Resp Flashcards
What is Potter’s Rot and what does it cause
Silicosis
Nodular inflammation and scarring of upper lobes
Obesity hypoventilation vs OSA
Obesity hypoventilation causes daytime hypercapnia and longer, more continuous hypoventilation overnight
OSA is where there is episodic upper airway collapse during sleep causing daytime sleepiness - measured with Epworth scale
NB. Usually occur together
Definition and features of bronchiectasis
Ix of choice?
Permanent and irreversible dilatation of part of the bronchial tree secondary to chronic infection
Sputum ++
Repeat infections
Clubbing
High res CT is Ix of choice
Indications for LTOT
PaO2 persistently <7.3kPa Or 7.3-8.0 AND - secondary polycythaemia - peripheral oedema - pulmonary hypertension
Asthmatic suffers with runny nose and cough in summer months. Dx?
Post-nasal drip
history of atopy often co-exists
Haemoptysis + round apical opacity on CXR + Hx of TB. Dx and Rx?
Aspergilloma
Rx: antifungals limited ie. focus on symptoms
Consider surgery if massive haemoptysis
IVDU presents with septic shock
CXR: patchy consolidation
?responsible organism
Staph aureus
Gout and arthralgia are SEs of which TB ABx?
Pyrazinamide
AIDS patient presents with dry cough, malaise, occasional SOB.
Recent travel to East Europe where exposed to bats
o/e: LNopathy
Dx and RFs?
Histoplasmosis - causes by inhaling fungus spores RFs: - young - bats - AIDS - bird droppings
A recreational drug that can cause ARDS
Heroin
Cryptococcus presentation, RFs, diagnostic Ix, Rx
Px: meningo-encephalitis or pneumonia
RFs: HIV, Haem malignancy, liver cirrhosis
Diagnostic Ix: cryptococcal antigen titre in CSF
Rx: 3 phases with meds such as amphotericin B, fulctosine, fluconazole
Cerebral toxoplasmosis CT findings
Cerebral toxoplasmosis treatment
CT: mass with ring of contrast enhancement
Rx: sulfadiazone, pyrmethiamine
Definition and some causes of ARDS
non-cardiogenic pulmonary oedema (secondary to acute alveolar damage) results in acute respiratory failure
Ax:
- pneumonia
- chest trauma
- heroin
- sepsis
- smoke inhalation
- NB. interestingly not asthma!
What is farmer’s lung and key organism?
Form of EAA
Organism: Saccharopolyspora rectivirgula
What is Bird Fancier’s Lung and key antigen?
Form of EAA
Avian proteins found in feathers/droppings
What is Malt Worker’s Lung and key antigen?
Form of EAA
Aspergillusclavatus (in mouldy barley ie. brewery workers)
SOB, cough productive of black sputum
CXR: small 1cm pulmonary nodules
Coal worker’s pneumoconiosis -> inflammation + fibrosis
What is silicosis? Key exposures?
Form of occupational lung disease causing fibrosis
Pottery, ceramics, glass exposure, sand blasting, icing, quarrying
What is Caplan’s syndrome?
RA + Pneumoconiosis due to mining/coal dust
What asbestosis worker’s lung?
Chronic inflammation of lungs resulting in restrictive defect ie. lung fibrosis
NB. Asbestosis does not cause EAA
Initial management of OSA
Lifestyle advice: lose weight, stop smoking
Routine referral if Epworth >10
(Consider urgent referral if hazardous working situation or comorbidities)
Suggest positional therapy ie. to avoid supine sleeping eg. “tennis ball technique”
Steroid therapy in acute asthma, yes or no?
5 days of pred for all acute asthma
Patient on SABA + ICS for asthma, still wheezy - next step?
Trial of LTRA for all ages
Smoking cessation medications + MOA + important contraindicaitons
Varenicline: partial nicotinic receptor agonist
Bupropion: NA + DA reuptake inhibitor + nicotinic antagonist
Both contraindicated in breastfeeding and pregnancy
Bupropion contraindicated in epilepsy
Treatment options for smoking cessation in pregnancy
CBT +/- NRT
COPD patient on SAMA still wheezy - next step?
Look for asthma responsive features:
if present: add LABA + ICS
if not present: add LAMA + LABA (and switch SAMA to SABA)
Criteria for Azithromycin prophylaxis in COPD
- Does not smoke
- On max inhaled therapy + vacs + chest physio
- One of the following in the previous year:
- frequent exacerbations
- prolonged exacerbations
- exacerbations requiring hospitalisation
CURB65 parameters
Confusion: AMT <10 Urea >7 RR >30 BP: SBP <90 or DBP <60 >65yo
Pleural aspirate findings that indicate urgent chest drain
Purulent or turbid fluid
+ve Gram stain/culture
pH <7.2
Best tests for lung function in long standing rest disease eg. fibrosis
lung diffusion test ~alveolar exchange
Best blood test to differentiate bacterial and non-bacterial exam of COPD
procalcitonin (high in bacterial)
NB. WCC/CRP can be raised in non-infective
Radiation pneumonitis Rx
roads
Common bacteria in CF LRTI
Pseudomonas
