Resp Flashcards
spirometry pattern in ILD
normal/reduced FEV1
reduced FVC
increased FEV1/FVC
restrictive pattern
Leukotriene receptor antagonist example
montelukast
management of obstructive sleep apnoea
- weight loss
- CPAP
preventing acute mountain sickness
Acetazolamide (a carbonic anhydrase inhibitor)
COPD criteria for LTOT
on 2 separate occasions, 3 weeks apart
Offer LTOT to patients with a pO2 of < 7.3 kPa
OR to those with a pO2 of 7.3 - 8 kPa and one of the following:
secondary polycythaemia
peripheral oedema
pulmonary hypertension
most common organism causing infective exacerbations of COPD is
Haemophilus influenzae
chronic infection with what organism is an important CF-specific contraindication to lung transplantation
Burkholderia cepacia
Vital capacity in male vs woman?
4,500ml in males, 3,500 mls in females
Pulmonary arterial hypertension is defined
as an elevated pulmonary arterial pressure of greater than 25mmHg at rest or 30mmHg after exercise
Causes of bilateral hilar lymphadenopathy
Infection: tuberculosis
Inflammation:
- sarcoidosis
pneumoconiosis e.g. berylliosis
fungi e.g. histoplasmosis, coccidioidomycosis
Malignancy:
lymphoma/other malignancy
what is a Catamenial pneumothorax?
is the cause of 3-6% of spontaneous pneumothoraces occurring in menstruating women. It is thought to be caused by endometriosis within the thorax.
Eosinophilic granulomatosis with polyangiitis (EGPA) is now the preferred term for Churg-Strauss syndrome
Key features
asthma
blood eosinophilia (e.g. > 10%)
paranasal sinusitis
mononeuritis multiplex - nerve issue
pANCA positive in 60%
Leukotriene receptor antagonists (eg. monteleukast) may precipitate the disease.
HLA associations
HLA-DR1: bronchiectasis
HLA-DR2: systemic lupus erythematous (SLE)
HLA-DR3: autoimmune hepatitis, primary Sjogren syndrome, type 1 diabetes Mellitus, SLE
HLA-DR4: rheumatoid arthritis, type 1 diabetes Mellitus
HLA-B27: ankylosing spondylitis, postgonococcal arthritis, acute anterior uveitis
Lung cancer: paraneoplastic features
Small cell:
ADH
ACTH - not typical, hypertension, hyperglycaemia, hypokalaemia, alkalosis and muscle weakness are more common than buffalo hump etc
Lambert-Eaton syndrome
Squamous cell:
parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia
clubbing
hypertrophic pulmonary osteoarthropathy (HPOA)
hyperthyroidism due to ectopic TSH
Adenocarcinoma:
gynaecomastia
hypertrophic pulmonary osteoarthropathy (HPOA)
upper zone fibrosing lung disease
‘egg-shell’ calcification of the hilar lymph nodes
silicosis
what is - Light’s criteria
- exudates have a protein level of >30 g/L, transudates have a protein level of <30 g/L
cavitating pneumonia
s.aureus
‘cherry red ball’ often seen on bronchoscopy
lung carcinoid tumour
which pneumonia is most associated with cold sores?
Streptococcus pneumoniae
Resp physiology: chloride vs Bohr vs Haldane effects
Chloride shift
CO2 diffuses into RBCs
CO2 + H20 —- carbonic anhydrase -→ HCO3- + H+
H+ combines with Hb
HCO3- diffuses out of cell,- Cl- replaces it
Bohr effect
increasing acidity (or pCO2) means O2 binds less well to Hb
Haldane effect
increase pO2 means CO2 binds less well to Hb
Contraindications to lung cancer surgery include
SVC obstruction, FEV < 1.5, MALIGNANT pleural effusion, and vocal cord paralysis
Management
Allergic bronchopulmonary aspergillosis
oral glucocorticoids
itraconazole is sometimes introduced as a second-line agent
A chest-x-ray demonstrates bilateral consolidation with superimposed areas of lucency
cavitating lesions
s.aureus
klebsiella (alcoholics)
tb
Mycoplasma diagnostic test
serology
Acute epiglottitis organism
is caused by Haemophilus influenzae type B
deciding between transudate vs exudate
exudates have a protein level of >30 g/L, transudates have a protein level of <30 g/L
if the protein level is between 25-35 g/L, Light’s criteria should be applied. An exudate is likely if at least one of the following criteria are met:
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
the most common cause of occupational asthma
Isocyanates
what is the haldane effect?
This is known as the Haldane effect, which describes how oxygenation of haemoglobin (Hb) in the lungs promotes the dissociation of carbon dioxide (CO2) from Hb. When the partial pressure of oxygen (pO2) increases, it lessens the affinity of Hb for CO2, causing it to be released and exhaled through the lungs.
A fall in the partial pressure of oxygen in the blood leads to vasoconstriction of the pulmonary arteries. This allows blood to be diverted to better aerated areas of the lung and improves the efficiency of gaseous exchange
Contraindications to lung cancer surgery
include SVC obstruction, FEV < 1.5, MALIGNANT pleural effusion, and vocal cord paralysis, stage IIIb or IV (i.e. metastases present)
investigation of choice for upper airway compression
Flow volume loop
Which type of secondary messenger system does nitric oxide stimulate?
cyclic GMP
(remember, adrenoreceptors work via cyclic AMP
insulin and growth hormone via tyrosine kinase)
Drugs causing lung fibrosis
amiodarone
cytotoxic agents: busulphan, bleomycin
anti-rheumatoid drugs: methotrexate, sulfasalazine
nitrofurantoin
ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)
classifying severity of COPD
1) confirm post bronchodilator FEV1/FVC is <0.7
2) The severity of COPD is categorised using the FEV1 (of predicted)
> 80% is stage 1 mild
50-79% is stage 2 moderate
30-49% is stage 3 severe
<30 is stage 4 very severe
diagnosing asthma tests
both a FeNO test (high NO indicates high inflammation) and spirometry with reversibility (positive if 12%increase)
The treatment for aspergilloma, especially in those with significant haemoptysis, is?
surgical resection
Pneumocystis jiroveci pneumonia common complication
- pneumothorax
salbutamol drug class
beta 2 agonist
treatment latent TB
3 months of isoniazid with pyridoxine and rifampicin
OR
6 months of isoniazid with pyridoxine
meningeal tuberculosis mx
RIPE (at least 12 months) with the addition of steroids
the most useful marker for monitoring the progression of patients with chronic obstructive pulmonary disease (COPD).
Forced expiratory volume in one second (FEV1)
superior vena cava (SVC). What is the most likely cause
primary malignancy
SOB after chest drain for pneumothorax
re-expansion pulmonary oedema (RPE)
likely due to rapid drainage of pleural fluid/air
BIPAP initial settings
IPAP = 10 cm H2O;
EPAP = 5 cm H2O
Zanamivir (Relenza) is an antiviral medication used to treat and prevent influenza. It works by inhibiting the neuraminidase enzyme, thus preventing the release of new virus particles from infected cells. However, it can cause bronchospasm in patients with underlying respiratory diseases such as asthma or chronic obstructive pulmonary disease (COPD). UK guidelines recommend caution when prescribing zanamivir in patients with these conditions due to the risk of exacerbation of their symptoms.
Pneumocystis jirovecii pneumonia treatment
co-trimox
or IV pentamidine
Steroids are also given if there is severe hypoxaemia
Determining if a pleural aspirate is transudate or exudate
exudates have a protein level of >30 g/L, transudates have a protein level of <30 g/L
if the protein level is between 25-35 g/L, Light’s criteria should be applied. An exudate is likely if at least one of the following criteria are met:
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
what kind of pleural effusion is caused by Dressler’s syndrome
exudative
what kind of pleural effusion is caused by Meigs’ syndrome
transudative
CURB score meaning
total CURB-65 score is 2. This score is related to a 30-day mortality risk around 9% and it is advised that management should be hospital admission. A score of 3 or more would suggest a higher level of care may be required. A score of 0 or 1 would suggest that admission is not likely to be required (unless for social reasons or unstable comorbid illness) and that oral antibiotics can be used. I
