Resp Flashcards
Mx of Acute Asthma (6)
ABC, contact senior
100% O2
Neb Salbutamol & Neb Ipratropium
IV hydrocortisone & Oral Prednisolone
IV MgSO4
IV salbutamol
IV aminophylline
How long between nebulised salbutamol back to back doses in acute asthma
15 minutes
Examination findings in COPD
Decreased Expansion
Decreased Breath Sounds (QUIET)
Decreased vocal resonance
Hyper-resonant percussion
Key hint that patient has COPD
Quiet Breath sounds
Complication of COPD
Cor pulmonale; COPD + RHF signs
Outline the stages of COPD
Predicted PEFR
Stage 1 - Mild: >80%
Stage 2 - Moderate: 50-80%.
Stage 3 - Severe: 30-50%.
Stage 4 - Very Severe: <30%
What to suspect in young COPD patient
a1 antitrypsin deficiency
Ventilation used in acute exacerbation of COPD if needed
BiPAP
What must COPD patients do before being offered Oxygen therapy
Stop smoking!
Flammable
Difference between Emphysema and Chronic Bronchitis
Emphysema - Pink Puffers
Breathless but not cyanosed, T1 resp failure
Chronic Bronchitis
Cyanosed but not breathless, T2 resp failure (High CO2)
What is yellow nail syndrome
Yellow dystrophic nails
Bronchiectasis
Pleural Effusions
Ix of bronchieactasis
High-resolution CT
–> signet ring sign
Mx of Bronchieactasis
Chest physiotherapy
Inhaled salbutamol, ICS
Abx if exacerbation
Causes of apical pulmonary fibrosis
Sacroidosis
Coal workers pneumoconiosis
Ankylosing Spondylitis
Tuberculosis
Extrinsic allergic alveolitis
Causes of Basal pulmonary fibrosis
Rheumatoid arthritis
Asbestosis
Scleroderma (SLE)
Drugs - amiodarone, nitrofurantoin, methotrexate, bleomycin
Sx of idiopathic pulmonary fibrosis
Breathlessness on exertion
Dry chronic cough (no wheeze)
Clubbing
Reduced breath sounds
Fine late inspiratory crepitations
How are FEV and FVC affected in pulmonary fibrosis?
Both decreased, ratio >0.8
CXR signs of pulmonary fibrosis
Ground glass
Honeycombing (advanced)
Tx of idiopathic pulmonary fibrosis
Pulmonary Rehabilitation Therapy
Smoking cessation
Pirfenidone
Long term Oxygen Therapy
Mx of Anaphylaxis
IM Adrenaline 0.5mg = 0.5ml 1:1000 solution. This can be repeated every 10 min
IV Fluids: 500ml Bolus
IV Hydrocortisone 100mg
IV Chlorpheniramine 10mg
–> Nebulised bronchodilators, IV adrenaline, Intubation
Most common cause of community-acquired pneumonia?
Strep. pneumoniae
Haemophilus Influenzae
Mcyoplasma pneumoniae
Halo sign on CT Thorax
Aspergillus
Mx of aspergillus
Amphoteracin B
What is a very strong indicator that something is pneumonia rather than an URTI?
Tachypnoea
Pneumonia Sx?
Breathlessness
Reduced Chest Expansion
Bronchial Breathing
Late inspiratory crepitations
Dull Percussion
Indications for lobectomy/pneumonectomy?
Non-Disseminated Bronchial Carcinoma in 90% of cases
Bronchiectasis
COPD
Mx of OSA
Advise on sleeping positions and weight loss
Mandibular advancement splints
CPAP
Causes of transudate pleural effusion?
HF
Cirrhosis
Nephrotic syndrome
Causes of exudative pleural effusion
Infection
Malignancy
Pneumonia
Causes of clubbing
Lung carcinoma
Bronchiectasis
Empyema
Pulmonary fibrosis
Mesothelioma
Lung Abscess
Examination findings in interstitial lung disease
Clubbing
Reduced chest expansion
Fine late end-inspiratory crepitations (do not clear with coughing but do quieten/disappear on leaning forwards)
What should you comment on if you think it is interstitial lung disease
The possible underlying cause:
Rheumatoid arthritis
Ankylosing spondylitis
Radiation
Connective tissue disease (lupus, dermatomyositis, systemic sclerosis)
What are your differentials for clubbing and crepitations?
Interstitial lung disease
Bronchiectasis
Lung Cancer
Abscess
Cystic fibrosis
Sx of Bronchieactasis
Clubbing
Reduced chest expansion
Wheeze
Early coarse inspiratory crepitations that alter with coughing but do not quieten/disappear on leaning forwards
Key difference in presentation of Bronchiectasis and interstitial lung disease
Both have early coarse inspiratory crepitations
In Bronchiectasis they alter with coughing but do not quieten/disappear on leaning forwards
In interstital lung disease they do not clear with coughing but do quieten/disappear on leaning forwards
CXR signs of bronchiectasis
Tramlines
Hyperinflation
Ring shadows
Sx of cystic fibrosis
Young, short, thin
Clubbing
Chronic productive cough
Sx of pleural effusion
Reduced expansion
Trachea displaced away from side of the effusion
Apex beat shifted away from effusion
Stony dull percussion note
Decreased vocal resonance
Reduced air entry/breath sounds
Bronchial breathing
What to look for if you suspect a lung transplant
Signs of steroid use, gum hypertrophy, tremor - immunosuppressive therapy
Abnormal lung on other side
Examination findings in COPD
Reduced chest expansion
Hyper-resonant percussion note
Expiratory wheeze
CO2 retention flap
Pursed lip breathing (using accessory muscles)
Differentials for wheeze
COPD
Asthma
Heart Failure
Bronchiectasis and mucus plugging
How does trachea shift in effusion
Away from lesion
dDx of Dull lung base
Consolidation: bronchial breathing + crackles
Collapse: ↑ VR
Pleural effusion
Ix of pleural effusion?
CXR
Bloods: FBC, U&E, LFTs
Diagnostic pleurocentesis
Causes of bronchiectasis
CF
PCD
Kartagener’s
Malignancy
Post infectious: pertussis, TB, measles
Abx which can be used in bronchiectasis
Exacerbations: cipro for 7-10 days
Prophylactic azithromycin
Cystic fibrosis Mx
MDT
Chest physio: postural drainage, active cycle breathing
Abx prophylaxis
Segregate from other CF pts.: risk of transmission - pseudomonas
Pancreatic enzyme replacement: pancreatin
ADEK supplements
Cause of
Bronchiectasis
Rhinosinusitis
Azoospermia
Young’s syndrome
Causes of upper and lower pulmonary fibrosis
Upper:
Asperillosis: ABPA
Pneumoconicosis: coal, silica
Extrinsic allergic alveolitis
TB
Lower:
Sarcoidosis
Drugs
Asbestos
Rheum: RA, SLE, Sjorgen’s
Complication of COPD
Cor pulmonale
Single most important intervention in COPD
Smoking cessation
What improvement in FEV1 with a β-agonist indicates asthma
≥15%
Features of severe asthma (4)
PEFR <50%
Can’t complete sentence in one breath
RR >25
HR >110
Features of life threatening asthma (7)
PEFR <33%
SpO2 <92%, PCO2 >4.6kPa, PaO2 <8kPa
Cyanosis
Hypotension
Exhaustion, confusion
Silent chest, poor respiratory effort
Tachy-/brady-/arrhythmias
When to discharge following acute severe asthma
Been stable on discharge meds for 24h
PEFR >75% with diurnal variability <20%
Indications for lobectomy/pneumonectomy
90% for non-disseminated bronchial carcinoma
Bronchiectasis
COPD: lung-reduction surgery
TB: historic, upper lobe
Lobes affected in TB
Lower
Pneumonia follow up?
CXR at 6 weeks
Pneumovax every 6 years
Outline curb-65 score
Confusion (AMT ≤8)
Urea >7mM
Resp. rate >30/min
BP <90/60
≥65 y/o
0-1 → home Rx
2 → hospital Rx
≥ 3 → consider ITU
