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Medicine Notes Medicine and Surgery Notes

Respiratory Notes

Updated Respiratory Notes

Medicine and Surgery Notes

Medicine and Surgery

Approximately 143 pages

Theses are my latest set of notes for my first year as a clinical medic, complementing the 3rd year curriculum perfectly. Each topic is briefly but thoroughly covered with clear headings and colour co-ordination.

The notes use a great mix of words and diagrams in an eye-pleasing layout making revision easier for you with plenty of space to annotate.

Each system is clearly marked and most of the core diseases are covered and broken down into prevalence, aetiology, clinical features, managemen...

The following is a more accessible plain text extract of the PDF sample above, taken from our Medicine and Surgery Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

COPD

Chronic bronchitis – cough & sputum production on most days for 3 months of 2 successive years

Emphysema – histologically enlarged air spaces, distal to terminal bronchioles with destruction of alveolar walls

COPD or Asthma, not both

10-20% of over-40s

  • PINK PUFFER

    • Increased alveolar ventilation

    • Normal PaO2

    • Low PaCO2

    • Breathless but not cyanosed

    • Type 1 respiratory failure

  • BLUE BLOATER

    • Reduced alveolar ventilation

    • Low PaO2

    • High PaCO2

    • Cyanosed but not breathless

    • May develop Cor Pulmonale

Clinical features

Complications

Acute exacerbations

Infection

Polycythaemia

Respiratory failure

Cor pulmonale

Pneumothorax

Lung carcinoma

Investigations

  • Lung function tests

    • FEV1:FVC is reduced

  • CXR is often normal

  • CT

  • Hb level can be raised due to hypoxaemia

  • ABG

    • Hypoxaemia

    • Hypercapnia

  • Sputum for exacerbations

    • Strep. Pneumonia

    • H. influenza

  • ECG

  • ECHO

Bronchiectasis

Abnormal, permanently dilated airways

Inflamed, thickened, irreversible damage

Aetiology

  • Congenital

    • Cystic fibrosis

    • Young’s syndrome

    • Primary ciliary dyskinesia

    • Kartagener’s syndrome

  • Post-infection

    • Measles

    • Pertussis

    • Bronchiolitis

    • Pneumonia

    • TB

    • HIV

  • Other

    • Bronchial tumour

    • Allergic bronchopulmonary aspergiollosis

    • RA

    • UC

Investigations

  • CXR

    • Dilated bronchi

  • CT

  • Sputum culture

  • Sinus X-ray

  • Serum immunoglobulins

  • Sweat electrolytes

  • Mucociliary clearance

Treatment

  • Postural drainage

    • Twice daily

    • Chest physio

  • ABX

  • Bronchodilators

    • Salbutamol

  • Corticosteroids

    • Prednisolone

  • Surgery

    • Localised disease to control haemoptysis

Cystic Fibrosis

Caused by mutations of the CF transmembrane conductance regulator gene

Investigations

Sweat test: high sodium sweat concentration

Genetics: screen for mutations

Faecal elastase: pancreatic dysfunction

Pneumonia

Inflammation of the substance of the lungs

Usually caused by bacteria

Investigations

CXR

Infecting agent Frequency as cause Clinical circumstance
Streptococcus pneumoniae 35-80% CAP in usually fit patients
Mycoplasma pneumoniae 2-14% CAP in usually fit patients
Influenza A virus 10-15% CAP in usually fit patients
Haemophilus influenzae 5-6% Pre-existing lung disease
Chlamydia pneumoniae 4-13% CAP
Chlamydia psittaci 4-13% Contact with birds
Staphylococcus aureus 3-14% Children, IV drug users, assoc with flu
Legionella pneumophila 2-15% Institutional outbreaks, sporadic, endemic
Coxiella burnetii 1% Abattoir and animal hide workers
Pseudomonas aeruginosa 4-9% Cystic fibrosis
Enteric Gram-negatuve bacilli 6-12%
TB 1-5%

Raised WCC, ESR & CRP

Management

  • ABX

    • CAP – amoxicillin/co-amoxiclav/clarithromycin

    • HAP – IV aminoglycoside + antipseudomonal penicillin

  • Oxygen

  • IV fluids

  • Analgesia

Sarcoidosis

Multisystem granulomatous disorder of unknown cause

20-40yrs women>men

Clinical features

50% present with respiratory Sx and abnormalities are found on a CXR

Investigations

CXR

FBC, normocytic anaemia, raised ESR & CRP

Serum calcium, raised

Transbronchial biopsy

Serum ACE, raised in untreated patients

Lung function

Treatment

If the disease does not spontaneously improve after 6 months, 30mg prednisolone for 6 weeks is needed, reducing to 15mg for 6-12 months

Tumours

Bronchial Carcinoma

1.3 million deaths annually

3rd most common cause in the UK after heart disease & pneumonia

Male: female 3:1

Significant association with smoking and occupational factors (asbestos, arsenic, chromium, oil etc)

No abnormal physical signs

Pleural effusion or lobar collapse possible

  • Direct spread

    • Pleura & ribs

    • Pancoast’s tumour – pulmonary apex

      • Can induce Horner’s syndrome...

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