Resp Flashcards
What are the signs of pulmonary oedema?
A-E
alveolar oedema (bat wings)
Kelley B lines
Cardiomegaly
Diversion of blood to upper lobes (where the vessels in the upper zone are larger than in lower zone)
pleural Effusions
How to assess adequacy of a plain CXR?
RIPE
Rotation
Inspiration
Projection (AP or PA)
Exposure
OR
PRIM
Projection
Rotation
Inspiration
Markings
Assessment of a chest x ray
Airway
Breathing (lungs and pleura)
Cardiac (size and borders)
Diaphragm (incl. costophrenic angles)
Everything else (mediastinal contours, bones, soft tissues, tubes, valves, pacemakers and review areas)
CXR findgins of pectus excavatum
7-shaped ribs
missing right heart border
heart displaced to the left
What ix should patients with unexplained persistent cough have?
CXR
What can increase the reliability of the sweat test?
giving fludrocortisone before
Summarise the BTS asthma management ladder
- Inhaled SABA
- add ICS
- Add LABA
- consider increasing ICS dose and adding 4th drug (LTRA, SR theophylline, b2 agonist tablet)
- oral steroids and refer to specialist care
examination findings in PE
sinus tachycardia
tachypnoea
hypoxaemia
loud s2
elevated JVP
calf swelling/tenderness
haemoptysis
3 commonest causes of persistent cough with normal CXR
asthma (50%)
sinusitis with postnasal drip (25%)
GORD (20%)
Causes of hypoxaemia (PaO2 <8)
- hypoventilation
- V/Q mismatch (shunting vs deadspace)
- Diffusion impairment
- high altitude
genetic RF for PE
protein C & S deficiency
Factor V leiden
FH
Management of haemodinamically unstable with PE
LMWH
thrombolysis
thromectomyn
IV fluids
warfarin
NOAC
medication for thrombolysis
alteplase
Causes of pulmonary HTN
group 1: PAH (idiopathic, hereditary, drug/toxin, CTD)
group 2: PH secondary to LHF (raised capillary wedge pressure)
group 3: PH secondary to underlying lung disease and hypoxia
group 4: chronic thromboembolic pulmonary HTN
group 5: secondary to conditions with multifactorial mechanisms causing PH
(you don’t come across group 5 that much)
sx of pulmonary HTN
breathlessness on exertion
Lower leg swelling
signs on examination of pulm HTN
pan systolic murmur (tricuspid regurgitation)
central cyanosis
signs of connective tissue disease
features of RHF
peripheral oedema
ascites
raised JVP
Management of group 1 pulm HTN
pulmonary vasodilator therapy aimed at decreasing pulmonary vascular resistance
Calcium channel blockers: First-line pulmonary vasodilator therapy for patients with PAH and positive vasoreactivity testing
Management of group 2 pulm HTN
Management of group 3 pulm HTN
Management of group 4 pulm HTN
anticoagulation
pulmonary endarterectomy
…
Management of COPD and asthma exacerbation - where do you give more steroids?
asthma
due to very inflammatory nature
what does inability to complete sentence indicate in asthma?
severe asthma attack
Is NIV a treatment option for asthma exacerbations?
no
but it is for COPD
Components of CURB 65
Confusion
Urea (>7 mmol/L urea)
RR > or = 30
BP (sys <90 or dia <or = 60)
> or = 65 age
Management of CAP based on CURB65 and HAP
1: amoxicillin or tetracycline/macrolide if allergic
2: amoxicillin + macroldie
3 or more: beta lactase (Co-amox) + macrolide
HAP: abx covering pseudomonas e.g. tazosin
which medications can cause pulmonary fibrosis?
methotrexate
chemotherapy
amiodarone
nitrofurantoin
biologics
Initial management of infective exacerbation of COPD
oral prednisolone 30mg OD for 5/7
abx (co-amox/amoxicillin/clarithromycin)
prevention of COPD exacerbation
stop smoking
flu and pneumococcal vaccines
mucolytic
pulm rehab
educatem safety net, rescue pack - steroids and abx
annual r/v (6 monthly if severe, <30% predicted)
review inhlaers and consider sustainability
-> discuss switching from MDI to DPI
correct disposal of inhalers, e.g. bring to pharmacy
recycle inhalers
What is the acronym for causes of upper lobe fibrosis?
CHARTS
C - Coal worker’s pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis
Does pneumonia predispose to a pneumothorax?
no
Which of these conditions predispose to pneumothorax?
- lung fibrosis
- lung carcinoma
- liver biopsy
- pneumonia
- emphysema
- central line insertion
- asthma
all except pneumonia
Features of moderate acute asthma
- PEF >50-75% expected
- worsening sx
- no features of acute severe asthma
Features of severe acute asthma
- PEF 33-50% expected
- RR 25 or above
- HR 110 or above
- unable to complete sentences in one breath
Features of life-threatening acute asthma
- PEF <33% expected
- sats <92%
- PaO2 < 8kPa
- normal PaCO2 (4.6-6.0 kPa)
- altered conscious state
- exhaustion
- arrythmia
- hypotension
- cyanosis
- silent chest
- poor respiratory effort
Features of near fatal acute asthma
Raised PaCO2 and/or requiring mechanical ventilation with raised inflation pressures
