clinical Flashcards
what is the treatment for sleep apnoea?
Underlying factors (weight, alcohol, endocrine) continuous positive airways pressure mandibular repositioning splint
OSA Severity scale (desaturation) for sleep apnoea of 0-5 is
normal
OSA Severity scale (desaturation) for sleep apnoea of >30 is
severe
OSA Severity scale (desaturation) for sleep apnoea of 15-30is
moderate
OSA Severity scale (desaturation) for sleep apnoea of 5-15 is
mild
what are the investigations for sleep apnoea?
Pulse oximetry limited sleep study full polysomnography (EEG, adiuovisual recording, EMG, ECG, PSG)
what are is this symptomatic of? Breathlessness orthopnoea ankle swelling morning headaches recurrent chest infections disturbed sleep
chronic ventilator failure
what are the signs of chronic ventilatory failure
Elevated bicarbonate pco2<6.0kPa normal blood Ph pO2 <8kPa chest wall abnormality airways disease respiratory muscle weakness central hypoventilation
what are the investigations for chronic ventilatory failure
Lung function lying/standing mouth pressure early morning ABG oximetry CO2 monitoring fluoroscopic screening of diaphragm
what is the treatment for chronic ventilatory failure
Non-invasive ventilation
oxygen therapy
t-IPPV
what is the treatment for narcolepsy
modafinil
clomipramine
sodium oxybate
what are these the symptoms of? Pleuritic chest pain cough haemoptysis dyspnoea syncope cardiac arrest
pulmonary embolism
what are these the symptoms of Dyspnoea, cough
basal crackles, cyanosis, clubbing
usual interstitial pneumonitis
what are these the symptoms of Fever, dry cough, myalgia, chills, crackles, tachyopnoea, wheeze, antibody
insidious, malaise, shortness of breath
hypersensitivity pneumonitis
what are these the symptoms of Dyspnoea
heart failure
respiratory failure type 1
Diffuse alveolar damage
what are these the symptoms of Acute althralgia Erythema nodusum bilateral hilar lymphadenopathy shortness of breath cough
sarcoidosis
what are these the Chest tightness
exertional dyspnoea
exertional syncope or presyncope
symptoms of
pulmonary hypertension
what are these the symptoms of Malaise fever Chest pain Cough rusty sputum Dyspnoea
pneumonia
what are these the symptoms of Lethargy
Weight loss
high swinging fever
lung abscess
what are these the symptoms of Chest pain
absence of cough
swinging fever
empyema
what are these the symptoms of Chronic cough daily sputum foul smelling wheeze dyspnoea tiredness chest pains Haemoptysis
bronchiectasis
what are these the symptoms of Recurrent infections chronic sputum dypnoea haemoptysis pneumothorax
cystic fibrosis
what are these the symptoms of Shortness of breath wheezing weight loss regular infections haemoptysis pain Neurological Difficulty swallowing raspy voice haematuria fatigue
lung cancer
what are these the symptoms of Weight loss progressive smoker’s cough wheeze chest tightness breathlessness coughing up sputum muscle loss regular chest infections
COPD
what are these the symptoms of rhinitis
runny nose
what are these the symptoms of ear ache
erythema
bulging ear drum
otitis media
what are these the symptoms of Stridor
hoarse voice
signs of common cold
barking cough
croup
what are these the symptoms of epiglottis
Stridor
hoarse voice
signs of common cold
barking cough
what are these the symptoms of Asymptomatic increasing breathlessness pleuritic chest pain dull ache dry cough weight loss malaise, fevers night sweats
pleural effusion
what are these the symptoms of
Coughing
sneezing
primary; erythema nodusm, malaise, fever, rarely chest signs.
secondary; Cough, sputum, haemoptysis, pleuritic pain, breathlessness, malaise, fevers, night sweats
tuberculosis
signs of pulmonary embolism
Recent surgery trauma cancer cardiopulmonary disease pregnancy thrombophilia Pyrexia Pleural rub stony dullness tachycardia tachypnoea hypotension hypoxia
treatment for pulmonary embolism
Oxygen Heparin warfarin anti-coagulants Thrombolysis (alteplase) pulmonary embolectomy
investigations for pulmonary embolism
Pre-test wells score and Geneva score full blood count, biochemistry and blood gas CXR ECG d-dimer V/Q CT scan (angiogram) echocardiography thrombophilia testing
investigations for hypersensitivity pneumonitis
Chest x ray ACE biopsy clinical findings serum CA
investigations for sarcoidosis
Serum Ca ACE Biopsy X-ray clinical findings
investigations for pulmonary hypertension
ECG lung function chest x ray echocardiography V/Q scan CTPA right heart catheter
investigations for pneumonia
Serum biochemistry, blood count CXR blood culture Throat swav urinary legionella antigen sputum microscopy and culture CURB
investigations for lung abscess
CT scan
sputum culture
investigations for empyema
CT thorax
pleural ultrasound
pleural aspiration
investigations for bronchiectasis
HRCT thorax sputum culture serum immunoglobulins Total IgE and aspergillus precipitins CF genotyping
investigations for cystic fibrosis
Antenatal and neonatal screening with Guthrie test, sweat test.
investigations for lung cancer
CRX PET/CT scan broncho/mediastinoscopy EBUS bone scane blood test pulmonary function test spirometry V/Q scan ECG angiogram biopsy thoracotomy renal and liver function
investigations for COPD
FEV1/FVC ratio <80% PEFR <400-600ml carbon monoxide transfer test BMI lung volume limited response to treatment CXR blood gas test full blood count ECG sputum culture pulmonary function test
investigations for pleural effusion
Protein content of fluid (trans/exudate) CXR (need 200ml) CT scan of thorax aspiration blood culture and samples look and sniff blood gas analyser biochemistry microbiology cytology pleural biopsy (abram, CT) 4 samples in saline and formaldehyde thoracoscopy
investigations for tuberculosis
Primary – heaf/tunerclin test of PPD administration.
sputum culture , smear, ziehl neilsen stain. PCR sputum sample. Chest radiograph.
CT scan, bronchoscopy, pleural aspiration and biopsy.
family scan
treatment for pulmonary hypertension
Oxygen anticoagulation Diuretics calcium channel antagonist prostacyclin endothelin receptor antagonists phosphodiesterase inhibitors thrombo-endarterectomy lung/heart transplant
treatment for pneumonia
Curb 1 – amoxycillin or clarithromycin 2 – amoxycillin and clarithromycin 3-5 co-amoxiclav and clarithromycin Oxygen I.v. fluids intubation and ventilation
treatment for lung abscess
Prolonged antibiotics
drainage if possible either through bronchial tree or percutaneous
treatment for empyema
Chest drain and antibiotic (6 weeks) maybe intrapleural DNase or surgery worst case
treatment for bronchiectasis
Chest physiotherapy
antibiotics for infections
inhaled therapy of beta agonist and ICS
treatment for cystic fibrosis
Infections from pseudomonas eradication with ciprofloxacin and colomycin lung transplant beta lactam and aminoglycoside antibiotics subcutaneous ports isolation from other CF ivacaftor multi management team enzyme enteric pills, fat soluble vitamins, Proton pump inhibitors high energy diet. vaccinations mucolytic and airway clearance. reduce inflammation palliative care therapy fertility assistance
treatment for lung cancer
If small enough NSCLC operate immunotherapy targeting PD1 chemotherapy radiotherapy palliativtoe care
treatment for COPD
Smoking cessation vaccines pulmonary rehabilitation inhalers such as bronchodilators and corticosteroids long term O2 treatment psychological support triple therapy
treatment for tonsillitis
Either nothing or 10 days penicillin
should last a week
treatment for croup
Oral dexamethasone
should last 4 days
treatment for epiglottis
Intubation
antibiotics
treatment for pleural effusion
Target underlying cause TB chemo Chemotherapy corticosteroids palliative care if malignant pleurodesis (4rth intercostal mid axillary)
treatment for pneumothorax
Tension – cannula in 2nd intercostal space (IS) in mid-clavicular line – chest drain
small primary just observe
large primary aspirate 2nd IS chest drain
secondary; 4rth is
fail to re-inflate visit surgeon
pleurodesis
pleurotomy
treatment for tuberculosis
Rifampicin, isoniazid, ethambutol, pyrazinamide 2 months then rifampicin isoniazid for 4 months
signs of pulmonary hypertension
Heart disease chronic respiratory disease thromboembolic elevated JVP right ventricular heave loud pulmonary heart sound hepatomegaly ankle oedema
signs of pneumonia
Pyrexia Central cyanosis dullness on percussion tachypnoea bronchial breath sounds inspiratory crepitations increased vocal resonance
signs of lung abscess
Recent pneumonia
certain organisms like staph. Aureus, or pseudomonas
signs of bronchiectasis
Cystic fibrosis measles aspergillosis hypogammaglobulinemia finger clubbing course inspiratory crepitations
signs of CF
Family history
reoccurring chest infections
nasal polyps, sinusitis, male infertility, failure to thrive
signs of lung cancer
Brachial plexus palsy nodules/masses pleural effusion hepatomegaly smoker occupation age finger clubbing horner’s syndrome vena cava obstruction anaemia
signs of COPD
Heart disease smoker asthma A1 antitrypsin deficiency pursed lips drug us barrel chest CO2 flap paradoxical chest movement hepatomegaly accessory muscles breathing peripheral oedema tachypnoea
signs of pleural effusion
Peripheral oedema liver disease orthopnoea PND one sided expansion stony dullness reduced breath sounds Reduced vocal resonance tar staining, clubbing increased JVP trachea diversion
signs of pneumothorax
Pres-existing lung disease recent trauma or surgery tall thin male <45 surgical emphysema hyper resonant trachea diversion absent breathing sounds
signs of Tb
Look for diabetes, immunosuppressed, prior tb, alcohol, immigrants, alcohol abuse. Signs of bronchial breathing, crackles, finger clubbing.
