Resp Flashcards
What is Tx for PE?
Subcut LMWH (dalteparin) Warfarin loading
What is the ideal INR for PE Tx?
2-3
How long will a pt have to take warfarin for post PE?
3 months
Define pancoast tumour
Tumour arising from lung apex - either R or L
List Sx of pancoast tumours
Voice hoarseness
Horners syndrome - miosis, ptsois, anhydrosis
What is sarcoidosis?
Multisystemic granulomatous disorder of unknown aetiology
Who does sarcoidosis primarily affect?
Afro Caribeans
List PC of sarcoidosis
20-40% ASYMPTOMATIC
Erythema nodosum, polyarthralgia
Dry cough, SoB, chest pain
What are erythema nodosum?
Painful, red, raised lesions on shins
What are CXR changes of sarcoidosis?
Bilateral hilar lymphadenopathy
Pulmonary infiltrates or fibrosis
List non pulmonary manifestations of sarcoidosis
Lymphadenopathy Hepatomegaly SPlenomegaly Uveitis Conjunctivitis Lacrimal & parotid enlargement
What blood tests indicate sarcoidosis?
Raised ESR
Lymphopenia
Deranged LFTs
Raised ACE / Igs
What does biopsy of sarcoidosis show?
Non caseating granulomas
What is Tx of sarcoidosis?
Bed rest, NSAIDs, +/- steroids
Dyspnoea, fatigue.
O/E cyanosis, tachycardia, raised JVP, RV heave. Dx?
Cor pulmonale
What murmur is heard in cor pulmonale?
Graham Steel - early diastolic
List categories for causes of cor pulmonale
Lung Pulm vascular Thoracic cage NMD Hypoventiliation
List lung causes of cor pulmonale
asthma, COPD, bronchiectasis, fibrosis, lung resection
List pulm BV causes of cor pulmonale
PE, vasculitis, HTN, ARDS, sickle cell
List thoracic cage causes of cor pulmonale
kyphosis, scoliosis
List NMD causes of cor pulmonale
MG, poliomyelitis, MND
List hypoventilation causes of cor pulmonale
sleep apnoea, big adenoids (kids)
Bilateral reticulo-nodular shadwoing on CXR. Dx?
Pulmonary fibrosis
Why can peripheral pulses be weaker on inspiration in a patient having an acute asthma attack?
Decreased left atrial filling
- this is due to reduced pulmonary venous return to LA due to airway narrowing
What is main ABx Tx for pt with CAP?
Amoxicillin
What is an empyema?
Pus in pleural space
To whom to empyemas happen?
Pts recovering from pneumonia
Is protein high or low in empyema?
High - exudate
What would pleural fluid with a low pH indicate?
Pleural infections Empyema TB Cancer Oesophageal rupture
Is CF dominant or recessive?
Recessive
What is the defect in CF?
XS chloride excretion and Na absoprtion
What is a diagnostic result in sweat test for CF?
> 60mmol/L NaCl
What 3 organisms are most likely to cause LRTI (pneumonia) in pts with CF?
Staoh aureus
H. influenzae
P. aeruginosa
Which lung cancer is associated with asbestos exposure?
Mesothelioma
What drugs can cause pulmonary fibrosis if used long term?
Amiodarone
Nitrofurantoin
Methotrexate
Sulfasalazine
List 4 jobs that can cause EAA
Mushroom picker
Bird keeper
Farmer (from mouldy hay)
Malt worker (from mouldy barley)
List Sx of EAA
Fever, rigors, dry cough, dyspnoea
Which jobs can cause infection with Legionella pneumophillia?
Plumber
Aircon worker
(Anything where water is stored in tanks <60 degrees)
What is Tx for aspergilliosus?
Amphotericin B (antifungal NOT ABx)
Pt has acute exacerbation of COPD. O2 and CXR ordered. Next best Ix?
ABG - so that O2 and CO2 levels can be assessed
Pt has lung cancer with hyponatraemia, haemoptysis. What kind of cancer is it likely to be?
Small cell carcinoma - ectopic ADH production
Numerically define mild COPD
FEV1 >80% predicted
Numerically define moderate COPD
FEV1 50-79% predicted
Numerically define severe COPD
FEV1 30-49% predicted
Numerically define very severe COPD
FEV1 <30% predicted OR FEV1 <50% + resp failure
Describe NICE COPD Mx
1st = SABA or SAMA 2nd = LABA or LAMA 3rd = + ICS
Which asthma medication can lead to hypokalaemia?
Salbutamol
Pt with haemoptysis has acid fast bacilli on film. Dx?
TB
Where in the lungs is TB found?
Apex - more aerobic here
Outline Mx of TB
1st = TWO MONTHS of isoniazid, rifampicin, ethambutol, pyrazinamide 2nd = FOUR MONTHS of isoniazid and rifampicin
Which TB drug can cause peripheral neuropathy?
Isoniazid
Why does isoniazid cause peripheral neuropathy?
Depletes vit B6
List 2 cardinal features of ARDS
Increased capillary permeability
Non cardiogenic pulmonary oedema
List the 4 diagnostic criteria of ARDS
Acute onset
Bilateral infiltrates on CXR
Pulmonary capillary wedge pressure <19mmHg OR no clinical features of heart failure
Refractory hypoxaemia with PaO2:FiO2 <200
Patient has aspiration pneumonia. Which ABx are used in Mx?
IV cefuroxime & metronidazole