Resp 2 Flashcards
Management of allergic bronchopulmonary aspergillosis (ABPA).
- sometimes introduced..
- oral glucocorticoids
- itraconazole is sometimes introduced as a second-line agent
or
-
-
-
-
pO2 of < 7.3 kPa
oe
pO2 of 7.3 - 8 kPa AND one of the following:
secondary polycythaemia
peripheral oedema
pulmonary hypertension
What must be ruled out before diagnosing ARDS?
can only be diagnosed in the absence of a cardiac cause for pulmonary oedema (i.e. the pulmonary capillary wedge pressure must not be raised)
how do you make definitive diagnosis of mesothelioma?
histology, following a thoracoscopy
patient info for CAP treatment
week 1:
week 4:
week 6:
month 3:
month 6:
CXR when?
week 1: fever should resolve
week 4: chest pain and sputum should have significantly reduced
week 6: cough and shortness of breath should have significantly reduced
month 3: most symptoms should have resolved, except for tiredness
month 6: should be returned to normal
CXR at 6 weeks
Infective exacerbation of COPD: first-line antibiotics are (3)
amoxicillin or clarithromycin or doxycycline
COPD O2 target sats should be 88-92% unless
on ABG they are seen to not be chronic CO2 retainers (normal CO2 and Bicarb normal) therefore they would just be the same as everyone else 94-98% target
Diagnostic criteria for ARDS
Clinical + CXR + pO2/fiO2 < 40kPa (300 mmHg)
NORMAL pulmonary capillary wedge pressure
Smoking Cessation:
- What can only be used in preg?
Nicotine Replacement Therapy- could try CBT first
Smoking Cessation:
Bupriopion
Start before deignated quit day and continue until several weeks after
CI:
1 drug
2 condition
3. Social (3)
CI:
1. aviod SSRI as lower seizure threshold?
2. Seizure history
3. preg, <18yo or breastbeeding
Smoking Cessation:
Varenicline
Start before deignated quit day and continue for 12 weeks
avoid in who/ PM of?
Psych illness!
CI also < 18yo, Preg or breastfeeding
Paeds Athma severity
Mod
HR
1-5yo -
>5yo -
RR
1-5yo -
>5yo-
Severe
HR
1-5yo -
>5yo -
RR
1-5yo -
>5yo-
Mod
HR
1-5yo - <140
>5yo - <125
RR
1-5yo < 40
>5yo < 30
Severe
HR
1-5yo - >140
>5yo - >125
RR
1-5yo > 40
>5yo > 30
Bronchiectasis: most common organism =
Haemophilus influenzae
Mining occupation, upper zone fibrosis, egg-shell calcification of hilar nodes → ?
silicosis
In the step-down treatment of asthma, aim for a reduction of 25-50% in the dose of inhaled corticosteroids
Important for meLess important
Alpha anti-trypsin deficiency
Background:
- Lack of…
- Produced in the…
- What is the role of Alph 1 antitrypsin?
Classic STEM-
Chromsome-
Genetic pattern-
Most who develop have the genotype…
Background:
- Lack of… protease inhibitor (Pi) produced by the liver
Role- Protects cells from enzymes such as neutrophil elastae
STEM: Young guy with COPD or emphysema non-smoker
Chromsome- 14
Genetic pattern- autosomal dominant/ co-dominant
Most who develop have the genotype… PiZZ
Alpha anti-trypsin deficiency
where in the lungs does it affect?
other manifestations (2 adults, 1 children)
-
Management
1. Conservative (2)
2. Medical (2)
3. surgical (2)
panacinar emphysema, most marked in lower lobes
adult
- Liver cirrhosis
- Hepatocellular carcinoma
kid
- cholestasis
Investigation
- A1AT concentration
- Spirometry; OBSTRUCTUVE!
Management
1. Conservative- non-smoker
2. physio
3. Med- bronchodilator
4. IV alpha1-antitrypsin protein concentrates
5. lung volume reduction surgery, lung transplantation
gauge needle for tension pneumothorax?
and where do you put it?
14 G- tension pneumoFOURax you use a FOURteen gauge needle
ATLS guidelines changed and the ideal place for tension pneumothorax
- decompression is at the 5th intercostal space anterior to the MAL. (triangle of safety)
Normal/raisedTLCO with raised transfer coefficient think (2)
- Asthma- will show OBSTRUCTIVE picture too
or
- pulmonary haemorrhage
(GoodPastures)
- falsely raised due to the CO binding to the haemoglobin in the RBC’s inside the alveoli
Sarcoidosis
Indications for treatment (6)
* rogue one in there
What do you treat with?
Indications for treatment
1. hepatic/ splenic/ cardiac / renal involvement
2. lupus pernio (cutaneous manifestation presents, blue red to violet smooth shiny nodules and plaques on the head and neck- predominantly nose, ears, lips, and cheeks.)
3. hypercalcemia
4. eye/CNS involvement
5. deteriorating pulmonary function tests
6. deteriorating chest x-ray changes
What do you treat with?
1. Oral prednisolone
2.
White out CXR look at the trachea for deviation which can give differentials
Trachea pulled towards
Trachea central
Trachea pushed away from white out
Trachea pulled towards
- pneumonectomy
- complete lung collapse e.g. endobronchial intubation
- pul hypoplasia
Trachea central
- Consolidation
- Pulmonary oedema (usually bilateral)
- Mesothelioma
Trachea pushed away from white out
- Pleural effusion
- Diaphragmatic hernia
- Large thoracic mass
