resp Flashcards
lung Ca causing SIADH
small cell carcinoma
mx of person with frequent IECOPD
home Abx (if purulent or clinical signs of pneumonia) and prednisolone 30mg (plus bronchodilator frequency increased)
mx COPD
SABA/SAMA
LABA +ICS
LAMA LABA ICS
pneumoconiosis where are opcaities
upper zones
Small cell cancer special features
ADH → hyponatraemia
ACTH → Cushing’s syndrome
ACTH secretion can cause bilateral adrenal hyperplasia, the high levels of cortisol can lead to hypokalaemic alkalosis
Lambert-Eaton syndrome: antibodies to voltage gated calcium channels causing myasthenic like syndrome
phases of churg strauss
1 allergy rhinitis asthma
2eosinophilia
3 vasculitis pANCA
severe asthma
PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm
buproprion contraindicated in
epilepsy
fev1 in moderate (stage 2 copd)
50-79% (very severe <30%)
sleep apnoea scale
epworth
Facial rash plus lymphadenopathy
sarcoidosis
causes ARDS
infection: sepsis, pneumonia massive blood transfusion trauma smoke inhalation acute pancreatitis cardio-pulmonary bypass
lung mets caused by
breast cancer colorectal cancer renal cell cancer bladder cancer prostate cancer (before computers people read books)
smoking cessation in preggo
none or nicotine replacement patch
long term o2 therapy if
pO2<7.3 twice
asbestos causes
benign pleural plaques asbestosis- lower lobe fibrosis mesothelioma- blue asbestos pleural thickening lung Ca
mx sarcoidosis
if asymptomatic nothing
first line prednisolone (hyper calcaemia etc)
features of steroid responsiveness in COPD
previous diagnosis of asthma or atopy
a higher blood eosinophil count
substantial variation in FEV1 over time (at least 400 ml)
substantial diurnal variation in peak expiratory flow (at least 20%)
mx of atelectasis
chest physiotherapy
Asthma may be diagnosed if any of the following criteria are met (in adults)
An exhaled FeNO of 40 parts per billion or greater (hence option 1 is incorrect)
A post-bronchodilator improvement in lung volume of 200 ml (hence option 2 is incorrect)
A post-bronchodilator improvement in FEV1 of 12% or more (hence option 3 is CORRECT)
A peak expiratory flow rate variability of 20% or more (hence option 4 is incorrect)
An FEV1/FVC ratio <70% (it is an obstructive lung disease) - hence option 5 is incorrect
haemoptysis for the past two weeks. Clinical examination reveals a loud first heart sound, a diastolic murmur and new-onset atrial fibrillation.
Haemoptysis in mitral stenosis is thought to occur secondary to rupture of the bronchial veins caused by raised left atrial pressure.
Fibrosis predominately affecting the lower zones
idiopathic pulmonary fibrosis
most connective tissue disorders (except ankylosing spondylitis) e.g. SLE
drug-induced: amiodarone, bleomycin, methotrexate
asbestosis
upper zone fibrosis charts
C - Coal worker's pneumoconiosis H - Histiocytosis/ hypersensitivity pneumonitis A - Ankylosing spondylitis R - Radiation T - Tuberculosis S - Silicosis/sarcoidosis
COPD mx after SABA/SAMA in asthma feature pictue
LABA ICS
Surgery contraindications
stage IIIb or IV (i.e. metastases present)
FEV1 < 1.5 litres is considered a general cut-off point*
malignant pleural effusion
tumour near hilum
vocal cord paralysis
SVC obstruction
mx ptx
primary less than 2 discharge
more than 2 drain
2dary drain/ admit
pH to intubate in acute asthma
less than 7.35 likely represents carbon dioxide retention in a tiring patient
azithromycin ix before starting
ECG and LFTs
when to use NIV in COPD
The evidence surrounding the use of NIV in COPD shows that patients with a pH in the range of 7.25-7.35 achieve the most benefit. If the pH is < 7.25 then invasive ventilation should be considered if appropriate
mx A1AT deficiency (obstructive)
no smoking
supportive: bronchodilators, physiotherapy
intravenous alpha1-antitrypsin protein concentrates
surgery: lung volume reduction surgery, lung transplantation
first-line treatment for moderate/severe obstructive sleep apnoea
Following weight loss, CPAP
tx in COPD that helps with exercise tolerance
pulmonary rehab
causes of exudative pleural effusion
Exudate (> 30g/L protein) infection: pneumonia (most common exudate cause), TB, subphrenic abscess connective tissue disease: RA, SLE neoplasia: lung cancer, mesothelioma, metastases pancreatitis pulmonary embolism Dressler's syndrome yellow nail syndrome
causes of transudate effusion
heart failure (most common transudate cause)
hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption)
hypothyroidism
Meigs’ syndrome
sleep apnoea ix
polysomnography
varencicline moa
nicotinic partial agonist
ank psond lung changes
restrictive- apical fibrosis and kyphosis
haemoptysis in valvulopathy
Haemoptysis in mitral stenosis is thought to occur secondary to rupture of the bronchial veins caused by raised left atrial pressure.
breathlessness after effusion drained
reexpansion pulmonary oedema
Bilateral interstitial shadowing in RA pt
methotrexate pneumonitis
tx and prevention of high altitude cerebral oedema
dexamethosone
acetazolamide
when to assess for LTOT
very severe airflow obstruction (FEV1 < 30% predicted). Assessment should be ‘considered’ for patients with severe airflow obstruction (FEV1 30-49% predicted)
cyanosis
polycythaemia
peripheral oedema
raised jugular venous pressure
oxygen saturations less than or equal to 92% on room air
mediastinal mass ddx
4 T’s: teratoma, terrible lymphadenopathy, thymic mass and thyroid mass
KCO vs TLCO
KCO is TLCO divided by the alveolar volume, which makes it a measure of how efficient gas exchange is in relation to the alveolar-capillary surface to volume ratio. In asthma, this is increased because there is increased pulmonary blood flow which increases the number of cells which come into contact with the gas.
causes of a rasied TLCO
asthma pulmonary haemorrhage (Wegener's, Goodpasture's) left-to-right cardiac shunts polycythaemia hyperkinetic states male gender, exercise
how to ascend safely
less than 500m a day, rest every 3rd day
empyema features
turbid effusion with pH<7.2, Low glucose, High LDH
Low total gas transfer with normal/ increased transfer coefficient
Extrapulmonary restrictive defect, or pneumonectomy
causes of bronchiectasis
post-infective: tuberculosis, measles, pertussis, pneumonia
cystic fibrosis
bronchial obstruction e.g. lung cancer/foreign body
immune deficiency: selective IgA, hypogammaglobulinaemia
allergic bronchopulmonary aspergillosis (ABPA)
ciliary dyskinetic syndromes: Kartagener’s syndrome, Young’s syndrome
yellow nail syndrome
indications for chest drain from aspirate info
Patients with frankly purulent or turbid/cloudy pleural fluid on sampling should receive prompt pleural space chest tube drainage.
The presence of organisms identified by Gram stain and/or culture from a non-purulent pleural fluid sample indicates that pleural infection is established and should lead to prompt chest tube drainage.
Pleural fluid pH < 7.2 in patients with suspected pleural infection indicates a need for chest tube drainage.
when is surgery an optioin in bronchiectasis
localised disease only
problem with CRP in pneumonia monitoring
it lags behind actual infection (2 types of error)
