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Summary Respiratory notes

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  • Course
  • (MBCHB)
  • Institution
  • The University Of Edinburgh (ED)
  • Book
  • Oxford Handbook of Clinical Medicine

Respiratory notes for Medical School finals. Contains information about clinical features of each condition, as well as relevant diagnostic tests and investigations, risk factors, causes and management guidelines. Everything has been cross referenced with passmedicine or Zero to finals and manage...

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Document information

  • No
  • Respiratory
  • November 20, 2023
  • 24
  • 2023/2024
  • Summary

Subjects

  • respiratory
  • medicine
  • chest disease
  • anatomy
  • clinical medicine
  • physiology
  • pharmacology

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Respiratory Conditions

Common Presentation

Breathlessness
Acute Breathlessness
Pulmonary causes Cardiac causes – pulmonary oedema secondary to
- Acute asthma - Acute HF
- Exacerbation of COPD - Sudden onset cardiac arrhythmia e.g. SVT
- Pneumonia - IHD
- Covid-19 - Acute valvular dysfunction
- PE - Cardiac tamponade
- Pneumothorax
- Pleural effusion Other causes
- Acute exacerbation of bronchiectasis - Metabolic e.g. aspirin overdose, DKA, renal
- Lung or lobar collapse (bronchial failure
obstruction, compression by cancer, - Blood loss
inhaled foreign body) - Thyrotoxicosis
- Acute pneumonitis - Neuromuscular disease e.g. GBS, myasthenia
- Upper airway obstruction gravis
- Hyperventilation
-
Chronic Breathlessness
Pulmonary causes Cardiac causes  chronic HF
- COPD - HTN
- Lung cancer - IHD
- Asthma - Cardiomyopathy
- Bronchiectasis - Valvular heart disease
- Pleural effusion - Cardiac arrhythmia
- Pleural infiltration by mesothelioma - Congenital causes
- Occupational lung disease
Other causes
- Anaemia
- Hypothyroidism
- Chest wall disease (including ankylosing
spondylitis)
- Diaphragmatic splinting (obesity, pregnancy,
ascites)
- Hypoventilation (GBS, MND)

Respiratory Function Tests
Spirometry

FEV1 FVC FEV1/FVC ratio
Normal >80% predicted >80% predicted 75-80%
Restrictive < 80% predicted < 80% predicted >70% normal

, Obstructive < 80% predicted Normal or low < 70% predicted


Obstructive vs Restrictive
Obstructive: asthma, COPD, bronchiectasis, CF
Restrictive: fibrosis, sarcoidosis, pneumoconiosis, interstitial pneumonias, connective tissue diseases,
pleural effusion, obesity, kyphoscoliosis, neuromuscular problems


Cough
Acute cough, < 3/52
- URTI [pharyngitis, common cold]
o Cough +/- sputum lasting 7-10 days followed by dry irritant cough, worse with exercise and
falling asleep
- LRTI
- Acute exacerbation of COPD/asthma/bronchiectasis
- Inhalation of FB
o Sudden onset, dry cough. May be associated with stridor, reduced chest sounds on affected
side and decreased breath sounds
- Whooping cough

Chronic cough, > 3/52
- Exposure to cigarette smoke
- Post-infective cough – dry intermittent cough post-URTI/bronchitis
- Post-nasal drip – persistent cough and throat clearing. May be associated with chronic sinusitis or
allergic rhinitis
o If coexisting sinusitis/rhinitis can trial intranasal corticosteroid or antihistamine
- Asthma
- GORD
- ACEi
- Lung cancer
- Bronchiectasis
- TB
- Whooping cough

Red flags: weight loss, cough persisting > 3/52, haemoptysis, finger clubbing, night sweats

Pneumonia
Acute LRTI associated with fever, symptoms + signs in chest + CXR abnormalities

Classification
- CAP
o Strep pneumoniae
o H. influenzae
o M. catarrhalis
o Atypicals: mycoplasma, S aureus, Legionella, Chlamydia
o Viral in 15%
- HAP - > 48 hours after hospital admission
o Mostly gram – enterobacteria or S aureus
- Aspiration

, - Immunocompromised: same organisms + pneumocystis jiroveci

Clinical presentation
Symptoms
- Fever, rigors
- Malaise, anorexia
- SOB, cough, purulent sputum, haemoptysis
- Pleuritic pain

Signs
- Pyrexia, cyanosis, confusion
- Tachypnoea, tachycardia, hypotension
- Signs of consolidation: dullness to percussion, reduced expansion, bronchial breathing, pleural rub

Investigations
- Obs: sats, RR, HR, BP
- ABG if Sats < 92%
- FBC, U+E, LFT, CRP
- CXR
o Lobar or multilobar infiltrates, cavitation or pleural effusion
- Sputum culture

CURB-65

0-1 = low severity, 2 = moderate, 3-5 = high severity

Confusion (MST 8 or less)
Urea > 7
RR > 30
SBP < 90, DBP < 60
Age > 65

Management

CAP

CURB = 0
Oral amoxicillin 500mg TDS
Penicillin allergy = oral doxycycline 200mg on 1st day followed by 100mg OD for 4/7; or oral clarithromycin
500mg BD for 5/7, or oral erythromycin 500mg QDS for 5/7 in pregnancy

CURB = 1-2
Oral amoxicillin 500mg TDS for 5/7 (and oral clarithromycin 500mg BD 5/7 if suspecting atypicals)

CURB = 3-5
Co-amoxiclav 1.2g TDS IV + IV clarithromycin 500mg BD oral (if route available)

HAP

Low severity
Doxycycline 200mg (D1) then 100mg OD for 4/7

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