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PACES Management > Resp > Flashcards

Resp Flashcards

1
Q

Management of haemodynamically stable PE

A

apixaban/rivaroxaban immediately if Well’s >4

Stable: DOAC for 3m/6m based on unprovoked/provoked
PESI score +/- Echo for Right Heart Strain

Consider IVC filter if CI to thrombolysis

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2
Q

Management of unstable PE

A

no CI to thrombolysis: unfractionated heparin
then hold heparin while administering alteplase
then heparin

CI to thrombolysis: heparin then surgery

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3
Q

Management of primary pneumothorax

A

<2cm: review in 2-4w

>2cm or SOB: aspirate

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4
Q

Management of secondary pneumothorax

A

<1cm: admit for 24h and O2
1-2cm: aspirate
>2cm: chest drain

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5
Q

Tension pneumothorax management

A

14-16G needle 5th ICS MAL

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6
Q

Management acute COPD

A

aim sats 88-92% (ABG again within 1h starting O2)

Start 28% O2 (or 24% if available)
Neb salbutamol 5mg b2b
Ipratropium 0.5mg every 4h
Pred PO 30mg
Co-amoxiclav/amox/clari/doxy

Consider aminophylline, ITU, NIV

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7
Q

Indications for BIPAP

A

COPD with resp acidosis 7.25-7.35
T2RF secondary to MND, deformity or OSA
Cardiogenic pulmonary oedema unresponsive to CPAP

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8
Q

Management of chronic COPD

A

Conservative: vaccines, smoking cessation, pulmonary rehab

Inhalers based on symptoms and risk (mMRC and GOLD system)
mucolytics
rescue packs
?Long term oxygen therapy if pO2 <7.2 or <8 and signs of decompensation (secondary polycythaemia, peripheral oedema, pulmonary HTN)

consider surgery: lung volume reduction, bullectomy, transplant

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9
Q

COPD inhaler management

A

1) SABA OR SAMA for breathlessness
2a) If NO asthmatic features: LABA + LAMA
2b) if ASTHMATIC features: LABA + ICS
3) LABA + LAMA + ICS

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10
Q

What is SABA/SAMA/LAMA/LABA/Symbicort/LTRA

A 
SABA: salbutamol
SAMA: ipratropium
LABA: salmeterol
LAMA: tiotropium
symbicort: LABA + ICS
LTRA: montelukast
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11
Q

Chronic Asthma management

A

Conservative: Review technique, avoid triggers, monitor peak flow, asthma action plan, flu vaccine

1) SABA + ICS
2) add LABA
3) Add LTRA or increase ICS
discard LABA if not working
4) Refer to specialist

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12
Q

FEV1 actual vs predicted COPD categories

A 
>80% = mild
50-79% = moderate
30-49 = severe
<30% = very severe
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13
Q

Acute Asthma management

A

High flow O2
Nebuliser (5mg salbutamol b2b + ipratropium every 4h)
pred PO OR hydrocort if can’t tolerate

Magnesium sulfate IV + senior support
Further support: aminophylline, ITU, intubation

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14
Q

Acute asthma PEF categories

A

50-75%: moderate
33-50%: acute severe
<33%: life threatening
normal/raised pCO2 = near-fatal

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15
Q

management for allergic bronchopulmonary aspergillosis

A

oral prednisolone
itraconazole 2nd line
consider antibiotics
salbutamol

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16
Q

3 forms of bronchiectasis

A

cylindrical
cystic
varicose

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17
Q

Management of bronchiectasis

A

Conservative: airway clearance techniques, flutter device
medical: mucolytics, prophylactic Abx, consider itraconazole
LABA/ICS

Surgery for severe disease/localised disease

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18
Q

Management of CF

A

conservative: physio, airway clearance techniques
pancreatic replacement therapy
high calorie diet

Medical: nebulised mucolytics, SABA/LABA, long term antibiotics (fluclox) with additional rescue antibiotics
nebulised hypertonic saline
laxatives
USDA

Surgical: Lung/liver transplant

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19
Q

Management of fibrosis

A

stop fibrosis drug
rehab
support groups

pirfenidone
LTOT if pO2 <7.3 OR 7.3-8 AND (polycythaemia, hypoxaemia, peripheral oedema or pul HTN)
steroids (poor evidence)

Treat any post nasal drip with steroids
Treat any GORD
transplant

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20
Q

management of sarcoid

A

NSAIDs

high dose steroids if parenchymal lung disease, uveitis, hypercalcaemia, neuro/cardio

consider other immunosuppression (methotrexate, ciclosporin)

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21
Q

Squamous Cell Carcinoma endo link

A

high calcium due to PTHrP

TSH hyperthyroidism

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22
Q

Small Cell carcinoma endo link

A

Lambert-Eaton
insulinoma
ACTH
ADH

23
Q

Investigations for lung cancer

A

CXR
CT
PET for mets

EBUS or VATS biopsy

24
Q

Pneumonia management

A

mild - amoxicillin
severe - co-amox + clarithromycin

legionella = clarithromycin and rifampicin

staph - fluclox

25
Q

CURB 65

A 
Confusion
Urea >7
Resp rate >30
Blood pressure <90/60
65yo

2 points consider inpatient
3 points admit

26
Q

PCP management

A

mild-moderate: co-trimoxazole
severe: IV pentamidine
Steroids if hypoxic

27
Q

Management of pleural effusion

A

aspirate for MC&S, cytology, pH, protein

chest drain

treat underlying cause

28
Q

Restrictive spiro result

A

FEV1:FVC ratio >70%

FVC very reduced

29
Q

Obstructive spiro result

A

FEV1:FVC ratio <70%

FEV1 very reduced

30
Q

Well’s Score for PE

A 
sign of DVT +3
PE most likely +3
HR>100 +1.5
immobilisation+1.5
Previous PE/DVT +1.5
haemoptysis
malignancy <6m
31
Q

Obstructive spiro causes

A

COPD
Asthma
Bronchiectasis
CF

32
Q

Restrictive spiro result

A

Fibrosis
parenchymal tumours
Pulmonary oedema
Lobectomy

33
Q

Hypersensitivity pneumonitis management

A

Avoid exposure

Steroids

34
Q

Pneumoconiosis management

A

Improve working conditions

35
Q

What can asbestos cause

A 
Pleural plaque
Mesothelioma
Asbestosis (fibrosis)
BAPE benign asbestos pleural effusion
Diffuse pleural effusion
36
Q

Indications for CPAP

A

Overall to recruit/splint open alveoli in T1RF
CHF
OSA
Severe pneumonia

37
Q

apical lung fibrosis causes

A 
CF
Sarcoid/TB
Pneumoconioses
ABPA
Ank Spond
38
Q

basal lung fibrosis causes

A

Rheumatoid
asbestosis
Scleroderma

39
Q

Investigations for TB

A

Tuberculin skin test
Sputum MC&S - Ziehl Nielsen stain and Lowenstein Jensen culture

CRP, IGRA
CXR
EBUS

40
Q

management of TB

A

RI 6m
PE 2m

ID input if resistant or extremely resistant TB

41
Q

RIPE drug side effects

A

Rifampicin: orange secretions
Isoniazid: hepatotoxic, give with pyroxidine to prevent peripheral neuropathy
Pyrazinamide: hepatotoxic
Ethambutol: Visual disturbance

42
Q 
Pneumonia buzzwords
Rusty
Smoking/COPD
Cavitation
Recent viral infection
Red-current jelly
Alcoholic
Cavitating upper lobes
Cold agglutinin
Erythema Multiforme
Air conditioner/water + hyponatraemia
Birds
Paeds
Farm animals
A 
Rusty: Pneumoniae
Smoking/COPD: H influenzae + Catarrhalis
Cavitation: Aureus
Recent viral infection: aureus
Red current: Klebsiella
Alcoholic: Klebsiella
Cavitating upper lobes: Klebsiella
Cold agglutinin: mycoplasma pneumoniae
Erythema multiforme: Mycoplasma
Air conditioner/water and hyponatraemia: Legionella
Birds: psattici
Paeds: chlamydia pneumo
Farm Animals: Burnetti
43
Q

Investigations for PCP

A

CXR
Exercise induced desaturation
Broncho-alveolar lavage and silver stain

44
Q

Define flail chest

A

3 consecutive rib fractures in >2 locations so chest wall moves in in inspiration and out in expiration

45
Q

Mx of flail chest

A

analgesia
Chest physio
consider: CPAP and surgical fixation

46
Q

Causes of upper lobe fibrosis

A 
TAAPE
TB
ABPA
Ank Spond
Pneumoconiosis
EAA
47
Q

Causes of lower lobe fibrosis

A 
TAIR
Toxins
Asbestosis
IPF
RhA
48
Q 
Extra-pulmonary manifestations of sarcoid
Bloods
Skin
Histology
Infiltrative
A

Bloods: ACE and calcium
Skin: EN and Lupus Pernio
Histology: Non-caseating granulomas, hilar lymphadenopathy
Infiltrative: Restrictive cardiomyopathy, uveitis

49
Q

Sarcoid management

A

Bed rest
NSAIDs
Oral high dose steroids
Immunosuppression in severe and refractory disease

50
Q

Gold standard for bronchiectasis

A

HRCT

51
Q

Lobe collapse signs

A

Right Upper lobe: S sign
Left Upper lobe: Veil sign
Lower lobe: Sail or raised hemidiaphragm

52
Q

Investigation mesothelioma

A

CXR
HRCT
Thoracoscopy and pleural biopsy

53
Q

Management of mesothelioma

A

instillation of sclerosants into the pleural space can prevent or reduce re-accumulation of pleural effusions and accompanying breathlessness.

PACES Management (11 decks)

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