Acute exacerbation of COPD

 AE of COPD is characterized by worsening of respiratory symptoms (cough, wheeze and dyspnea) more than usual day to day variation and requires changes in the medications.

Pathophysiology of breath sounds

 Normal breath sounds originate from the larynx .When the sound leaves the larynx it travels down the trachea and then divides when the airway divides. Some sound must be transmitted through the lung parenchyma but most travels down the airway. Eventually the sound travels along airways of different lengths and therefore becomes out of phase. Next it arrives in the respiratory bronchioles and alveoli and then gets transmitted through the chest wall to your stethoscope. The fat layer filters out much of the high frequency sound (above 4 kHz). The resulting sounds are much softer (because the sound has effectively been diluted throughout the whole of the lungs). There is no gap between inspiration and expiration (because all of the sound has become out of phase and therefore 'filled in' the gap. Finally, the first third of expiration is now the only part that is audible because the latter two-thirds are much quieter.

Reference: Chamberlain

Bronchiectasis

 Bronchiectasis is derived from Greek roots, bronchion meaning windpipe and ektasis is stretching out.

Bronchiectasis is present when one or more Bronchiectasis are abnormally and permanently dilated.

Reference: Crofton and Douglas page 794

Bronchiectasis is an entity characterized pathologically by airway inflammation and permanent bronchial dilatation 

Clinically by cough,sputum production,and exacerbations with recurrent respiratory tract infections.

Reference: Fishman edition 6 page no 862

Drugs causing breathlessness

 DRUGS CAUSING ORGANISING PNEUMONIA

1.Amiodarone

2.Amphotericin B

3.Carbamazepine

4.Cephalosporins

5.Coacine

6.Gold salts

7.Interferon alpha

8.Minocycline

9.Nitofurantoin

11.D-Penicillamine

12.Phenytoin

13.Rituximab

14.Sotalol

15.Sulfasalazine/Mesalamine

DRUGS CAUSING INTERSTITIAL INFILTRATES/FIBROSIS:

1.Amiodarone

2.Beta adrenargic blockers

3.Carbamazepine

4.Gold salts

5.Hydralazine

6.Methotrexate

7.Penicillins

EOSINOPHILIC LUNG DISEASE

1.ACE inhibitors

2.Amiodarone

3.Amphotericin B

4.Carbamazepine

5.Cephalosporins

6.Erythromycin

7.Ethambutol

8.Isoniazid

9.Minocycline

10.Methotrexate

11.Nitofurantoin

12.NSAIDS

13.PAS

14.Tetracycline

15.Trazadone

IDSA sinusitis management

 

Gram positive bacilli and Gram negative cocci

 Gram positive bacilli

Spore forming

Aerobic- Bacillus

Anaerobic- Clostridium 

Non spore forming

Filamentous 

Nocardia(weakly acid fast) ,actinomyces

Non filamentous

Listeria,corynebacterium

Gram negative cocci

Neisseria ,Moraxella

Gram negative coccobacilli

Hemophilus influenza

Upper vs lower respiratory tract

 Upper respiratory tract is arbitrarily regarded as that part above cricoid cartilage. It includes nose,pharynx,paranasal sinuses,eustachian tube, larynx.

Lower respiratory tract extends from trachea

Reference - Crofton page 4

Muscles of respiration

 Muscles of inspiration 

1.Diaphragm

2.External intercostal muscle 

Acessory Muscles of inspiration 

1.Sternocleidomastoid

2 Scalene Muscles

3.Trapezius

4 Pectoralis major and minor

Muscles of expiration

 Only during forced expiration 

1.Internal intercostal

2.subcoastalis

3.External oblique

4.Internal oblique

5.Rectus abdominis

3.Transverse abdominis

Complication of tb

 Local complications 

1. Bronchiectasis 

2 Hemoptysis 

3.Fungal ball

4.TB endobronchitis ,tracheitis

5.calcification of lungs

6.scar carcinoma

7.obstructive airway disease

8.secondary pyogenic infection

9.non tuberculosis mycobacteria

Pleural complications 

Chronic empyema 

Acute empyema

Fibrothorax

Spontaneous pneumothorax 

Systemic complications 

1.secondary amyloidosis

2.chronic type 1 and type 2 respiratory failure.

3.pulmonary hypertension 

4.chronic cor pulmonale 

High grade and low grade fever

 Low-grade: 37.3 to 38.0 C (99.1 to 100.4 F)

High-grade: 39.1 to 41 C (102.4 to 105.8 F)

Ref:Islam MA, Kundu S, Alam SS, Hossan T, Kamal MA, Hassan R. Prevalence and characteristics of fever in adult and paediatric patients with coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis of 17515 patients. PLoS One. 2021;16(4):e0249788