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Terms in this set (22)
Definition of bronchiectasis
Permanent dilatation of the bronchi
How is bronchiectasis diagnosed?
High resolution CT scan of Thorax
- Signet ring sign
- Lack of bronchial tapering
- Bronchial lumen > 1.5x adjacent vessel
- Bronchial wall thickening
What are the CxR signs of Bronchiectasis?
Ring shadows and team lines
What are the causes of diffuse bronchiectasis?
- alpha 1 antitrypsin deficiency
- Bacterial such as psuedomonas
- Viral such as measles
What are the causes of focal bronchiectasis?
What is defined as an infective exacerbation of bronchiectasis?
O'donnel's symptoms 4/9
- Increased SOB
- Increased cough
- Increased sputum production
- Increased wheezing
- Change in chest sounds
- Reduced pulmonary function
- Radiographic changes
Non-pharmacological management of bronchiectasis?
Pharmacological management of bronchiectasis?
Treat complications such as infective exacerbation and bleeds
- Nebulised antibiotics
- lobectomy for recurrent bleeds, unable to clear infection
- Lung transplant
Causes of upper zone ILD?
Coal worker pneumoconiosis
ABPA, Ank spon
Causes of lower zone ILD?
What are the drugs that cause ILD?
How would you investigate?
- Autoimmune screen (ANA, rheumatoid factor, anti-CCP, myositis panel)
- HIV screen
Lung function test - restrictive pattern
DLCO - reduced
CxR - reticulonodular shadowing
HRCT - ground glass appearance, honey combing
Management of ILD?
- Patient education
- Smoking cessation
- Pulmonary rehabilitation
- Oxygen supplementation
- Trial of steroids
- Anti-fibrotics (Pirfenidone, Nintedanib)
2 months of
4 months of RH
Side effects of TB medications?
Rifampicin - orange secretions, enzyme inducer
Isoniazid - peripheral neuropathy, prevent with pyridoxine
Ethambutol - optic neuritis
Pyrazinamide - hepatotoxicity
What is Light's criteria?
To determine exudate or transudate in pleural effusion
Pleural protein / Serum protein > 0.5
Plerual LDH / Serum LDH > 0.6
Pleural LDH > 2/3 upper limit of normal
How to diagnose COPD?
- Chronic cough
Presence of risk factors
- Occupational exposures
Obstruction without reversibility on spirometry
Non-pharmacological management of COPD
Assess inhaler technique
Pharmacological management of COPD?
Based on symptoms and exacerbation risks
Low symptoms low risk
High symptoms low risk
- LABA or LAMA
Low symptoms high risk
- LABA + ICS
- LABA + LAMA
High symptoms high risk
- LABA + LAMA + ICS
- Consider adding macrolides
- Consider adding roflumilast
Indications for LTOT in COPD?
PaO2 < 55mmHg or SpO2 < 88% when stable
Management of acute exacerbation of COPD?
- oxygen supplementation via venturi mask aim 88-92%
- Nebulisation with salbutamol, consider adding ipratropium
Systemic steroids either PO or IV
Consider antibiotics if increased sputum volume, purulence and SOB
- KIV NIV and intubation
- Blood culture if infection suspected
Management of acute asthma exacerbation
ABCs (tend not to do well with NIV)
- Oxygen supplementation
- Obtain IV access (may require IV drugs)
IV magnesium sulphate