Resp Flashcards
Squamous NSCLC paraneoplastic lesions
PTH secretion -> ↑Ca2+, clubbing, HPOA, Hyperthyroid (ectopic TSH), Cavitation lesions
Adenocarcinoma SCLC paraneoplastic syndrome
gynaecomastia, HPOA, non smokers
SCLC Paraneoplastic syndrome
SIADH + ↑ACTH (cushings)
Lambert Eaton Myasthenic syndrome - muscle weakness, diplopia, dysphagia, speech
Mining occupation, upper zone fibrosis, egg shell calcification hilar nodes
dx
silicosis
Extertional dyspnea, dry cough, inspiratory crackles
Fine reticular/honeycomb appearance on CXR, lower lobes
Restrictive - ↓ FEV1, ↑FEV1/FVC
dx
asbestosis
Mx extrinsic allergic alveoli’s
Avoid + glucocorticoids
Clubbing, fine insp crackles
Exertional dyspnea, dry cough, weight loss. Typically men 50-70
Spirometry - FEVR N/ ↓, ↓ TLCO, ground glass-> honeycoming. CT is best for diagnosis
Lif expect 3-4 years
Dx
Idiopathic pulmonary fibrosis
Erythema nodosum, plaques on face, cough, ↑Ca, ↑ESR ↑ACEi, LNS. Can cause facial paralysis
dX
Sarcoidosis
UPPER ZONE FIBROSIS
Hypersensitivity pneumonitis, coal workers pneumoconciosis, silicosis, sarcoidosis, ankylosing spondylitis, TB,
Lower zone fibrosis
Drug induced - amiodarone, methotrexate, asbestosis, idiopathic
Symptoms and diagnosis of mesothelioma
Dyspnea, weight loss, chest wall pain, clubbing.
Dx - thoracoscopy and histology for Dx
Type pneumonia in bronchiectasis
Haemophilus influenza
Type pneumonia in alcohol and DM with caveatting lesions
Klebsiella pneumona
Type pneumonia in influenza
Staph aureus
hotel air con + ↓Na
type pneumonia
Legionella
Pneumonia organism with erythema multiforme
Mycoplasma Pneumoniae
Tx HAP vs CAP
HAP - CO-amox
CAP - DOxy
CURB65 score and Abx choice
Confusion
Urea >7
RR>/30
BP <90/60
Age >/65
Amoxicillin
Macrolide if mod-severe
Surgery type in A1 Antitrypsin def
If bad - surgery - Lung/liver transplant or lung vol reduction surgery
COPD MX
SAMA(ipatropium)/SABA
No asthma - LABA/LAMA
Asthma - LABA + ICS..
LTOT in COPD - when
LTOT = PaO2 <7.3 or secondary polycythaemia/pulm HTN
Tx for exacerbation in COPD
Azithromycin for prophylaxis if lots recurrent exacerbations
Exacerbation -
At home needs prednisolone/inhaler/Abx (doxy for CAP).
Only give Ab if purulent sputum/clinical signs pneumonia.
In hospital - neb bronchs, steroids, Abx
Asthma chronic mx
SABA
+ICS
+LABA (if child <12 then LRTA)
Consider others
Acute asthma mx
SABA
SABA/Ipatropium bromide neb 5mg
Prednisolone PO or iV hydrocortisone 100mg
MgS04-…
Mod, severe and life threatening asthma
Mod = PEFR 50-75%
Severe = PEFR 33-50%, RR>25, HR>110,Can’t complete sentences
Life threatening = silent chest, hypotension…
Smoking cess in pregnancy
NRT
What pattern spirometery and examples
FEV1/FVC ratio N/↑
FVC ↓ ↓
FEV1 ↓
Restrictive
FEV1/FVC ratio N/↑
FVC ↓ ↓
FEV1 ↓
Pulm fibrosis, asbestosis, sarcoidosis, ARDS, Kyphoscoliosis, neuromuscular disorders
What pattern spirometry and examples
FEV1/FVC ratio <75%
FEV1 ↓
Persistent cough, sputum, exertional breathlessness
Coarse crackles + low pitched wheeze
High pitched inspiratory squeeks
dx
Bronchiectasis
Pleural effusion transudative vs exudative
Exudative = ↑ protein (lung cancer/pathologies), protein/serum protein ratio >0.5
Transudative = ↓ protein (congenital HF…)
Empyema - ph<7.3, low glucose, ↑ LDH
Primary vs secondary mx pneumothorax
primary:No SOB and <2cm = No TxSOB +/- >2cm = Aspiration
Secondary: 1-2cm or SOB = aspirate>2cm drain
Persistent air leak or recurrent episodes of pneumothorax mx
consider referral for VATS to allow for mechanical/chemical pleurodesis +/- bullectomy
Sinusitis mx
Intranasal corticosteroids if >10d. If severe then Abx (Pen V)
Acute bronchitis vs pneumonia
Differentiating acute bronchitis from pneumonia
History: Sputum, wheeze, breathlessness may be absent in acute bronchitis whereas at least one tends to be present in pneumonia.
Examination: No other focal chest signs (dullness to percussion, crepitations, bronchial breathing) in acute bronchitis other than wheeze. Moreover, systemic features (malaise, myalgia, and fever) may be absent in acute bronchitis, whereas they tend to be present in pneumonia.
Acute bronchitis symptoms and mx
Cough (may/may not be productive), sore throat, rhinorrhoea, wheeze
18+ = doxy/ <18 = amoxicillin
Only Abx if high risk/co-morbidities/systemically unwell or CRP>100. If CRP 20-100 maybe delayed prescription)
Epistaxis, sinusitis, dyspnea, haemoptysis, rapidly progressive glomerulonephritis, saddle shape nose, vasculitis rash…
dx, ab on bloods and mx
Granulomatosis with polyangitis
cANCA
Mx - steroids, cyclophosphamide, plasma exchange…
In children 5-16 with obstructive spirometry is this enough for asthma dx or need more?
Need bronchodilator reversibility testing with improvement 14%
