Confusion (abbreviated mental test score 7) R Respiration rate >= 30/min B Blood pressure: systolic = 65 years >2 = hospital

Resp Flashcards by Alice Hanton

what does granulomatous condition mean

nodules of inflammation full of macrophages

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Pulmonary manifestations of sarcoid

mediastinal lymphadenop
pulm fibrosis
pulm nodules

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What is Lofgren’s syndrome

triad of a specific sarcoid presentation

erythema nodosum
bilat hilar lymphad
polyarthralgia

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What does raised serum ACE indicate

sarcoid

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sarcoid can cause what electrolyte imbalance

Hypercalcaemia

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Gold standard for sarcoid dx

histology from biopsy- shows non-caseating granulomas with epithelioid cells

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mx sarcoid

if asymptomatic - nil, often self resolves in 6m

Oral steroids for 6-24m and bisphosphonates

2nd line- mtx/azathioprine

rarely needs a lung transplant

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Is most bronchial carcinoma small cell or non small cell

non small cell

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Most common cause of CAP

Streptococcus pneumoniae

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CAP pathogen COPD

Haemophilus influenzae

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CAP pathogen post influenza, or HAP, or IVDU

Staphylococcus aureus

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CAP in alcoholics / impaired swallow/ diabetic

Klebsiella pneumoniae

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CF/immunocomp CAP pathogen

Pseudomonas aeruginosa

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atypical pneumonia affecting young adults with diffuse infiltrates

Mycoplasma pneumoniae

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Milder atypical pneumonia

Chlamydophila pneumoniae

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Most common viral pneumonia

influenza

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most common viral influenza in infants or elderly

RSV

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CURB criteria

Confusion (abbreviated mental test score <= 8/10)

(urea >7)

R Respiration rate >= 30/min

B Blood pressure: systolic <= 90 mmHg and/or diastolic <= 60 mmHg

65 Aged >= 65 years

> 2 = hospital

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tension ptx management

large bore cannula 2nd IC space MCL (then chest drain)

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Drugs causing interstitial lung disease

‘MAN B messing up my lungs’

mtx
amiodarone
nitrofurantoin

bleomycin

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Novel drug for ILD

pirfenidone

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klebsiella pneumonia is often which lobe and what might complication be

upper

abscess and empyema

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mycoplasma pneumonia complications

erythema multiforme
haemolytic anaemia

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blood results in legionella

hyponatraemia
lymphopenia

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type of pneumonia with bi-basal consolidation

legionella

fungal pneumonia pathogen in HIV - desat on exertion

pneumocytis jiroveci

HAP is after how long in hosp

48h

PE mx if Wells >4

CTPA, if delay start DOAC

If you have low suspicion of PE anyway what can you do

PERC- if negative then probability <2%

PE Mx if Well's <4

D dimer

Length of treatment for provoked PE

3 months then reassess

Length of treatment for PE with malignancy

6m or until cure of cancer

Length of treatment for PE with pregnancy

until end of pregnancy, nb should have LMWH i think

first-line treatment for massive PE where there is circulatory failure

thrombolysis

COPD sx in a young person - consider

alpha 1 antitrypsin defic

bronchiectasis affects which airways

medium sized

genetic causes of bronchiectasis

CF PCD/kartageners syndrome

Other causes of bronchiectasis

post infective aspiration or lung ca obstructing Allergic bronchopulmonary aspergillosis COPD

Imaging signs for bronchiectasis

signet ring sign on CT XR- tram lines and ring shadows

How to diagnose PCD

nasal biopsy

pleural aspirate pH <7.2 suggests

pus- needs chest drain

pleural fluid protein <30g/L

transudate

pleural fluid protein >30g/L

exudate

XR findings in silicosis

upper zone fibrosis 'egg-shell' calcification of the hilar lymph nodes

If pleural fluid protein level is between 25-35 g/L what do you do to determine if trans or exudative

Lights criteria

To be considered an exudate at least one of: pleural fluid protein divided by serum protein >0.5 pleural fluid LDH divided by serum LDH >0.6 pleural fluid LDH more than two-thirds the upper limits of normal serum LDH

when do you definitely put in a chest drain after a pleural tap is done

if the fluid is purulent or turbid/cloudy if the fluid is clear but the pH is less than 7.2

What is the main therapeutic benefit of inhaled corticosteroids in patients with COPD

reduces exacerbations

what are 'asthmatic features' of COPD

prev dx asthma/atopy eosinophils diurnal variation in PEFR variation in FEV1 over time

COPD first line

SABA/SAMA

COPD second line in no asthmatic features

LABA and LAMA

COPD second line in asthmatic features

LABA and ICS

Ipatropium type of drug

SAMA (note tiotripium is LAMA)

FEV1:FVC in COPD

<0.7

when do you give prophylactic abx in COPD patient

non smoker, have optimised standard treatments and continue to have exacerbations need to exclude bronchiectasis (CT) and atypical cultures Check LFT and QTc first

Pulm fibrosis picture on spirometry and TLCO

restrictive spirometry picture (FEV1:FVC >70%, decreased FVC) and impaired gas exchange (reduced TLCO)

Are pleural plaques themselves pre-malignant?

No, and they are not associated with an increased risk of lung cancer or mesothelioma.

Difference between asbestosis and mesothelioma

asbestosis- lower lobe fibrosis (not cancerous) mesothelioma- pleural disease

Is mesothelioma or lung cancer more common in asbestosis exposure?

lung ca

COPD severity scale

FEV1 >80% mild (stage 1) >50% mod (2) >30% severe (3) <30% very severe (4)

Does coal dust increase risk of cancer

no, more coal workers pneumoconiosis or COPD

rounded opacity in the right upper zone surrounded by a rim of air, b/g of TB

Aspergilloma

What valve issue can cause haemoptysis

mitral stenosis

pulmonary haemorrhage (haemoptysis), renal impairment (rapidly progressive glomerulonephritis) and flat or saddle nose (due to a collapse of the nasal septum) is characteristic of

granulomatosis with polyangiitis.

Haemoptysis Systemically unwell: fever, nausea Glomerulonephritis

Goodpastures

commonest causes of an anterior mediastinum mass

can be remembered by the 4 T's: teratoma, terrible lymphadenopathy, thymic mass thyroid mass