Resp Flashcards
The Symbicort inhaler consists of which two drugs?
Budesonide (steroid)
Formeterol (long-acting beta agonist)
Name an anti-muscarinic drug that is used to treat COPD.
Tiotropium
What is an important complication of COPD?
Pulmonary hypertension
How is COPD a risk factor for pneumothorax?
COPD leads to the formation of bullae (an air pocket that replaces lung tissue)
List causes of sudden-onset breathlessness (within seconds).
PE
Pneumothorax
Foreign body
NOTE: anxiety can also cause sudden-onset breathlessness
List causes of breathlessness that develops over minutes/hours.
Problems with the airways (inflammation/obstruction)
Pus in the interstitium (due to chest infection (e.g. pneumonia))
Fluid in the interstitium (due to acute heart failure)
Blood in the lungs (pulmonary haemorrhage)
List causes of breathlessness that develops over days/weeks.
Interstitial lung disease Malignancy Large pleural effusion Neuromuscular Anaemia/thyrotoxicosis
What is CPAP and what is it used for?
Continuous positive airway pressure
It provides positive airway pressure that keeps the airways open
It IMPROVES OXYGENATION
It is used in people with type 1 respiratory failure
E.g. if someone has pulmonary oedema and is not getting better, you may give them CPAP
Describe the management of a primary pneumothorax that is:
< 2 cm
> 2 cm
< 2cm Discharge and repeat CXR > 2 cm Aspiration If that fails, insert a chest drain
Describe the management of a secondary pneumothorax that is:
< 2 cm
> 2 cm
< 2cm
Aspiration
> 2 cm
Chest drain
What important feature of the chest drains must the patient be made aware of when they have on put in?
There is an underwater seal and it should be bubbling as the air comes out
It should be kept below waist height
State a cause of homogenous white shadowing in the lung field on CXR.
Pleural effusion
State a cause of reticulo-nodular shadowing on CXR
Interstitial lung disease (e.g. pulmonary fibrosis)
State causes of fluffy white shadowing on CXR.
.
Pus – e.g. pneumonia
Fluid – e.g. pulmonary oedema
What is the first step in the acute management of a patient with PE?
What are RBBB and Right Axis Deviation signs of?
High flow oxygen
State three ECG changes that may be seen in a patient with PE.
S1Q3T3
RBBB
Right axis deviation
How do you determine axis deviation on an ECG?
Look at leads I and II – are either of them overall negative?
If either of them is overall negative – there is axis deviation
Then look at lead aVL
What are RBBB and Right Axis Deviation signs of?
Right sided heart strain
What is the next step in the acute management of a patient with PE?
Low molecular weight heparin (e.g. enoxaparin, tinzaparin, dalteparin)
Explain BiPAP.
Form of non-invasive ventilation
Provides positive pressure outside the lungs at the beginning of inspiration (iPAP) so that air goes into the lungs
When the patient expires, the pressure doesn’t drop down to zero, it is maintained at an expiratory positive airway pressure (ePAP)
NOTE: if iPAP = ePAP then it is CPAP
In what condition is BiPAP used?
Respiratory acidosis
NOTE: COPD can cause CO2 retention and respiratory acidosis
Why is it important to continue LMWH for a few days once warfarin has been started?
Because warfarin causes a transient procoagulant phase due to the inhibition of protein C and protein S
LMWH needs to be continued for a few days until INR remains within the target range for > 24 hours
What are the indications for thrombolysis in a case of PE?
Massive PE and blood pressure has dropped (haemodynamic compromise)
What is the main diagnostic test for PE?
CTPA
What important type of medication should patients a pneumothorax requiring a chest drain be put on?
Regular analgesia (the chest drain is very painful)
What is a bulla?
A thin-walled air-filled space within the lung, arising congenitally or in emphysema. It may cause trouble by rupturing into the pleural space causing a pneumothorax.
Describe the difference in FEV1/FVC for restrictive and obstructive lung disease.
Obstructive: < 70%
Restrictive: > 70%
Describe the differential diagnosis of reticulo-nodular shadowing on CXR.
Idiopathic fibrosing alveolitis
Connective tissue disease (e.g. SLE, scleroderma)
Drugs (e.g. methotrexate, nitrofurantoin)
Asbestosis (ship builder?)
Define asbestosis.
Pulmonary fibrosis due to asbestos
NOTE: the presence of plaques of asbestos does NOT constitute asbestosis
How many anterior ribs must be visible to consider the lungs as being hyperinflated?
7 ribs
What causes hyperinflation of the lungs?
COPD
Which parts of the lungs does pulmonary TB tend to affect most?
Upper lobes
What respiratory condition is keeping pigeons a risk factor for?
Extrinsic allergic alveolitis
What features of an X-ray are important to comment on when presenting an X-ray?
PA/AP X-ray Name and DOB Date and time Rotation – spinous processes should be equidistant from the two ends of the clavicles Inspiration Penetration
What is a classic feature of right middle lobe pneumonia on CXR?
You cannot see the right heart border
What should you always be able to see behind the heart on CXR?
Right hemidiaphragm
If you can’t see it then consider collapse and consolidation
What does homogenous white shadowing on a CXR indicate?
Pleural effusion
What does fluffy white shadowing on CXR indicate?
Pulmonary oedema
What does reticulo-nodular shadowing show on CXR?
Pulmonary fibrosis (interstitial lung disease)
State two conditions that can cause total white shadowing across an entire lung field.
Massive pleural effusion
Lung collapse
What feature of the CXR would help you differentiate between these causes?
Deviation of the trachea
Pleural effusion – away from the affected side
Collapse – towards the affected side
State three causes of a cavitating lung lesion with an air-fluid level.
Infection (e.g. TB, Klebsiella)
Inflammation (e.g. rheumatoid arthritis)
Malignancy (e.g. squamous cell carcinoma)
Describe the appearance of a pericardial effusion on CXR.
The heart has a globular appearance
It will be homogenous white
List three causes of bilateral hilar lymphadenopathy.
TB
Sarcoidosis
Lymphoma
