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RESP Flashcards

1
Q

D-dimer uses? When is it indicated?

A

Used to diagnose or exclude thrombotic clots

Indicated in CVT, PE, DIC (disseminated intravascular coagulation)

  • can also be used to monitor the effectiveness of DIC tx
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2
Q

What can cause a false D-dimer?

A

If someone is on anticoagulant therapy

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3
Q

When would a D-Dimer be requested as a first line investigation?

A

DVT Wells Score less than 1

PE Wells Score less than 4

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4
Q

What are the 2 types of respiratory failure? How is it detected?

A

Type 1 RF = Hypoxic
Type 2 RF = Hypoxic and Hypercapnic

Blood gases are used to asses these levels of oxygen in the blood

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5
Q

When are capillary blood used?

A

Heel-pricks in babies

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6
Q

Indications for and ABG?

A

Drop in sats below 90% during sleep in a normal pt

deteriorating sats

increased breathlessness in a ot with stable hypoxaemia i.e. COPD

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7
Q

Indications for CXR?

A 
Infection 
Major Trauma 
Acute chest pain 
Asthma/Bronchiolitis
Acute/Chronic dyspnoea 
Haemoptysis 
Suspected mass, metastasis or lymphadenopathy
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8
Q

Indications for CT?

A

Evaulation of an abnormality detected on CXR

Evaulation of aortic disease (aneurysm/dissection or trauma)

Malignant disease - staging, detecting lymphadenopathy, assess suitability for biopsy

Evaluation of pleural disease (CTPA - suspected PE)

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9
Q

Respiratory Ix offered in Primary care?

A

PEFR, Spirometry, CXR, Blood tests

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10
Q

Main respiratory Ix in ED/2° care?

A

PEFR, Blood gases, D-Dimer, CXR, CTPAm VQ scan, viral swabs

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11
Q

What is spirometry and what is used for?

A

method allowing the assessment of lung function via the amount of air expelled after maximal inspiration

can help to differentiate between Obstructive and Restrictive Conditions

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12
Q

Normal Spirometry interpretation?

A

FEV 1 = >80%
FVC = >80%
FEV/FVC ratio >70%

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13
Q

Obstructive picture of spirometry?

A

Reduced FEV1 (<80% of predicted normal)

Reduced FVC (less than the FEV1 drop)

FEV1/FVC ratio <0.7

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14
Q

Restrictive picture of Spirometry?

A 
Reduced FEV1 (<80%)
Reduced FVC (<80%)
Normal FEV1/FVC (>70%)
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15
Q

What is Bronchodilator reversibility and when is it used?

A

Patients asked to stop bronchodilator prior to therapy and then during the test the effect of the bronchodilator is observed

Baseline spirometry without use of inhaler - 400mcg of salbutamol administered and spirometry is repeated after 15mins

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16
Q

Interpretation of Bronchodilator reversibility?

A

Presence of reversibility - suggestive of asthma

Absence of reversibility - COPD

Partial reversibility - suggestive of coexisting conditions of asthma and COPD

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17
Q

What is Peak Flow?

A

mainly used in the diagnosis of asthma
- reduced PEFR in asthma

can also be used for the monitoring of asthma

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18
Q

What Ix are involved in TB?

A
  • CXR (/CT)
  • sputum smear - acid fast bacilli
  • GOLD STD = Sputum culture
  • NAATs
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19
Q

What does TB CXR usually show?

A

upper lobe focal infiltrates/caviating lesions

enlarged hilar lymphadenopathy

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20
Q

What does Acid-fast Bacilli tests involve?

A
  • Pulmonary TB - 3 sputum samples of TB microscopy and culture (AAFB) - 8-24hr intervals
  • microscopy of AFB
  • stain used to visualise is the Ziehl-Nelson stain
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21
Q

What is the limitations of Acid fast bacilli test?

A

cannot distinguish between viable and dead bacterium - only used upon dx not monitoring of tx

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22
Q

Interpretation of sputum culture?

A

microscopy = granulomatous inflammation - characteristic caesating necrosis

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23
Q

what Ix are used in malaria?

A

giesma-stained blood film - microscopy of thick and thin smears

RDT - detect malaria parasite antigens - provides a qualitative result

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24
Q

What Ix is used in whooping cough?

A

PCR of Nasopharyngeal swab/aspirate

Anti-pertussis toxin IgG detected in serum or oral fluid

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25
Screening involved in Cystic Fibrosis?
new-born screening test meconium ileus (~2wks), failure to thrive, resp symptoms (14 wks) Blood spot immunoreactive trypsinogen (IRT) conc CFTR gene analysis
26
Other Ix in Cystic Fibrosis?
Sweat test - pilocarpine soaked pad is placed onto arm - current passed through 5x for 5 mins - skin washed & dried - then sweat collector is placed over stimualted area for 30mins sweat chloride of >60mmol/L supports diagnosis of CH >40 makes CF unlikely
27
What Ix are done in Alpha-1-antitrypsin deficiency? | How is A1AT diagnosed?
CXR - findings include bullae at lung bases and emphysemtaous changes DX - serum a1-antitrypsin <18mmol/L - Spirometry , BDR - obstructive picture - imaging to determine extent of disease Pma
28
When can viral throat swabs be done?
used to identify cuasative organism in patients with a acute hx of ...\ - fever - headache - cough - sore throat - myalgia - corysal symptoms Panel include = influenza, parainfluenza, adeno/corona/rhine/entero.metapneumovirus mycoplasma pneumonia and RSV
29
Ix in Covid?
URT samples - single throat swab - throat and nose combined swab - Nasopharyngeal aspirate LRT - sputum sample - CXR?
30
What is asthma defined as?
- hx of wheeze, SOB, chest tightness, cough - vary with time & intensity - variable expiratory air flow limitation
31
What Ix are done in Asthma
1. Spriometry 2. BDR 3. FeNO 4. Peak flow
32
Asthma Spirometry Interpretation | Error?
3 relaxed and 3 forced blows Look for evidence of Obstruction - FEV, FVC, ratio all reduced Errors include - early termination, slow start and extra breath
33
Asthma BDR test Interpretation?
evidence of obstruction reversible in asthma - improvement of >12% or 200mls
34
Asthma FeNO testing Interpretation?
consider asthma diagnosis in adults >40ppb children >35ppb
35
FeNO levels altered when...
may be higher in - allergic rhinitis - rhinovirus - tall ppl & increased dietary nitrates may be lower in - children - cigarette smokers - administration oral/inhaled steroids
36
Peak Flow Asthma Interpretation?
BD for 2/52 - morning & evening - narrow at 4am and wide at 4pm diurnal variability of >20% difference - 3 days in week for 2weeks
37
What is a bronchoscopy? When is it indicated?
bronchoscopy - test used to visualise the lungs/airways if seen on CT suspected mass - allows diagnosis treatment - can take a biopsy which allows histological evidence
38
What are sputum cultures used for? How are they taken?
To detect and identify the cause of bacterial respiratory tract infections; to monitor the effectiveness of treatment Excpectorated/induced samples coughed up bronchoscopy - lavage transtracheal/transoesophageal aspirates
39
Indications of sputum culture ?
abnormal CXR, productive cough, chest signs suggestive of LRTI e.g cough, fevers/rigors, SOB, myalgia, chest pain and confusion
40
Appearance if sputum?
Blood -?TB Rusty - ?Pneumococcal Purulent - ?green/yellow or milky opaque white foamy - obstructive conditions or oedema
41
2WWR in Respiratory conditions
abnormal CXR findings, 40yrs+, unexplained haemotoptysis | CT confirm whether scan is needed -
42
Investigation in suspected aspiration pneumonia?
Bloods - FBC, CRP, U&Es, blood culture and gases sputum culture CXR - lung infiltrates or consolidation - usually in mid or lower lobes if mechanical obstruction os present then bronchoscopy is used to remove it
43
Investigation in suspected Pneumonia?
CXR - classically consolidation is present (lower lobes) Bloods - FBC, U&Es and CRP ABG - if oxygen saturations are low or the patient gas a pre-exisiting respiratory disease
44
Scoring system used to Decipher whether Pneumonia is to be treated in community or hospital?
``` CURB65 Confusion of <8/10 on MMTS ureas above 7mmol/L resp rate above 30/min BP - sys <90 and dias <60 aged 65+ ``` 0 - community 1- assess sats and arrange CXR 2+ - hospital
45
Investigation in suspected acute bronchitis?
Usually a clinical diagnosis | CXRs are often normal
46
Investigation in suspected complicated Influenza?
Diagnosis confirmed by laboratory testing | - rapid testing done in all pts with complicated influenza
47
Investigation in suspected Croup?
vast majority are diagnosed clinically CXR (PA) will show a steeple sign i.e. subglottic narrowing
48
Investigation in suspected RSV/bronchiolitis?
Immunofluorescence of nasopharyngeal secretuons | - may show RSV
49
Investigation in suspected Acute epiglottitis?
Diagnosis usually clinical. and often given by senior airway trained staff XR may be done to rule out any FB once airway stable CXR = 'thumb sign' on lateral view/plane
50
Investigation in suspected Pertusis/whooping cough?
nasal swab culture - PCR and serology
51
Investigation in suspected Emphyema?
Sputum culture Blood test esp WCC and CRP XR - collections of fluid around the lungs
52
Investigation in suspected Tuberculosis?
CXR - upper lobe caviations, pleural effusions, mediastinal or bilateral hilar lymphadenopathy Sputum Culture = GOLD STANDARD - NAATs Sputum smear - 3 positive Acid fast bacilli positive specimens needed
53
what does screening for Tuberculosis involve?
Mantoux test - intradermal injection - results read 2-3days laters - diameter of induration 6-15mm suggests a tuberculin protein sensitivity
54
Investigation in suspected Pulmonary fibrosis?
Spirometry FEV1 = increased/normal FEV1/FVC = increased Reduced transfer factor/TLCO Imaging CXR - bilateral interstitial shadowing - ground glass appearance/honeycombing high res CT = investigation of choice
55
Investigation in suspected in Sarcoidosis?
CXR - earlier stages = bilateral hilar lymphadenopathy which can then lead to interstitial infiltrates - very later stages = diffuse fibrosis
56
Investigation in suspected pneumoconiosis?
CXR = fibrosis o=in upper zones of lungs Spirometry = restrictive picture
57
Investigation in suspected COPD?
spirometry - FEV/FVC <0.7 cosider alpha-1-antitrypsin deficiency CXR FBC - ?anaemia/polycythaemia
58
Investigation in suspected Asthma?
Spirometry - FEV significantly reduced - FVC normal, - FEV1/FVC <70% FeNO testing → 40ppb in 17yrs and older, 5-16yrs 35ppb BDR → FEV1 improvement of 12% or more/ 200mL with SABA/ICS = positive if imporvement is 4000mL = strongly suggestive of asthma Peak flow → more than 20% varibalility - moniroting BD for 2-4weeks
59
Investigations in suspected Obstructive sleep Apneoa?
sleep studies (polysomnography) done at sleep clinic → monitoring of oximetry, EEG, resp airflow, snoring, throaco-abdo movement
60
Investigations in suspected Bronchiectasis?
clinical diagnosis mostly Ix usually done to rule out other ddx - sputum culture, CXR, spirometry, O2 sats, FBC (wcc) High-resolution CT - establishes the diagnosis of bronchiectasis
61
Investigations in suspected Cystic Fibrosis?
sweat test → CF abnormally high sweat chloride >60mEq
62
Investigations in suspected Pulmonary Hypertension?
ECHO - RV function assessment and estimate PAP Right-heart catherization CXR - exclude other lung diseases ECG - RV hypertrophy and strain patterns
63
Investigations in suspected Pulmonary Embolism?
PE wells Scoring assessed 4+ = admit and urgent CTPA <4 = D-dimer test - if raised to urgent CTPA All patient have CXR - wedge shaped opacification ECG changes = RBBB, S1Q3T3, Leg USS = if initial CTPA is negative, if patient is pregnant VQ scan = renal impairment
64
Investigations in suspected pleural effusions?
PA CXR should be done on all pts US (pleural aspiration) contrast CT - can help to investigate underlying cause pleural fluid findings → low glucose, raised amylase and heavy blood staining
65
Investigations in suspected Pneumothorax?
CXR - darker areas chest X-ray indicating gas/no tissue | ABG - check extent of hypoxia
66
Investigation in suspected Pleurisy?
CXR - typically normal
67
Investigation in suspected Lung Cancer?
CXR ⇒ check for masses, areas of opacification CT ⇒ investigation of choice bronchoscopy ⇒ allows biopsy and thus histological diagnosis Bloods ⇒ FBC → raised platelets
68
Investigations for suspected Mesothelioma?
CXR = pleural effusions or pleural thickening Pleural CT MC&S of any pleural effusion fluid thoracoscopy

ICM Revision (19 decks)

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