resp Flashcards
Normal FEv1
> 80%
risk factors for endometrial cancer
excess oestrogen eg nulliparity
PCOS
Tamoxifen
obesity
diabetes
HNPCC
what cancer are psammoma bodies seen in and what are they
collections of calclium
seen in serous cystadenocarcinoma
what conditions would cause a decrease in TLCO
pneumonia
pulmonary fibrosis
PE
Pulmonary oedema
emphysema
Anaemia
prognostic indicator is melanoma
breslow thickness
what O2 sats in asthma warrant an ABG
<92%
what level of FEV1 would show bronchodilator reversibiltiy
12%
treatment of hyponatraemia based on fluid status
hypovol - norm saline
euvol - fluid restrict
hypervol - fluid restrict 500-1L daily
an FEv1/FVC ratio of what indicates obstructive lung disease
<0.7
what antibiotics are given prophylactically in COPD and what tests need to be done ?
Azithromycin, LFT due to heaptic cholestatisi and U+E due to long QT
What non pharmalogical management is offered to COPD patients
pulmonary rehab
smoking cessation
Annual flu
one of pneumococcal vaccine
what is second line treatment for COPD
steroid if asthmatic features
SABA+ LABA+ICS
IF NOT
SABA+ LABA + LAMA
what features suggest steroid responsiveness in COPD
prev diagnosis of asthma or atopy
eosionophilia
FEV1 variation >400ml
20% diurnial variation in peak flow
first line antibiotics for infective exacerbation of COPD
Amox, clarithromycin or doxycyclin
what does capnography monitor
end tidal co2
what anaestheic agent doesnt casue a drop in Bp so good in trauma
Ketamine
mangement of acute heart failure and hypotension
inotropic agents- dobutamin
noreadrenaline - if inotropes not work
mechanical assisstance - intra-aortic balloon
STOP BB
what could cause an transudative thoracentesis
HF, , hypoalbineumia, atelectasis, hypo thyroid, meigs peritoneal dialysis
what could cause an exudative thoracentesisi
malignancy, Infection, Infarct adn asbestos
pancreatitis, PE, connective tissue
if lymphocytes are seen on cytology of pleural effusion what should be suspected
TB or malignancy
first line treatment of acute bronchitis if requiring antibiotics
oral doxycyclin
in a secondary pneumothorax <1cm how should it be mananged
admit and O2
is alpha 1 antiprypsin obstructive or restrictive
obstructive
Does ACEI cause hypo or hyperkalaemia
and how
hyper
block aldosterone - aldosterone casues reabsorptions of Na and water adn secretion of K
in non smokers what type of lung cancer is most likely seen
adencarcinoma
what antibiotics are used fro atypical pneumonias
macrolides and tetracycline eg doxy
pleural effusion with low glucose is characteristic of
rheumatoid or Tb
when is lights criteria used and what is it
used in Pleural Effusion to distinguish between exudate and transudate
- pleural fluid protein divided by serum protein >0.5
- pleural fluid LDH divided by serum LDH >0.6
- pleural fluid LDH more than two-thirds the upper limits of normal serum LDH
what is meigs syndrome and what type of pleural effusion woud it cause
transudative
ovarian tumour causes ascites and pleural effusion
what pH of pleural effusion would warrant chest tube
<7.2
most common casue od exudative pleural effusion
pneumonia
the pill:
what cancer does it casue
what cancer does it protect against
increased risk of breast and cervical cancer
protective against ovarian and endometrial cance
most common septci arthritis organism in young adults
neuserria gonorrhoea
treatment of a 0-2 CURB65 score CAP
Amoxicillin 1g tds IV/PO (5 days)
treatment of a 3-5 CURB65 score CAP
Co-amoxiclav IV 1.2g tds + Doxycycline PO 100mg bd
up to what age can asthma be diagnosed without FeNO
up to 5 yrs then must get FeNO test
diagnosis of asthma in 5-16 years
BDR test
FeNO if norm spirometry or obstructive spiromtry with no BDR
positive FeNO test results in children and adutls
adult - 40 parts per billion
children 35 parts per billion
what is used to measure COPD severity and what are the levels
FEV1
> 80% = mild should have symps
50% = mod
30% - severe
<30% - v severe
if a COPD patient has severe COPD and >2 exacerbations in the last year and alreasy on triple therapy what shoudl be added
PDE-4 inhib roflumilast
factors that improve survivial in COPS
smoking cessation
long term o2 therapy
lung redution surgery
when is chest xray repeated in pneumonia
6 weeks
paraneoplastic syndrome of small cell
ADH
ACTH
lambert eaton
what blood abnormality may be seen in lung cancer
thrombocytosis (high platelets)
features of legionella pneumonia and mycoplasma pneumoni
legionella - hyponatraemia and lymphopenia
mycoplasma - dry cough AIHA+ erythema multiforme
hypoxia and SOB post surgery diagnosis and treatment
atelectasis - sit upright and breathing exercises
mangement of HAP and aspiration pneumonia compare to CAP
HAP = amox+gent for gram -ve cover
Asp - amoz+met for anaerobe cover
investigations for Goodpasteurs
renal biopsy - linear IgG
Increase TCLO due to po haemorrhages
mangement of goodpasteurs
plamaphoresis
steroids
cyclophosphamide
type og collagen inolevd in anti-GMB
type 4
investigation of PE in individual with renal impairement
V/Q scan
what is dabigatran
direct thrombin inhibitor
treatment of PE:
- normally
-severe renal impaire <15
- anti- phospholipid
norma - DOAC eg apixaban
REnal -LMWH
anti- LMWH followed by warfarin
PE with hypotension treatment
thrombolyse
treatent of antiphospholipid sydnrome
primary thromboprophylacis - aspirin
secondary thromboprophylaxis - warfarin
treatment for viraly induced episodic wheeze in kids
salbutamol first
ntermittent leukotriene receptor antagonist(montelukast ) 2nd line
