resp Flashcards
criteria for severe asthma
PEFR 33-50% best or predicted
cannot complete sentences
RR >25
HR >110
criteria for life-threatening asthma
PEFR <33%
SpO2 <92%
silent chest, cyanosis or feeble respiratory effort
dysrhythmia or hypotension
exhaustion, confusion or coma
normal pCO2, if borderline low might need ventilation
asthma not controlled by SABA + ICS
add LTRA (NICE guidance)
asthma not controlled by SABA + ICS + LTRA
add LABA
can cont LTRA depending on response
infective exacerbation of COPD ABX
amoxicillin or clarithromycin or doxycycline
avoid amoxicillin if penicillin allergic
avoid clarithromycin in long QT
differentiating between transudate and exudate pleural effusion
exudate: protein >30 and LDH >200, pleural effusion fluid protein:serum protein is >0.5
transudate: protein <30
causes of transudate pleural effusion
heart failure (most common)
hypoalbuminaemia (which can be due to nephrotic syndrome)
hypothyroidism
causes of exudate pleural effusion
pneumonia (most common)
connective tissue disease: RA, SLE
neoplasia
PE
causative organism of atypical pneumonia in bird owners
Chlamydia psittaci (psittacosis)
smoking cessation treatment for pregnant women
nicotine replacement therapy
bupropion is CI
restrictive spirometry
FEV1:FVC >70%
decreased FVC
normal/decreased FEV1
inhaler technique
- remove cap and shake
- breath out
- put mouthpiece in mouth, breath in slowly, press canister down and continue to inhale slowly and deeply
- hold breath for 10s
- for second dose wait 30s
causes of upper lobe fibrosis
CHARTS
Coal workers pneumoniconiosis Hypersensitivity pneumonitis (aka extrinsic allergic alveolitis) Ankylosing spondylitis Radiation TB Sarcoidosis
causes of lower lobe fibrosis
RASIO
Rheumatoid Asbestos Scleroderma Idiopathic pulmonary fibrosis - most common Other - AMIODARONE
COPD not controlled by SABA, no asthmatic features/features suggesting steroid responsiveness
add LABA (Formoterol) + LAMA (Tiotropium) if already taking SAMA (e.g. Ipratropium) stop this and switch to SABA
when do you aspirate a pneumothorax
if primary and >2cm rim of air or SoB
if secondary and 1-2cm rim of air
when do you insert a chest drain for pneumothorax
if primary and aspiration fails
if secondary, >50 years and rim of air >2cm or if aspiration fails
COPD still breathless despite SABA/SAMA + LABA + ICS
add LAMA
when should non-invasive ventilation be used in COPD
respiratory acidosis (pH 7.25-7.35 and pCO2 >6kPa) that persists despite best medical mx
mx of acute asthma
O SHIT ME!
- Oxygen
- Salbutamol nebulisers
- Hydrocortisone IV or Prednisolone PO
- Ipratropium bromide nebulisers
- Theophylline
- Magnesium sulfate IV
- ESCALATE
obstructive spirometry
decreased FEV1:FVC
decreased FVC
significantly decreased FEV1
mx of allergic bronchopulmonary aspergillosis
prednisolone
ix for suspected lung cancer
- CXR
- contrast-enhanced CT
- ultrasound guided biopsy
mx for alpha1-antitrypsin deficiency
no smoking
supportive: bronchodilators, physio
IV alpha1-antitrypsin protein concentrates
surgery: lung volume reduction surgery
ix for mesothelioma
thoracoscopy and histology
CURB-65 score
Confusion Urea >7 mmol/l RR >=30/min BP: SBP <=90; DBP <=60 65 years or older
idiopathic pulmonary fibrosis pulmonary function test results
increased FEV/FVC1
decreased TLCO
ix for sleep apnoea
sleep studies - polysomnography
paraneoplastic syndrome associated with squamous cell lung cancer
increased parathyroid hormone-related hormone
hypercalcaemia
‘squamous squishes your bones’
paraneoplastic syndrome associated with small cell lung cancer
SCLC: SIADH Cushing's (increased ACTH and ADH) Lambert-Eaton myasthenic syndrome (proximal muscle weakness) Cerebellar syndrome
COPD still breathness despite SABA/SAMA and asthma/steroid responsive features
LABA + ICS
how to diagnose occupational asthma
PEFR at work and away
CI to lung cancer surgery
SVC obstruction
FEV <1.5
malignant pleural effusion
vocal cord paralysis
respiratory causes of finger clubbing
A-F
Abscess Bronchiectasis Cancer DO NOT SAY COPD Empyema Fibrosis
causes of bilateral hilar lymphadenopathy
sarcoid
TB
ix for idiopathic pulmonary fibrosis
high-res CT
empyema aspirate findings
turbid effusion
pH <7.2
low glucose
high LDH
diagnostic criteria for ARDS
acute onset
pulmonary oedema
non-cardiogenic (if pulmonary capillary wedge pressure >15 mmHg consider cardiac pulmonary oedema)
pO2/FiO2 <40 kpa (200 mmHg)
indications for starting corticosteroids in sarcoidosis
PUNCH
Parenchymal lung disease Uveitis Neuro involvement Cardiac involvement Hypercalcaemia
paraneoplastic syndrome associated with adenocarcinoma of the lung
gynaecomastia
causes of lung white out on CXR - trachea pulled towards
pneumonectomy
complete lung collapse
pulmonary hypoplasia
causes of lung white out on CXR - trachea central
consolidation
pulmonary oedema
mesothelioma
causes of lung white out on CXR - trachea pushed away
pleural effusion
diaphragmatic hernia
large thoracic mass
what tests must be done prior to starting Azithromycin
ECG (to exclude QT prolongation)
LFTs
when can long-term oxygen therapy be offered in COPD
pO2 <7.3 kPa OR
pO2 7.3-8 and one of:
secondary polycythaemia, peripheral oedema, pulmonary hypertension
mx for massive PE + hypotension
thrombolyse with Alteplase
embolectomy is last resort if thrombolysis fails/is CI
Ipratropium
SAMA
Formoterol
LABA
Salmeterol
LABA
Tiotropium
LAMA
sleep apnoea can cause which deranged observation
hypertension
which non-invasive ventilation is used in an acute exacerbation of COPD resistant to best medical mx
BiPAP
risk factors for invasive aspergillosis
immunocompromised patients - HIV, leukaemia
following broad-spectrum ABX
borders of safe triangle for chest drain insertion
lat dorsi
pec major
line superior to nipple
apex of axilla
what does a very high bicarbonate on ABG suggest
chronic respiratory acidosis
vaccinations received in COPD
annual influenza
once-off pneumococcal
features of Addisonian crisis
hyponatraemia
hyperkalaemia
hypoglycaemia
multiple nodules seen on CXR, most likely dx
metastatic cancer
risk factors for pneumothorax
pre-existing lung disease: COPD, asthma, CF
Marfan’s, RA
non-invasive ventilation
salbutamol
SABA (beta-2 agonist)
extra-pulmonary features of cystic fibrosis
male infertility, female subfertility
diabetes mellitus
rectal prolapse
nasal polyps
whiteout of a lung following aspiration (i.e. choking aspiration not aspiration for pneumothorax)
atelectasis secondary to bronchial obstruction
most likely cause of unilateral pleural effusion
local problem such as bronchial carcinoma
pleural plaques found on CXR mx
they are not malignant so reassurance with no follow up
features of myasthenia crisis
acute respiratory failure characterised by FVC <1 litre
use of accessory muscles
weak cough
risk factors for aspergilloma
existing lung cavities, e.g. secondary to TB, lung cancer or cystic fibrosis
features of aspergilloma
may be asymptomatic
may present with non-productive cough, haemoptysis
non-smoker - lung cancer
adenocarcinoma
factors which improve survival in COPD
smoking cessation
long term oxygen therapy
lung volume reduction surgery
