resp Flashcards
what is the most common organism isolated from a patient with bronchiectasis
haemophilus influenza followed by pseudomonas
what can occur following thoracic trauma when a lung parenchymal flap is created
tension pneumothorax
management of tension pneumo
needle decompression and chest tube insertion
what features suggest a steroid response in COPD
previous diagnosis of asthma - atopy
higher blood eosinophil count
substantial variation in FEV1 over time ( 400 ml)
Substantial diurnal variation in peak expiratory flow ( 20%)
gold standard investigation for idiopathic pulmonary fibrosis
high resolution CT
symptoms - pulmonary fibrosis
exertional dyspnoea
bibasal fine end inspiratory crepitations
dry cough
clubbing
what sign points towards pulmonary fibrosis on CXR
ground glass progressing to honeycombing
what is the management of asymptomatic sacroidosis
no treatment
sign of sarcoidosis on CXR
Bilateral hilar lymphadenopathy
first line treatment of sarcoidosis
prednisolone
give 5 causes of ARDS
infection - sepsis / pneumonia
blood transfusion
trauma
acute pancreatitis
cardio pulmonary bypass
signs + symptoms of ARDS
dyspnoea
inc resp rate
bilateral lung crackles
low o2 sats
signs + symptoms of ARDS
dyspnoea
inc resp rate
bilateral lung crackles
low o2 sats
what is the minimum time patient needs to wait between first and second puff of inhaler
30 seconds
nature of inheritance of A1AT
autosomal recessive
what does positive HBsAB indicate
previous infection, now immune/ vaccinated
features of A1AT
panacinar emyphysema in lower lobes
liver cirrhosis and HCC in adults, cholestasis in kids
can A1AT be diagnosed prenatally
Yes
what is a diagnostic test for asthma
bronchodilator reversibility test - improvement of 14%
first line test for obstructive sleep apnoea
Epworth
diagnostic test for sleep apnoea
polysomnography
when would you manage a pneumothorax with aspiration
> 2cm / signs of SOB
triad seen in Meig’s syndrome
benign ovarian tumour, ascites, pleural effusion
what activity must be permanently avoided in those with pneumothorax
deep sea diving
what test can be used to confirm asthma if there is a negative result on spirometry
FeNO testing
what observation makes the diagnosis of tension pneumothorax more likely than simple pneumothorax
hypotension
what spirometry tests indicate pulmonary fibrosis
reduced FVC
FEV1/FVC normal
what spirometry tests indicate an obstructive pattern of lung disease ?
FEV1 = reduced
FVC= reduced or normal
FEV1/ FVC = reduced
expand on CURB 65
C - confusion ( <= 8/10 on AMT)
U - > 7 mmol/L
R - rr > - 30
B - 90/60 <=
65 >
Management of low severity CAP
500 mg Amoxicillin 5 day course TDS
management of moderate - high severity CAP
oral amoxicillin 500 mg TDS for 5 days and oral clarithromycin 500 mg BD for 5 days
what is the follow up procedure for CAP
repeat cxr after 6 weeks
gynaecomastia is associated with which type of cancer
adenocarcinoma of lung
give 6 features of pulmonary oedema
insterstitial oedema
bats wings appearance
kerley b lines
pleural effusion
cardiomegaly if there is a cardiogenic cause
upper lobe diversion
top 2 interventions that improve survival in COPD
Smoking cessation
LTOT
what are pleural plaques
benign, not requiring follow up
most common cause of asbestosis related lung disease
what are the features of asbestosis
symptoms after latent period of 15-30 years
dyspnoea
reduced exercise tolerance
bilateral end inspiratory crackles
restrictive pattern
key sign on examination in idiopathic pulmonary fibrosis
fine end inspiratory crackles
most common lung cancer in non smokers
Adenocarcinoma
what is the most common organism causing infective exacerbations of COPD
H. Influenzae
categorise COPD on the basis of FEV1 readings
stage 1 : mild >80%
stage 2 : moderate 50-79%
stage 3 : severe 30-49%
stage 4 : very severe <30%
what is the first line management of acute bronchitis
oral doxycycline
what is the criteria for the 2 week wait pathway for lung cancer
-chest x-ray findings suggesting lung cancer
- aged 40 and over with unexplained haemoptysis
which type of lung cancer is most associated with cavitating lesions on chest radiograph
squamous cell carcinoma
what is the gold standard investigation for a pleural effusion
diagnostic aspiration with green 21g needle and 50 ml syringe
what is lights criteria
used to distinguish between transudate and exudate :
exudate is likely if one of the following criteria are met -
pleural fluid protein / serum protein > 0.5
pleural fluid LDH / serum LDH > 0. 6
pleural fluid LDH > more than 2/3rds the upper limits of normal serum LDH
which sights are most commonly affected by aspiration pneumonia ?
right and lower lung lobes
what is the triangle for safety of insertion of a chest drain ?
base of the axilla
lateral edge of pectoralis major
5th intercostal space
anterior border of latissimus dorsi
what type of picture does alpha one anti trypsin deficiency show on spirometry
obstructive picture
first line management of hospital acquired pneumonia
co -amoxiclav
what can precipitate ARDS
She died Having trauma, acute pancreatitis and long bone injury
Sepsis
direct lung injury
head injury
trauma
acute pancreatitis
long bone fracture
what is the treatment of choice for allergic bronchopulmonary aspergillosis ?
oral glucocorticoids - Prednisolone
what are the main indications for placing a chest tube in pleural infection?
-Purulent or turbid / cloudy pleural fluid
-presence of organisms identified by Gram stain from non purulent pleural fluid
-Pleural fluid with pH < 7.2 with suspected pleural infection
which type of lung cancer causes para-neoplastic syndromes
Small cell bronchial carcinoma
which medication is used for COPD prophylaxis
Azithromycin
give the SIGN guidelines for escalation of care of asthma
- Oxygen
- Salbutamol nebulisers
- Ipatropium bromide nebulisers
- Hydrocortisone IV / Oral prednisolone
- Magnesium Sulfate IV
- Aminophylline / IV Salbutamol
what treatment is offered to pregnant women who smoke
Nicotine replacement therapy
which medications can be used to aid smoking cessation ?
Varenicline and Bupropion
name 3 organisms that can cause a chest abscess
Staph. Aureus
Klebsiella Pneumonia
Pseudomonas aeruginosa
what are the features of a chest abscess ?
fever
productive cough ( foul smelling sputum)
chest pain
dyspnoea
give 2 signs of a chest abscess
dull to percuss and bronchial breathing
clubbing
what is the management of a chest abscess
IV Abx
Percutaneous drainage
gold standard testing for asthma
FeNo and spirometry with reversibility
ABG interpretation - low pH + High PaCO2
respiratory acidosis
ABG interpretation - high pH and low PaCO2
respiratory alkalosis
ABG interpretation - low pH + low bicarb
metabolic acidosis
ABG interpretation- high pH + high bicarb
metabolic alkalosis
what is the targeted oxygen saturation level in acute asthma
15 L high flow oxygen with target saturations of 94-98
what is the criteria for discharge after an acute asthma attack
- stable on discharge medication for 12-24 hours
-PEFR > 75% of expected - inhaler technique should have been checked and recorded
what FEV1/FVC ratio indicates obstruction
< 0.7
3 spirometry features of pulmonary fibrosis
restrictive spirometry ( FEV1:FVC >70%)
Decreased FVC
Impaired gas exchange ( reduced TLCO)
3 spirometry features for an obstructive pattern
FEV1/FVC ( <70%)
FVC normal / reduced
FEV1 Reduced < 80%
what vaccinations should COPD patients be offered ?
Annual flu vaccine
Pneumococcal vaccine
above what wells score would a CTPA be recommended
4 and above
how long do you prescribe dalteparin for in PE on discharge
provoked - 3 months
unprovoked - 6 months
active cancer - 6 months
what is the mechanism of an anaphylactic reaction
Type 1 hypersensitivity reaction , IgE stimulates mast cells to rapidly release histamine ( mast cell degranulation)
what is the immediate management and treatment of anaphylaxis
securing airway
oxygen
2 large bore peripheral access
adrenaline 300 mcg Im
how long do patients who have suffered an anaphylactic reaction need to observed
24-48 hours
what investigation do you need to order in a patient who has suffered with an anaphylactic reaction once they are stable and in what time frame ?
serum mast cell tryptase within 6 hours
what is the most common cause of hospital acquired pneumonia
pseudomonas aeroginosa
how do you manage a pneumothorax with the rim of air < 2 cm in an asymptomatic patient.
consider discharge
what activity must be avoided in a patient who has suffered from a pneumothorax ?
Under what circumstances can this activity be permitted ?
Deep sea diving
permitted if patient has undergone bilateral surgical Pleurectomy and has normal lung function and chest CT scan post-operatively.
what is a side effect of over rapid aspiration/ drainage of pneumothorax ?
Re-expansion pulmonary oedema
name 2 of the most common causes of bilateral hilar lymphadenopathy
sarcoidosis
TB
what test can help diagnose asthma in the case of indeterminate FeNo testing
Bronchodilator reversibility testing
what is the most common cause of exudative pleural effusion
pneumonia
what’s the difference between primary and secondary pneumothorax
no underlying lung disease in Primary pneumothorax
how does Klebsiella pneumoniae show under the microscope ?
Gram negative rod
which bacteria causes red currant jelly sputum
Klebsiella
Give 4 specific features of Klebsiella Pneumoniae
- more common in alcoholics and diabetics
- may occur following aspiration
-red currant jelly sputum
-often affects upper lobes
what is the management of a primary pneumothorax
rim of air > 2 cm –> chest drain
rim of air < 2cm –> consider discharge
what is the management of a tension pneumothorax
ABCDE assessment
-high flow oxygen 15 L via non rebreather mask
-open thoracostomy followed by chest drain or needle decompression with 16 gauge cannula inserted at 5th intercostal space, mid axillary line
what are contraindications to bupropion
epilepsy
eating disorder
CNS tumours
withdrawal
pregnancy + breastfeeding
what heart sounds are present in pulmonary HTN
Split 2nd heart sound with loud pulmonary component
pansystolic murmur - tricuspid regurgitation
end diastolic murmur - pulmonary regurgitation
____________ is associated with lung abscesses in alcoholic patients.
Klebsiella Pneumonia
which medication is first line for prevention of asthma
Inhaled corticosteroids
give 4 features of a severe asthmatic attack
Inability to speak in complete sentences
respiratory rate > 25 breaths / minute
peak flow 33-50% predicted
HR > 110 bpm
give features of a life threatening asthma attack
peak flow < 33% of predicted
silent chest
altered consciousness
bradycardia
hypotension
hypoxia
cyanosis
4 key features of sarcoidosis
fever
polyarthralgia
erythema
nodosum
bilateral hilar lymphadenopathy
what is the management of PE with haemodynamic instability
thrombolysis
2 features of legionella that can be seen on blood tests
hyponatraemia and deranged LFT’s
what are the features of chlamydophilia psittaci pneumonia
from contact with infected birds like parrots, cattle, horse and sheep
lethargy, headache, anorexia
what is the management of PE if DOAC is contraindicated due to renal failure
unfractionated heparin
what happens to the FEV1/ FVC in asthma
it is reduced
what happens to FEV1 and FVC in asthma
low FEV1
preserved FVC
what are examples of exudative pleural effusions
Cancer
Infection
Autoimmune
PE
pneumonia of which lobe characteristically results in loss of right cardiac border
right middle lobe
when is co-amoxiclav recommended first line in the management of pneumonia
in adults with comorbidities such as -
chronic heart disease
liver disease
renal disease
T2DM
Alcoholism
immunosuppression
hospitalization in the past year
distinguish between spontaneous and traumatic pneumothorax
Spontaneous pneumothorax
Primary: no underlying lung pathology
Secondary : connective tissue disorders, obstructive and infective lung disease, fibrosis and neoplastic disease
Traumatic:
Iatrogenic : insertion of central line / positive pressure ventilation
Non-iatrogenic : penetrating trauma / blunt trauma with rib fracture
what is the initial management of hypercalcaemia due to malignancy
intravenous fluid replacement to correct dehydration and increase urinary excretion of calcium
what is the most likely cause of Horner’s syndrome due to lung cancer ? how would this present ?
Apical lung tumour on the side of the syndrome known as Pancoast tumour presenting with unilateral ptosis, miosis and anhidrosis.
what is the investigation of choice for PE in a pregnant woman
Ventilation Perfusion scan
which lobes of the lung are most commonly affected by an aspiration pneumonia
right middle and lower lung lobes
What are key features of acute respiratory distress syndrome ?
acute onset respiratory failure
severe dyspnoea
tachypnoea
confusion
presyncope
what sign is indicative of ARDS on chest xray / CT ?
Bilateral alveolar infiltrates
give 2 risk factors for ARDS
Drowning
inhalation of hyperbaric oxygen
what are the features of paraneoplastic syndrome associated with squamous cell carcinomas
Ectopic production of parathyroid hormone related peptide ( PTHrP) resulting in symptoms such as-
hypercalcaemia causing constipation, myopathy, polydipsia, behavioural changes.
what signs are noticed on examination in pleural effusion ?
stony dullness to percuss
lymphadenopathy may be present indicating infection or malignancy.
may be reduced/ absent breath sounds
what is the first line therapy ( pharmacological ) for idiopathic pulmonary fibrosis ?
Pirfenidone
what is the most useful non -pharmacological management of bronchiectasis
postural drainage twice daily to aid mucus drainage
how do you diagnose
mycoplasma pneumonia
legionella and pneumococcal
Mycoplasma - PCR
legionella and pneumococcal - urine antigen
what is the management of non small cell lung cancer ?
1st line : Lobectomy
curative radiotherapy
chemotherapy
what is the management of small cell lung cancer
Palliative chemotherapy
what histological finding can be seen in asthma ?
Curschmann spirals
what is the criteria for discharge following acute asthma attack ?
been stable on discharge medication for 12-24 hours
inhaler technique checked and recorded
PEF > 75% of best or predicted
side effect of inhaled steroids
oral candidiasis
what are the indications for Bipap
COPD with respiratory acidosis ( 7.25-7.35)
Type II respiratory failure secondary to chest wall deformity, neuromuscular disease, OSA
Cardiogenic pulmonary oedema unresponsive to CPAP
weaning from tracheal intubation
what is atelectasis ? How does it present ? How would you manage it ?
Common post-operative complication in which basal alveolar collapse causes respiratory difficulty
should be suspected in the presentation of dysponoea and hypoxaemia around 72 h post operatively
management
positioning patient upright
chest physiotherapy : breathing exercises
what is the guidance on inhaler technique for pressured meter dose inhaler
Ideally hold your breath for 10 seconds after pressing down on the canister
causes of upper zone fibrosis
CHARTS
Coal workers pneumoconiosis
Histiocytosis / hypersensitivity pneumonitis
Ankylosing spondylitis
Radiation
TB
Silicosis
what are common causes of respiratory alkalosis ?
Anxiety causing hyperventilation
PE
Salicylate poisoning
CNS disorders : stroke, SAH, encephalitis
altitude
pregnancy
what is the most common cause of occupational asthma
Isocyanates
how is occupational asthma investigated?
Serial measurements of peak expiratory flow
how is an asymptomatic pneumothorax managed?
Conservative care, regardless of size
what are causes of widened mediastinum on chest x-ray?
vascular problems: thoracic aortic aneurysm
lymphoma
retrosternal goitre
teratoma
tumours of the thymus
what is allergic bronchopulmonary aspergillosis? what are its features? How is it investigated and managed?
Allergy to aspergillus spores.
features include :
Bronchoconstriction ( wheeze, cough etc)
bronchiectasis ( proximally)
Investigations :
eosinophilia
management is :
Oral glucocorticoids
Itraconazole
what drugs used in the management of asthma can be continued in pregnancy?
beclomethasone
salmeterol
theophylline
prednisolone
what is the management of non-cystic fibrosis bronchiectasis?
Physical training ( inspiratory muscle training) and postural drainage
how do skin lesions related to sarcoidosis manifest?
lupus pernio: affecting nose, cheeks, lips and digits
what type of fibrosis affects the lower zones?
A:Asbestosis
C: connective tissue disorders ( SLE)
i: Idiopathic pulmonary fibrosis
D: Drug induced - amiodarone, bleomycin, methotrexate
what types of fibrosis affects the upper lobes?
C - Coal worker’s pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis
what are some of the key signs and symptoms of pleural effusion?
Pyrexia- suggests infection
cachexia and clubbing - suggests malignancy
JVP and ankle oedema - suggests HF
stony dullness to percuss might be present
reduced / absent breath sounds
bronchial breathing
what are the side effects of the drugs involved in the management of TB?
Rifampicin : Liver toxicity ,red urine
Isoniazid : peripheral neuropathy
Pyrazinamide : liver toxicity, arthralgia, hyperuricaemia
Ethambutol : visual disturbances
what is the diagnostic investigation for sarcoidosis ?
Bronchoscopy with transbronchial lung biopsy
how does ARDS present on cxr ?
Bilateral pulmonary infiltrates and no other features of HF
what are the indications for surgery in a patient with COPD
they have upper lobe-predominant emphysema
FEV1 >20% predicted
paCO2 <7.3 kPa
TLCO >20% predicted
what are the indications for BiPAP ventilation?
COPD with respiratory acidosis pH 7.25-7.35
Type II respiratory failure secondary to chest wall deformity, OSA, neuromuscular disease
cardiogenic pulmonary oedema unresponsive to CPAP
what are the features of Kartagener’s syndrome?
dextrocardia
bronchiectasis
recurrent sinusitis
subfertility
what is the admission criteria for asthma exacerbation?
Any life-threatening features
features of severe acute asthma
previous near fatal asthma, pregnancy
what is the stepwise management of asthma exacerbation
start patient on oxygen 15L non re-breathable mask if hypoxaemic.
Bronchodilation with SABA
Corticosteroid 40-50 mg of prednisolone.
Ipratropium bromide
IV Magnesium sulphate
IV Aminophylline
how does asbestosis present on CT chest? What is the best management to improve prognosis.
Intralobular, small, rounded and branching opacities; thickened interlobular septa; pleural plaques.
Patients should be advised to stop smoking.
what are the guidelines for reducing inhaled steroid dose in asthma?
reduce dose by 25-50% at a time and consider stepping down treatment every 3 months or so.
what patients with COPD are candidates for LTOT?
pO2 < 7.3 kPa
pO2 of 7.3-8 kPa and one of
secondary polycythaemia
peripheral oedema
pulmonary hypertension
when are patients having COPD exacerbations considered for antibiotics? What medications are used?
purulent sputum / clinical signs of pneumonia
medications include : amoxicillin, clarithromycin, doxycycline
what is coal worker’s pneumoconiosis ?
Sometimes referred to as ‘’ black lung’s disease’’.
It is prevalent in populations with higher levels of exposure.
Upper lobe fibrosis and restrictive picture on lung function tests.
what are the risk factors for aspiration pneumonia?
Poor dental hygiene
swallowing difficulties
prolonged hospitalization / surgical procedures
impaired consciousness / muco-ciliary clearance
what are oxygen targets in a patient with COPD ?
CO2 normal : 94-98
otherwise 88-92
what features of an aspirate suggest empyema?
Turbid effusion with pH<7.2, Low glucose, High LDH
what are 2 complications of Klebsiella pneumonia?
lung abscess
empyema
how do you confirm correct placement of NG Tube?
if pH < 5.5 on aspirate
what is the action of bupropion ?
Norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist.
what is the action of varinecline
Nicotinic receptor partial agonist
what is silicosis ? what are it’s features?
fibrosing lung condition caused by inhalation of fine particles in occupations like mining, slate works, foundries, potteries.
features include : upper zone fibrosing lung disease
egg shell calcification of hilar lymph nodes
what are the contraindications for chest drain insertion ?
INR > 1.3
Platelet count < 75
Pulmonary bullae
Pleural adhesions
what are the complications of chest drain insertion ?
Failure of insertion
bleeding
infection
penetration of the lung
re-expansion pulmonary oedema
what are the causes and symptoms of a lung abscess? what is the management ?
causes include :
Staph. aureus
Klebsiella pneumonia
Pseudomonas aeruginosa
symptoms are similar to pneumonia but fever, productive cough, chest pain and foul smelling sputum are key features.
Management includes :
IV Abx
percutaneous drainage
what conditions cause obstructive picture ?
Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans
what conditions present as restrictive ?
Pulmonary fibrosis
Asbestosis
Sarcoidosis
Acute respiratory distress syndrome
Infant respiratory distress syndrome
Kyphoscoliosis e.g. ankylosing spondylitis
Neuromuscular disorders
Severe obesity
what is the management of COPD patient who is not tolerating LABA + LAMA + ICS
Oral theophylline
what can be used to guide need for antibiotic therapy in patients with acute bronchitis ? what is the recommended therapy ?
systemically unwell
pre-existing co-morbidities
CRP of 20-100
doxycycline recommended
what medication is used the prophylactic management of pneumocystic jirovecci
co-trimoxazole
what is the definition of pulmonary HTN
MAP > 20 mm Hg
what is the triad seen in Lofgrens syndrome
erythema nodosum
bilateral hilar lymphadenopathy
polyarthralgia
What blood test finding is an indication for urgent investigation for lung cancer?
raised platelets
what features are seen in yellow nail syndrome
yellow nails
bronchiectasis
lymphoedema
what common abx causes pulmonary fibrosis
nitrofurantoin
whats a contraindication to anti embolism stockings
PAD
operation for OSA
Uvulopalatopharyngoplasty
what pneumonia is associated with erythema multiforme
mycoplasma pneumoniae
what is the management of latent TB
3 months of isoniazid ( with pyridoxine) and rifampicin OR
6 months of isoniazid ( with pyridoxine)
what is the main technique used to diagnose latent TB
Mantoux test
what is the most common form of asbestosis related disease ? How are they managed
pleural plaques
no follow up is required
which type of pneumonia commonly occurs after influenza
staph aureus
how does legionella pneumonia present
bilateral, mid to lower zone patchy consolidation especially if there is a history of possible contaminated water or soil exposure
decrease in lymphocytes
hyponatraemia
deranged liver function tests
flu like symptoms
what are the features of mycoplasma pneumonia? what are its complications ?
Prolonged and gradual onset, flu-like symptoms classically precede a dry cough.
bilateral consolidations on x-ray
complications = haemolytic anaemia, thrombocytopenia, erythema, meningoencephalitis.,, pericarditis
what are the investigations performed for mycoplasma pneumonia
mycoplasma serology, positive cold agglutination test- peripheral blood smear showing red blood cell agglutination
how is mycoplasma pneumoniae managed
doxycycline /macrolide
give the stepwise management of asthma
SABA
SABA + ICS
SABA + ICS + LRTA
swap LRTA for LABA
swap ICS/ LABA for MART
What is an LRTA
Leukotriene receptor antagonist-montelukast
what is the stepwise management of COPD with diurnal variation
SABA or SABA
LABA + Inhaled ICS
add LAMA
Pneumonia, peripheral blood smear showing red blood cell agglutination
Mycoplasma pneumonia
what is the management of patients with acute asthma who do not respond to full medical treatment
intubation and ventilation
most common organism causing infective exacerbation of COPD
H influenzae
Consider referring children with bronchiolitis to hospital if they have any of the following:
resp rate > 60
difficulty with breastfeeding / inadequate oral fluid intake
clinical dehydration
what antibiotic prophylaxis is offered to COPD patients
azithromycin
Aspergilloma
Often past history of tuberculosis.
Haemoptysis may be severe
Chest x-ray shows rounded opacity
Granulomatosis with polyangiitis
Upper respiratory tract: epistaxis, sinusitis, nasal crusting
Lower respiratory tract: dyspnoea, haemoptysis
Glomerulonephritis
Saddle-shape nose deformity
Mitral stenosis
Dyspnoea
Atrial fibrillation
Malar flush on cheeks
Mid-diastolic murmur
If a pleural effusion fluid protein/serum protein ratio is >0.5
exudate
what is the surgical management of A1AT
lung volume reduction surgery
signs of chlamydia psittaci
unilateral crepitations and vesicular breathing
abdomen : hepatomegaly , splenomegaly
Treatment of chlamydia psittaci
doxycycline
erythromycin
management of pneumonia according to CURB score
first line : amoxicillin
moderate/ high severity : beta-lactamase stable penicillin such as co-amoxiclav and macrolide
an improvement of _________ in FEV1 or more suggests asthma on reversibility testing
12%
FeNO positive for asthma
in adults level of >= 40 parts per billion (ppb) is considered positive
in children a level of >= 35 parts per billion (ppb) is considered positive
action of varenicline
Nicotinic receptor partial agonist
recurrent pneumothorax
video-assisted thoracoscopic surgery (VATS)
Emphysema is most prominent in _______ in A1AT and ________ in COPD
lowerlobes - A1AT
upper lobes - COPD
Causes of a raised TLCO
Asthma, vasculitis
causes of lower TLCO
pulmonary fibrosis, pneumonia, pulmonary oedema , emphysema
trachea position in =
pleural effusion
lung collapse
pleural effusion - away
lung collapse = towards
most common cause of exudate pleural effusion
pneumonia
detection of occupational asthma
serial peak flow measurements at work and at home
lower zone fibrosis acronym
A - asbestos.
C - connective tissue diseases.
I - idiopathic pulmonary fibrosis.
D - drugs e.g. methotrexate, nitrofurantoin.
mx of SCLC
combination of chemo and radio
Trachea pulled toward the white-out
Pneumonectomy
Complete lung collapse e.g. endobronchial intubation
Pulmonary hypoplasia
Trachea pushed away from the white-out
Pleural effusion
Diaphragmatic hernia
Large thoracic mass
Trachea central
Consolidation
Pulmonary oedema (usually bilateral)
Mesothelioma
indications for corticosteroid treatment in sarcoidosis
parenchymal lung disease
uveitis
hypercalcaemia
neurological / cardiac involvement
allergic bronchopulmonary aspergillosis mx
oral prednisolone
Extrinsic allergic alveolitis
hypersensitivity induced lung damage due to a variety of inhaled organic particles.
causes of EAA
malt
mushroom
farmer
fly ( bird)
ivg for EAA
fibrosis, lymphocytosis and IgA
blood - no eosinophilia
management of EAA
avoiding precipitating factors
medications that slow the progress of pulmonary fibrosis
pirfenidone and nintedanib
medications causing pulmonary fibrosis
Amiodarone
cyclophosphamide
methotrexate
nitrofurantoin
presentation of pulmonary HTN
tachycardia
raised JVP
Hepatomegaly
Peripheral oedema
causes of pulmonary HTN
primary pulmonary HTN
left sided HF
Chronic lung disease
PE
sarcoidosis
ECG changes seen in pulmonary HTN
RVH
Right axis deviation
RBBB
CXR signs of pulmonary HTN
dilated pulmonary veins
right ventricular hypertrophy
blood marker of pulmonary HTN
NT-PRO BNP
what are granulomas
nodules of inflammation full of macrophages
surgical mx of OSA
uvulopalatopharyngoplasty PPP
key morning symptom in OSA
morning headache
d dimer can also be positive in :
pneumonia
malignancy
surgery
pregnancy
mx of pe in pregnancy
LMWH
mx of massive pulmonary embolism
continuous infusion of unfractionated heparin and consider thrombolysis
iatrogenic causes of Pneumothorax
lung biopsy
mechanical ventilation
central line insertion
main Ivx for pneumothorax
erect CXR
triangle of safety
5th intercostal space
mid-axillary line
anterior axillary line
management of tension pneumo
4/5th intercostal space, anterior to mid axillary line - needle decompression - remember 2nd intercostal space
Pulmonary hypertension is defined as
mean pulmonary arterial pressure of more than 20 mmHg
Idiopathic pulmonary hypertension may be treated with:
Calcium channel blockers
Intravenous prostaglandins (e.g., epoprostenol)
