Rep Flashcards
Active TB investigation
Sputum MCS (3 if pulmonary/1 if extra)
- Acid fast bacilli (Ziehl-neelsen/Auramine 24-48hrs)
- NAAT (quickest test and should be performed at least on one specimen)
- Culture (6 weeks)
CXR - cavitation, pleural effusion, BHL, upper lobe parenchymas infiltrates
Investigations for latent TB
Mantoux test (tuberculin skin test) - >5mm induration after 2-3 days
IFN-gamma release assay
PE confirmed Haemodynamically unstable management
Unfractionated heparin infusion
Alteplase for thrombolysis
DOAC afterwards
GOLD COPD
FEV1 percentage
1: > 80%
2: < 80%
3: < 50%
4: < 30%
Hospital management for asthmatic exacerbations
O2 targeted to 94%-98%
SABA by pMDI or nebulised if life threatening/near fatal
Oral Prednisolone for 5 days/ IV hydrocortisone
Ipratropium bromide is severe/life threatening
Magnesium sulphate can also be given if nothing else works
IV aminophylline after if nothing else
Non small cell lung cancer management
Stage I/II:
- lobectomy/pneumectomy (SABR if not suitable for surgery)
- post operative chemo (Ib/II) or radio (II + high risk)
Stage III:
- Pre-op chemo/chemoradiotherapy
- Lobectomy/pneumectomy
- Consider post op chemoradiotherapy
Stage IIIb/c (tumours too extensive for chemoradiotherapy) or stage IV:
- Supportive care, mutation specific treatments +/- chemotherapy
Management for small cell lung cancer
Chemotherapy
Radiotherapy (only if limited at presentation)
Prophylactic cranial irradiation
If relapsed, chemo/radiotherapy again
For pulmonale management
Loop diuretic
LTOT considered
Drug class of ipratropium bromide
SAMA
In asthmatic severe/life threatening exacerbations
In COPD regular pathway
COPD exacerbation management in GP
Increase bronchodilator use
Oral Prednisolone 5 days
Amoxicillin/clarithromycin/doxycycline if purulent sputum or pneumonia (CXR)
COPD exacerbation management in hospital
Nebulised bronchodilator
Oral prednisolone/IV hydrocortisone (5 days)
Theophylline if nebulised bronchodilator not working
LTOT if pO2 < 7.3 or 7.3-8 if:
- polycythaemia, peripheral oedema, pulmonary hypertension
Bi-PaP (non invasive ventilation) if ARDS2
Asthma diagnosis in adults
Spirometry with BDR > 12% improvement/increase in volume of 200ml
FeNO > 40 parts per billion
Tuberculosis management
4 for 2 months then 2 for 4:
- isoniazid + rifampicin
Latent:
- 3 months isoniazid + rifampicin or 6 months of isoniazid
B6 always given with isoniazid