Resp Flashcards
Classification of airflow limitation
- Mild: FEV1 >80% - but FEV/FVC 0.7 and syptomatic
- Mod: FEV1 50-79%
- Severe : 30-49%
- Very severe: Fev1
BODE index
Define: multidimensional tool to predict mortality in COPD
BMI
Obstruction: FEV1
Dyspnoea: MRC score
Exercise capacity - 6 minute walk
Light’s criteria
Used to diagnose of an exudative effusion
Effusion: serum protein ratio > 0.5
Effusion: serum LDH ratio > 0.6
Effusion LDH IS 0.6 time the limit of normal
Cause of pleural effusion.
Transudate - less than 25gL
- CCF
- renal failure
- low albumin: nephrotic syndrome, liver failure, enteropathy
- meig syndrome: right sided pleural effusion, ascites and ovarian fibroma
Exudate - protein > 35g/l
- infection: pneumonia, TB
- neoplasm: primary or secondary
- inflammation: RA, SLE
- infarction: PE
- trauma
Stages of clubbing
- Bogginess/increased fluctuate of nail bed
- Loss of concave nail fold angles
- Increased longitudinal and transverse curvature
- Soft tissue expansion of distal phalanx
Features of life threatening Asthma
CHEST Cyanosis Hypotension Exhaustion, confusion Silent chest, poor resp effort Tachyarrhythmia or bradyarrhytmias
PEFR4.6kpa, PaO2
Features of severe asthma
PEFR : 33-50%
Can’t complete sentences in one breath
RR>25
HR>110
Cause of pulmonary fibrosis
Environmental: asbestosis and silicosis
Drugs: bleomycin, amiodarone, nitrofuratonin, sulfasalazine, methotrexate
Hypersentivity: EAA
Infection: TB, viral,funghi
Associated systemic disease: sarcoid, RA, SLE, Systemic sclerosis, UC, anksponk, sjogrens
Kartageners syndrome
Situs inversus
Chronic sinusitis
Bronchiectasis
Young syndrome
Bronchiectasis
Rhinosinusitis
Azoospermia
mMRC Dyspnoea score
- SOB only on vigorous exercise
- SOB only on hurrying or walking up stairs
- Walks slowly or has to stop for breath
- Stops for breath after
CURB - 65
Confusion - AMTS less than on equal to 8
Urea - 7mM
Resp rate > 30/min
BP = 90/60
0-1 - home
2 - hospital
3 consider ITU
SIRS
Inflammatory response to a variety of insults manifest by >=2 of
- Temp >38 or 90
- RR> 20
- WCC >12x10^9 or less than 4
Sepsis
SIRS caused by localised infection
Severe sepsis
Sepsis with at least 1 organ dysfunction or hypoperfusion
Septic shock
Severe sepsis with refractory hypotension
MODS
Impairment of >=2 organ system
Homeostasis can not be maintained without therepeutic intervention
Complications of pneumonia
Septic Shock and multi organ failure
Para-pneumonic effusions/empyema
Abscess: S. Aureus, klebsiella, anerobes
Resp failure
Side effects of TB medication
Rifampacin: hepatitis, orange secretions, enzyme induction
Isoniazid: peripheral sensory neuropathy
Pyrazinamide: hepatitis, arthralgia
Ethambutol - optic neuritis - loss of colour vision first
Indication for long term oxygen therapy
Stable non-smokers with Pa02
Aim of long term oxygen therapy in COPD
PaO2 8>= for greater than or equal to 15 hours a day
Increase survival by 50%
Chronic medial management of Asthma
- Inhaled short acting B2 agonist prn
- Inhaled corticosteroids- 200-800 micro gram a day
- Add long acting b2 agonist and asses response. If inadequate or no response increase steroids to 800mg and consider addition of a leukotrine receptor antagonist
- Trial of steroids - 2000ug/day - consider addition of other drugs
- Continuous use of frequent oral steroids
CURB - 65
Confusion - AMTS 7mM
Resp rate > 30/min
BP = 3 consider ITU
SIRS
Inflammatory response to a variety of insults manifest by >=2 of
- Temp >38 or 90
- RR> 20
- WCC >12x10^9 or less than 4
Sepsis
SIRS caused by localised infection
Severe sepsis
Sepsis with at least 1 organ dysfunction or hypoperfusion
Septic shock
Severe sepsis with refractory hypotension
MODS
Impairment of >=2 organ system
Homeostasis can not be maintained without therepeutic intervention
Complications of pneumonia
Septic Shock and multi organ failure
Para-pneumonic effusions/empyema
Abscess: S. Aureus, klebsiella, anerobes
Resp failure
Side effects of TB medication
Rifampacin: hepatitis, orange secretions, enzyme induction
Isoniazid: peripheral sensory neuropathy
Pyrazinamide: hepatitis, arthralgia
Ethambutol - optic neuritis - loss of colour vision first
Indication for long term oxygen therapy
Stable non-smokers
Oxygen less than 7.3
Oxygen 7.3 - 8 and evidence of any of the following: secondary polycythemia, nocturnal hypoxemia, peripherals odema and pulmonary HTN
Aim of long term oxygen therapy in COPD
PaO2 8>= for greater than or equal to 15 hours a day
Increase survival by 50%
Definition of chronic bronchitis
Cough and sputum production on most days for 3 months of 2 successive year
Definition of emphysema
Histopathalogical diagnosis of enlarged air spaces distal to terminal bronchioles with destruction of alveolar walls
Wells score
Clinical signs and symptoms of a DVT - 3
Alternative diagnois is less likely than a PE - 3
HR>100 bpm -1.5
Immobilisation or surgery in previous 4 weeks - 1.5
Previous DVT/PE - 1.5
Heamoptysis - 1
Malignancy - 1
Complications of COPD
Acute/infective excaerbations Pulmonary HTN pneumothorax Polycythemia Lung cancer
Parameters used in the gold classification
mMRC dyspnoea score
Airflow limitation
Numbers of excaerbations a year
Complication of pneumonia
Resp failure Hypotension AF Pleural effusion - exudative Empyema Lung abcess Sepsis Jaundice - can be due to sepsis, drugs or bacteria specific
Detention of asthma
Episodic, reversible airway obstruction due to bronchial hyper-reactivity to a variety of stimuli
Complication of lung cancer
Local - bronchial obstruction: collapse of distal airway and increased infection risk - invasion of local structures: SVC, oseophagus( dysphagia) nerves - recurrent laryngeal, sympathetic( Horners) phrenic - AF -lymphatic carcinomoatosis Parenoplastic - SIADH - cushings - serotonin - PTHrp - dermtomyositis - cerebellar degeneration Metastatic - pathological fracture - hepatic failure - confusion fits, focal Neuro - Addisons
Assessment of risk in lung cancer surgery
Thoroscore - based on cardiorepsitiory function and co- morbidities
Definition of pulmonary hypertension
Pulmonary aterial pressure >25mmHg
Cause of pulmonary hypertension
Left heart disease e.g. MS, MR
lung parenchymal disease e.g. COPD, interstitial lung disease
Pulmonary vascular disease e.g. Idopathic pulmonary HTN, PE
Hypoventillation: OSA, thoracic cage abnormality, neuromuscular
Gold standard for diagnosis of pulmonary HTN
Right heart catheterisation
Complication of pulmonary HTN
Cor pulmoanle
Supraventricular tachyarrhythmia
Definition of cor pulmonale
RHF due to chronic pulmonary hypertension
Signs of cor pulmonale
Increased JVP with prominent a waves Left parasternal heave Loud P2 and S3 Graham steel Tricuspid regurgitation
Cause of apical fibrosis
Aspergillosis ABPA Pneumoconiosis - coal and silica Extrinsic allergic alveoltitis Ankylosis spondylitis TB
