Resp 2 Flashcards
causes of exudate
pnuemonia/ infections
PE
dresslers
malignancy
connective tissue disease
pancreatitis
lupus pernio is seen in
sarcoidosis
how to differentiate LEMS from myasthenia gravis
LEMS symptoms get slightly better with use
what structural change occurs in bronchiectasis
permanent dilation of the bronchi
what do you hear on auscultation in bronchiectasis
scattered crackles, wheeze and squeaks
ix for diagnosing bronchiectasis and what you might see
high resolution CT chest
tram track opacities and ring shadows
bronchiectasis pseudomonas aerunginosa exacerbation abx choice
cipro
ix for diagnosing interstitial lung disease and what is seen
high resolution CT thorax
ground glass opacities
ground glass opacities on CT chest indicate what
ILD
medications for slowing idiopathic pulmonary fibrosis progression
pirfenidone
nintedanib
drugs causing pulmonary fibrosis
amiodarone
cyclophosphamide
methotrexate
nitrofurantoin
extrinsic allergic alveolitis involves what kind of hypersensitivity reactions
III and IV
how is extrinsic allergic alveolitis diagnosed
bronchoalveolar lavage
shows lymphocytosis
what is cryptogenic organising pneumonia
bronchiolitis obliterans previously
a focal area of inflammation
transudate vs exudate protein content
transudate <30g/L
exudate >30g/L
lights criteria
pleural fluid protein:serum protein >0.5
pleural fluid LDH: serum LDH >0.6
pleural fluid LDH greater than 2/3 normal upper limit of LDH
causes of exudate
malignancy
pneumonia
PE
rheumatoid
causes of transudate
congestive HF
hypoalbuminaemia
hypothyroidism
meigs syndrome
what side does the trachea deviate in pleural effusion
away from effusion
x ray signs of pleural effusion
blunting of costophrenic angles
fluid in lung fissures
meniscus level
tracheal deviation away from effusion
mediastinal shift
what is an empyema
an infected pleural effusion
pleural aspiration analysis for an empyema
low pH
low glucose
high LDH
pus
what mx of pleural effusion prevents recurrence
chest drain
what is a pneumothorax
when air enters the pleural space and separates the lung from the chest wall
what size pneumothorax can be manage conservatively
<2cm
safe triangle boundaries
5th intercostal space
mid axillary line
anterior axillary line
mid axillary line corresponds to
the lateral edge of the latissimus dorsi
anterior axillary line corresponds to
the lateral edge of the pectoralis major
what will you see in the chest drain that indicates the pneumothorax has resolved
no bubbling in the water
reduced swinging of water
complications of chest drain
air leak around drain site
surgical emphysema
what surgery can be used in refractory pneumothorax and what is done
VATS
pleurodesis- the lining of the pleura is irritated so it sticks to the lung
what happens in a tension pneumothorax
trauma to the chest wall breaks the pleura
this occurs in more air entering the pleural space with every breath but no air being able to escape, creating constant additional pressure on the lung
tension pneumothorax mx
insert a wide bore cannula into the 2nd ICS mid clavicular line or 4th/5th ICS anterior midaxillary line
chest drain after decompression
contraindications to LMWH for VTE prophylaxis
current bleeding
warfarin
DOAC
wells score <4
d dimer
wells score >4
CTPA
when may CTPA be unsuitable for a patient
renal impairment
contrast allergy
resp alkosis with low po2 vs high po2 indicates
low= PE
high= hyperventilation
riavroxaban dosing for PE
25mg BD for 21 days
then 20mg OD
1st and 2nd line anticoagulation for PE
1st=DOAC
2nd= LMWH
DOAC contraindications in PE mx
severe renal impariment
antiphospholipid syndrome
pregnancy
1st line anticoagulation for PE in pregnancy
LMWH
1st line anticoagulation for PE in pts with antiphospholipid syndrome
warfarin
what side of the heart does pulmonary htn strain
right
MAP pulmonary hypertension
20 mmHg
ECG changes due to right heart strain
P pulmonale (peaked p waves)
RVH
right axis deviation
right bundle branch block
RVH signs on ECG
tall r waves in V1 and V2
deep S waves in V5 and V6
causes of pulmonary hypertension
idiopathic
left heart failure
chronic lung disease
PE
what is lofgrens syndrome
a type of sarcoidosis with a triad of:
erythema nodosum
bilateral hilar lymphadenopathy
polyarthralgia
what is seen on bloods for sarcoidosis
raised ACE
hypercalcaemia
histology in sarcoidosis
non caseating granulomas
epitheloid cells
sarcoidosis mx
nothing if not needed
steroids with bisphosphonates for 6-24 months if needed
methotrexate second line
sarcoidosis prognosis
usually spontaneously resolves within 2 yrs in most patients
what is used to assess symptoms of OSA
epworth sleepiness scale
OSA mx
lifestyle= reduce weight, alcohol and smoking
CPAP
surgery if refractory- uvulopalatopharyngoplasty
