Resp Flashcards
Initial NIV settings
IPAP 10
EPAP 4
Aerospace engineer gets cough, night sweats fatigue
Reticular cxr changes
Berylliosis
What test can be performed to assess if the effusion is an empyema?
If visibly pus, then that’s diagnostic
If unsure, centrifuge
Chronic productive cough, dextracardia
primary ciliary dyskinesia.. a type of bronchiectasis
Diagnose with ciliary function tests - can they taste saccharin 20m after placed in nose?!
worsening SOB in a middle-aged pt
clear lung fields
diastolic murmur
CXR: enlarged proximal pulmonary arteries
Pulmonary arterial hypertension
Murmur is pulmonary regurgitation
Diagnosis R heart cath
Management of new pulmonary nodule
=> 8mm urgent CT pet
5-6mm or low risk then CT at 1 year, if 6 or 7 then in three months
Nodule <5mm, or clear benign features, or unsuitable for treatment: discharged
ARDS, history of exposure to bats and their droppings in Mississippi
Histoplasmosis
Tx Amphotericin or itraconazole
Pneumothorax, after drain inserted when would you involve surgeons
persistent air leak or failure of the lung to re-expand, an early (3-5 days) thoracic surgical opinion should be sought
Secondary pneumothorax,1.3cm, breathless, mx
Any secondary pneumo with SOB: Chest drain
Which lung cancer is assx w gynaecomastia
Adenocarcinoma
Also assx w hypertrophic pulmonary osteoarthropathy (HPOA)
most common type of lung cancer in non-smokers
Adenocarcinoma, although the majority of patients who develop lung adenocarcinoma are still smokers
Upper Vs lower zone fibrosis
ACID causes lower, the rest upper
Asbestosis
Connective tissue disorders (except ank spond)
Idiopathic pulmonary fibrosis
Drugs…… (Amiodarone, bleomycin, methotrexate).
Upper: C -Coal worker's pneumoconiosis H -Histiocytosis/hypersensitivity pneumonitis A -Ankylosing spondylitis R - Radiation T -Tuberculosis S -Silicosis/sarcoidosis
How long can’t you fly for after pneumothorax
1/52 after clear CXR if simple pneumothoraces
Or two weeks after traumatic
LTOT w NIV
If develop a respiratory acidosis and/or a rise in PaCO2 of >1 kPa (7.5 mmHg) during an LTOT assessment on two repeated occasions, while apparently clinically stable, should only have LTOT w NIV
(Also need PaO2 is < 7.3 kPa)
Scoring system for PE 30d mortality and long term morbidity
PESI score
Indications for thrombolysis in PE
systolic <90 or drop off more than 40 for longer than 15 mins
New onset RHF….. Raised JVP/loud P2/ECG abnorm
Pathogenesis of TRALI
Thought to be due to anti - HLA or anti-neutrophil antibodies
Usually within 6hr of transfusion
More common in patients who are multiparous women, or receiving donors from multipara women
If you’ve previously had TRALI, you can have male donors in future (1-5% antibodies compared to 20% in women)
CXR changes with aspergilloma
CXR showing round opacity in upper zone with surrounding halo of air
CXR showing round opacity in upper zone with surrounding halo of air
History of tb
Aspergilloma
Usually asymp but can be large haemoptysis
Manage surgically
ECG changes in PE
S waves in v1 , q waves and inverted t in v3
S1Q3T3
But only in 20%
RBBB, tachy
What measure do you use to judge severity of copd
Fev1
80% Stage 1 - Mild - symptoms should be present to diagnose COPD in these patients
50-79% Stage 2 - Moderate
30-49% Stage 3 - Severe
< 30% Stage 4 - Very severe
Young non smoking female presents with spontaneous pneumothorax on the BG of gradual reduction of exercise tolerance. .
Lymphangioleiomyomatosis (LAM) affects non smoker premenopausal women causing proliferation of atypical smooth muscle cells in the lungs, lymphatics and uterus, most likely caused by oestrogens.. reticulonodular interstitial pattern
Exclude atypical Langerhans cell histiocytosis… Presents in smokers Which also has spontaneous pneumothorax, reduced ET. Can have cranial diabetes insipidus
Purpose of seldinger chest drain Vs surgical chest drain
Surgical is larger, so if just blood aspirated or trauma
If bloodstained fluid then the smaller seldinger is ok
CT chest showing widespread tram-track and signet ring signs
bronchiectasis
Flu like symp dry cough erythema multiforme
Mycoplasma pneumoniae
second most common cause of erythema multiforme after HSV
What resp parameter do you monitor in GBS for ? invasive ventilator support
FVC <15ml/kg
Estimate if appropriate PaO2
2/3 of inspired O2
So 15L is 90% , therefore 60 kPa
Microorganism in CF sputum which has worst prognosis
Burkholderia cepacia has worse prog… can get Capacia Syndrome with necrotising pneumonia
Also a contraindication to lung transplantation
Pseudomonad also v difficult to eradicate
Important microorganism contraindication to lung transplantation in CF
Burkholderia cepacia
Pharmacological therapy for idiopathic pulmonary fibrosis
Pirfenidone
Only other option is lung transplantation
Chest drain inserted for empyema. 5 days later it’s bubbling
Bronchopleural fistula
Possibly iatrogenic pneumothorax, but the drain would have bubbles throughout then
Diagnosis of whooping cough
In first two weeks nasopharyngeal swab culture
After that serology
Too late for abx by then though
Indication for LTOT on ABG
Indicated if:
pO2 is <7.3, on two separate ABGs 3 weeks apart
Or pO2 7.3-8 with secondary polycythaemia, peripheral oedema, nocturnal hypoxaemia or pulmonary hypertension
Features of TB meningitis
Risk factor like homeless 6th nerve palsies Siadh Cxr may show upper lobe fibrosis Nodular enhancing lesion on MRI Lymphocytic CSF with low glucose
management of bronchiectasis
daily postural drainage and abx for exacerbations
CXR features of coal workers pneumonoconiosis
Simple CWP is multiple small round opacities 1-10mm, mostly upper
complicated will have much larger opacities in upper zones, with fibrosis
19y old with sob, Pharyngitis, wheeze rash, muscle tenderness. Cxr lower zone fibrosis which seems worse than OE. diagnosis
Mycoplasma
Often affects young
Clari
Management for SVC obstruction
Stent insertion
Most specific ECG changes in PE
Simultaneous T wave inversions in the inferior (II, III, aVF) and right precordial leads (V1-4)
Distinguish between ACS and PE
simultaneous T wave inversion in III and V1 are diagnostically significant for PE
(only 1% of ACS, 88% w Acute PE)
- LITFL
ACS rarely tachy
cryptogenic organising pneumonia features
assx w autoimmune / inflammatory conditions like RA,
Can mimic bacterial pneumonia on CXR and crackles OE
Raised ESR
Rheumatoid lung disease tends to be bilat basal opacification CXR - honeycomb/reticulonod on HRCT
cryptogenic organising pneumonia management
corticosteroids (it’s non-infectious)
non-small cell bronchial carcinoma (T2a, N1, M0, stage IIB management
if FEV1 >60% and good baseline then pneumonectomy is best (35% 5yr)
pneumonia w hyponatraemia
legionella
pt w diagnosis of asthma, started on monteleukast and gets signif worse. why?
Leukotriene receptor antagonists can precipitate Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
Ascaris lumbricoides (giant roundworm) on serology, respiratory compromise
pulmonary eosinophilia where the nematode migrate to lung causing Loffler’s syndrome
can also be due to Strongyloides
Mx of aspergilloma
surgical resection
Investigation to diagnose methothelioma
Thoracoscopy pleural biopsy
PE with haemodynamic instability
IV fluids to increase RV filling pressure
First line: Thrombolysis if not improving after 15-30 minutes
management of PCP
co-trimoxazole w pred
if intolerant then
Clindamycin and Primaquine w pred
or IV Pentamidine w pred
management for cystic fibrosis F508
Lumacaftor/Ivacaftor (Orkambi)
patient presents w sats 90% on 10L, but ABG on RA P02 10.8. Young person, taking ilicit drugs. Cause and management?
Methaemoglobin
(Methaemoglobin MetHb levels usually <1.5%)
IV methylthioninium chloride (methylene blue) if acquired
drugs: sulphonamides, nitrates (including recreational nitrates e.g. ‘poppers’), dapsone, sodium nitroprusside, primaquine
chemicals: aniline dyes
CT Thorax findings in Anti-glomerular basement membrane (GBM) disease (Goodpasture’s syndrome)
and
Granulomatosis with polyangiitis (Wegener’s granulomatosis)
both cause pulmonary-renal syndrome
GBM GroundGlass changes
Granulomatosis multiple cavitating lesions - usually apical
