Respiratory Flashcards
What are ecg findings in PE?
large S wave in lead I, a large Q wave in lead III and an inverted T wave in lead III
RBBB (as right heart strain)
RAD
Sinus tahcycardia
TWI (if RV ischaemia)
Management of high altitude cerebral oedema?
Descent + dexamethasone
Best way to monitor progression in COPD?
FEV1
Diagnosing asthma in patients <5 years?
Clinical judgement
Diagnosing asthma in patients 5-16 yo?
1) All patient Spirometry with bronchodilator reversibility (BDR) test
2) FeNO (fraction exhaled nitrous oxide) if normal spirometry or obstructive spirometry with negative BDR test
Diagnosing asthma in patients 17+?
1) ask all patients if symptoms better away from work - if so, refer for possible occupational asthma
2) All patients Spirometry with bronchodilator reversibility (BDR) test
3) All patients FeNO test
What makes a positive FeNO test?
Adults: >=40ppb
Children: >=35ppb
What spirometry result indicates obstructive disease?
FEV1/FVC <70%
FVC normal
What spirometry result indicates restrictive disease?
Both FEV1 + FVC reduced –> therefore FEV1/FVC normal
What is allergic bronchopulmonary aspergillosis?
Results from allergy to aspergillus spores
If a question states bronchiectasis with eosinophilia what is the likely diagnosis?
allergic bronchopulmonary aspergillosis
How does allergic bronchopulmonary aspergillosis present?
Bronchoconstriction [wheeze, cough, dyspnoea] (may have asthma diagnosis)
with PROXIMAL bronchiectasis
What is the treatment of allergic bronchopulmonary aspergillosis?
steroids
Where does absestos cause lung fibrosis?
lower zones
From the roof
What are the causes of upper zone fibrosis?
CHARTS C - Coal worker's pneumoconiosis H - Histiocytosis/ hypersensitivity pneumonitis A - Ankylosing spondylitis R - Radiation T - Tuberculosis S - Silicosis/sarcoidosis
What are the causes of lower zone fibrosis?
idiopathic pulmonary fibrosis
most connective tissue disorders (except ankylosing spondylitis) e.g. SLE
drug-induced: amiodarone, bleomycin, methotrexate
asbestosis
What is the initial settings for BIPAP in COPD?
IPAP - 10cm H2O
EPAP - 5cm H2O
what is brupropion contraindicated in?
Epilepsy, pregnancy + breast feeding
What condition should you use varenicline with caution in?
Depression / self-harm history as increased risk of relapse
What are the indications for corticosteroid treatment in sarcoidosis?
PUNCH: Parenchymal lung disease Uveitis neurological or cardiac involvement Hypercalcaemia
commonest cause of infective exacerbation COPD?
Haemophilus influenzae
> strep pneumoniae > moraxella catarrhalis
In exacerbations of COPD what do NICE recommend when to give antibiotics/treat as infective exacerbation?
if sputum purulent or clinical signs of pneumonia (including CXR showing consolidation; or inflam markers raised)
What is Churg strauss syndrome? What is seen on serology
Eosinophilic granulomatosis with polyangitis
pANCA
What is seen on serology with granulomatosis with polyangitis?
cANCA
