Resp I Flashcards
Which factors make the Centor criteria? [4]
The Centor criteria are as follows:
* presence of tonsillar exudate
* tender anterior cervical lymphadenopathy or lymphadenitis
* history of fever
* absence of cough
A patient has PCP.
What is the standard treatment? [1]
Under what conditions do you add steroids to ^? [1]
Co-trixamazole
- Adjunctive steroids should be administered to patients with PaO2 ≤8 kPa and/or evidence of hypoxaemia e.g. oxygen saturations < 92%.
Which stages of sarcoidosis do you provide treatment for? [4]
What is the treatment? [4]
Bilateral hilar lymphadenopathy alone:
- Usually self-limiting and often does not require treatment
Acute sarcoidosis:
- Bed rest and NSAIDs for symptom control
Steroid treatment:
- Oral or intravenous, depending on the severity of the disease
Immunosuppressants
- Used in severe disease.
A patient presents with small cell lung cancer.
What is the main stay of treatment? [1]
Surgery plays little role in the management of small cell lung cancer, with chemotherapy (& radiotherapy) being the mainstay of treatment
The patient has symptoms of a lung abscess further supported by foul smelling sputum, recurrent fever and a history of stroke (risk of aspiration due to impaired swallow).
[] is an additional clinical feature than can be seen in patients with recurrent lung abscesses
The patient has symptoms of a lung abscess further supported by foul smelling sputum, recurrent fever and a history of stroke (risk of aspiration due to impaired swallow).
Finger clubbing is an additional clinical feature than can be seen in patients with recurrent lung abscesses
How do you manage secondary pneumothorax persistent leak? [1]
Risk of surgery is greater: need to consider risk benefit:
- medical pleurodesis: put talc through chest drain (not as effective as surgical pleurodesis & painful)
- Abrasive / surgical pleurodesis (using direct physical irritation of the pleura)
- Open thoracotomy
How do you manage haemothoraxes? [4]
- Sufficient analgesia
- For trauma cases: tranexamic acid
- The majority of haemothorax require the insertion of a surgical chest drain, to evacuate the blood from the pleural cavity
- For patients with large volume blood loss (approx. >1500ml) or continuing moderate volume blood loss (approx. >200ml per hour), surgical exploration should be considered, in attempt to identify and stop the bleeding vessel - usually via VATS
Timing of VATS is crucial when evacuating a haemothorax, ideally being performed within 48-72 hours, to enable successful evaluation and early re-expansion of the lung.
Describe the clinical presentation of Meig’s syndrome [3]
TOM TIP: Meigs syndrome involves a triad of a :
- benign ovarian tumour (usually a fibroma)
- pleural effusion
- ascites.
This often appears in exams. The pleural effusion and ascites resolve with the removal of the tumour.
How would pH analysis of pleural fluid help to determine cause? [3]
< 7.20 in complicated parapneumonic effusion & empyema, rheumatoid arthritis, or advanced malignancy
What size needle [1] and syringe [1] should be used for pleural aspiration?
A 21G needle and 50ml syringe should be used
How would you treat the following? [3]
- simple parapneumonic effusion
- complicated parapneuomic effusion
- Empyema
- simple parapneumonic effusion: Abx
- complicated parapneuomic effusion: chest drain
- Empyema: chest drain
Describe the management of mesothelioma [5]
Pleural effusions
- Drainage & pleurodesis (medical or surgical)
Radiotherapy
- To reduce chest wall invasion risk & pain relief
Chemotherapy
- Cisplatin with Pemetrexed or Gemcitibine
Surgery
- selected cases only (high mortality)
- Pain relief
- Palliative Care
Describe chemotherapy that can be used for mesothelioma [3]
- Chemotherapy
- Cisplatin with Pemetrexed or Gemcitibine
Describe the treatment algorithm for a patient with mesothelioma with operable disease [3]
BMJ BP
1ST LINE: surgery
- extra-pleural pneumonectomy [EPP]: removes parietal and visceral pleura
- pleurectomy with decortication pleurectomy removes the lining around the lung (the pleura). Decortication removes tumors or fibrous tissue from the surface of the lung.
PLUS – pre- and/or postoperative chemotherapy:
- cisplatin
AND
- pemetrexed
CONSIDER – radiotherapy
- Post-extrapleural pneumonectomy (EPP) radiotherapy (RT)
Which conditions would you not perform a needle aspiration and go straight to a chest drain to manage a pneumothorax? [6]
- Haemodynamic compromise (suggesting a tension pneumothorax)
- Significant hypoxia
- Bilateral pneumothorax
- Underlying lung disease
- ≥ 50 years of age with significant smoking history
- Haemothorax
If a patient has persistent pneumothoraces, how do you treat them? [1]
If a patient has a persistent air leak or insufficient lung reexpansion despite chest drain insertion, or the patient has recurrent pneumothoraces, then video-assisted thoracoscopic surgery (VATS) should be considered to allow for mechanical/chemical pleurodesis +/- bullectomy.
How long should you get a primary spontaneous pneumothorax patient to come to outpatients after letting them go? [1]
How long should you get a secondary spontaneous pneumothorax patient to come to outpatients after letting them go? [1]
Primary spontaneous pneumothorax that is managed conservatively should be reviewed:
- every 2-4 days as an outpatient
Secondary spontaneous pneumothorax:
- follow-up in the outpatients department in 2-4 weeks
What is Apnoea and Hypopnoea Index? [1]
What are normal, mild, moderate and severe scores? [4]
AHI – number of apnoeas and hypopnoeas
per hour of the study
- 0 to 5 Within normal limits
- 5 to 15 Mild OSA
- 15 to 30 Moderate OSA
- 30 plus Severe OSA
What trio of crtieria make a diagnosis of obesity hypoventilation syndrome? [3]
- Daytime hypercapnia PaCO2 ≥ 45 mmHg
- Obesity (BMI > 30)
- Sleep disordered breathing (which can include OSA)
Desribe a key difference in OSA and OHS [1]
Patients with OHS often experience daytime hypoventilation, which leads to chronic hypercapnia and hypoxemia, resulting in symptoms such as dyspnea, exercise intolerance, morning headaches, and cognitive dysfunction.
In summary, OHS is a more complex disorder involving chronic hypoventilation, obesity, and sleep-disordered breathing, whereas OSA is specifically characterized by upper airway obstruction during sleep
Describe what is meant by direct bronchial challenge testing [1]
What results would indicate a positive result for asthma? [1]
Direct bronchial challenge testing is the opposite of reversibility testing.
Inhaled histamine or methacholine is used to stimulate bronchoconstriction, reducing the FEV1 in patients with asthma.
NICE say a PC20 (provocation concentration of methacholine causing a 20% reduction in FEV1) of 8 mg/ml or less is a positive test result.
What are the different colours of venturi mask colours? [6]
What are the oxygen flow rate (L/min) for these different colours of venturi mask? [6]
What are the FiO2 (approx. oxygen) delivered for these different colours of venturi mask? [6]
Label A-F
A: Blue
B: White
C: Orange
D: Yellow
E: Red
F: Green
What changes to the face might suggest someone is suffering from sarcoidosis [1]
Bilateral parotid gland swelling
Describe the stepwise approach to treating COPD
First line treatment:
- SABA (salbutamol) or SAMA (e.g ipratropium bromide)
The next stage depends on whether the patient has asthmatic features / features suggesting steroid responsiveness
If NONE: use a combination:
- Add LABA AND LAMA regularly
If ASTHMATIC features:
- Add LABA & ICS regularly
Next stage for both:
- Use LABA AND LAMA AND ICS
Label A-E
Explain the physiological reasons of what can happen to CO2 levels when treated with oxygen in COPD patients? [2]
Many patients retain CO2 when treated with oxygen (oxygen induced hypercapnia)
Due to:
Increased V/Q mismatch (most important)
- COPD ptx optimise gas exchange by hypoxic vasoconstriction leading to altered Va/Q ratios
- Excessive oxygen administration overcomes this, leading to increased blood flow to poorly ventilated alveoli, and thus increased Va/Q mismatch and increased physiological deadspace
The Haldane effect:
- deoxygenated Hb binds CO2 with greater affinity than oxygenated Hb
- Thus: oxygen induces a rightward shift of the CO2 dissociation curve (Haldane effect)
