Resp Flashcards
Classification system for COPD?
GOLD classification
- mMRC dyspnoea score
- Airflow limitation
- Number of exacerbations per year
Non medical Mx of COPD?
MDT approach, regular review
Smoking cessation
Pulmonary rehab therapy (exercises, education, psychosocial support)
Medical Mx of COPD?
SABA, then anti muscarinics and LABA, then inhaled corticosteroids
LTOT if low PaO2/cor pulmonale/polycythaemia
Mx of acute exacerbation of COPD?
Sit up, 24% O2 via venturi mask, keep sats between 88-92%
Salbutamol 5mg/ipratropium 0.5mg nebs
Hydrocortisone 200mg IV/Prednisolone 40mg PO
Antibiotics if evidence of infection
What is the BODE index?
Used to predict mortality in COPD
BMI
Obstruction: FEV1
Dyspnoea mMRC score
Exercise capacity: 6 min walk
Define asthma
Episodic, reversible airway obstruction due to bronchial hyper reactivity
What Ix would you do for asthma?
Bedside: PEFR
Bloods: FBC, IgE, aspergillus serology
CXR: hyperinflation
Spirometry: would show obstructive picture, FEV1:FVC <70%
Atopy: skin prick test
Non medical asthma Mx
MDT TAME
MDT approach Technique for inhaler use Avoidance of triggers and allergens Monitor with peak flow Educate
Medical Mx of asthma
SABA \+ ICS low dose \+ LABA \+ ICS higher dose/LTRA/LAMA \+ Specialist care, another of above \+ Steroid tablet
Example of SABA, ICS, LABA, LTRA, LAMA
Salbutamol - SABA Budesonide / beclametasone - ICS Salmeterol - LABA Montelukast - LTRA Tiotropium - LAMA
Causes of ILD?
UPPER - "TB SPACE" TB Sarcoidosis Pneumoconiosis Ankylosing spondylitis Cystic fibrosis Extrinsic allergic alveolitis
LOWER - "ACID" Asbestosis Connective Tissue disease Idiopathic pulmonary fibrosis Drugs
DRUGS - “AMEN”
Amiodarone
Methotrexate
Nitrofurantoin
What would spirometry and HRCT show in ILD?
Restrictive, FEV1:FVC > or equal to 70%
Honeycomb lung
What is bronchiectasis?
Chronic, permanent dilation of bronchi caused by repeated cycles of airway inflammation and infection
Causes of bronchiectasis?
Congenital:
CF
Alpha 1 antitrypsin deficiency
Hypogammaglobulinaemia
Infectious:
TB
Pertussis
Rheumatological:
RA
SLE
Sjogren’s
Ix for bronchiectasis?
Bloods: included RA screen Abs
CXR: tramlines and ring shadows (bunch of grapes)
Signet ring sign
Spirometry: obstructive
Complications of bronchiectasis?
Cahexia
Pulmonary HTN
T2 resp failure
Mx of bronchiectasis?
Conservative: MDT, physio
Medical: Abx Bronchodilators Treat underlying cause VACCINATIONS (influenza, pneumococcus)
What is Kartagener’s?
Autosomal recessive defect in ciliary motility
Poor mucociliary clearance
Reduced sperm motility in males
Situs inversus
Cystic fibrosis pathophysiology and inheritance?
Autosomal recessive
Mutation in CFTR gene
Reduced luminal Cl- secretion and Na reabsorption causing viscous secretions
Dx of cystic fibrosis?
Sweat test, Na and Cl >60mM
Faecal elastase; tests pancreatic exocrine function
Genetic screening
Mx of CF
MDT
Chest: Physio; postural drainage Abx Mycolytics Vaccinations: flu, pneumococcus
GI:
Pancreatin (creon)
ADEK supplements
Insulin
Pleural effusion causes?
Transudate:
Protein <25
Often bilateral
Causes: CCF, renal failure, low albumin
Exudate:
Protein >35
Often unilateral
Causes: infection, cancer, inflammation (RA, SLE)
Ix for pleural effusion
Sputum: MC+S, cytology
CXR: Homogenous opacification
Volumetric CT
Bloods: look for high creatinine, low albumin, etc
DIAGNOSTIC PLEUROCENTESIS, look for
- Chemistry
- Bacteriology
- Cytology
- Immunology
Pleural biopsy if inconclusive
Criteria for Dx of exudative effusion?
Transudate = protein <25g/L
Exudate = protein >35g/L
Between the two, apply Light’s criteria (lactate dehydrogenase and serum protein ratio)
Treatment of pleural effusion?
Rx underlying cause
Drainage if symptomatic
Lung cancer peripheral inspection
Hands and face: Cachexia Clubbing Tar staining Horner's syndrome Plethora
Chest:
Thoracotomy scar
Radiotherapy burns/tattoos
Acanthosis nigricans
Lung:
COLLAPSE or EFFUSION
Complications of lung cancer on examination?
SVCO
Horner’s syndrome
Recurrent laryngeal nerve palsy
Pneumonectomy and lobectomy on examination?
Tracheal shift
Reduced expansion
Reduced (lobectomy) or absent breath sounds (pneumonectomy)
Indication for lobectomy/pneumonectomy?
Bronchial carcinoma
Bronchiectasis
COPD; lung reduction surgery
TB; historic
Types of lung cancer?
Small cell
Non small cell:
- SCC
- Adenocarcinoma
- Large cell
Paraneoplastic lung tumours?
ADH → SIADH (euvolaemic ↓Na+)
ACTH → Cushing’s syndrome
Serotonin → carcinoid (flushing, diarrhoea)
PTHrP → 1O HPT (↑Ca2+, bone pain)
Ix for lung cancer?
Bloods FBC (anaemia, WCC) U+E (SIADH) LFT (mets) Bone profile (higher Ca)
Imaging
CXR
Contrast volume CT
Cell analysis
Cytology (pleurocentesis)
Histology (FNA)
Staging CT PET Radionucleotide bone scan Thoracoscopy/mediastinoscopy
Mx of lung cancer?
General: smoking, MDT, nutrition
NSCLC: Surgery (wedge resection, lobectomy) and chemo (platinum based and biologics)
SCLC: Usually disseminated at presentation, chemo my have benefit
Palliative: Radiotherapy (haemoptysis or bone mets), anagesia, stent for SVCO
Prognosis for lung cancer?
NSCLC: 50% 5ys w/o spread; 10% with spread
SCLC: 1-1.5yrs median survival treated; 3mo untreated
HAP vs CAP? Microbes?
CAP:
- Pneumococcus, mycoplasma, haemophilus
HAP: (>48 hours after admission)
- Pseudomonas, MRSA
How to assess severity of pneumonia?
CURB65 score
Confusion Urea Resp rate BP >65 years old
Determines whether they need home, hospital or ITU management (>3)
TB medical treatment?
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
RIPE for 2 months, RI for 4 months
Side effects of rifampicin and isoniazid?
Rifampicin: orange secretions, liver enzyme inducer
Isoniazid: peripheral neuropathy, agranulocytosis, liver enzyme inhibitor
Where to insert a chest drain?
“triangle of safety”: anterior to mid axillary line, posterior to pectoral groove, above 5th intercostal space
Define COPD
Chronic bronchitis (productive cough most days of >3 months on 2>years)
Emphysema
Peripheral signs of COPD
Bounding pulse
CO2 retention flap
Tar staining
Plethora
Complications of Lung Cancer
SVCO
Pancoast’s tumour causing Horner’s syndrome
Recurrent laryngeal nerve palsy
Follow up pneumonia
CXR after 6 weeks to look for underlying cancer and resolution
Primary TB
Ghon focus then forms Ghon complex
Latent TB can be reactivated to secondary TB
Ix for active TB
CXR; if suggestive, take >3 sputum samples
Microscopy for acid fast bacilli (Ziehl Neelsen stain)
Culture in Lowenstein-Jensen media
What is alpha-1-antitrypsin deficiency?
Genetic disorder, onset 20s-50s
Results in not enough A1AT
Associated with COPD, cirrhosis, cancer
Vaccines recommended
Tx with bronchodilators, steroids, Abx
