Resp Flashcards
Pneumonia symptoms
Productive cough(green)
Fever
Rigours
SOB(dyspnoea)
Pleuritic chest pain
Confusion(elderly)
Pneumonia examination signs
Increased RR
Cyanosis
Reduced/asymmetrical chest expansion
Dull percussion over affected area
Basal creps (coarse)
Bronchial breathing
Increased vocal resonance
Pneumonia investigations
Sputum MC&S
Bloods: FBC, LFT, CRP, ESR, ABG, culture
CXR: alveolar consolidation, air bronchograms, consolidation
pneumonia management
CURB65
0-1: outpatient
2: consider admission
3 or more: consider ICU
Community acquired:
Amoxicillin 500mg TDS 5/7
Or
Clarithromycin 500mg BD 5/7
Doxycycline 200mg 1/7, 100mg 4/7
Hospital acquired:
Co-amoxiclav 500mg TDS 5/7
Vancomycin(MRSA)
IV tazocin + metronidazole(pseudomonas)
S. Aureus: flucloxacillin 1g QDS 7/7
PCP: co-trimoxazole 960mg BD 5/7
Bronchiectasis signs and symptoms
Chronic daily productive cough(>8w)
Large amount of mucopurulent sputum, foul smelling, green/yellow/white
Haemoptysis
SOB
Fever
Weight loss
Non-pleuritic chest pain
Clubbing
Coarse crackles
Bronchiectasis investigations
Sputum MC&S:
Bloods: FBC, CRP, ESR, LFT, ABG
CXR
High resolution CT(gold standard): signet ring sign
Caused by cystic fibrosis(developed), TB(developing)
Bronchiectasis management
Conservative:
Diet, exercise
Smoking cessation
Vaccinations
Airway clearance->chest physio
Medical:
Steroids/bronchodilators
IV antibiotics if acute exacerbation
Pseudomonas: ciprofloxacin
TB signs and symptoms
Productive cough
Haemoptysis
Dyspnoea/SOB
Fever, weight loss
Erythema nodosum
Immunosuppressed
Recent travel
TB investigations
Sputum MC&S: Ziehl-Nielsen stain
Bloods: FBC, CRP, ABG
CXR: bi-hilar lymphadenopathy
Mantoux test
Interferon gamma release assay
TB management
Rifampicin(6m)
Isoniazid(6m)
Pyrazinamide(2m)
Ethambutol(2m)
Lung cancer symptoms
Haemoptysis
Cough
Dyspnoea
FLAWS
Lung cancer examination signs
Clubbing
Tar stains
Lymphadenopathy
Dull percussion
Creps
Increased vocal resonance
Lung cancer associations
Small cell:
Cushing’s syndrome
SIADH
Lambert-Eaton myasthenia syndrome
Squamous cell:
PTHrp
Lung cancer pancoast tumour(apical) signs and symptoms
Horner’s syndrome
Brachial plexus lesion
Recurrent laryngeal nerve lesion
Superior vena cava syndrome: SVC obstruction, facial oedema&flushing
Lung cancer investigations
Sputum cytology
FBC: Ca(bone met), ALP(bone met), LFT(liver met)
CXR
CT
PET(staging)
Lung biopsy: bronchoscopy/CT guided biopsy
Mesothelioma signs and symptoms
Asbestos exposure
Dry cough
FLAWS
Pleural friction rub
Mesothelioma investigations
Sputum cytology
Bloods: FBC, Ca, ALP, LFT
CXR: pleural thickening, plaques
CT
PET(staging)
Thoracentesis: pleural fluid cytology
Thoracoscopy+biopsy: pleural lining
Asthma signs and symptoms
SOB
Dry cough
Chest tightness
Polyphonic wheeze
Pets/dust
Asthma investigations
Spirometry: FEV1 reduced, FEV1/FVC<0.7, BDR>12%
FeNO>40(adult)/35(child) ppb
Peak flow variability > 20%
spO2 is expected to be low in acute attack
Asthma management
NSAIDs WORSEN asthma
1st: SABA
2nd: low dose ICS
3rd: ICS + LABA
4th: ICS + LABA + LTRA
COPD signs and symptoms
SOB, worse on exertion
Chronic productive cough
Recurrent LRTIs
Smoking history
Chest hyperinflation
Cachexia
Cyanosis
Wheeze/crackles
COPD investigations
Spirometry: reduced FEV1, FEV1/FVC<0.7
CXR
FBC
Sputum MC&S
ECG
CT
Alpha 1 antitrypsin
COPD management
Smoking cessation
Pulmonary rehab
One off pneumococcal vaccine + annual flu jab
Consider azithromycin prophylaxis
1st Line:
Salbutamol + ipratropium
No asthma, no steroid response:
Salmeterol(LABA) + tiotropium(LAMA)
Asthma, steroid response:
Salmeterol + ICS
COPD exacerbation management
Hospital admission if:
Cyanosis
Confusion
Arrhythmia
SpO2 < 90%
Medical:
30mg oral pred OD 5/7
Increase frequency of salbutamol
Consider amoxicillin, doxycycline, clarithromycin
Rescue pack
Pulmonary fibrosis signs and symptoms
Worsening Dyspnoea, worse on exertion
Dry cough
Keeps pigeons
Asbestos exposure
Connective tissue disorder
Pulmonary fibrosis investigations
CXR: interstitial fibrosis
CT
lung function tests: restrictive pattern
Biopsy
Pulmonary fibrosis management
Underlying cause: stop drug/exposure
Exercise, physio
Oral steroid therapy
Prompt treatment of infections
Pneumothorax signs and symptoms
Acute onset SOB
Chest pain
Pneumothorax investigations
CXR
Rule out PE
Pneumothorax management
Analgesia, O2 mask
Primary:
<2m -> repeat CXR
>2cm/SOB -> aspirate (chest drain if fail)
Secondary:
<2cm -> aspirate
>2cm -> chest drain
Sarcoidosis signs and symptoms
Flu like symptoms
Pyrexia
Hypercalcaemia
Erythema nodosum
Sarcoidosis investigations
CXR: bihilar lymphadenopathy
Lymph node biopsy
serum ACE
Serum calcium
Sarcoidosis management
Bed rest
Oral prednisolone 40mg daily
Oral ibuprofen 30mg TDS
PE signs and symptoms
Acute SOB
Raised JVP
shock
Chest pain
PE investigations
CTPA (gold standard)
ECG, CXR to rule out other pathology
ABG
D dimer (non specific)
Troponin
PE management
PE+hypotension:
Thrombolysis (streptokinase)
No comorbidity:
Apixaban/rivaroxaban 3/12
Anti phospholipid syndrome:
LMWH + warfarin 5 days til INR>2 then stop LMWH
Provoked: 3 months
Unprovoked: 6 months
Acute cough management
Systematically well:
Honey
Herbal medicine
Systematically unwell/risk factors:
Adult -> doxycycline 200mg 1/7, 100mg 4/7
Child -> amoxicillin maximum 500mg TDS 5/7
Anaphylaxis management
ABCDE
Adrenaline 500mg IM
Hydrocortisone IV
Chlorphenamine IV
