RESP Flashcards
Ix of pneumonia
a-e assessment obs sputum MCS urinary antigens FBC- WCC U&E CRP ESR LFTS ABG BLOOD culture image- CXR pleural fluid MCS
ix for mycoplasma pneumonia
PCR
legionella ix?
urinary antigens
blood film ix for pneumonia ?
blood film - cold agglutyins
crub65 score of 3?
icu admission
curb65 score of 2
admit to hospital
pneumonia Mx
amoxicillin
clarithromycin - atypical cover
doxycycyline - if allergic to penicillin
if curb65 3
mx?
IV co amoxiclav
clarithromycin
pneumonia and pregnant
CAP
mx?
erythromycin
HAP- staph aureus confirmed
flucloxacillin
PCP confirmed pneumonia mx?
co-trimoxazole
anerobes from gut flora pneumonia
amoxicillin and metronidazole
1st line HAP
mx?
co amoxiclav
MRSA pneumonia mx?
IV vancomycin
pseudomonas mx?
iv tazocin and gent
bronchiectasis IX
sputum MCS- haemophilus \FBC ue crp LFTs ABG culture xray HRCT
What is gold standard Ix for bronchiectasis
High resolution
CT
xray finding of bronchiectasis
tram tracking
bronchiectasis HRCT
signet ring sign
bronchiectasis Mx
gold standard conservative
airway clearance - chest physio
bronchiectasis vaccines?
one of pneumococcal seasonal influenza
bronchiectasis oral abx for pseudomonas exarcebation
ciprofloxacin
Tb bedside investigation
sputum MCS x3 early morning
acid fast bacilli stain - zieiel neelson -
takes 6-8 weeks to culture
TB imaging
CXR- bilateral bi hilar lympahdenopthy
caseating granulomas on lymph node biopsy
non caseating granuloma on CXR
sarcoidosis
crohns
latent tb test?
mantoux / tuberculin skin
interferon gamma relase assay
if + > cxr
lung cancer Ix
sputum cytology fbc ca2 alp - bone mets lfts - liver mets
cxr
ct chest abdo pelvis
pet
cavitaing lesion on CXR?
malignancy cause
SqCC
secondary lung cancer on CXR?
canon ball mets
SIADH ix results?
hyponatraemia - euvolemic from SCLC
urine osmolality high
mesothelioma
ausculatation?
malignant neoplasm of mesothelial cells - asbestos
pleural friction rub
xray mesothelioma
pleural thickening
plaques
pleural effusion
gold standard for asthma investigation?
spirometry
FENO >40
peak flow is useful investigation for what?
asthma
ECG sign of PE
tachycardia
RBBB
s1q3t3
cxr on PE
westermark sign
gold standard for PE
and pregnant?
CTPA
V/Q perfusion screen
Mx of a PE
respiratory support
thrombolysis anticoagulate
DOAC 3/6 months
haemodynamically unstable PE
thrombolysis - alteplase, rtPA
thrombectomy
primary pneumothorax sob and 0.8cm in size?
needle aspirate and give oxygen admit
no sob
Pneumothorax 3cm in size
needle aspirate and admit
1cm pneumothorax no sob
discharge
OPD review
tension pneumothorax
mx
large bore cannula - 2nd ICS MCL
orange or grey cannula
ARDS mx?
ICU referral ventilator support 12-24 hours trial aprv >6 dueresis if volume overload drainage of effusion
proning
gold standard for pulmonary htn?
Right heart catheterisation
pulmonary fibrosis Ix gold standard?
HRCT
spirometry
cystic fibrosis Mx
when pancreatic insufficency has occured
creon
mesothelioma management
Extrapleural pneumonectomy / Pleurectomy
Cisplatin / Pemetrexed
acute management of asthma
- Oxygen – target 94-98%
- Salbutamol (SABA) Nebulised
- Ipratropium Bromide
- Hydrocortisone IV / Oral Prednisolone
- Magnesium Sulfate IV
- Aminophylline / IV Salbutamol (SABA)
when can you be discharged from an acute asthma attack in hospital stay?
Can discharge if:
a. Stable on discharge meds for 12-24hrs
b. Inhaler technique checked and documented
c. PEF >75% of best/predicted
is bronchiectasis an obsturctive or restrictiive picture
obstructive
mx of bronchiectasis
carbocysteine
nebulsied isotonic/ hypertonic saline
azithromycin >3 exarcebations
Antifibrotic agents:
when indicated
pirfenidone or nintedanib – indicated if
FVC is 50% - 80%