Respiratory Flashcards
What is the treatment for COPD?
O SHIT
oxygen
salbutamol
hydrocortisone
ipatropium
thiotropium
Why are COPD patients are higher risk of pneumothoraces?
due to bullae formation
what are the respiratory causes of clubbing?
carcinoma of bronchus
mesothelioma
abscess
bronchiectasis
empyema
cystic fibrosis
What are the clinical features of extrinsic allergic alveolitis?
fever
rigors
dry cough
SOB
coarse end-expiratory crackles
CXR mottling
Bob has a suspected respiratory tract infection. Tests come back with cold agglutinins.
What is the likely pathogen
mycoplasm pneumoniae
What organism might cause pneumonia and hyponatraemia?
legionella
what are the clinical features of fibrosing alveolitis?
SOB, clubbing, fine end-inspiratory crackles
honeycombing and ground glass shadowing on imaging
What are some differentials for unilateral pleural effusions?
usually: infection or neoplasm
other important factors:
RA, autoimmune disease, benign asbestos effusion, pancreatitis, haemothorax
what are some causes of ARDS?
common = pneumonia, aspiration, severe trauma, sepsis [PASS]
any severe systemic or pulmonary disease may lead to ARDS
what are the respiratory diseases linked to asbestos exposure?
BENIGN - pleural plaques, pleural thickening or pleural effusions
INTERSTITIAL LUNG DISEASE -> asbestosis
MALIGNANT = mesothelioma, lung cancer
what respiratory diseases may be caused by aspergillus
aspergilloma
allergic bronchopulmonary aspergillosis
invasive aspergillosis
what group of patients are more commonly affected by allergic bronchopulmonary aspergillosus ?
asthmatics
what test can be done for ABPA?
skin antigen sensitivity test for aspergillus
a 30 year old asthmatic presents to GP with recurrent pneumonia with associated wheeze, cough, fever and malaise.
what might be the underlying pathogen and disease?
aspergillus infection of the airways
causing allergic bronchopulmonary aspergillosis
What might one see on CT of invasive aspergillosis?
nodules surrounded by ground glass appearance (halo sign)
what is the halo signs associated with?
CT finding of invasive aspergillosis
what kind of a hypersensitivity reaction is asthma?
type 1
what investigations might one order for diagnosis of asthma?
peak flow
pulmonary function tests (obstructive picture - reversible)
bloods - eosinophils, IgE levels, aspergillus antibody titre
skin prick tests to identify allergens
what is the gold standard for diagnosis of asthma?
clinical diagnosis on history if strongly suggestive
if not do peak flow or spirometry before and after bronchodilator to demonstrate reversibility of obstruction
FeNO is becoming more commonly used to support asthma diagnosis
what test measures airway inflammation?
FeNO
fraction expired nitric oxide
as during inflammatory processes epithelial cells are activated to produce NO
what are the aims of asthma management?
no daytime symptoms
no night time waking due to symptoms
no need for rescue medications
no attacks
no limitations on daily activities
normal lung function
describe the long term management of asthma?
personalised asthma action plan
avoid triggers and allergens
ensure proper inhaler technique and good preventer compliance
- short acting beta agonist
- regular ICS + short acting beta agonist (if patient presents with significant symptoms at diagnosis start on step 2)
- SABA + ICS + LABA
if inadequate control with LABA add high dose ICS
no response to LABA stop and use high dose ICS - high dose ICS and consider adding 4th drug (leukotriene antagonist, slow release theophylline)
- low does oral steroids, high dose ICS + steps above, refer for specialist care
what is the management of acute asthma
- ABCDE approach and resuscitation
- monitor O2, ABG and PEFR
- high flow oxygen
- salbutamol nebulisers (5mg) continuous
- ipatropium bromide nebulisers (0.5mg)
- steroids 100-200mg IV or 40mg prednisolone. continue for 5-7 days
- no improvement = magnesium sulphate, IV aminophylline infusion or IV salbutamol. get senior help
continue to monitor ABGs for normalising CO2 as sign of fatigue
may require anaesthesia and intubation if fatigued
what electrolyte abnormality can asthma treatment cause?
hypokalaemia
how do you grade the severity of an acute asthma attack?
PEFR 50-75% = moderate
PEFR 33-50% = severe
PEFR < 33% = life threatening
near fatal = hypercapnic, needs mechanical ventilation with increasing inflation pressures
what are the organisms commonly involved in bronchiectasis?
H. influenza
Strep. pneumoniae
staph. Aureus
Pseudomonas aeruginosa
whats the aetiology of bronchiectasis?
repeated infections with causative organisms
cystic fibrosis, primary ciliary dyskinesia
bronchial obstruction, ABPA, RA
idiopathic (50%)
pneumonia, TB, HIV
what is bronchiectasis?
fibrosis and permanent dilation of airways due to chronic/recurrent lung infections
what might one notice on examination of a patient with bronchiectasis?
clubbing
coarse inspiratory crackles
what sign is seen on CXR in bronchiectasis patients?
tram lines and ring shadows
what is the management of an exacerbation of bronchiectasis?
Antibiotics (if known pseudomonas give ciprofloxacin)
ICS
bronchodilators (salbutamol neds/inhaler)
may require chest physio
what are the most serious complications of bronchiectasis?
massive haemoptysis cor pulmonale (RHF)
what are the acute features of extrinsic allergic alveolitis?
4-6 hrs post exposure
rigors, fevers, myalgia, dry cough, dyspnoea, crackles
what are the chronic features of extrinsic allergic alveolitis?
increasing SOB
weight loss
exertional dyspnoea
type I resp failure
cor pulmonale
what are the CXR findings in extrinsic allergic alveolitis?
upper zone mottling/consolidation honeycomb lung (chronic)
what are the HRCT findings of extrinsic allergic alveolitis?
patchy ground glass shadowing and nodules
what are the OE of idiopathic pulmonary fibrosis?
bibasal fine late inspiratory crackles
rarely - clubbing
dry irritation cough
dyspnoea
weight loss, fatigue
what are the types of lung cancer?
small cell cancer
non-small cell cancer (squamous, adenocarcinoma, large cell, carcinoid tumours, bronchoalveolar)
what is a pancoast tumour?
a lung cancer situated in the lung apices which compresses the sympathetic ganglion chain when large enough. this leads to horners syndrome (miosis, ptosis, anhidrosis)
what are common sites for lung cancers to metastasis to?
adrenal gland, bone, brain, liver, other lung
what is pneumoconiosis?
fibrosing interstitial lung disease caused by chronic inhalation of mineral dusts
what are the types of pneumoconiosis?
simple - asymptomatic
complicated - causing reduced lung function (symptomatic)
what materials or occupations are risk factors for pneumoconiosis?
Coalworker
silicosis exposure
beryllium exposure (chronic)
asbestos (causes asbestosis)
occupations: coal mining, quarrying, metal foundries, stone cutting, sandblasting, insulation, construction, plumbers, ship yards
what specific symptom suggests coalworker’s pneumoconiosis?
black sputum
what signs may be noted during examination of a patient with pneumonia?
tachypnoea, tachycardia, pyrexia
reduced chest expansion
over affected area: dull to percussion, increased tactile/vocal fremitus, bronchial breathing, coarse crepitations
what are the components of the CURB-65 score?
confusion (AMTS < 8)
urea ( > 7)
respiratory rate (>30)
blood pressure (low, SBP < 90 or DBP < 60)
age ( >65)
what findings would be detected in a patient with a pneumothorax?
may have deviated trachea if tension
resp distress, tachypnoea, cyanosis
increased resonance on percussion, reduced chest expansion, reduced breath sounds, reduced tactile/vocal fremitus
what is the first step of managing a tension pneumothorax?
high flow O2
insert a large bore needle/cannula in the 2nd ICS mid-clavicular line on affected side
where is a chest drain inserted?
triangle of safety = 4th or 5th ICS mid-axillary line above the rib
what are the risk factors for a PE?
previous PE/DVT
clotting disorders
long distance travel
recent immobility
recent surgery
OCP
smoking
malignancy
how does the Well’s score help determine management?
considers likelihood of patient having a PE
if < 4 then suggests unlikely and do D-dimer
if > 4 suggests high likelihood of PE so start LMWH therapy and order a CTPA to confirm
what are the skin manifestations of sarcoidosis?
lupus pernio, erythema nodosum
what are the drugs used to treat TB?
rifampicin, isoniazid, pyrazinamide, ethambutol
what are some of the SE of rifampicin?
orange urine
purple tears
hepatitis
induces liver enzymes
what are some of the SE of isoniazid?
hepatitis
peripheral neuropathy
what are some of the SE of pyrazinamide?
hepatitis
photo sensitivity
gout
what are some of the SE of ethambutol?
optic neuritis
what are the skin manifestations of TB?
erythema nodosum
lupus vulgaris -> jelly like nodules on face and neck
what are the findings on CXR indicative of TB?
abscess/cavitating lesion in the lung apices
miliary TB - fine diffuse shadowing across both lungs
hila lymphadenopathy
what is the test for TB?
acid fast bacilli on a ziehl-neelson stain (+ve)
Risk factors for PE
clots in legs (DVT), previous PE, recent fracture, malignancy, recent surgery, recent immobility, oral contraceptive pill
long haul flight (immobility)
differentials of pleuritic chest pain
5 Ps
Pericarditis
PE
Pneumonia
Pneumothorax
Pleural pathology
sub-diaphragmatic pathology may cause it too e.g. hepatic abscess