2/5 Flashcards
How are patients managed with carbon monoxide poisioning?
High flow O2
Azithromycin - what should be tested for first before using as prophylactic AB?
ECG - check for long QT as can worsen
What other conditions can cause a raised D-dimer?
Malignancy
Heart failure
Surgery
Pregnancy
Pneumonia
DIC
Explain the treatment pathway for PE
How does AC management change afterward if patient with antiphospholipid syndrome or pregnant?
- Immediate DOAC as soon as suspicion
- If massive PE w/ haemodynamic compromise -> thrombolyse w/ atelepase
Then start on DOAC (3mnth provoked, 6 month unprovoked)
Antiphospholipid - warfarin
Pregnant - LWMH
CTPA or VQ scan in pregnant?
VQ - lower dose of radiation - important to ask pt if they could be pregnant
Write out asthma severity chart for wall
What are the features of bronchiectasis?
What could be heard on auscultation?
Persistent and purulent cough with large volumes of sputum
Dysponea
Haemoptysis
Coarse crackles and wheeze
~clubbing
What sign is seen on CT for bronchiestasis? - method of diagnosing
What can be seen on CXR?
Signet ring sign
CXR - tram-track opacities + ring shadows
Most common organism found in bronchiectasis?
What can colonise?
Haem influenzae
Pseudomonas colonisation
Hypersensitivity pneumonitis is scarring in the lungs caused by certain allergens.
What are the allergens in each of the following:
- Bird-fancier
- Farmer’s lung
- Mushroom worker’s lung
- Malt worker’s lung
Bird droppings
Mould in hay
Mushrooms
Mould in barley
egg-shell calcification of the hilar lymph nodes and upper zone fibrosing (v different to hypersensitivity pneumonitis/IPF)
Silicosis
What is acute bronchitis why is it not pneumonia?
Acute bronchitis - basically presents as a bad cold - most likely viral infection which causes inflammation of bronchi and trachea. Self-limiting normally over in 3 weeks
On examination
- wheeze BUT NO other chest signs e.g. dullness, crepe, bronchial breathing
- systemic features may be absent in bronchitis but unlikely in pneumonia
Clinical diagnosis
Yellow fingernails
Bronchiectasis
Lymphoedema
What is this?
Yellow finger syndrome
What is the management of acute bronchitis?
Good self-care
- analgesia
- rest and good fluids
Sometimes ABx if v unwell or co-morbidities - if use doxy.
Use doxycycline in pregnancy?
NO NO NO
List conditions which mean you can’t drive or need to inform the DVLA
Resp
Cough syncope
OSA
Cardio
Unstable angina
MI
Angioplasty
AAA
Neuro
Stroke
TIA
Epliepsy/seizures
ENT
Dizziness
Optho
Sight worse than 6/12 bilaterally
Glucoma
Endo
Diabetes
FEV and FVC for obstructive and restrictive
FEV and FVC reduced in restrictive so ratio stays >0.7
FEV1 reduced but FVC stays the same (in asthma) or not as reduced as FEV1 (in COPD) - so ratio <0.7
When do patients with COPD need Long term O2 therapy?
4 Bs
- Blood (polycythemia)
- Breathlesnness
- Ballooning (peripheral oedema)
- Blue (cyanosis)
What score is used to measure sleepiness in OSA?
Epworth sleepiness scale
Resp rate of what in CURB score?
30
If CTPA has shown that there is no PE but signs of DVT. What happens next?
NOT routine practice to repeat CTPA
Perform a USS to assess for DVT
Foul smelling sputum
Lung abscess
Go through how to read a CXR
ABCDE
Airway
- adequacy of penetration - should just be able to see spinal processes
- trachea - any deviation
- rotation - how close are clavicles to the spine
- additional equipment - any tubes in place etc?
Breathing
- bones - able to see 10 posterior ribs each side?
- lung vessels branch out okay?
- borders - heart borders, costophrenic angles crisp?
Circulation
- heart - <1/2 of chest? 2/3rds to L and 1/3rd to R?
- hilar vessels at similar level
Diaphragm
- R > L ? (as it should be)
Everything else
- further describe USING ZONES
You have to be careful with consolidation as have to have air bronchograms going through to use that word. What word can describe white on CXR instead?
Opacifications
What causes dermatomyositis in 25% of cases?
Malignancy - hence CT CAP should be ordered when diagnosed
