Resp Conditions Flashcards
Pneumonia
Ix: FBC (Increased WCC, CRP/ESR), U+E, LFT, sputum culture, atypical screen - mycoplasma, chlamydia, legionella
Imaging: CXR for consolidation
Mx: calculate CURB 65 score if <1 then treat at home with a course of ABx, if >1 then admit to hospital and prescribe ABx in accordance with trust guidelines
Lung cancer
Ix: FBC, U+E, LFT, if paraneoplastic syndromes symptoms test ADH, ACTH, PTH. Imaging: CXR - hilar shadowing, peripheral opacity, pleural eff, Contrast CT for staging/PET, EBUS for biopsy
Mx depends on the type of cancer. Non small cell: lobectomy, wedge resection, radiotherapy, adj chemo, Small cell: chemo, radio, also treat paraneoplastic syndromes
IPF
Ix:Routine bloods,
Imaging: CXR: lower zone fibrosis, high res CT ‘ground glass opacification’, lung biopsy/histology to confirm dx
Mx: supportive management - stop smoking, physio, pulmonary rehab, home oxygen if hypoxic, annual flu + 5 yr pneumococcal vaccines, two meds to slow progression -pirfenidone, nintedanib (tk inhibitor), ?lung transplant
Asthma/COPD
Acute:
Asthma
Ix:
Mx:
AECOPD
Ix:
Mx:
Chronic:
Asthma:
Ix:
Mx:
COPD:
Ix:
Mx:
PE
Ix: FBC, U+E, LFT to exclude other pathology
Imaging: ECG sinus tachy, CXR normal, use 2 level wells score: if <2 do d dimer if negative then rule out PE, if well score is >4 or D dimer raised then do CTPA (VQ if contrast intolerant)
Mx: supportive with O2 and analgesia, treatment dose LMWH, long term anticoag with LMWH, DOAC or warfarin, 3 months if provoked, 6 if unprovoked, thrombolysis in large PE (pt haemodynamically unstable) LMWH/compression stockings for VTE prophylaxis
Asthma
Acute:
Dx: PEFR (moderate, severe, life threatening), RR, HR, whether they can complete sentences, wheeze/silent chest on auscultation, BP (haemodynamic instability)
Mx:
Moderate: Nebulised salbutamol PRN + ipratropium bromide, Steroids (Oral prednisolone or IV hydrocortisone). Antibiotics if there is convincing evidence of bacterial infection
If Severe: O2 to maintain sats 94-98%, Aminophylline infusion, Consider IV salbutamol
If Life threatening: IV magnesium sulphate infusion, admission to HDU / ICU, Intubation in worst cases
Monitoring: ABG (initially T1 RF, if progresses to T2 bad sign), RR/resp effort, PEFR, sats
Discharge pt with ‘asthma action plan’, rescue pack/steroids incase of another exacerbation
AECOPD
Ix: FBC (increased WCC/CRP), U+E, LFT, blood/sputum cultures, ABG
Imaging: CXR
Mx: Oxygenation - optimise without depressing resp drive with venturi - aim for 88-92% if retaining CO2, if not >94%
If well enough to be at home:
Oral pred
Regular inhalers/home nebs
Abx if evidence of infection
In hospital:
Nebulised salbutamol and ipratropium
Steroids (IV hydrocortisone, oral pred)
Abx if evidence of infection
Physio to help clear sputum
Severe cases not responding to first line treatment:
IV aminophylline
NIV
Intubation and ventilation, Doxapram (if CI)
Chronic:
Asthma:
Ix: FBC, U +E, LFT (other causes of breathlessness), FeNO, spirometry with bronchodilator reversibility, PEFR diary
Mx: SABA PRN (reliever) + ICS (maintenance, if not controlled add LABA + LAMA or LTRA, still no control add theophylline
Check inhaler technique, lifestyle - exercise and stop smoking, annual flu jab + asthma review
COPD:
Ix: Clinical Dx + spirometry result (obstructive picture i.e. FEV1/FVC<0.7, with minimal reversibility to B2 agonists), severity graded using FEV1, FBC (anaemia, polycythaemia), U+E, LFT, sputum culture
Imaging: CXR/CT for alternative Dx e.g. lung cancer, IPF, ECG/ECHO for Cor Pulmonale
Mx: SABA/SAMA, if not steroid responsive then add LABA+LAMA, if steroid responsive add LABA+ICS, if still doesn’t work add LABA+LAMA+ICS, LTOT if severely hypoxic and not smoking, annual flu jab and pneumococcal vaccine