Resp medicine block Flashcards
1
Q
What are some common presenting complaints for a resp hx?
A
- Dyspnoea
- Chest pain
- Wheeze
- Cough
- Sputum
- Haemopytsis
2
Q
What are some specific qs for dyspnoea and chest pain?
A
Dyspnoea - MRC score, exercise tolerance, T+R, PND, dinural variation
Chest pain - site, severity, radiation, T+R, associated sx
3
Q
What are some specific qs for wheeze and cough?
A
Wheeze - T+R, dinural variation, cough
Cough - dry or productive, T+R, dinural variation, w eating or dyspepsia, positional, nasal secretion, fever
4
Q
What are some specific qs for sputum and haemopytsis?
A
Sputum - amount in 24 hours, colour, consistency
Haemopytsis - amount, freq, fever, night sweats, weight loss
5
Q
What is some relevant PMH?
A
- Surgery
- Cancer
- Childhood/previous lung infection
- Asthma
- COPD
- Nasal polyps
- DVT/PE
- CVS disease
6
Q
What do you ask in a drug hx?
A
- What drug?
- Route, dose, freq, adherance
- OTC or herbal remedies
- Allergies
7
Q
What relevant FH is there?
A
- Resp disease
- CVS disease
- Thrombophilia
- CF
- Cancer
8
Q
What qs do you ask in a SH?
A
- Performance status
- Smoking - how long for/when stopped, pack years
- Alcohol
- ADL, accom, carers?
- Occupational exposure, esp asbestos
- Recent foreign travel/immobility
- Pets
9
Q
What is the MRC dyspnoea score? 1-5
A
- SOB only on strenuous exercise
- SOB when in a rush or walking up a small hill
- SOB on flat ground/need to stop for breath
- SOB when walking 100m
- Too breathlessness to leave the house, when dressing
10
Q
What is the WHO performance score? 0-5
A
- No restriction to activity
- Restricted in physically strenuous activity but able to do light work
- Ambulatory and self care but can’t do work activities
- In bed >50% of day
- In bed/chair all of day, can’t do self care
- Dead
11
Q
Give the definition for:
- Ambulatory
- Dinural variation
- PND
- Orthopnoea
A
Ambulatory - adapted for walking
Dinural variation - variation in symptoms (in this case pulm func) depending on the time of day
PND - paraoxysmal nocturnal dyspnoea
Orthopnoea - SOB lying down
12
Q
How do you report a CXR?
A
- Name and age of pt, date of XR
- What type of XR - AP, PA, erect or mobile
- Quality of XR - rotation, penetration, adequate inspiration
- ABC - airwarys+lungs, bones, cardio + diagphragm, apices etc
- Say what you can obviously see
13
Q
What are the different regions of the lung on CXR?
A
Upper
Middle
Lower zones
14
Q
What is the cardio thoracic ratio?
A
Diameter of the heart should be half the diameter of the thorax. If the diameter of the heart is increased = cardiomegaly.
15
Q
What is spirometry? What does the FEV1:FVC ratio indicate?
A
Way to measure different lung volumes, can create flow time graphs and flow vol loops from these.
FEV1:FVC >80% = restrictive lung disease and <70% = obstructive lung disease.
16
Q
What are some examples of obstructive and restrictive lung diseases?
A
Obstructive - COPD and asthma
Restrictive - pulm fibrosis, interstitial lung disease, asbestosis, neuromuscular disease
17
Q
What are FEV1 and FVC?
A
FEV1 - forced expiratory vol in first second
FVC - forced vital capacity over 6 seconds after max inspiration
18
Q
Draw the different flow time graphs, label what they show
A
Answers on iPad
19
Q
Draw the different flow vol loops and label what they show, there are 6
A
Answers on iPad
20
Q
What can you see on ABG?
A
- Hypoxia
- Acid base balance
- A-a gradient
21
Q
What are the 4 causes of hypoxia?
A
- Hypoventilation
- V/Q mismatch
- Shunt
- Diffusion impairment
22
Q
What are the causes of resp acidosis?
A
Hypoventilation eg. neuromuscular disease
Alveolar hypoventilation - COPD.
23
Q
What is the A-a gradient?
A
A = alveolar O2
a = arterial O2
In a healthy young person it should be <2 kPa and in elderly people <4 kPa. >4 kPA = lung pathology
24
Q
How do you work out the A-a gradient?
A
PAO2 = PIO2(room air) - PCO2/o.8.
Then PAO2 - PaO2 to calculate the gradient.
25
What is anaphylaxis?
Serious allergic reaction. IgE - antigen - mast cells and basophils increase - histamine increase - body response
26
What is the body's response to anaphylaxis?
- Pruritis, uticaria
- Angioedema
- Stridor, bronchial obstruction, hoarseness, wheeze, tight chest
27
How is anaphylaxis managed?
- Remove trigger, manage airway and 100% O2
- 5mg IM adrenaline, repeat every 5 mins
- IV hydrocortisone 200 mg
- IV chlorpheniramine 5 mg
- If hypotensive = lie flat and resus
- Bronchospasm = NEB salbutamol
- Laryngeal oedema = NEB adrenaline
28
What are the parameters to define mild, moderate and severe asthma attacks?
Mild - PEFR >75%
Mod - PEFR 50-75%
Severe - PEFR 33-50%, can't complete sentences, RR >25/min, pulse >110 bpm
29
What defines a life threatening and then a near fatal asthma attack?
Life threatening - <33% PEFR, confused, exhausted, poor resp effort, silent chest, cyanosis, hypotension, arrhythmias, sats <92%, ABG pO2 <8 kPa
Near fatal - raised pCO2
30
What is acute asthma management?
- AtoE, 100% O2 - aim for 94-98%, if <92% do ABG
- 5mg NEB salbutamol, can repeat after 15mins
- 40mg oral prednisolone STAT
31
What do you add on to acute asthma management in a severe attack?
- NEB ipratropium bromide 500mcg
| - Consider back to back salbutamol
32
What do you add on to acute asthma management if life threatening attack?
- Consider IV salbutamol
- ITU/anaesthetic assessment
- Urgent portable CXR
- IV aminophylline
33
What is aminophylline?
Theophylline (adenosine receptor antagonists, reduces bronchoconstriction) + ethylenediamine, relaxes smooth muscle and relieves bronchial spasm
34
What are the causes of COPD exacerbations? How can you distinguish between the two?
Infective - fever, change in sputum vol and colour, increased WCC or CRP
Non infective causes eg. PE or pollution
35
How do you manage COPD exacerbations?
Always AtoE approach.
- Give O2 - aim 94-98% but if have acute/previous type 2 resp failure 88-92%
- NEB salbutamol and ipratopium
- Prednisolone 30mg STAT and OD for 7 days
- If purulent sputum and raised WCC = Abx
- CXR
- Consider IV aminophylline and NIV if type 2 resp fail, pH 7.25-7.35
- Consider ITU referral if pH <7.25
36
# Define these terms:
- NIV
| - Type 2 resp failure
NIV - non invasive ventilation
| Type 2 resp failure - raised PaCO2
37
What is the criteria to diagnose pneumonia?
Consolidation on CXR with fever. +/- purulent sputum, raised WCC and CRP.
38
What is the management of pneumonia?
Always AtoE approach.
- If signs of sepsis start immediately w IV Abx and fluids
- Otherwise Abx as per the CURB65 score, local guidelines and pt allergies
39
What is the CURB65 score?
```
C - confusion
U - urea >7
R - RR >30/min
B - <90mmHg systolic <60mmmHg diastolic
65 - older than this
```
40
What defines massive haemopytsis?
240ml over 24 hours or 100ml/day over consecutive days.
41
How is massive haemopytsis managed?
AtoE approach!
- Lie pt on side of lesion
- Stop NSAIDs, aspirin, anticoag
- Oral tranexamic acid for 5 days or can be IV
- Consider Vit K
- CT aortogram, may be able to do bronchial artery embolism
42
What is tranexamic acid?
Anti fibrinolytic by binding to plasminogen, inhibiting plasmin formation.
43
What are the signs and sx of tension pneumothorax?
Signs - tracheal and mediastinal shift away from pneumothorax, reduced lung sounds, reduced chest movement, hyperresonance, cyanosis, tachy, hypotension
Sx - pleuritic chest pain, SOB
44
How is tension pneumothorax managed?
Large IV cannula in 2nd ICS mid clav line. Chest drain in affected side.
45
What are the sx of PE?
- Pleuritic chest pain
- SOB
- Haemopytsis
- Signs of low cardiac output
46
What are some signs of low cardiac output?
- Fatigue, confusion, reduced consciousness
- Cold peripheries, delayed cap refill
- Hypotension and tachy
47
What are some RF of PE?
- Obstetrics
- Surgery
- Malignancy
- Period of immobility
- Previous VTE
- Lower limb fracture/varicose vein
48
What is the initial management of PE?
- AtoE, oxygen if SOB, analgesia if in pain
| - Subcut LMWH whilst waiting for CTPA
49
How is PE diagnosed and what is the treatment once diagnosis is confirmed?
CTPA - CT pulm angiogram. Then full anticoag.
50
What are the options of anticoag to treat PE?
Dalteparin
Enoxaparin
Tinzaparin
Fondaparinux
51
What are the signs of massive PE and how is it treated?
Treat = IV alteplase
| Signs - R sided heart strain, hypotension, almost at cardiac arrest
52
What are some contraindications of thrombolysis?
- Aortic dissection
- CNS malignancy
- Thrombolytic/ischaemic stroke
- GI bleed
- Bleeding disorder
53
What are the characteristics of asthma?
- Chronic airway inflam and obstruction
- Reversible w treatment or spontaneously
- Airway more responsive to stimuli than normal = increased narrowing
54
What are the sx of asthma?
- SOB
- Tight chest
- Cough that is worse at night
- Wheeze
- Increased RR
55
What are some differentials of wheeze?
- Bronchitis
- Allergies
- Acute asthma exacerbation
- Pulm oedema
- GORD
- Foreign body
56
What is the pathophysiology of asthma?
- Airway and epithelial damage causes fibrosis and BM thickening
- Eosinophils, T lymphocytes and mast cells release histamine, leukotrienes, prostaglandins and cytokines
- Increased mucus (mucus plugging can be fatal in severe asthma), SM hyperplasia and hypertrophy
57
What is eosinophilia?
Some pt w asthma have eosinophilic inflam which normally responds to steroids. There are other causes eg. COPD, hayfever, lymphoma, SLE, aspergillosis
58
What is the criteria for discharge after asthma exacerbation?
- PEFR >75%
- Stop NEB 24 hours before discharge
- Asthma nurse reassess inhaler technique and adherance
- Go home w 5 days prednisolone
- GP follow up w/i 2 days and clinic w/i 4 weeks
59
What are some asthma trigger factors?
- Smoking, pollution, occupational irritants
- URTI
- Allergies, exercise, cold air
- Stress
- Drugs - aspirin, b blockers
- Food and drink eg. dairy
60
What is COPD and what are the causes of it?
Progressive airway obstruction, not fully reversible and primarily caused by smoking. Emphysema + chronic bronchitis.
Causes - smoking, a1 antitrypsin def, industrial exposure, childhood infection eg. pertussis
61
What is the effect of COPD on the lungs ?
- Mucus gland hyperplasia
- Loss of cilial func
- Chronic inflam and fibrosis or small airways
- Emphysema = alveolar wall destruction = enlargement of air spaces distal to terminal bronchioles
62
What is the COPD care bundle?
Outpatient treatment of COPD:
- Stop smoking
- Pulm rehab
- Bronchodilators
- Antimuscarinics
- Mucolytics
- Steroids
- Diet
- LTOT if needed
63
What is pulm rehab?
MDT team 6-12 weeks supervised exercise, unsupervised home exercise, nutritional advise and disease education.
64
What is LTOT?
Long term oxygen therapy: = long term hypoxia causes renal and cardiac damage. Give up to 16 hours a day. If pO2 <7.3 kPa consistently or 8kPa w cor pulmonale. Pt mustn't smoke or retain CO2.
65
What are the different types of pneumonia and their causative organisms?
CAP - S.pneumoniae. H.influenzae, Moraxella catarrhalis
HAP - MRSA, E.coli, pseudomonas
Atypical - Legionella pneumophilia, Chlamydia pneumoniae
Other types eg. aspiration
66
How is pneumonia diagnosed?
Consolidation on a CXR
67
What are the differentials for consolidation on a CXR?
- Pneumonia
- Haemorrhage
- Lobar collapse - bronchial blockage
- Lung cancer
- TB (upper lobe)
68
What is the treatment of pneumonia?
Need to calculate a CURB65 score and then use this as well as local guidelines and pt allergies to diagnose Abx. +/- paracetemol.
Even if low CURB65 score respond to signs of sepsis - refer to ITU.
69
What Ix are needed into pneumonia?
- CXR
- Routine bloods
- Sputum cultures
- If febrile - blood cultures
- If high CURB65 do an atypical pneumonia screen = serology and Legionella urine test
- Low sats = ABG
70
What is involved in a pneumonia follow up?
Resp clinic 6 weeks post:
- HIV test
- CXR to confirm resolution
- Immunoglobulin
- IgG - pneumococcal and H.influenzae
71
What are the causes of non resolving pneumonia?
```
CHAOS
Complication - empyema, abscess
Host - immunosuppressed
Abx - wrong dose or poor oral absorption
Organism - resistant or unexpected
Secondary diagnoses - PE, cancer
```
72
What are corona viruses?
Group of viruses causing illness ranging from the common cold to much more severe resp distress eg. SARS-CoV
73
What are the clinical features of a pt requiring hospital admission w corona virus?
- Hypoxia
- Lymphopenia - reduced lymphocyte level
- Bilateral lower zone changes on CXR
74
What is the management of COVID 19 ?
- O2 supplementation, may need CPAP or invasive ventilation
- Dexamethasone
- Abx if suspect superadded bacterial infection
75
# Define these terms:
- CPAP
| - SARS
CPAP - continuous positive airways pressure
| SARS - severe acute resp syndrome
76
What are the clinical features of TB?
- Weight loss, night sweats, fever, malaise
- Resp - cough +/- sputum, haemopytsis, pleural effusion
- Non resp - skin, bone, abdo, CNS features
77
What are the differentials for haemopytsis?
- Infection - pneumonia, TB, CF, bronchiectasis
- Haemorrhage - vasculitis, coagulopathy, bronchial artery emobolism
- Malignancy - lung cancer, mets
- PE
78
What are the RF of TB?
- Past hx of TB or TB contact
- Recent foreign travel to country w high TB incidence
- Immunosuppressed = DM, IVDU, dialysis/renal fail, transplant pt, HIV, alcoholic, low BMI
79
What is the immediate management of TB?
- AtoE approach
- Start infection control measures - side room, PPE<
- Culture ASAP
- If can't tell between pneumonia or TB start Abx for pneumonia
80
What are the Ix into TB?
- If productive cough = x3 sputum samples for AFB and TB culture
- If not productive bronchoscopy
- Maybe CT if suspect but CXR shows nothing
- Routine bloods +LFTs +HIV +Vit D
81
What are the drugs of anti TB therapy?
- x2 months x4 Abx = rifampicin, ethambutol, isoniazid, pyrazinamide
- Then x4 months x2 Abx = rifampicin + isoniazid
82
What is important when doing anti TB therapy?
- Need compliance - may even need DOT
- Need visual acuity test before ethambutol as it can cause retrobulbar neuritis
- Need to give pyridoxine w isoniazid to prevent peripheral neuropathy
83
What are the SE of anti TB therapy drugs?
All = hepatitis and rashes, need to measure LFTs often
- Pyrazinamide - arthralgia, vomiting
- Isoniazid - peripheral neuropathy, psychosis
- Ethambutol - retrobulbar neuritis
- Rifampicin - orange/red secretions, febrile reaction
84
What is bronchiectasis?
- Chronic dilation of one or more bronchi
| - Poor mucus clearance = predisposition to recurrent bacterial infection
85
What are the causes of bronchiectasis?
- Immune def eg. HIV, malignancy
- Post infective - whooping cough or TB
- Genetic mucociliary clearance defects eg. CF, primary ciliary dyskinesia
- Obstruction eg. tumour, foreign body, lymph node
- Toxic insult eg. gastric aspiration
- RA
86
What are the IX to confirm bronchiectasis diagnosis? What are the signs?
Gold standard - high resolution CT chest, can see signet ring sign
CXR - tram tracks
87
What are the bloods to decide the cause of bronchiectasis?
- HIV test
- Immunoglobulin levels
- CF genotype
- Rheumatoid factor
- Auto Ab
- Alpha 1 antitrypsin
88
What are the common infective organisms in bronchiectasis?
- H.influenzae
- Moraxella catarrhalis
- Pseudomonas aeurginosa
- Aspergillosis or candida
89
What is the management of bronchiectasis?
- Physio for mucus clearance
- Treat the underlying cause
- 10-14 days Abx depending on culture in exacerbation
- Supportive - vaccines and inhalers
- Pulm rehab if MRC >3
90
What is the management of bronchiectasis exacerbations?
H.influenzae = amoxicillin/doxycyline. Pseudomonas - ciprofloxacin
IV if severe.
Long term prophylactic Abx if recurrent infective exacerbations.
91
How do you define a bronchiectasis exacerbation?
Worsening of 3 or more key symptoms over 48 hours:
- Cough
- Sputum vol, consistency or purulence
- Haemopytsis
- SOB
- Fatigue
92
What is ABPA?
Allergic bronchopulm aspergillosis - caused by aspergillus fumigatus exposure = combination type 1 and 3 hypersensitivity reaction.
Seen more in pt w asthma, CF and bronchiectasis.
93
What can ABPA lead to?
Bronchiectasis, often in the upper lobe
94
How is a diagnosis of ABPA made?
- Symptoms = dry cough and wheeze
| - Blood test = raised total IgE and raised aspergillus IgE
95
What is the treatment of ABPA?
Steroids, needed if ongoing symptoms and raised total IgE
96
What is CF?
Cystic fibrosis - autosomal recessive disease which causes mutation of CFTR = thickened secretions, most commonly affects resp and GI but can affect anywhere.
97
How is CF diagnosis made?
- Hx of CF in sibling or positive newborn screen
- Sweat test = increased NaCl
- x2 CF mutations identified
98
What are the clinical features of CF?
- Chronic sinusitis, nasal polyps, bronchiectasis, recurrent LRTI
- Liver disease, portal hypertension, gallstones
- Pancreatic insufficiency
- Intestinal obstruction
- Clubbing and osteoporosis
- Male infertility
99
What are the presentations of CF?
- Meconium ileus = newborn not passing ileus, bilious vom and abdo distension
- Malabsorption due to pancreatic insuff
- Recurrent chest infections
- Positive new born screen
100
What are the complications of CF?
- Resp infection - aggressive Abx and physio
- Reduced body weight - high cal, nutritional supplement, NG or PEG
- DIOS
- CF related diabetes - insulin
101
What is DIOS? How is it treated?
Distal intestinal obstruction syndrome - hard dehydrated faeces causing obstruction - palpable mass in RIF. Can see on AXR.
Treat - PO gastrograffin enema = draws water into bowel and rehydrates faeces in hopes it will pass
102
What is CF management?
- Physio for airway clearance
- Pancreatic enzyme replacement therapy
- Long term prophylactic Abx
- Novel CFTR modulators eg. Kaftrio
- Monitoring new problems or things like weight and liver disease
103
What is the lifestyle advice for pt w CF?
- No smoking !!!
- Avoid other CF pt, people w colds, jacuzzis and stables
- NaCl tablets in hot weather or strenuous exercise
- Annual flu jab
- Keep Nebulisers dry and clean
104
What is the pleural cavity?
Potential space between the outer pleura (parietal) and inner pleura (visceral) containing pleural fluid.
105
What are the types of pleural disease?
- Pneumothorax
- Pleural effusion
- Empyema
- Pleural tumour
- Pleural plaques
- Pleural thickening
106
What are the different types of pneumothorax?
- Spontaneous, primary or secondary (have lung disease)
- Traumatic
- Tension
- Iatrogenic
107
What are the RF of pneumothorax?
- Lung disease
- Height
- Smoker
- Trauma
- Diver
- Marfan's
108
What is the management of tension pneumothorax?
- Primary = O2 and aspirate then reaspirate or drain if didn't work
- Secondary = ICD sooner
- Tension = needle decompression in 2nd ICS MCL
109
What are the Ix into pleural effusion?
- CXR
- ECG and echo
- Bloods - FBC, CRP, LFT, U&E, LDH, bone profile, clotting
- Staging CT contrast if suspect exudative cause
- US guided needle aspiration = protein, LDH, pH, cytology, microbiology
110
Transudate vs exudate effusion
```
Transudate = <30 g/L protein
Exudate = >30g/L protein
```
111
What are the causes of transudate effusion?
- Heart failure
- Cirrhosis
- Hypoalbuminaemia
Often can just treat the underlying cause.
112
What are the causes of exudate effusion?
- Infection
- Lung malignancy
- Inflam
113
What is Light's criteria?
If there is increased protein and LDH in serum/pleural fluid then effusion is more likely to be exudative.
114
What is interstitial lung disease?
Umbrella term for conditions affecting the lung parenchyma. Need to take a comprehensive occupational and environmental Hx.
Restrictive on PFTs.
115
What is UIP and what are the classical findings?
Usual interstitial pneumonia - most common ILD, mainly iatrogenic.
Findings - clubbing, reduced chest expansion, fine inspiratory crackles (velcro) best heard in basal and axillary areas, may have features of pulm HTN
116
What is extrinsic allergic alveolitis and what is the clinical presentation?
Hypersensitivity pneumonitis, inhalation of an antigen individual is sensitised to.
Can be acute (reversible) or chronic (less reversible).
117
What are the common drugs that cause fibrosis of lung?
- Amiodarone
- Bleomycin
- Methotrexate
- Nitrofurantoin
- Penicillamine
118
What is sarcoidosis?
Multisystem inflam condition, idiopathic. Non caseating granuloma usually affecting resp but can affect any organ.
50% spontaneously resolve and the rest lead to progressive disease.
119
What are the Ix into sarcoidosis?
- CXR and PFT
- Bloods - U&Es, ACE, Ca2+
- ECG, echo, cardiac MRI
- CT/MRI head if headaches
120
What are the treatment principles of ILD?
- Remove environmental, occupational and drug triggers
- Stop smoking
- Treat infective exacerbations
- O2 if resp failure
- Palliative
- Transplant
121
What are the clinical features of lung cancer?
- Asymptomatic, found incidentally
- Horner's syndrome
- Mets and paraneoplastic disease
- Worsening of any resp symptom
- SVC obstruction
- Increased risk TE disease
122
What are Horner's syndrome and paraneoplastic disease?
Horner's - mitosis, anhydrosis and partial ptosis due to compression of sympathetic nerve in neck by pancoast tumour.
Paraneoplastic syndromes - Cushing's, clubbing, anaemia, hypercalcaemia, SIADH
123
What are the RF of lung cancer?
- High pack years
- FH of lung cancer
- Carcinogen exposure eg. asbestos
- Airflow obstruction
- Increasing age
124
What are the histological classes of lung cancer? What are their prognoses?
Small cell lung cancer - more aggressive so worse prognosis, 1.5 year survival.
Non small cell lung cancer - 80% 5 year Hx in stage 1 and decreases a bit as increase stage.
125
What are the Ix into lung cancer?
- Bloods - FBC, U&E, Ca2+, LFTs, INR
- CXR and staging CT for TNM
- FNA of lymph node, CT biopsy and bronchoscopy
- PET scan for mets
126
What is the treatment of lung cancer?
- Surgery = curative in stage 1 and 2
- Surgery and adjuvant chemo in stage 3
- RT curative if not suitable for surgery or used in palliative care
- Just chemo stage 3-4
127
What is OSA?
Obstructive sleep apnoea: upper airway obstruction during sleep = sleep fragmentation. Usually affecting obese males. Either small pharynx w normal narrowing (narrowing normal in sleep as pharyngeal dilators relax) or normal pharynx w excessive narrowing,
128
What are the causes of a small pharynx?
- Large tonsils
- Craniofacio abnormalities
- Extra submucosal tissue eg. myoxedema
- Increased neck fat
129
What are the causes of excessive narrowing causing OSA?
- Obesity
- Neuromusc disease eg. MS, stroke
- Muscle relaxants eg. alcohol and sedatives
- Increasing age
130
What are the clinical features of OSA?
- Repetitive upper airwards collapse = arousal = fragmented sleep and excessive day time sleepiness
- Arousals increase BP
- Nocturia
- Nocturnal sweating, GORD and reduced libido
131
What is the Epworth sleepiness score?
Chance of dozing when doing activites eg. driving, passenger in car, watching TV or reading book
132
What is a CPAP?
Cont positive airway pressure = prevents airway collapse so prevents sleep fragmentation and daytime sleepiness. Given via a nasal mask.
133
Sympathomimetics:
- Example
- Indication and MOA
- SE
eg. salbutamol (short) and formeterol (long). Used for bronchospasm. B2 selective adrenergic agonists, increase cAMP in SM = bronchodilation.
SE - tremor, headache, GI upset, palpitations, tachy
134
Antimuscarinics:
- Example
- Indication and MOA
- SE
eg. Ipratropium (short) and tiotropium (long). Used for bronchospasm normally in COPD, muscarinic antagoinst. Decreases cGMP = reduces intracell Ca2+ = decreased SM contractility.
SE - dry mouth, cough, constipation, headache
135
Xanthines:
- Examples
- Indication and action
- SE
eg. Aminophylline, theophylline
Used for asthma and COPD by blocking phosphodiesterases = decreased cAMP breakdown = bronchodilation.
SE - headache, GI upset, reflux, palpitations, dizziness.
136
Inhaled steroids:
- Examples
- Indication and MOA
- SE
Eg. budesonide, beclomethasone, fluticasone. Used for asthma and COPD. Decreased bronchial inflam.
SE - cough, oral thrush, hoarse. voice
137
Corticosteroids:
- Examples
- Indication and MOA
- SE
eg. Prednisolone, hydrocortisone, dexamethasone. Used to suppress inflam, allergy and immune responses by altering gene transcription of inflam mediators.
SE - adrenal suppression, hyperglycaemia, psychosis, indigestion, mood swings.
138
What is DLCO?
Diffusing capacity of the lungs for CO:
- Reduced = empysema, pulm fibrosis, alveolar inflam
- Normal = problem w chest wall, neuromusc disease
139
What is Batwing's distribution?
Apical and basal sparing in pulmonary oedema as fluid leaks from central hilar vessels.
140
What is part of the Wells' score?
- Clinical sx of DVT
- PE is no1 diagnosis
- HR >100
- Immobilisation for 3 days or surgery w/i 4 weeks
- Previously diagnosed PE/DVT
- Haemopytsis
- Malignancy w/i last 6 months
141
What is ARDS?
Acute respiratory distress syndrome = non cardiogenic pulmonary oedema and diffuse lung inflam:
- Acute onset (w/i 1 week)
- Bilat opacities on CXR
- PaO2/FiO2 ratio <300 on positive end expiratory pressure
142
What are the CF of ARDS?
- Dyspnoea and hypoxaemia
- Critically ill pt
- Increased RR
- Pulm crackles
143
What are the RF and causes of ARDS?
RF - sepsis, aspiration, pneumonia, severe trauma
144
What are the complications of ARDS?
- Pneumothorax
- Ventilator associated pneumonia
- Multiple organ failure
- Pulm fibrosis w prolonged resp failure
145
How do you treat ARDS?
Mechanical ventilation, shown to reduce mortality
146
What does an elevated A-a gradient idicate?
pO2 higher in alveoli than in arterial blood = V/Q mismatch:
- Dead space ventilation - pneumonia, asthma, COPD, PE
- L to R shunt - pulm oedema, ARDS, pneumonia
- Alveolar hypoventilation - pulm fibrosis, ILD
