Corrections 2 Flashcards
What type of hypersensitivity reaction is an asthma attack?
IgE type 1
What type of asthma attack does an inability to speak in full sentences indicate?
Severe
Give features of a life-threatening asthma attack
1) PEFR <33%
2) O2 sats <92%
3) Confusion
4) Silent chest
5) ‘Normal’ PaCO2
6) Exhaustion
7) Cyanosis
8) Bradycardia
9) Hypotension
What are some asthmatic features or features suggestive of steroid responsiveness in COPD?
1) previous diagnsois of asthma or atopy
2) diurnal variation in PEFR (>20%)
3) substantial variation in FEV1 (>400 ml)
4) raised eosinophils
Target of antibodies in Lambert-Eaton myasthenic syndrome?
It is caused by antibodies against SCLC cells.
These abs also target and damage voltage-gated calcium channels on the PREsynaptic terminals in motor neurones.
Referral criteria for 2ww suspected cancer pathway?
1) chest X‑ray findings that suggest lung cancer
2) aged 40 and over with unexplained haemoptysis
Which type of lung cancer is most likely to cause a pleural effusion?
Adenocarcinoma (& mesotheliomas)
Prior to discharge, following an acute asthma attack, how long must patients be stable for on their discharge medication (i.e. no nebulisers or oxygen)?
12-24h
Stepwise diagnostic testing in asthma (age 5-16 y/o)?
1) all children should have spirometry with a bronchodilator reversibility test
2) FeNO test should be requested if there is NORMAL spirometry or obstructive spirometry with a negative bronchodilator reversibility test
Stepwise diagnostic testing in asthma (age ≥17 y/o)?
1) patients should be asked if their symptoms are better on days away from work/during holidays. If so, patients should be referred to a specialist as possible occupational asthma
2) ALL patients should have spirometry with a bronchodilator reversibility (BDR) test
3) ALL patients should have a FeNO test
Does a negative result on spirometry exclude asthma as a diagnosis?
No - refer for FeNO testing
What anaesthetic agents are patients with myasthenia gravis very sensitive to?
Non-depolarising agents e.g. rocuronium
Why should you be cautious of using EllaOne (Ulipristal acetate) in severe asthma?
Due to the anti-glucocorticoid effect of ulipristal acetate
Describe Light’s criteria for establishing an exudative effusion
1) Fluid protein/serum protein >0.5
2) Fluid LDH/serum LDH >0.6
3) Pleural fluid LDH >2/3 of normal upper limit of serum LDH
What 2 medications are licensed that can slow the progression of pulmonary fibrosis
1) Pirfenidone
2) Nintedanib
What should be done before prescribing Abx in bronchiectasis?
Sputum culture
What is the Abx of choice for bronchiectasis exacerbations caused by Pseudomonas aeruginos?
Ciprofloxacin
When is Abx prophylaxis required in COPD patients?
≥4 excacerbations requiring steroids in past year, and 1 requiring hospitalisation
Pleural fluid findings of low glucose may indicate what?
1) RA
2) TB
Pleural fluid findings of raised amylase may indicate what?
1) pancreatitis
2) oesophageal perforation
What does lung abscess most commonly form 2ary to?
Aspiration pneumonia
What is silicosis a risk factor for?
Developing TB
Is post-exposure prophylaxis for HIV recommended following human bites?
No (even if the individual has known HIV/AIDS) due to low risk of transmission
Who is prone to developing endocarditis secondary to Viridans streptococci e.g. Streptococcus sanguinis?
Patients with poor dental hygiene
Post-exposure prophylaxis for HIV routine?
Treat within 72h
4 weeks of ART
HIV testing at 12 weeks
What is the most common cause of death in measles?
Pneumonia
How can the risk of oral candidiasis be reduced in inhaled steroid use?
Take ICS using a large volume spacer –> less drug deposition in mouth
Why are dry powder asthma inhalers better for the environment than metered dose inhalers?
Metered dose inhalers use hydrofluorocarbon propellant (a greenhouse gas).
Dry powder inhalers do not
use propellants.
Location of consolidation if it is above the R horizontal fissure?
R upper lobe
Mx of persistent air leak or recurrent episodes in pneumothorax?
consider referral for VATS to allow for mechanical/chemical pleurodesis +/- bullectomy
Symptom control in non-CF bronchiectasis?
Physiotherapy for inspiratory muscle training and postural drainage
Why are combination inhalers recommended where possible?
to increase medication compliance
Gold standard for diagnosis of mesothelioma?
Thoracoscopy & histology
What should be considered if a lung abscess is not improving with intravenous antibiotics?
Percutaneous drainage
When draining a pneumothorax, if after 3-5 days there is persistent air leak (e.g. bubbling chest drain) or failure of the lung to re-expand, what should you do?
Seek a thoracic surgical opinion
Spirometry results in idiopathic pulmonary fibrosis?
- restrictive picture
- reduced transfer factor
- reduced coefficient
What is transfer factor?
The transfer factor describes the rate at which a gas will diffuse from alveoli into blood.
How can results for transfer factor be given?
a) as the total gas transfer (TLCO)
or
b) that corrected for lung volume (transfer coefficient, KCO)
Causes of a raised TLCO?
- asthma
- polycythaemia
- male gender, exercise
- pulmonary haemorrhage
Causes of a lower TLCO?
- pulmonary fibrosis
- pneumonia
- pulmonary emboli
- pulmonary oedema
- emphysema
- anaemia
- low cardiac output
Pleural fluid results in an empyema?
- low pH
- low glucose
- high LDH
TLCO in pulmonary fibrosis?
Reduced
What type of shock can tension pneumothorax cause?
Obstructive shock
Patients with COPD with a pH in the range of what will achieve the most benefit of BiPAP?
pH 7.25-7.35
If pH is <7.25 then invasive ventilation should be considered if appropriate
What is the p/f ratio?
PaO2 / FiO2
What can the p/f ratio be useful for?
Checking if the patient’s O2 has responded adequately to the supplemental oxygen.
What is the normal P/F ratio?
55kPa or 400mmHg (depending on whether PaO2 is measured in kPa or mmHg).
What is myasthenic crisis?
An acute respiratory failure characterised by:
a) FVC <1
b) negative inspiratory force ≤20cm H20
c) the need for ventilatory support
What is the most appropriate test to monitor respiratory function in a myasthenic crisis?
FVC
When should all cases of pneumonia have a repeat CXR?
6 weeks after clinical resolution
What variation in FEV1 over time indicates steroid responsiveness in COPD?
At least 400ml
What picture does asbestosis given on pulmonary function testing?
Restrictive
What are the indications for steroid treatment in sarcoidosis?
1) hypercalcaemia
2) parenchymal lung disease
3) uveitis
4) neurological or cardiac involvement
In bacterial infections, does the WCC or CRP return to normal first?
White cells back into normal ranges faster than the CRP as the CRP response ‘lags.’
How is assessment for LTOT done?
Measuring ABG on 2 separate occasions at least 3 weeks apart in patients with stable COPD on optimal mx.
Define a substantial diurnal variation in peak flow
≥20%
What type of lung cancer are cavitating lesions more common in?
Squamous cell
WHat does a raised pulmonary wedge pressure indicate?
Cardiogenic pulmonary oedema
Can sarcoidosis cause enlargement of the parotid glands?
Yes - Mikulicz syndrome
Prior to the availability of blood gases, which venturi mask should be used in COPD patients who are known retainers?
28% venturi mask 4L/min
