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Respiratory > Other respiratory > Flashcards

Other respiratory Flashcards

1
Q

In what pH range are people likely to benefit from NIV?

A

7.25-7.35

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2
Q

What is a blood contraindication for chest drain insertion?

A

INR >1.3

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3
Q

What can worsen a tension pneumothorax?

A

ventilation through endotracheal tube

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4
Q

NRT (ADR, use)

A
  • nausea and vomiting, headaches and flu-like symptoms

- nicotine patches + another form of NRT e.g. gum, inhalator, nasal spray) if high level of dependence

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5
Q

Varenicline (MOA, ADR, CONTRA)

A
  • nicotinic receptor partial agonist
  • more effective than bupropion
  • ADR: nausea, insomnia, headache, abnormal dreams
  • caution if depression or self harm
  • CONTRA in breast feeding and pregnancy
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6
Q

Bupropion (MOA, ADR, CONTRA)

A
  • norepinephrine and dopamine reuptake inhibitor, nicotinic antagonist
  • small risk of seizures
  • CONTRA: epilepsy, pregnancy and breast feeding
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7
Q

Smoking cessation in pregnancy:

A
  • CBT

- NRT if failure

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8
Q

When should oxygen therapy be administered:

A
  • critically ill (anaphylaxis, shock etc)

- reservoir mask 15L/min

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9
Q

Oxygen target sats in oxygen therapy:

A
  • acutely ill: 94-98%
  • patients at risk of hypercapnia (e.g. COPD): 88-92%
  • reduce in stable patients with satisfactory sats
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10
Q

Oxygen therapy in COPD patients:

A
  • prior to blood gases, 28% venturi mask at 4L/min and aim for 88-92%
  • with risk factors for hypercapnia and no Hx of respiratory acidosis
  • adjust range to 94-98% if pCO2 normal
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11
Q

Situations where oxygen therapy should not be routinely used if no evidence of hypoxia:

A
  • MI or ACS
  • stroke
  • obstetric emergencies
  • anxiety-related hyperventilation
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12
Q

Common causes of lobar collapse:

A
  • lung cancer
  • asthma (mucous plugging)
  • foreign body
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13
Q

CXR signs of lobar collapse:

A
  • tracheal deviation towards
  • mediastinal shift towards
  • elevation of hemidiaphragm
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14
Q

Causes of obstructive lung disease:

A
  • asthma
  • COPD
  • bronchiectasis
  • bronchiolitis obliterans
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15
Q

Causes of restrictive lung disease:

A
  • pulmonary fibrosis
  • asbestosis
  • sarcoidosis
  • ARDS
  • infant RDS
  • kyphoscoliosis e.g. ankylosing spondylitis
  • neuromuscular disorders
  • severe obesity
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16
Q

Respiratory manifestations of RA:

A
  • pulmonary fibrosis
  • pleural effusion
  • pulmonary nodules
  • bronchiolitis obliterans
  • complications of drug therapy e.g. methotrexate pneumonitis
  • pleurisy
  • Caplan’s syndrome - massive fibrotic nodules with occupational coal dust exposure
  • infection secondary to immunosuppression
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17
Q

Key indications NIV:

A
  • COPD with respiratory acidosis pH 7.25-7.35
  • type II RF secondary to chest wall deformity, neuromuscular disease or OSA
  • cardiogenic pulmonary oedema unresponsive to CPAP
  • weaning from tracheal intubation
18
Q

Kartagener’s

A
  • primary ciliary dyskinesia
  • dextrocardia/complete situs inversus (quiet heart sounds, small volume complexes in lateral leads)
  • bronchiectasis
  • recurrent sinusitis
  • subfertility (diminished sperm motility and defective ciliary action in fallopian tubes)
19
Q

Contraindications to chest drain insertion:

A
  • INR >1.3
  • platelet count <75
  • pulmonary bullae
  • pleural adhesions
20
Q

Where should a chest drain be inserted?

A

5th intercostal space in midaxillary line

21
Q

Complications of chest drain insertion:

A
  • failure of insertion
  • bleeding
  • infection
  • penetration of lung
  • re-expansion pulmonary oedema
22
Q

What is re-expansion oedema:

A
  • preceded by onset of cough or SOB

- avoid by clamping tube regularly in event of rapid fluid output (should not exceed 1 L over less than 6 hours)

23
Q

How can you confirm the position of the chest tube?

A
  • aspiration of fluid from drainage tube

- swinging of fluid within drain tubing when patient inspires and on XR

24
Q

Examples of extrinsic allergic alveolitis:

A
  • bird fancier’s lung
  • farmer lung
  • malt workers’ lung: aspergillum clavatus
  • mushroom worker’s lung: thermophilic actinomycetes
25
Q

Investigation of extrinsic allergic alveolitis:

A
  • imaging: upper/mid zone fibrosis
  • bronchoalveolar lavage: lymphocytosis
  • serological assays for specific gig antibodies
  • blood: NO eosinophilia
26
Q

Management of extrinsic allergic alveolitis:

A
  • avoid precipitating factors

- oral glucocorticoids

27
Q

Causes of haemoptysis:

A
  • lung cancer
  • pulmonary oedema: bibasal crackles and S3
  • TB
  • PE
  • LRTI
  • bronchiectasis
  • mitral stenosis: mala flush, mid-diastolic murmur
  • aspergilloma: history of TB, rounded opacity
  • granulomatosis with polyangiitis
  • Goodpasture’s
28
Q

Investigation of mesothelioma:

A
  • CXR shows pleural effusion or pleural thickening
  • pleural CT
  • pleural effusion - send for biochem and cytology
  • LA thoracoscopy
29
Q

Prevention and treatment of acute mountain sickness:

A
  • gain altitude no more than 500m per day
  • acetazolamide (carbonic anhydrase inhibitor) to prevent
  • descend
30
Q

Management of high altitude pulmonary oedema:

A
  • descend
  • nifedipine, dexamethasone, acetazolamide, phosphodiesterase, type V inhibitors
  • oxygen
31
Q

Management of high altitude cerebral oedema?

A
  • descend

- dexamethasone

32
Q

Causes of raised TLCO:

A
  • asthma
  • pulmonary haemorrhage
  • left to right cardiac shunts
  • polycythaemia
  • hyperkinetic states
  • male gender, exercise
33
Q

Cause of decreased TLCO:

A
  • pulmonary fibrosis
  • pneumonia
  • pulmonary emboli
  • pulmonary oedema
  • emphysema
  • anaemia
  • low cardiac output
34
Q

Increased KCO with normal or reduced TLCO:

A
  • pneumonectomy/lobectomy
  • scoliosis/kyphosis
  • neuromuscular weakness
  • ankylosis of costovertebral joints
35
Q

Superior vena cava syndrome

A
  • can present with lung cancer
  • distended veins
  • also lymphoma, sarcoidosis and aortic aneurysm
36
Q

Is it safe to continue prednisolone in pregnancy?

A

yes

37
Q

Conditions causing a cavitating lung lesion in CXR:

A
  • abscess
  • squamous cell lung cancer
  • TB
  • Wegener’s
  • PE
  • RA
  • aspergillosis, histoplasmosis, coccidioidomycosis
38
Q

Pulmonary oedema signs on CXR:

A
  • interstitial oedema
  • bat’s wing appearance
  • upper lobe diversion (increased blood flow to superior part)
  • Kerley B lines - expansion of interstitial space by fluid
  • pleural effusion
  • cardiomegaly if cardiogenic cause
39
Q

Causes of mediastinal widening on CXR:

A
  • vascular problems: thoracic aortic aneurysm
  • lymphoma
  • retrosternal goitre
  • teratoma
  • tumours of thymus
40
Q

Signs of lobar collapse on CXR:

A
  • tracheal deviation towards
  • mediastinal shift towards
  • elevation hemidiaphragm
41
Q

Empyema aspirate:

A

pH <7.2
low glucose
high LDH

Respiratory (3 decks)

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