Respiratory Flashcards
Give the appropriate tests for asthma in over 17s with values
Spirometry with bronchodilator reversibility test (FEV1/FVC ratio <70% positive test)
FeNO test (>40 parts per billion is positive test)
Give the appropriate tests for asthma in 5-16s with values
Spirometry with bronchodilator reversibility test (FEV1/FVC ratio <70% positive test)
FeNO test should be requested if there is normal or obstructive spirometry with a negative bronchodilator reversibility (BDR) test (>= 35 parts per billion (ppb) is considered positive)
Give the appropriate tests for asthma in <5yo
clinical judgement
Give the appropriate tests for suspected COPD
post-bronchodilator spirometry to demonstrate airflow obstruction: FEV1/FVC ratio less than 70%
chest x-ray: hyperinflation, bullae, flat hemidiaphragm. Also important to exclude lung cancer
full blood count: exclude secondary polycythaemia
body mass index (BMI) calculation
Spirometry results for suspected COPD shows Post-bronchodilator FEV1/FVC <0.7 and FEV1 >80%. What is the severity?
Stage 1 - mild symptoms
Spirometry results for suspected COPD shows Post-bronchodilator FEV1/FVC <0.7 and FEV1 <30%. What is the severity?
Stage 4 - Very severe
What is the FVC and FEV1?
FVC: total amount of air exhaled
FEV1: air forced from lungs in one second
Indications for D-Dimer
DVT (Deep Vein Thrombosis), PE (Pulmonary Embolism), or DIC (Disseminated Intravascular Coagulation)
What does a positive D-Dimer test indicate?
presence of an abnormally high level of cross-linked fibrin degradation products (significant clot formation and breakdown` in the body)
Sweat chloride testing indication and physiology
Cystic Fibrosis
Normally chloride travels in and out of cells through the cystic fibrosis transmembrane conductance regulator (CFTR.) In CF, a mutation in CTFR means it cannot work properly so there is a higher concentration of chloride in sweat.
Acid-Fast Bacillus (AFB) Testing indication
identify mycobacterial (rod shaped) infection, TB or monitor treatment effectiveness
Bordetella pertussis culture
in patients with persistent or fits of coughing (whooping cough)
Alpha-1 Antitrypsin indication and physiology
diagnose the cause of early onset emphysema and/or liver disease
A1AT is a protein prduced by the liver and released into the blood. It inactivates elastase in the lungs which is produced by neutrophils in response to inflammation. Elastase breaks down proteins so they can be reused by the body but if not regulated by A1AT it can damage the lung tissue by breaking down itself.
If A1AT doesn’t work it accumulates in liver cells and can cause liver damage.
Indications for CXR
Infection
Major trauma ( pneumothorax and haemothorax )
Acute chest pain
Asthma/bronchiolitis
Acute dyspnoea: exclude heart failure, pleural effusion
Chronic dyspnoea: exclude heart failure, effusion and interstitial lung disease
Haemoptysis
Suspected mass, metastasis or lymphadenopathy
Indication for CT
Evaluation of an abnormality detected on a chest X-ray
- Pulmonary mass or nodule
- Mediastinal mass
Evaluation of aortic disease
- Aortic aneurysm/dissection
- Trauma
Malignant disease
- Staging
- Lymphadenopathy
Evaluation of pleural disease
- Suspected pulmonary embolus
What is a bronchoscopy?
During a bronchoscopy, a bronchoscope is passed through your nose or mouth, past your larynx (voice box), down your trachea (windpipe) and into the bronchi. The images taken by the bronchoscope are projected onto a TV screen and the doctor can look at them to check whether or not any disease is present in your lungs.
Sometimes a biopsy—a sample of tissue—is taken for analysis (testing) in the laboratory. The tissue is removed through the endoscope using tiny forceps
Which investigations are likely to take place under a two week rule for suspected lung cancer?
Spirometry , Chest xray and CT scan
