resp Flashcards
prophylactic Abx used in COPD
marcolides (azithromycin)
what does A1AT increase the risk of?
hepatocellular carcinoma
Management of acute bronchitis
oral doxycycline (if NOT pregnant- if pregnant use amoxicillin)
COPD- if the patient has raised eosinophils (regardless of FEV1) what therapy should be commenced?
ICS
most common organism causing infective exacerbations of COPD
Haemophilus influenzae
what are blue bloaters/ pink puffers?
blue bloater= chronic bronchitis
pink puffer= emphysema
diagnosis of COPD
spirometry- obstructive patter:
FEV1/FVC= 0.7
no change on reversibility testing
treatment pathway in COPD (non-acute management)
lifestyle- stop smoking, flu vaccinations
1- SABA (salbutamol/ terbutaline) or SAMA (ipratropium bromide)
2- if no asthmatic features= LABA (formeterol) + LAMA (tiotropium bromide)
- if asthmatic features (or raised eosinophils)= LABA + ICS
management of an acute COPD exacerbation
- nebulised bronchodilators (salbutamol an ipratropium)
- 02 sats 88-92%
- prednisolone
- ABx if infection
what is cor pulmonale?
right sided heart failure caused by chronic pulmonary arterial hypertension
commonly caused by COPD
clinical features of cor pulmonale
dyspnoea, fatigue, syncope
cyanosis, tachycardia, raised JVP
tricuspid regurgitation (pansystolic murmur)
what organs does A1AT affect?
lungs (bronchiectasis and emphysema- think breakdown of elastase)
liver (cirrhosis)
diagnosis of A1AT
low serum A1AT
liver biopsy- acid-Schiff-positive staining globules
pulmonary function tests- obstructive lung disease pattern and causes
FEV1 reduced
FVC reduced/ normal
FEV1/FVC ratio <0.7
causes:
- asthma
- COPD
- bronchiectasis
pulmonary function tests- restrictive lung disease pattern and causes
FEV1 reduced
FVC significantly reduced
FEV1/ FVC= normal/ increased
causes:
Pulmonary fibrosis
Asbestosis
Sarcoidosis
Acute respiratory distress syndrome
Infant respiratory distress syndrome
Kyphoscoliosis e.g. ankylosing spondylitis
Neuromuscular disorders
Severe obesity
what is sarcoidosis?
multisystem granulomatous disorder
presentation of sarcoidosis
lungs- mediastinal lymphadenopathy, pulmonary fibrosis, pulmonary nodules
systemic- fever, fatigue, weight loss
liver- nodules, cirrhosis, cholestasis
eyes- conjunctivitis, uveitis, optic neuritis
skin- erythema nodosum
sarcoidosis- bloods
hypercalcaemia
raised serum ACE
raised CRP
Sarcoidosis- CXR
hilar lymphadenopathy
sarcoidosis- gold standard investigation
histology- biopsy via bronchoscopy
sarcoidosis- treatment
only if symptomatic/ eye involvement
long term prednisolone (prescribe bisphosphonates alongside to protect bones)
methotrexate/ azathioprine second line
Describe a tension pneumothorax
Tension pneumothorax is caused by trauma to the chest wall that creates a one-way valve that lets air in but not out of the pleural space. The one-way valve means that during inspiration air is drawn into the pleural space and during expiration, the air is trapped in the pleural space. Therefore, more air keeps getting drawn into the pleural space with each breath and cannot escape. This is dangerous as it creates pressure inside the thorax that will push the mediastinum across, kink the big vessels in the mediastinum and cause cardiorespiratory arrest.
presentation of a tension pneumothorax
Tracheal deviation away from side of the pneumothorax
Reduced air entry on the affected side
Increased resonance to percussion on the affected side
Tachycardia
Hypotension
management of a tension pneumothorax
Insert a large bore cannula into the second intercostal space in the midclavicular line
idiopathic pulmonary fibrosis- medications to slow progression
Pirfenidone is an antifibrotic and anti-inflammatory
Nintedanib is a monoclonal antibody targeting tyrosine kinase
most common cause of community acquired pneumonia
Streptococcus Pneumoniae.
side effects of TB treatment- rifampicin
red/orange discolouration of secretions like urine and tears.
side effects of TB treatment- isonizaid
peripheral neuropathy
side effects of TB treatment- pyrazinamide
hyperuricaemia (high uric acid levels) resulting in gout
side effects of TB treatment- ethambutol
colour blindness and reduced visual acuity
pneumonia- most common causative organism in COPD patients?
haemophilus influenzae
pneumonia- most common causative organism post- influenza infection
staph aureus
pneumonia- what is seen on the bloods of a patient with legionella pneumonia?
hyponatraemia
lymphopenia
pneumonia- most common causative organism in alcoholics
klebisella pneumoniae
pneumonia- most common causative organism in HIV patients
pneumocystitis jiroveci
describe CURB 65
Confusion (AMT <8/10)
Urea >7mmol/l
respiratory rate > 30
BP- systolic <90 or diastolic <60
65- age over
management of low and moderate/ high severity CAP?
low:
amoxicillin- oral, 5 days
use a macrolide or tetracycline if penecillin allergy
moderate/high:
amoxicillin and macrolide for 7-10 days
how is pneumocystitis jiroveci pneumonia treated?
co-trimoxazole
in patients with COPD with a confirmed diagnosis of pneumonia, what should be co-prescribed alongside antibiotics?
prednisolone
what investigation is done and when in all confirmed pneumonia cases post-resolution?
CXR at 6 weeks
management of an unprovoked PE
6 months DOAC
What type of lung cancer would cause hyponatraemia?
SIADH is a paraneoplastic feature of small-cell lung cancer
