Respiratory

URTI - more viral

LRTI - acute bronchitis & pneumonia

Acute Bronchitis

Definition - inflammation of the bronchi

Clinical features

  • Cough - dry —> productive (clear/white/yellow sputum)

  • Wheeze

  • Dyspnoea

  • Mild fever

Diagnosis

  • Clinical

  • CXR if suspect pneumonia

Management

  • Pain relief

  • Abx if bacterial infection

Asthma

Bronchiectasis

Definition - dilation of bronchi

Aeitology

  • Chronic inflammation

  • Post-infection - TB, pneumonia

  • Immunodeficient - HIV

  • Connective tissue disorders - Marfan’s, RA, SLE

  • Congenital - CF (must exclude)

Clinical features

  • Persistent cough with purulent copious sputum

  • Chest pain, dyspnoea, haemoptysis

  • Coarse crackle on early inspiration —> lower zones

  • Wheeze

Diagnosis

  • HRCT — bronchial dilation, bronchial wall thickening

Management

  • Bronchodilators

  • Chest physical therapy

  • Postural drainage

  • Smoking cessation

  • Immunisation - influenza, pneumonia

Chronic obstructive pulmonary disease (COPD)

Definition - lung disease that has 2 types - chronic bronchitis + emphysema

Risk

Interstitial Lung disease

Diseases that cause inflammation & fibrosis to the pulmonary interstitium

Pulmonary Fibrosis

Definition - progressive scarring of lung tissue

Causes:

  • Idiopathic pulmonary fibrosis

  • Sarcoidosis

  • Asbestosis

  • Hypersensitivity pneumonitis

Risk factors

  • Male

  • 50-70 years old

  • Smoker

Clinical features:

  • Dry, non-productive cough

  • Dyspnoea

  • Clubbing

  • Inspiratory bibasilar crackles

Investigations

  • HRCT — honeycombing

  • Biopsy

  • Spirometry

Management

  • Meds

  • Surgery — transplant

Lung cancer

Lung cancer is initially classified histologically as being either small cell lung cancer (SCLC) or non-small cell lung cancer (NSCLC) due to the different features, management and prognosis see in the two groups.

SCLC accounts for around 15% of cases and generally carries a worse prognosis.

NSCLC can be broken down into

  • adenocarcinoma

    • this is now the most common type of lung cancer. The increased in the proportion of lung cancer cases caused by adenocarcinoma is thought to be have been caused by the increased use of low-tar cigarettes

    • often seen in non-smokers: amongst 'never' smokers adenocarcinoma accounts for 62% of cases compared to 18% caused by squamous cell

  • squamous

    • cavitating lesions are more common than other types of lung cancer

  • large cell

  • alveolar cell carcinoma

    • not related to smoking

    • ++sputum

  • bronchial adenoma

    • mostly carcinoid

Pleural effusion

Definition - accumulation of fluid in pleural cavity

Exudative > transudative = protein

Causes:

  • Exudative

    • Infection e.g. pneumonia

    • Malignancy

    • RA

    • TB

  • Transudative

    • Congestive heart failure

Clinical features:

  • SOB

  • Dull percussion

  • Reduced breath sounds

  • Tracheal deviation

Investigation — CXR

Management

  • Conservative

  • Aspiration

  • Chest drain — non-recurrence

Light’s Criteria establishes exudative effusion

  • Pleural fluid protein / serum protein greater than 0.5

  • Pleural fluid LDH / serum LDH greater than 0.6

  • Pleural fluid LDH greater than 2/3 of the normal upper limit of the serum LDH

Pulmonary embolism (PE)

Definition - blood clot obstructing the pulmonary artery

Cause - DVT

Risk factors:

  • Immobility/ long haul travel

  • Recent surgery

Presentation:

  • Dyspnoea

  • Pleuritic chest pain

  • Cough — haemoptysis

PERC Rule to rule out PE

Wells Score used when PE is suspected

Diagnosis

  • CXR - to rule out other pathologies

  • Likely PE — CTPA

  • Unlikely PE — D-dimer —> +ve —> CTPA

D-dimer is raised in VTE

Management

  • Supportive — O2, analgesia, hospital admission

  • Apixaban/rivaroxaban — LMWH

  • Massive — thrombolysis, unfractioned heparin

  • Long-term

    • DOAC - “-ban“

    • Warfarin (vitamin K antagonist) - antiphospholipid syndrome

    • LMWH - pregnant

Continue medication for 3 months

Pneumonia

Obstructive sleep apnoea

Examination

Unilateral reduced chest expansion —> collapse/pneumonia

Percussion

  • Resonant = normal

  • Dull = consolidation, collapse, effusion (pneumonia/effusion)

  • Hyper-resonant = pneumothorax

Auscultation

  • Inspiratory stridor = URTI

  • Wheeze = asthma / COPD

  • Coarse = pneumonia / pulmonary oedema

  • Inspiratory fine crackles = pulmonary fibrosis