Notes

COPD

·         FEV1/FVC lower and can’t be reversed well with bronchodilators

·         Treatment

o   Smoking cessation

o   Bronchodilators

o   Corticosteroids

o   Oxygen

o   Infection prevention/treatment

·         BODE index

o   BMI

o   Obstruction (airflow)

o   Dyspnoea

o   Exercise capacity

Obstructive sleep apnoea

·         Sleepiness due to waking up many times at night

·         Fall in arterial O2 sats many times (measured on pulse oximetry)

·         Treatment

o   CPAP

o   Weight loss

Bronchiectasis

·         Permanent dilation of airways caused by CF or post-infectious

·         Recurrent infections

·         High resolution CT for diagnosis

·         Treatment

o   Physiotherapy

o   Antibiotics

o   Bronchodilators

o   Inhaled or oral steroids

o   Surgery (lung or heart/lung transplantation

Cystic fibrosis

·         Autosomal recessive

·         CFTR on chromosome 7 (CF transmembrane conductance regulator)

·         Treatment

o   Bronchiectasis

o   Pancreatic insufficiency (exocrine)

Asthma

·         Airflow limitation, airway hyperresponsiveness and inflammation of the bronchi

·         Extrinsic (younger) or intrinsic (older)

·         Diagnosis: Demonstrate variability by measuring PEFR or FEV1 (15% minimum), and look at CXR and atopy (histamine challenge?)

·         Treatment

o   B2 agonist

o   Add inhaled corticosteroids

o   Add LABA or leukotriene receptor antagonist (monteleukast or oral theophylline

o   Increase corticosteroids to 2000 micrograms daily

o   Add 40mg oral prednisolone daily

o   Hospital

Tuberculosis

·         Notifiable

o   Test all relatives (Mantoux?)

o   Treat relatives

o   Look at CXR and cultures

·         Standard treatment

o   Rifampicin

§  Turns secretions pink

§  Increased LFT and induces liver enzymes

o   Isoniazid

§  Polyneuropathy

§  ADD pyridoxine to prevent this

o   Pyrazinamide

§  Rashes and arthralgia and hyperuricaemia and gout

o   Ethambutol

§  Optic neuritis (check regularly)

o   Streptomycin

·         Prevent

o   BCG (Bacille Calmette-Guerin)

Sarcoidosis

·         Multisystem granulomatous disorder of unknown cause

·         Affects

o   Chest

§  Cough, breathlessness, wheeze, crackles

o   Skin

§  Erythema nodosum, lupus pernio, infiltration of scars

o   Eye

§  Anterior and posterior uveitis, conjunctival nodules, lacrimal gland enlargement, uveoparotid fever (Heerfordt’s syndrome with uveitis, parotid gland enlargement and facial nerve palsy)

o   Bone

§  Arthralgias, bone cysts

o   Metabolic

§  Hypercalcaemia (sarcoid macrophages produce 1,25 dihydroxyvitamin D)

o   Liver

§  Granulomatous hepatitis, hepatosplenomegaly

o   Neurological

§  Meningeal inflammation, seizures, mass lesions, hypothalamic-pituitary infiltration, diffuse sensorimotor neuropathy

o   Cardiac

§  Ventricular arrhythmias, conduction defects, cardiomyopathy with cardiac failure

·         Managed by:

o   Usually nothing

o   Can give prednisolone or even methotrexate/azathioprine/cyclophosphamide

·         Kills by

o   Respiratory damage

o   Renal damage due to hypercalciuria