Resp Flashcards
Pulmonary oedema mx
- Sit pt up, 2. Iv furosemide, 3.nitrate infusion OR morphine infusion if SOB+++
Asthma acute Mx
- High flow 02
- salbutamol nebulisers
- ipratroprium bromide nebulisers - iv mgSo4
– ICU ref/specialist
COPD mx (chronic)
- SABA or SAMA (e.g. ipratroprium)
2.
If steroid responsive: corticosteroid + LABA (fluticasone/salmeterol)
If steroid unresponsive: LAMA + LABA (tioptoprium/salmeterol) - LABA + LAMA _ ICS
When is BIPAP used?
T2 RF to facilitate CO2 exhalation
(IPAP > EPAP)
Which resp disease is this?
Reticulo-nodular shadowing as in interstitial lung disease
Interstitial lung disease causative drugs
- Nitrofurantoin
- MTX
- Amiodarone
- Chemo drugs
What does this CXR show?
Bilateral hilar lymphadenopathy as in sarcoidosis
Features of sarcoidosis
- Dry cough
- Malaise
- Hyperca features
- Erythema nodosum
Biopsy results for sarcoidosis
Granulomas (clusters of macrophages, lymphocytes, etc.)
Myasthenic crisis and features
Acute resp failure where forced vital capacity (FVC) <1L + need for ventilators support
- Use of accessory muscles
- Weak cough
Severe pneumonia + multi focal consolidation initial Mx
IV Co-Amox and clarithro
What do for airway of an alert pt with respiratory acidosis
Non-invasive ventilation
Idiopathic pulmonary fibrosis features
- Dry cough
- Increasing SOBOE
- Finger clubbing
- On ausc, bibasal creps
Bronchiectasis features
- Younger pt usually
- SOB worsening
- Productive cough
- Recurrent chest infx during childhood
- Bilat scattered wheeze
- Coarse inspiratory crackles
Empyema
1) What that
2) Features
3) Ix
4) Mx
1) collection of pus in the pleural space
2) SOB, pleural effusion
3) Pleural effusion: purulent aspirate and microscopy shows growth
4) Chest tube (catheter thoracotomy) drainage
Obstructive sleep apnoea
1) Features
2) Mx
1)
- Heavy snoring
- Day time sleepiness ++ (Epworth sleepiness score)
- Often plus weight
2) - CPAP
- +/- weight loss & diabetes mx
TB
1) Features
2) CXR finding
3) Next diagnostic ix?
1) - Malaise
- Weight loss
- Haemoptysis
2) Consolidation with cavitation
3) Sputum microscopy
Pneumothorax v lobar collapse
- Pneumothorax is more rapid onset with severe syx ++
Which gram negative bacteria is likely to be causing pneumonia in CF patient?
Pseudomonas aeruginosa
Lung ca w keratin pearls
SCC
Bronchiectasis and features
Abnormal widening bronchi -> excess mucous & damaged cilia
Productive cough + dull percussion
Abx for legionella
Clarithromcyin
Abx for klebsiella
Ceftriaxone/cefotaxime
COPD acute mx
- ±O2
- Neb salbutamol + neb ipratropium bromide
- IV hydrocortisone + PO pred (5 days)
- Amox/co-amox
- Further support: aminophylline/ITU/NIV)
Asbestos plaques v mesothelioma
both conditions caused by asbestos
- Mesothelioma is a Ca
What spirometry result represents a restrictive picture?
- FEV1/FVC normal or incr
- FEV1 and FVC both proportionally reduced
What spirometry results represents an obstructive picture?
- FEV1/FVC<0.7
- FEV1 reduced
pneumothorax + (haemodynamically nstable OR bilat)
Chest drain
Primary pneumothorax <= 2cm
D/c and r/v in OPD
Primary pneumothorax >2cm
Needle aspiration
Done needle aspiration for pneumothorax, but not successful
Chest drain
Secondary pneumothorax >2cm
Chest drain + admit
Secondary pneumothorax 1-2cm
Needle aspiration + admit
Secondary pneumothorax <1cm
Admit (+observe 24h)
Tension pneumothorax cxr
airway deviate away from side of pneumothoraz
Tension pneumothorax mx
Needle decompreession
- gret cannula
-2nd ICS, MCL
Increased compliance of lung
emphysema (underlying COPD)
Where is needle aspiration done?
Triangle of safety
Borders:
- Front: pec major
- Back: lat dorsi
- Top: axilla
- Bottom: 5th ICS
Where is chest drain inserted?
4th-5th ICS, MAL
Cor pulmonale features and ix
Features: peripheral oedema, raised JVP, loud P2
Ix: echo
How is pulmonary HTN defined?
Pulmonary artery pa >= 20mmHg
SCC of lung -> why hyperCa?
PTHrP release
Small cell lung Ca + muscle cell improving on repetitive movement
Lambert Eaton syndrome
Which Ab associated w Lambert eaton syndrome?
anti-voltage gated calcium channel
Breast ca or small cell lung ca + progressive muscle stiffness
Stiff man syndrome
Stiff man syndrome associated ab
Anti-amphiphysin
Symptomatic asthma
- Using SABA >=3/week
- Cough/wheeze >= 3/weel
- Nocturnal syx
Chronic asthma mx
- SABA
- SABA + low dose ICS
- LTRA (montelukast) + low dose ICS
- Good resp to LTRA: LTRA + low dose ICS + LABA
- Min resp to LTRA: Low dose ICS + LABA
- LTRA + med dose ICS + LABA
- Med dose ICS + LABA
Severe asthma feature
- peak flow 33-50%
- Inability to complete sentences
Life threatening asthma
- peak flow <33%
- PaCO2 normal
- silent chest
Near-fatal asthma feature
- Raised PaCO2
Ix for active and latent TB
Active
- CXR & sputum
Latent
- Mantoux or interferon gamma assay
Alternative name for extrinsic allergic alveolitis
Hypersensitivity pneumonitis
Allergic bronchopulmonary aspergillosis features
- episodic syx of infx
- elevated IgE
- Flitting consolidation on XR
- Bronchiectasis pic on xr (dilated central airways)
development of multiple round pulmonary nodules in patients with
Rheumatoid Arthritis and a background of Coal workers pneumoconiosis
Caplan’s syndrome
