Resp Flashcards
How does acute mountain sickness present and how is it managed
at 2500-3000m
headache, nausea, fatigue over 6-12hrs
Mx descent
prophylaxis acetazolamide
Pathophysiology HAPE
> 4000m
hypoxia -> uneven pulm vasoconstriction & blood flow -> areas with increased blood have increased cap pressure and leak causing oedema
HAPE management
descent
nifiedipine, dex, acetazolamide
HACE pathophysiology
hypoxia causes cerebral vasodilation increases cerebral blood flow causing oedema
HACE presentation and management
headache, ataxia, papilloedema
Mx: descent, dex
acute Mx asthma
SABA
Pred
SAMA
IV MG
IV amiophylline
I&V
ECMO
Diagnosis of asthma <5
clinical
Diagnosis asthma 5-16
spirometry and BDR test
FeNO if normal spiro or obstructive spiro with -ve BDR test
Diagnosis asthma >17
spiro and BDR test
FeNO
?occupational
Causes of acute exercabtion of COPD
h. influenza
strep pneumoniae
moraxella catarrhalis
rhinovirus
NIV starting settings
pH <7.35
EPAP 4-5cm h20
IPAP 10-15cm H20
How is COPD diagnosed
post bronchodilator spiro
FEV1/FVC <70%
FEV1 >80%: mild
FEV1 50-80%: mod
FEV1 30-50%: severe
FEV1 <30%: very severe
CXR findings in COPD
hyperinflation
bullae
flat hemidiaphragm
signs of asthma/steroid responsiveness in COPD
asthma/atopy hx
increased eosinophils
FEV1 variation
diurnal variation PEF
When to consider LTOT
2 ABG more than 3 weeks apart
pO2 <7.3 or 7.3-8.0 +
polycythaemia, peripheral oedema or pulmonary hypertension
What causes lung mets & appearance on CXR
Breast
bladder
prostate
renal
colorectal
- cannonball
Carcinoid ca
40-50
long Hx
cherry red ball on broncoscopy
Mx: surgical
Small cell lung CA
ectopic ADH: low Na
ACTH: Cushings
Lambert Eaton Syndrome
Mx: chemo/radio
Non small cell lung Ca
Radiotherapy
Mediastinoscopy prior to surgery ?lymph node involement
CI to non small cell lung Ca surgery
SCV obstruction
Vocal cord paralysis
FEV1 <1.5
Malignant effusion
Squamous cell Ca
PTH related protein: High Ca
Clubbing
HPOA
TSH: hyperthyroid
Adenocarcinoma
gynaecomastia
HPOA
Cystic fibrosis gene and inheritance type
chromosome 7
autosomal recessive
Cystic fibrosis defect
defect in CFTR which codes cAMP regulated chloride channel
Organises that colonise in CF pts
s. aureus
p. aeruginsosa
burkholderia cepacia CI to transplant
aspergillus
Mx CF
chest physio
high cal high fat diet, pancreatic enzyme sups, vit sups
lung transplant b cepecia CI
Orkambi - homozygous
Causes of transudate pleural effusion
protein <30
HF, low albumin, hypothyroid
Causes of exudate pleural effusion
protein>30
infection, CTD, Ca, pancreatitis, PE
When do you use lights criteria
When protein 25-35
What could low glucose in pleural effusion indicate
RA, TB
What would high amylase in pleural effusion indicate
pancreatitis, oesophageal perforation
what would blood in pleural effusion indicate
mesothelioma, PE, TB
When would you insert a chest drain if pleural effusion likely from infection
if aspirate is cloudy/purulent or pH <7.2
What is sarcoidosis
non caseating granulomas, unknown cause
Sarcoidosis presentation
young adult, african
erythema nodusum
BHL
swinging fever
polyarthralgia
SOB, cough, malaise, weight loss, hypercalcaemia
Management of sarcoidosis
2/3rds self limiting
steroids if
- symptomatic + CXR S2-S3
- hypercalcaemia
-eye, heart, neuro involvement
Poor prognostic factors of Sarcoidosis
insidious
no erythema nodosum
extra pulm
CXR S3-4
Black or afro/Caribbean
CXR stages of sarcoidosis
1- BHL
2- BHL + interstitial infiltrates
3- diffuse interstitial infiltrates only
4- diffuse fibrosis
What is ARDS
increased permeability of alveolar capillaries leading to fluid in alveoli
Causes of ARDS
infection
trauma
transfusion
Mx ARDS
Itu for organ support
treat cause
What is alpha 1 antitrypsin deficincy genetic and inheritance pattern
autosomal recessive
chromosome 14
How does A1AT deficiency present
PiZZ
panacinar emphysema, cirrhosis, hepatocellular ca
Management A1AT def
no smoking, bronchodilators
IV A1AT
lung volume reduction surgery, lung transplant
types of pneumothorax
primary: young, tall, no lung disease
secondary: lung disease
traumatic
iatogenic
tension: displacement of mediastinal structures
management primary pneumothorax
<2cm and not SOB : discharge
otherwise aspirate, chest drain if fails
management secondary pneumothorax
<1cm: 02 and observe 24h
1-2cm: aspirate, chest drain if fails
>2cm/>50/SOB: chest drain
Management recurrent pneumothorax
VATS for pleurodesis +/- bullectomy
Discharge advice post pneumothorax
stop smoking
no flying 2 weeks
no diving
What is eosinophilic granulomatosis with polyangiitis
ANCA associated vasculitis
asthma, sinusitis, SOB
high eosinophils
pANCA +ve
What is granulomatosis with polyangiitis
ANCA associated vasculitis
upper and lower resp tract
glomerulonephritis
cANCA +ve
renal bisopy: epithelial cresents in Bowmans capsule
Management of granulomatosis with polyangiitis
steroids
cyclophosphamide
plasma exchange
Symptoms of ABPA
wheeze, cough SOB
eosinophilia
+ve RAST for aspergillus
raised IgE
Management of ABPA
1st line glucocorticoids
2nd line itraconazole
Causes of EAA
bird: avain proteins from poo
farmers: saccharopolyspora retivirgula
Malt: asp claratus
What kind of hypersensitity reaction is EAA
type III /IV
Presentation of EAA
acute: SOB, cough fever
chronic: SOB, cough, lethargy, weight loss
Ix EAA
upper/mid fibrosis
bronchoalvealor lavage: lymphocytosis
IgG AntibodiesMan
management EAA
avoidance
glucocorticoids
