Resp - recap Flashcards
asthma - Ix
resp exam bloods - FBC, WCC FEV1 (reduced)/ FVC - <0.7 PEF - reversibility with bronchodialtor FeNO
asthma - Mx
SABA SABA + ICS SABA + IN ICS SABA + IN ICS + LABA SABA + IN ICS + LABA + LTRA SABA + IN ICS + LABA/ LTRA + oral steroid
acute asthma - Ix
A-E
obs - HR, RR, BP
cardio/ resp exam
ABG
acute asthma - Mx
oxygen salbutamol neb ipatropium neb hydrocrotisone IV magnesium sulphate IV aminophylline IV intubation and ventilation,extracorporeal membrane oxygenation (ECMO)
bronchiectasis - Ix
obs, resp exam
bloods - FBC, WCC, CRP, ESR
imaging - CXR (thick, cysts), high res CT (signet rings)
specialist - sputum culture, spirometry (obstructive), bronchoscopy
cause - serum Ig (hypogammgloulinaemia), CF sweat test, aspergillus precipitins/ skin prick test, RF/ ANA
bronchiectasis - Mx
mx underlying cause, stop smoking
physio - inspiratory mm
postural draining b.d
dyspnoea and wheeze - salbutamol
carbocysteine - mucolytic
abx if exacerbation - MCS (commonly haemophilus but also kleb, pseudo, strep pneumoniae)
surgery - lobectomy - rare, lung transplant
lung cancer - Ix
cardio, resp exam
bloods - FBC, UE (calcium), LFT, VGCC ab
CXR - cavitating (squamous), perihilar/ central (SCLC), peripheral (adenocarcinoma), pleural effusion, lung collapse (squamous)
bronchoscopy and biopsy - histology
Endobronchial uss and transbronchial needle aspiration - LN, paratracheal, bronchial lung lesions
PEF, lung function tests - surgrical mx
lung cancer - Mx
- SCLC
chemotherapy
+- radiotherapy
generally palliative, worse prognosis
lung cancer - Mx
- NSCLC
surgery - lobectomy
- >2cm carina, good reserve, no LN, peripheral
radiotherapy - stage I and II
chemo - stage III and IV
lung cancer - Mx
- palliative
chemotherapy - improve symptoms and QoL
endobronchial - stent, debulking
Cystic fibrosis - Ix
cardio, resp exam
bloods- FBC, UE, CRP, LFT, clotting, trypsin, faecal elastase
sputum cultures
heel prick test - 8 days
sweat test - pilocarpine, Cl>60 dx for CF
CXR - bronchiectasis
sputum cultures
abdo USS - gallstones, pancreatitis, cirrhosis
cystic fibrosis - Mx
- general
genetics
growth
DM
infertility
Cystic fibrosis - Mx
- medical
GI - CREON, ADEK, insulin
resp - fluclox, neb salbutamol, neb DNase (mucolytic)
cystic fibrosis - Mx
- surgery
lung and liver transplant in failure and cirrhosis
COPD - Ix
resp, cardio exam
bloods - FBC (polycythaemia), WCC, ESR, CRP
CXR, ECG (RA/ RV hypertrophy)
sputum sample, post-bronchodilator spirometry FEV1/FVC
COPD - mx
- medical
SABA/ SAMA
- asthma - LABA + ICS (+LAMA)
- no asthma - LABA + LAMA
- all failed - po aminophylline
carbocysteine
prophylactic abx - azithromytcin
COPD - mx
- specialist
pulmonary rehab - 3/w for 6Wks if functional disability
vaccinations - pneumococcal, influenza
roflumilast - PDE4 inhibitor
LTOT - PO2<7.3 or PO2<8 + polycythaemia/ pulomonary HTN/ peripheral oedema
COPD - mx
- acute
O2 aiming for 88-92% neb salb, ipratropium steroids - oral pred, iv hydrocortisone abx - amoxicillin, clarithromycin or doxycycline bipap
EAA - Ix
resp exam - wheeze, dyspnoea
bloods - IN neutrophils
bronchoalveolar lavage - raised lymphocytes and mast cells
CXR/ CT - ILD
EAA - Mx
acute - O2
prevent - mask, LT pred
ILD - untreatable
compesnation for farmer’s lung (mouldy spores in hay)
Idiopathic pulmonary fibrosis/ ILD- Ix
resp exam - fine end bi-basal insp crackles
bloods - FBC, UE, ANA, RF,
ABG
CXR - bi reticulo-nodular shadowing, ground glass
high res CT - honeycombing
IPF - Mx
pirefenidone - anti-inflam
nantedanib - tyrosine kinase inhibiator
ILD - Mx
C - wt loss, exercise, stop smoking
M - anti-fibrinolyics, LTOT
S - lung transplant
sarcoidosis - mx
analgesia
nsaids
occasional steroids if progressive lung fibrosis
obstructive sleep apnoea - Ix
epsworth sleepiness scale
home pulse oximeter, endoscopy
polysomnography - gold
Dx - >15 episodes in 1hr sleep
OSA - mx
wt loss, avoid alcohol/ smoking
CPAP via nasal (or oral)
emypema - Mx
chest drain and IV abx
empyema - Ix
pleural aspirate - pH<7.2, yellow and turbid, low glucose, IN LDH
pleural effusion - Ix
cardio, resp exam - DE chest expasion, dull to percussion, DE breath sounds, DE vocal resonance
CXR - pleural effusion, meniscus
- uni - ?malignancy
pleural aspiration + USS - 21G needle + 50ml syringe - cytology, micrscopy, LDH, protein, glucose
CT contrast - malignancy
pleural effusion - Mx
conservative if small
treat underlying cause
pleural aspirate - small
chest drain - large or recurrent
pneumonia
a
pneumothorax
a
TB
a
causes of restrictive lung disease
pulmonary fibrosis asbestosis sarcoidosis acute resp distress AS NMD severe obesity
mesothelioma dx
thoracoscopy and histology
