resp Flashcards
Which drugs should you avoid giving to asthma pts?
Aspirin
Beta blockers
What Ix would you do first in a patient suspected asthma?
PEF and spirometry
Outline the stages of management for asthma
1) SABA
2) SABA + inhaled steroid (beclomethasone dipropionate)
3) SABA + ICS + LTRA/LABA
What are the markers of severe asthma?
PEF 33-50
RR > 25
HR >110
Inability to complete sentences
What are the markers of life-threatening asthma?
PEF<33% SpO2 < 92% PaO2 < 8kPa Silent chest Confusion Exhaustion
What tx should be considered if an acute exarcerbation of asthma is not responding to inhaler and steroid tx?
Single dose magnesium sulphate or IV salbutamol
What would a CXR show in COPD?
Flattened diaphragms due to over inflation
What are the management stages for COPD?
1) SABA or SAMA
2) No asthmatic features = LABA + LAMA
OR asthmatic features (low FEV1/obstructive) = LABA + ICS
3) Triple therapy (LABA, LAMA + ICS)
What is the tx for acute COPD exarcerbation?
SABA + SAMA + pred PO + O2
Only abx if clinically indicated
When do you diagnose HAP instead of CAP?
If pneumonia develops greater than 2 days post admission
Outline the CURB 65 score?
Confusion Urea > 7 Resp rate > 30 BP < 90/60 >= 65
What score in the CURB 65 score corresponds to what?
0-1 PO amox at home
2 hospital tx with PO amox and clarith
3-5 - hospital tx with IV co-amox
What test can you do for legionella/pneumococcal?
Urinary antigen test
Name two tests for latent TB
Tuberculin skin test (Mantoux)
Interferon gamma release assay
How is active TB infection diagnosed?
CXR
3 X sputum acid fast bacilli smear
Sputum culture
NAAT of sputum if rapid dx needed
What are the advantages of using NAAT to dx TB?
Rapid (useful if immunocompromised pt)
Provides information about drug resistance
What is TB tx?
6M Rifampicin and isoniazid
2M pyrazinamide and ethambutol
SEs of TB drugs
Rifampicin = orange secretions , liver enzyme inducer Isoniazid = peripheral neuropathy Pyrazinamide = hepatotoxic Ethambutol = colour blindness/ optic neuritis
What tests are important to do before starting TB tx?
LFTs and vision testing
How are PEs/DVTs prevented in hospital?
Heparin to all immobile pts
Stop HRT and COCP pre-op
Compression stockings
What spirometry pattern is seen in restrictive lung disease?
FEV1 and FVC less than 80% predicted
FEV1/FVC ratio normal (>0.7)
What spirometry pattern is seen in obstructive lung disease?
FEV1 < 80% predicted
FVC normal/low
FEV1/FVC less than 0.7
What are the features of pulmonary fibrosis? (4Ds)
Dry cough
Dyspnoea
Digital clubbing
Diffuse inspiratory crackles
What does a CT show in idiopathic pulmonary fibrosis?
Honeycombing
What drug can help tx IPF?
Pirfenidone
Name some supportive mx options in IPF
o2, PT, exercise, weight loss, vaccinations, smoking cessation
steroids for acute exarcerbations
What criteria is used to determine whether a pleural effusion is an exudate or transudate?
Lights criteria
What are the causes of bilateral hilar lymphadenopathy?
(TIMES) TB Inorganic dust (silicosis) Malignancy EAA Sarcoidosis
How do you tx a tension pneumothorax?
Large bore cannula in second intercostal space mid clavicular
Aim just above rib to miss neurovascular bundle
Which bacteria most commonly affects CF sufferers?
Pseudomonas aeruginosa
What ix for bronchiectasis/
Sputum culture
CXR
HRCT chest
Spirometry - obstructive
Tx of bronchiectasis
Exercise
Airways clearance physio
If culture +ve - always give abx
Which 4 conditions can aspergillus cause?
Asthma exarcerbation
Allergic bronchopulmonary aspergillosis
Aspergilloma
Invasive aspergillosis
What blood test is used to dx CF in neonates?
Immunoreactive trysinogen
What are the signs on ECG of pulmonary htn?
P pulmonale
Right axis deviation
RV hypertrophy
What are the types of lung Ca?
Small cell
Non-small cell (squamous, large cell, adenocarcinoma)
What are the features of goodpastures syndrome?
Glomerulonephritis and pulmonary haemorrhage
What Ix diagnoses goodpastures syndrome/
Anti-GBM Abs
What abx would you use for atypical pneumonia such as legionella?
Clarithromycin (macrolides)
What are the causes of a transudate pleural effusion?
Heart failure
Nephrotic syndrome
Liver cirrhosis
Hypoalbuminaemia
What is Lofgren syndrome?
BHL Erythema nodosum Arthralgia Fever (favourable prognosis of sarcoidosis)
Which chromosome carries the gene defect in cystic fibrosis?
7
What are the components of virchows triad?
Circulatory stasis
Hypercoaguble state
Endothelial injury
What is the anion gap equation?
(sodium + potassium) - (chloride + bicarbonate)
What does a normal anion gap in acidosis indicate?
Increased bicarbonate losses (e.g. diarrhoea)
Acid ingestion
What is the diagnostic test for bronchiectasis?
HRCT - signet ring sign
