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Respiratory - Summary
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Respiratory - Summary Table of all respiratory conditions organised by history findings, examination findings, investigation findings and management according to Australian guidelines.
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Nikita Goyal; RespiratoryObstructive Pulmonary Conditions
Info History/RF Examination Investigation Management
Asthma Ax; Allergic (90%) - environmental Recurrent SOB High pitched polymorphic PFT Avoid trigger, monitoring,
Chronic or occupational allergens; Non- Wheeze expiratory wheeze ↓ FEV1/FVC<70% + reversible review – pt education
inflammatory allergic (10%) - viral infections, Non-productive cough in Hyper-resonant percussion with BD (>12%) or ↑200ml in Assess inhaler technique
airway disease cold, physical exertion, GORD, morning Increased HR either FEV1 or FVC; flow volume SABA – for trigger
characterized sinusitis/rhinitis, Chest tightness Hypoxic – cyanotic signs loop; ↓ FEV1 ICS (can be prn) + SABA prn
by intermittent aspirin/NSAIDs/beta blockers, Tachycardic/tachypnoeic Accessory/intercostal m use ↓ PEFR/DLCO (normal) – LABA** + ICS – always
airway stress, irritants Runny nose, sneezing, rashes, Hypocapnia monitoring, not Dx – diurnal together
obstruction and Severity – intermittent, mild hives, itchy eyes etc Harrison’s sulcus variation >20% Inc doses if need be
hyper-reactivity persistent, moderate persistent, Episodic/nocturnal Methacholine challenge test – ↓ Leukotriene antagonists
Type 1 severe persistent Extra Q – any triggers? Recent Severe attack – cyanosis, FEV1 > 20% - stimulates asthma Mast cell stabilisers –
Hypersensitivity Pathophys - Affects conducting resp infections? SABA use? stridor, altered mental attack cromones
system, mast cells, histamine, Exercise tolerance? state, tachycardic, hypoxic, Asthma action plan
leukotrienes, inflammatory Frequency, impact on tachypnoeic, accessory m Allergy workup
mediators, eosinophils life/sleep? use, inability to speak in full Bloods – FBE (eosinophilia, IgE), Acute Asthma – Assess
Bronchial m constriction, mucous Asthma education + Mx, plan? sentences, lie supine, loud ABG (CO2 retention) severity using MOWS –
secretion, oedema; variable – oral thrust, tachycardic or wheezes or silent chest, CXR – hyperinflation, flattened metal state, O2 sats, work
reversible airflow limitation, Th2 palpitations, jitters pulsus paradoxus diaphragm, wider intercostal of breathing, speech
hypersensitivity, Extra – Puffer Names spaces O SHIT ME – O2,
inflammation/hyperresponsiveness PHx – eczema, allergic rhinitis, Ventolin – salbutamol **PEFR – adults salbutamol,
of endobronchial smooth muscle asthma (atopic triad), smoking Bricanyl – terbutaline hydrocortisone,
DDx – anaphylaxis RF - FHx Flixotide – fluticasone ipratropium bromide,
Seretide – fluticasone + theophylline, MgSO4,
salmeterol escalate care – intubation +
Pulmicort – Budenoside ventilation
Symbicort – Budenoside +
formoterol Cannot use LABA alone
COPD Chronic Bronchitis – productive Productive (no colour) Tachycardic, Cyanotic PFT Non-pharm – quit smoking,
Irreversible cough for at least 3 months each chronic cough Pursed lip breathing ↓ FEV1/FVC<70% - irreversible pneumococcal/flu
airway year for two years; emphysema – SOB/SOBOE – gradual onset Accessory m use with BD vaccination, O2 therapy
obstruction due permanent dilatation of pulmonary Wheeze Asterixis ↓ FEV1 < 80% predicted/FVC – >16hrs, pulmonary rehab,
to chronic air spaces distal to the terminal Chest tightness Tracheal Tug this decides severity weight control, exercise, pt
inflammation of bronchioles caused by destruction Fatigue Hoover’s sign TLC ↑ w/ emphysema education, monitoring,
small airways of alveolar walls and pulmonary Recurrent pulmonary Barrel chest + tar staining DLCO ↓ w/ emphysema alcohol, diet
capillaries infection Hyper-resonant & distal
GOLD Baseline exercise tolerance, heart sounds Bloods – FBE (polycythaemia), Pharm – SABA+/-SAMA
Ax – emphysema, chronic
Mild FEV1 ≥ hospitalisations, frequency of Expiratory wheeze, ABG then LABA/LAMA then
bronchitis, chronic asthma
80% Sx decreased breath sounds, Pulse oximetry LABA + LAMA then ICS +
Genetic - α1-anti-tryspin deficiency
Moderate – RF - age, smoking, end inspiratory coarse Sputum MCS LABA or LABA + LAMA + ICS
Pathophys - Affects conducting and
50% ≤ FEV1 ≤ inflammation, crackles CXR – hyperinflation, flattened Mucolytics
, Nikita Goyal; Respiratory
80% gas exchange system, fibroblasts, hypertrophy/hyperplasia of Displaced liver diaphragm, narrow heart, Assess inhaler technique
Severe – macrophages, neutrophils, release goblet cells, air pollution, Weight loss, cachectic horizontal ribs, ↑ AP diameter –
30% ≤ FEV1 ≤ of cytokines recurrent pulmonary RHF - JVP Distention, barrel chest, increased Surgical – Lung transplant
50% Fibrosis, destruction of alveolar infections, A1AT deficiency peripheral oedema radiolucency of lungs, rapid
Very severe – walls, mucous secretion tapering vascular shadows **smoking + O2 therapy -
FEV1 <30% Note – due to chronic hypercapnia, ECG contraindication
O2 controls respiratory drive
instead of CO2
GOLD classification
Comps – hypoxic vasoconstriction
➝ pulmonary HTN ➝ RV
hypertrophy ➝ RHF
Cor pulmonale; polycythaemia; resp
failure; depression/anxiety,
osteoporosis
Epi – high morbidity/mortality, 13%
of Au pop
Bronchiectasis Destruction of elastic and muscular Chronic productive cough Barrel chest CT – dilated airways, tree-in-bud Non-pharm – SNAPW,
Irreversible components of the bronchial wall SOB Decreased fremitus CXR – tubular opacities, obscured vaccination, physio
dilation of Wheeze Hyper-resonant percussion hemidiaphragm, tram lines Pharm – mucolytic agents,
airways and Ax – recurrent infections, mucous Fatigue Crackles + rhonchi empirical amox + doxy
chronic secretion, COPD, aspiration, Possible haemoptysis High pitched inspiratory Bloods – FBE Postural drainage to
inflammation, tumours, CF, ciliary dysfunction Recurrent resp infections squeaks Sputum MCS remove mucous
mucous syndromes, immunodeficiency, α1- Fever, tachypnoeic, hypoxic Wheeze Sweat test for CF Airway clearance therapy –
plugging & anti-tryspin deficiency Rhinosinusitis Cachectic PFT – Decrease in lung capacity oral hydration, chest
progressive Weight loss Accessory m use physio, nebulized
airway Frequently due to pseudomonas RF – CF, immunodeficiency, Clubbing hyperosmolar agents,
destruction. aeruginosa previous infections, primary mucolytic agents
cell dyskinesia, α1-anti- Breathe through pursed Surgery if tumour or
tryspin deficiency, IBD lipids foreign body
Lung Transplant
Cystic Fibrosis Pathophys – mutation leads to Positive newborn screen Sweat test – elevated
Autosomal defective Cl – channels in cell Failure to pass meconium Immunoreactive trypsinogen
recessive membranes of exocrine glands Failure to thrive test – positive
disorder caused which start producing hyper-viscous Voracious appetite Genetic testing – presence of
by mutation in secretions Wet sounding cough two disease causing mutations
CFTR gene RF – FHx of CF, known carrier status Recurrent infection
of both parents, ethnicity Chronic sinusitis
Genital abnormalities in males
Respiratory Infections
Info History/RF Examination Investigation Management
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