Repiratory Flashcards
Signs and symptoms of pneumonia
Cough Sputum Wheeze Systemic signs - fever Rigors
Signs - cyanosis Crackles on auscultation Increased RE and HR Dull percussion Confusion
Common infection in COPD
Haemophilus influenza
Common lung infection in diabetics and alcoholics and its antibiotic
Klebsiella
Cefotaxime
Water associated pneumonia pathogen and its antibiotic
Legionella
Hyponatraemia common
Fluoroquinolone (ciprofloxacin) or clarithromyin
Mycoplasma infection findings and antibiotics
Dry cough, atypical CXR findings
Clarithromycin
Scoring system in pneumonia
CURB-65
Confusion Urea - > 7 RR > 30 BP <90 systolic, < 60 diastolic Age > 65
Empirical treatment for pneumonia
Amoxicillin
If curb > 2 = amoxicillin and clarithromycin
If curb > 3 = co-amoxiclav
First step in asthma management
Inhaled SABA as required
Someone’s asthma isn’t controlled on SABA
Add an inhaled corricosteroid (low dose)
Someomes asthma isn’t controlled on a SABA and ICS
Add a LeuKotriene reception antagonist
Montelukast
Someones asthma isn’t controlled on SABA, ICS and LTRA
Add a long acting B2 agonist (LABA)
Someone asthma isn’t controlled with SABA, ICS, LTRA, LABA
Increase doe of ICS or try another drug - theophylline
Signs of a severe asthma attack
Pefr 33-50 % of best
Cant complete ful sentences
RR > 25/MIN
Signs of a life-threarenjg asthma attack
PEFR < 33%
Oxygen sats < 92%
Silent chest
Cyanosis
Tests in COPD
Diagnosis based on clinical findings + spirometry
Spirometry will show obstructive pattern
ECG + echo for heart function
Peak flow
FBC - FBC - polycythaemia and anaemia
Alpha 1 antitrypsin - deficiency causes more severe disease
CXR - bronchial wall thickening, air space enlargement and rule out differentials
ABG - decreased oxygen with/out hypercapnia
Spirometry - obstructive pattern
Sputum cultures
Example of a SAMA
Ipratropium bromide
Example of SABA
Salbutamol,
Terbutaline
Step one in COPD management
SABA or SAMA
Someone’s COPD is not controlled by SABA, they do not have asthma and no response to steroids. What is next step?
LABA+LAMA (+SABA) as required
Someone’s COPD is not controlled by SABA, they do have asthma and show response to steroids. What is next step?
LABA+ICS (+SABA)
Someones COPD is not controlled by SABA, LAMA and LABA. Next step?
LAMA+LABA+ICS (+SABA)
Indications for long term oxygen therapy in COPD
Patients with paO2 < 7.3 kPa
Or those who have 7.3-8 and one of
- secondary polycythaemia
- peripheral oedema
- pulmonary HTN
Risk factors for PEs
Long haul flight Immobility Cancer Surgery Thrombophilia - antiphospholipid syndrome Leg fracture Previous PE COCP Pregnancy
Investigations for PE
Obs
ECG - sinus tachycardia
Bloods - FBC, U+E, ABG - decreased O2 and CO2
Wells score
D-DIMER
CT pulmonary angiogram
Definitive diagnosis of a pulmonary embolism
Wells score
<4 = D dimer, if positive then do CT pulmonary angio
If >4 = treat or CT pulmonary angio
Alternative = ventilation, perfusion scan - will be ventilated but not perfused
Management of PE
Oxygen if hypoxic Morphine and anti-emetic IV access Fluid if drop in BP Consider ITU
Haemodynamically unstable - thrombolysis
If not - apixaban or rivaroxiban, LMWH as an alternative
Long term coagulation - 3 months if provoked, 6 months if unprovoked, lifelong if active cancer
Someone treated for a PE with LMWH is being put onto long term warfarin how should this be done?
Continue warfarin for 5 days or until INR 2-3 for 24 hours (whichever is longer)
Causes of exudate pleural effusions and what does exudate mean
Protein concentration >35g/L
Think inflammation
- pneumonia
- cancer
- RA
- TB
Causes of transudate pleural effusions and what this means
Protein concentration <25 g/L
Think fluid movement
- heart failure
- hypoalbuminaemia- liver disease
- hypothyroidism
- meigs syndrome