Resp Flashcards
What are the indications for long term oxygen therapy(LTOT)?
PO2 of <7.3 reading 2 weeks apart
or pO2 7.3 - 8 kPa AND one of the following: secondary polycythaemia, peripheral oedema, or pulmonary hypertension
In COPD, what does the ECG show and any cardiac symptoms associated with it?
-Right axis deviation
-Parasternal heave(Right ventricular heave)
What are changes that may be seen in COPD on an ECG?
Right axis deviation
Prominent P waves in inferior leads
Inverted P waves in high lateral leads (I, aVL)
Low voltage QRS
Delayed R/S transition in leads V1-V6
P pulmonale
Right ventricular strain pattern
RBBB
Multifocal atrial tachycardia
What happens to the DLCO value in COPD?
The patient has a history of chronic obstructive pulmonary disease. The histology finding of destruction to the alveolar walls is indicative of emphysema. In this condition the DLCO is reduced due to the destruction of the alveolar wall, the surface available for diffusion is reduced
What happens to asthma if pt takes aspirin?
Samter’s triad refers to three conditions which commonly cluster together: asthma, nasal polyps and aspirin sensitivity (sometimes also known as Aspirin Exacerbated Respiratory Disease or AERD). It is very classical for patients with asthma to have worsening symptoms following aspirin, as well as beta blockers, and great care should be taken with these medications in this population
What would you see on chest x-ray for asbestosis?
Pleural plaques and reticulonodular opacities
What is a para-pneumonic effusion defined as according to the lights criteria?
-Protein content >35g/L
-or a ratio of pleural LDH to serum LDH >0.6
How would interstitial lung disease present as and look?
s
Diagnostic criteria for ashtma in children
-First line is FeNO, if >35ppb them asthma and start on LABA/ICS
-If cant do FeNO then spirometry with bronchodilator relief and if BDR is >12% then asthma
What is squamous cell carcinoma charcaterised by and assoicated with?
Characterised by hypercalcaemia and therefore associated with Hypertrophic pulmonary osteoarthropathy (HPOA) so pt will have clubbing, bone pain or mass on bone.
croup vs epiglotitis
-Croup involves a bark like cough and inspiratory high pitched whistle
-epiglottis is sudden onset, stridor, drooling of saliva
What is ARDS and what can it be secondary to and how may it present?
Its pulmonary oedema which is not cardiogenic and chest x-ray reveals bilateral alveolar infiltrates, and cardiothoracic ratio of <0.5
What is given to patients with aspiration pneumonia and what can this do to the INR if pt is on Warfarin?
Metronidazole as pts with aspiration pneumonia are more likely due to oropharyngeal anaerobes
-INR increases as it potentiates action of warfarin
What can strep pneumonia reactivate in a patient?
Herpes labialis and therefore pts infected with this strain will have reappearance of cold sores around lips
Clinical findings for bronchiectasis
-Pts with hx of arthritis
-Finger clubbing
-Production of a lot of sputum with persistent cough
-Coarse inspiratory crepitation
What staining is used for pneumonia and what is the most common sign of it on an x-ray?
-Ziehlls nelson stain and tests postiive for acid-fast bacili
-Cavity formations is the most common sign on x-ray
Indications to intubate in asthma exacerbation
If there PCO2 is normal as they’re tiring out from hyperventilating and it wont be long before they become hypercapnic
Diagnostic criteria for asthma in adults
-FeNO >50ppb to be diagnostic
-Eosinophils >0.6
What is ileocaecal TB?
Type of extrapulmonary TB
-Most common type in GI TB
-Night sweats, fevers, mass in right lower quadrant
-Homelessness is a RF
How would a lung malignancy present in a patient?
-Blood in cough, weight loss, shortness of breath
-Pleural fluid is exudative pattern as LDH >0.6 and protein >35g/L
Lambert-eaton myasthenic syndrome presentation, whats it caused by and what antibody
-muscle weakness that gets better with exertion
-Ptosis
-Caused by small cell lung cancer
-VGCC antibody
When would it be mycoplasma in pneumonia?
-Low Hb
-Skin lesions(erythema multiforme)
-Raynauds
What do you give for severe pneumonia?
Co-amoxiclav and sometimes clarithromycin with it
What is Mx for COPD?
-Saba or Sama
-Then Laba + ICS or LABA+LAMA
-SABA/SAMA + LABA + LAMA + ICS
When would you use bipap vs CPAP in COPD?
Type 1 resp failure - CPAP
Type 2 resp failure - BiPAP
What would spirometry results be for bronchioectasis?
Reduced FEV1/FVC ratio as its obstructive
What is the most likely organism that would cause Hospital acquired pneumonia in a patient that has been in hospital for longer than 5 days?
Pseudomonas aeruginosa, Haemophilus influenzae, methicillin-resistant staphylococcus aureus, and other non-pseudomonal gram-negative bacteria
What mx would reduce exacerbation of bronchoectasis?
Postural drainage
What is the most common ECG finding in patients with PE?
Sinus tachycardia
If young patient comes in and has COPD, think whay?
alpha-1 antitrypsin defciency
What is alpha-1 antitrypsin?
It is a protease inhibitor that inhibits neutrophil elastase in the lungs
Ix for asthma
First line: FeNO or blood eosinophil
Second line: Spirometry before and after bronchodilator use
Where does fibrosis occur in the lungs for TB and asbestosis?
In Tb- Upper lobes
-Asebestosis- Lower lobes
What is the most common cause of transudate vs exudate pleural effusion?
Transudate:-liver, kidney or heart failure
Exudate: infection or malignancy
If patient has had recent flu and has painless haematuria, what would we see on a renal biopsy?
IgA deposition in the mesangium
Mx for exacerbation of asthma
Oh shit i hate my asthma
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