
risk factors for asthma
Definition
not breast feeding
maternal smoking
low birthweight
high exposure to allergens
air pollution
Term
signs of asthma
Definition
expiratory wheeze on auscultation
PEFR reduced
Term
adult asthma mx
Definition
1st:SABA and low dose ICS
2nd: add LABA
3rd: no response to LABA? stop and increase ICS to medium dose. If response to LABA then cx and increase ICS to medium dose.

alternative: cx with current rx and try LTRA, SR Theophylline or trial of LAMA

4th: trials of increasing steroids to high dose. adding 4th drug like LTRA, SR Theophylline, beta agonist tablet or LAMA..refer

5th: PO prednisolone and refer,
Term
asthma mx in children < 5 years

LABA not licensed for use in < 5 year olds.
Definition
1st line: saba and very low dose ICS
2nd: LTRA
3rd: increase ICS to low dose and refer
4th: adding 4th drug: SR theophyline, medium dose ICS.
Term
mx for asthma >5
Definition
1st SABA and very low ICS
2nd: LABA
3rd: if LABA works then cx and increase ICS to low dose. if LABA not working, stop it and increase iCS to low dose
4th: increase ICS to medium dose, add 4th drug SR theophyline. Refer to specialist.
5th: PO steroids
Term
pulmonary fibrosis definition
Definition
restrictive lung disease characterised by xs fibrous connective tissue
Term
pper zone and lower zone causes of pulmonary fibrosis

CARTEx
CAID (more common)
Definition
CARTEx - upper zone

ankylosing spondylitis
Coal
Radiation
TB
extrinsic alveolitis

CAID - lower
CT diseases (ra, scleroderma)
Asbestos
idiopathic pulmonary fibrosis
Drugs
Term
drugs that can cause pulmonary fibrosis?
Definition
MTX
bloemycin
nitrofurantoin
amiodarone
cyclophosphamide
ergot derivatives
Term
symptoms of pulmonary fibrosis?
Definition
chronic cough
chronic progressive SOB
Term
signs of pulmonary fibrosis
Definition
clubbing
reduced expansion
fine end inspiratory crepitations
Term
signs of causes of pulmonary fibrosis
Definition
clubbing - idiopathic lung fibrosis
hand deformity (RA)
signs of CREST - scleroderma (small mouth, telangiectasia)
butteryfly rash
radiation burns
kyphosis (ankylosing spondylitis)
Term
ix in pulmonary fibrosis?
Definition
CXR: to show reticulonodular shadowing
CT: honeycombing, group glass changes
spirometry: restrictive changes
Bloods: ANA, RhF, anti centromere antibody
lung biopsy
Term
mx for lung fibrosis?
Definition
fibrosis is permanent
steroids can help in some cases
anti fibrotic meds e.g perfenidone
rx/withdraw cause
long term O2 therapy
lung transplant
Term
what would you do if you found a lung lesion?
Definition
do chest/abdo/pelvis CT + pet to confirm no mets
attain histology
pulmonary function tests to determine FEV1 and if to operate or do further tests
Term
causes of bronchiectasis
Definition
CF, yellow nail syndrome, kartegeners
measles, pertussis, TB
HIV, hypogammaglobulineamia
Term
symptoms of bronchiectasis?
Definition
heamoptysis
recurrent chest infections
chronic productive cough
Term
signs of bronchiectasis?
Definition
coarse crackles
clubbing
Term
signs of cause of clubbing?
Definition
yellow nails: yellow nail syndrome
tall and thin: CF
Dextrocardia: Kartegners syndrome
Tall with long arm span and high arched palate? Marfans
Term
dx of bronchiectasis
Definition
CXR: tramlines and ring shadows
CT: signet ring sign and bronchial wall thickening
spirometry: obstructive

to ascertain cause:
sweat test: CF
electrophoresis: hypogammaglobulineamia
sputum culture: to determine any colonising bacteria
Term
mx of bronchiectasis?
Definition
chest physio
prompt rx of infections
pneumococcal/influenza vaccines
lung resection if medically uncontrolled localised disease
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