Resp Flashcards
Asthma Acute Mx
1 - high dose inhaled SABA
2 - 40-50 mg PO Prednisolone - 5/7
3 - Nebulised Ipratropium bromide (SAMA)
4 - IV Mg Sulph
5 - IV aminophylline
Cough, sore throat, wheeze, nil creps/crackles
Acute Bronc
Conservative Mx
Common inf caused of ieCOPD
H Inf
Step Pneu
RSV
Features of emphysema/COPD in young non-smoker
A1 Antitrypsin def
spiro = obstructive picture
Tx - supportive, surg (lung vol reduction)
Asthma Tx ladder in age > 12
1 - low dose ICS/Formetorol inhaler PRN
2 - Low dose MART (combi inhaler daily meintenance + PRN)
3 - mod dose MART
4 - check FeNO + eosinophil count - if raised, refer specialist care
if not raised - add LTRA or LAMA to MART
Causes of bilat hilar lymphadenopathy
Sarcoidosis
TB
Lymphoma
Features of pulmo oedema on Xray
interstitial oedema, bats wing appearance, kerley B lines, pleural effusion, cardiomeg
COPD Staging
NB - COPD = post bronch dilator therapy - FEV1:FVC < 0.7
Stage 1 - FEV1 > 80% predicted
2 = 50-79% predicted
3 = 30-49% predicted
4 = < 30% of predicted
COPD Mx
One-off Pneumococcal + Annual influenza Vacc
1 - SABA / SAMA (ipratropium) PRN
2 - Check for asthma features (raised eosinophil count, diurnal variation)
+ve - Regular LABA +ICS w/ SABA/SAMA prn
-ve - Regular LABA + LAMA w/ SABA prn
3 - LAMA + LABA + ICE reg w/ SABA prn
If prophylaxis req - PO azithro
Rescue pack = steroids + PO Abx (if had an exacerbation in last year)
Asthma, eosinophilia, paranasal sinusitis, renal involvement, SOB, vasculitis
pANCA +ve
Churg Strauss syndro
(Eosinophilic granulomatosis with polyangitis)
ACNCA asso small vessel vasculitis
Sinusitis, nasal crusting, SOB, Haemoptysis, strange shaped nose, renal involvement
cANCA +ve
Wegeners Granulomatosis
(Granulomatosis with polyangitis)
Saddle-shaped nose deformity, rapidly progressive glomerulonephritis
Progressive exertional SOB
CXR - bilat interstitial shadowing (small, irreg, periph opacities) `
Idiopathic pulmo fib
CXR - ground glass -> honeycombing
Paraneoplastic features ScLC
Nb - cancer usually central
ADH (SIADH) -> hyponat
ACTH - > (cushings) HTN, hypergly, hypokal, muscle weakness
Lambert eaton syndro
Paraneoplastic features SqcLC
PTH sec -> hypercal
Clubbing
hyperthyroid
Lung cancer in non smoker
Adeno
Key indications for NIV
COPD with resp acidosis (7.25-7.35)
T2RF secondary to chest wall deformity, NMD or OSA
Cardiogenic pulmo oedema unresponsive to CPAP
Pleural effusion - Ix
Ix - pleural aspirate with 50ml syringe and 21G needle
Lights criteria
Exudate = prot level > 30, transudate = prot level < 30
if 25-30 - apply lights criteria
Exudate likely if:
Pleural prot > 0.5 serum prot
Pleural LDH > 0.6 Serum LDH
Pleural fluid Mx
If Aspirate cloudy - chest tube
If aspirate clear but pH < 7.2 - chest tube
Pneumonia in COPD
H Inf
Pneumonia post recent viral illnes
Staph A (post influenza)
Dry cough, atypical chest signs, erythema multiforme, AIHA
Mycoplasma pneumonia
Dry cough, chest crackles, hyponat
Legionella pneumonia
Commonly from infected air con units
Alcoholic with pneumonia
Kleb
dry cough, exercise induced saturation, clear chest
Pneumocystis jiroveci
Common ly seen in HIV/immunocomp
