capsule RESP Flashcards
first line Ix for acute asthma attack (3)
ECG, peak flow, blood gas
first line treatment for acute asthma attack (4)
-high dose of O2 until PaO2 normalised
salbutamol and ipratopium bromide administered at once by nebuliser (if not respond then IV aminophyline)
-high dose steroids to reduce inflammation eg IV or oral prednisolone
what signs could indicate life threatening asthma (7)
cyanosis, exhaustion and poor resp effort, bradycardia, low BP, ph 7.25 on ABG, pCO2 6kPa, silent chest on auscultation
how would you manage asthma attack, after imrpovement (4)
continue O2 at lower dose, commence oral steroids, 4 hourly nebulised salbutamol, monitor peak flow and O2 saturation
what is aminophyline
phosphodiesterase inhibitor which can be administered via IV in severe asthma. is may cause low K and cardiac arthymias so heart monitor needed.
Reduce dose in cardiac or liver failure and in patients on certain drugs e.g. Ciprofloxacin, Cimetidine
Omit loading-dose for IV infusion in patients already on oral treatment and, in all cases, monitor drug levels carefully whilst the infusion is ongoing.
what can cause consolidation in x ray (3)
aspiration, infection eg pneumonia, haemorrage in lungs
consolidation due to filling of air space with whatever materials.
how does lung fibrosis and mesothelioma present in x rays?
Lung fibrosis involves the interstitium rather than the alveoli and causes linear shadows.
Mesothelioma involves the pleura and so does not cause lung consolidation
commonest cause of CAP
strep pneumoniae
first line treatment for pneumonia (5)
analgesia, continued pulse oximetry, IV ABx, IV fluids, O2 by mask
what are some complications of bacterial pneumonia (6)
AF, empyema, jaundice, pericarditis, resp failure, septic shock
what are some radiographical changes associated with bronchiectasis (4)
Thickened bronchial walls
Ring shadows (thickened airways seen end-on)
Volume loss secondary to mucous plugging
Air-fluid levels may be visible within dilated bronchi
what Abx is choice for uncomplicated CAP
amoxycilin
what is drug of choice for suspected pneumocystitis carinii pneumonia
co trimoxazole
what are some causes of bronchiectasis?
congenital: CT, marfans, alpha 1 antitrypsin deficiency
post infection: pneumonia, measules, Tb
obstruction: tumour, nodes, foreign body
inhalation/ aspiration
pul fibrosis
immunodeficiency states eg AIDS
rheumatoid arthirtis and sarcoidsosi
what are some causes of lymphadenopathy
sarcoidosis, infectious mononucelosides and lymphoma, Tb
when would you check for serume ACE
raised in 2/3 pt with sarcoidosis but not specific for this. serum Ca may also be raised for
what are some pathology associated with sarcoidosis (4)
hypercalcaemia, lung fibrosis, hepatosplenomegaly, uveitis
what conditions associated with erythema nodosum (3)
Tb, corhn’s, oral contraceptives
additional treatments for asthma (after ICS and SABA)
long acting beta agonist (Salmererol/ formoterol) adding montelukast
side effects of LT steroids (3)
cataracts, weight gain, candida
side effect of rifampicin
can cause hepatic and renal impairment. Patients should be warned of red/orange discolouration of urine and mucous membrane secretions.
side effect of isoniazid
peripheral neuropathy is a common side effect and is more likely in those with risk factors, e.g. diabetes, alcohol dependence, malnutrition, renal impairment and HIV. These patients should be prescribed prophylactic pyridoxine. Hepatitis is rare but more common in those who are over 35 years old and those who drink alcohol daily.
side effect of ethambutol
may lead to colour blindness, loss of visual acuity and restriction of visual fields. Patients should be advised to stop the drug if visual symptoms occur. Ethambutol undergoes renal excretion, therefore, the dose should be reduced in those with renal impairment.
side effect of pyrazinamide
may cause hepatotoxicity, particularly in those with pre-existing liver disease.
side effect of streptomycin
may cause ototoxicity and nephrotoxicity. Serum concentrations should be monitored in patients with renal impairment.
when is strpetomycin used in treatment of TB
Streptomycin is now rarely used in the treatment of TB, unless there is resistance to isoniazid. Treatment duration for pulmonary TB is 6 months
what should you check prior to starting Tb treatment?
HIv counselling and testing, LFT, renal function, visual acuity
what ECG changes seen on PE
Typical ECG findings are sinus tachycardia and this is commonly the only ECG abnormality. There may be right axis deviation and a SI QIII TIII pattern (deep S in lead I with a Q wave in lead III), although the absence of this pattern would not exclude a PE
when do you see prominent u wave
hypokalaemia
when do you see delta wave
wolff parkinson white syndrome
when do you see LBBB
ischaemic heart disease, signs of ACS
factor V leiden
autosomal dominant point mutation in gene, which encodes clotting factor V. inc risk of pro-thrombotic event
x ray sign for tb or sarcoidosis
bilateral hilar lymphadenopathy and interstitial lung changes
how to test between Tb and sarcoidosis?
mantoux for TB
sarcoidisois: people may make extra vit D and ACE so detect surplus in blood test
biopsy of nodes to exclude malignancy
CT used to evaluate lungs and degree of lymphadenopathy and rule out malignancy
