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Year 6 Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is COPD

A

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs

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2
Q

What are the investigations for COPD?

A

bedside: examination, obs, sputum sample (MC&S)
Bloods: baseline FBC (polycythaemia), CRP, ABG, BNP (cor pulmonale)
Imaging: CXR, HR-CT, echo (cor pulmonale)
Special tests: biopsy (PAS stain;A1AT), spirometry (gold standard)

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3
Q

What is the scale used for COPD assessment?

A

mMRC (modified medical research council scale`0
0 only breathless with strenuous exercise
1 SOB when hurrying or walking slightly uphill
2 slower than average person of same age, need to stop for breaks
3 stop for breath after walking 100 m or after a few minutes
4 too breathless to leave the house; breathless when dressing

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4
Q

What is the conservative management of COPD?

A 
Smoking cessation
mucolytics
Prophylactic azithromycin
Vaccines 
LTOT
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5
Q

Which patients with COPD should be given azithromycin?

A

non smoker
optimised medical management
referred for pulmonary rehabilitation
x4 IE/year with >=1 hospitalisation

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6
Q

What is the medical management of COPD?

A
  1. PRN SAMA or SABA
  2. asthmatic features -> LABA + inh steroid
    no asthmatic features -> LABA + LAMA
  3. LABA + LAMA + ICS
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7
Q

What are the asthmatic features in COPD to look out for?

A

History of asthma or atopy
FEV1 variation over time (>400mL)
Eosinophilia
Diurnal variation in PEFR (>20%)

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8
Q

What is the surgical management of COPD?

A

Remove diseased lung to allow non-diseased parts to become more ventilated:
- bullectomy
- lung reduction surgery (indication: heterogenous emphysema)
- endobronchial valve placement (valve placed in part of lung -> iatrogenic distal collapse)
Lung transplant

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9
Q

How is mild COPD categorised?

A

FEV1/FVC <0.7

FEV1 >80%

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10
Q

How is moderate COPD categorised?

A

FEV1/FVC <0.7

FEV1 50-79%

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11
Q

How is severe COPD categorised?

A

FEV1/FVC <0.7

FEV1 30-49%

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12
Q

How is severe COPD categorised?

A

FEV1/FVC <0.7

FEV1 <30%

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13
Q

Who is eligible for LTOT?

A

Non smoker AND…

  1. pO2 of <7.3 kPa (x2 measurements) OR
  2. pO2 of 7.3-8 kPa and of of…
    - secondary polycythaemia
    - peripheral oedema
    - pulmonary hypertension
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14
Q

what are the indications for NIV in COPD?

A

resp alkalosis pH 7.25-7.35
T2RF secondary to chest wall deformity, neuromuscular disease, OSA
cariogenic pulmonary oedema
weaning from tracheal intubation

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15
Q

what is the management of COPD exacerbation

A 
24% fiO2 venturi 
neb salbutamol 5mg
neb ipratropium bromide 0.5 mg 
IV hydrocortison 200 mg
PO pre 40-50 mg (5 days)
IV amox/co-amox

Senior support
IV aminophylline
BiPAP

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16
Q

What are the complications of COPD?

A

Local - pneumothorax, lobar collapse, bull formation, lung cancer
systemic - pulmonary hypertension +/-cor pulmonale, polycythaemia, medication/ steroid complications

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17
Q

What are some differentials for a wheeze?

A

Resp: asthma, COPD
Rheum: GPA (obliterative bronchiolitis), rheumatoid arthritis
Cardiac: HF

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18
Q

Which features are present in a life threatening asthma attack?

A

PEFR <33%
pO2 <92%
GCS down, exhaustion, low BP
Silent chest, confusion, arrhythmia

ADMIT

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19
Q

What is a moderate asthma attack?

A

PEFR
50-75%
No other features

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20
Q

What is a severe asthma attack?

A

PEFR 33-50%
Not completing full sentenes
RR >25, HR >110, pO2 >92%

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21
Q

What is a near fatal asthma attack?

A

pCO2 RAISED

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22
Q

When should a patient be discharged after an asthma attack?

A

discharge when stable for 48 hours

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23
Q

When should a patient be reviewed after attending hospital for asthma

A

If discharged - review in GP in 2 days

If admitted - review in GP in 2 days, review in respiratory clinic in 4 weeks

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24
Q

What aspects of asthma need to be reviewed after admission to hospital?

A 
TAME
Technique
Avoidance of triggers
Monitor (PEFR)
Educate
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25
Q

What drugs should a patient be discharged with after an asthma attack?

A

prednisolone 40 mg OD PO 5 days OR

quadruple inhaled ICS dose for 14 days if not admitted

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26
Q

How often can salbutamol and ipratropium be given in asthma attack

A

salbutamol can be given back to back PRN

ipratropium bromide can be given every 4 hours PRN

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27
Q

How is an asthma attack management

A 
O2 100%
Neb salb
neb iptratropium
PO pred 
100mg IV hydrocort

Senior
IV magnesium sulphate
IV aminophylline
ITU + intubate

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28
Q

What are the most common organisms that cause a CAP?

A

S.pneumoniae (30-50%)

H. Influenzae (15-35%)

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29
Q

Which antibiotic is used for a mild CAP

A

amoxicillin

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30
Q

Which antibiotic is used for a severe CAP/atypical

A

co-amoxiclav + clarithromycin

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31
Q

Which antibiotic is used for legionella?

A

Clarithromycin + rifampicin

catheter - change with gentamicin cover

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32
Q

Which antibiotic is used for staphylococcus?

A

flucloxacillin

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33
Q

What is the most common atypical pneumonia organism?

A

mycoplasma pneumoniae

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34
Q

what is the antibiotic cover for atypical CAP?

A

Clarithromycin, doxycycline

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35
Q

What are the buzzwords for S.pneumonia?

A

rusty sputum, lobar pattern, reactivate HSV

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36
Q

What are the buzzwords for H.influenzae?

A 
pre-existing lung disease (smoking/COPD)
bronchoalveolar pattern (lower lobes).
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37
Q

What are the buzzwords for M.catarrhalis?

A

smoking

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38
Q

What are the typical organisms for CAP?

A 
S.pneumoniae
H.influenzae
M.Catarrhalis
S.aureus
K.pneumoniae
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39
Q

What are the atypical organisms for CAP?

A 
M2C3BL
M.pneumoniae
M.tuberculosis
C.pneumoniae
C.psittaci
C.burnetii
B.pertussis
L.pneumophilia
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40
Q

What are the buzzwords for S.aureus?

A

recent viral infection +/- cavitation CXR

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41
Q

What are the buzzwords for K.pneumoniae?

A

redcurrant jelly sputum, alcoholism, dm, elderly, haemoptysis, caveatting upper lobes

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42
Q

Gram -ve typicals?

A

H.influenzae
M.Catarrhalis
K.pneumoniae

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43
Q

Gram +ve typicals?

A

S.pneumoniae

S.aureus

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44
Q

Gram -ve atypicals?

A

c.burnetii

B.pertussis

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45
Q

Gram +ve atypicals?

A

m.tuberculosis

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46
Q

Buzzwords for M.pneumoniae?

A

systemic, joint point, cold agglutinin test, erythema multiform, SJS, AIHA

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47
Q

Buzzwords for L.pneumophilia?

A

Air travel, air conditioner, water tower, hepatitis, hyponatraemia, urinary antigen

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48
Q

Buzzwords for C.psittaci?

A

birds

haemolytic anaemia

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49
Q

Buzzwords for C.pneumoniae?

A

child

adolescent

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50
Q

Buzzwords for B.pertussis?

A

whooping cough

unvaccinated

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51
Q

What is the curb 65 score

A 
Confusion (AMTS <=8)
Urea >=7
Resp rate >=30
BP <90/60
65 yo
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52
Q

What most commonly causes early onset (48h - 4d) HAP?

A

Strep pneumoniae

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53
Q

What most commonly causes later onset (>4 days) HAP?

A

Enterobacteria (E.coli, K.pneumoniae) > S.aureus (MRSA) > pseudomonas

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54
Q

Abx for non severe HAP?

A

Co-amox or doxy

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55
Q

Abx for severe HAP?

A

Piptazobactam or cef+gent

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56
Q

Abx for MRSA?

A

Vancomycin

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57
Q

Abx for Klebsiella?

A

cephalosporin

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58
Q

Abx for pseudomonas?

A

piptazobactam

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59
Q

Ix for TB?

A

Bedside; exam, obs, TST, sputum (MC&S), sputum smear +zh/auramine stain
Bloods: FBC, U&E, CRP, IGRA
Imaging: CXR
Special: EBUS

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60
Q

Which test is the gold standard for tb?

A

BAL + SPUTUM culture (1-3 w)

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61
Q

Which TB test shows if the patient has been exposed

A

IGRA (Does not show if latent or active)

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62
Q

Which TB test shows latent TB?

A

TST/mantoux test

check size of bleb

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63
Q

Which test is used if not sputum culture for TB?

A

Sputum smear X3 -> NAAT
auramine stain - screening
Ziehl-neelson - diagnosis

64
Q

What is the management of TB?

A 
RIPE
rifampicin (6m)
Isoniazid (6m)
Pyrazinamide (2m)
Ethambutol (2m)
65
Q

what are the side effects of rifampicin ?

A

orange secretions
raised ALT/AST
inducer

66
Q

what are the side effects of isoniazid?

A 
Drug induced liver injury (dili)
peripheral neuropathy (give with pyridoxine)
67
Q

what are the side effects of pyrazinamide?

A

DILI

68
Q

what are the side effects of ethambutol?

A

visual disturbance

69
Q

What is the most common opportunistic AIDS infection?

A

PCP

70
Q

What are the S/S of PCP?

A

sob
dry cough, fever, exercise induced low oxygen
pneumothorax
extra pulmonary:hepatosplenomegaly, lymphadenopathy, choroid lesions

71
Q

Ix of PCP

A

CXR - bilat infiltrates but can be normal
BAL > sputum (silver stain shows cysts)
Exercise induced desaturation

72
Q

Management for PCP?

A

Mild/mod: co-trimoxazole

severe: IV pentamidine

73
Q

What are the complications of inserting a chest drain?

A

Immediate: failure, pain, haemorrhage, pneumothorax

early: infection haematoma, long thoracic nerve damage (winged scapula), blockage
late: scar formation

74
Q

What is flail chest?

A

life threatening condition when >=3 consecutive ribs fracture in >=2 locations resulting in part of the chest wall moving independently of the rest

75
Q

How does a flail segment move on inspiration?

A

moves inwards

76
Q

How does a flail segment move on inspiration?

A

moves outwards

77
Q

why is a flail segment dangerous?

A

increased WOB and pulmonary contusions

free rib may puncture -> tension pneumothorax

78
Q

Ix for flail segment?

A

CXR: fracture, subcut emphysema, pneumothorax, mediatstinal shift

79
Q

Mx for flail chest?

A

analgesia, chest physio (expansion and secretions), CPAP, surgical fixation

80
Q

Causes of exudate pleural effusion?

A 
>30 g protein
Malignancy
Infection (pneumonia, TB, abscess)
PE
Trauma
pancreatitis
CTD (RA, SLE)
Dresslers
81
Q

Causes of transudate pleural effusion?

A 
<30 g protein
CCF
Cirrhosis
Nephrotic syndrome
Myxoedema
Meig's (benign ovarian tumour, ascites, R sided pleural effusion)
Hypothyroid
Hypoalbuminaemia
82
Q

Investigations for pleural effusion?

A

bedside: exam, obs, urine dip (protein)
bloods: baseline, LFTs, CRP, clotting, culture
imaging: CXR, echo (CCF), contact CT (exudative causes
special: USS guided pleural aspiration and chest drain, EBUS (sarcoid, TB)

83
Q

what features of a pleural tap would suggest an empyema?

A

pH <7.2
LDH high
glucose low

84
Q

When do you use lights criteria?

A

if tap shows 25-35g/L of protein to help differentiate cause

85
Q

What is lights criteria?

A

an exudate is likely if:
pleural fluid protein/serum protein >0.5
pleural fluid LDH/serum LDH >0.6
pleural fluid LDH>2/3 ULN serum LDH

86
Q

What is the management of pleural effusion?

A
  1. if aspirate turbid/cloudy, +ve MCS and pH <7.2 -> chest drain
  2. Treat cause
  3. recurrent: aspiration, pleurodesis, indwelling pleural catheter, drug management e.g opioids for SOB
87
Q

What is the management of an acute exacerbation of COPD?

A

increase frequency of bronchodilator use and consider giving via a nebuliser
give prednisolone 30 mg daily for 5 days
it is common practice for all patients with an exacerbation of COPD to receive antibiotics. NICE do not support this approach. They recommend giving oral antibiotics ‘if sputum is purulent or there are clinical signs of pneumonia’
the BNF recommends one of the following oral antibiotics first-line: amoxicillin or clarithromycin or doxycycline.

88
Q

What is the management of sarcoidosis

A

steroids

89
Q

What are some indications for steroids in sarcoidosis?

A
  • patients with chest x-ray stage 2 or 3 disease who are symptomatic.
  • Patients with asymptomatic and stable stage 2 or 3 disease who have only mildly abnormal lung function do not require treatment
  • hypercalcaemia
  • eye, heart or neuro involvement
90
Q

what are 4 types of pulmonary fibrosis?

A

Idiopathic (IPF)
Hypersensitivity pneumonitis
Sarcoidosis
Pneumoconiosis

91
Q

what are the symptoms of hypersensitivity pneumonitis

A

mild fever

92
Q

Ix for hypersensitivity pneumonitis?

A

BAL - increased cellularity

93
Q

what are the causes of upper lobe fibrosis?

A 
TAPE
TB
ABPA
Pneumoconiosis (silica, coal)
EAA (hypersensitivity pneumonitis
94
Q

what are the causes of lower lobe fibrosis?

A

STAIR
Sarcoid (mid zone)
Toxins (Bleomycine, amoidarone, nitrofurantoin, sulfasalazine, methotrexate)
Asbestosis
Idiopathic pulmonary fibrosis (diagnosis of exclusion)
Rheumatology (RhA, SLE, Sjogrens, CREST/scleroderma)

95
Q

What are the signs and symptoms of IPF?

A

Progressive exertion dyspnoea
Dry cough
Clubbing
Bibasal fine end inspiratory crepe on auscultation

96
Q

What are the investigations for pulmonary fibrosis?

A

Bedside: examination, obs
Bloods: baseline, SLE screen, IgE, ABG
Imaging: CXR, HR-CT, echo (pulmonary hypertension)
Special tests: Spirometry (restrictive), TLCO (low), BAL (cellularity), EBUS (sarcoid)

97
Q

what is the management of IPF?

A

Conservative: physio, pulmonary rehabilitation, smoking cessation
Medical: LTOT, antitussives, pirfenidone/ninetadinib, immunosuppressants
Surgical: lung transplant

98
Q

What is the criteria for long term oxygen therapy (IPF)?

A
  1. pO2 <7.3kPA (x2) OR
  2. pO2 of 7.3-8kPA and one of…
    - secondary polycythaemia - nocturnal hypoxaemia
    - peripheral oedema - pulmonary hypertension
99
Q

When should you give steroids in sarcoidosis?

A 
HUNP
Hypercalcaemia
Uveitis
Neurological/cardiac involvement
Parenchymal lung disease
100
Q

What is the prognosis for IPF?

A

Poor

life expectancy 3-4 y

101
Q

What is bronchiectasis?

A

permanent dilatation of airways secondary to chronic inflammation

102
Q

What are some causes of bronchiectasis?

A

Infection: haemophilia influenzae (most common), pseudomonas, klebsiella spp, strep pneumoniae
obstruction (tumours or foreign body)
idiopathic (majority)
CF
Kartageners
Autoimmune: selective IgA, hypogammaglobulinaemia, ABPA, rheumatoid

103
Q

What are some signs and symptoms of bronchiectasis?

A

Hx of cause

ABPA

104
Q

What are the ix for bronchiectasis?

A

bedside: exam, obs, sputum (MCS), sweat test
bloods: baseline, CRP, immunoglobulin, CF tests, aspergillus
Imaging: CXR, HR-CT
Special: spirometry

105
Q

What is the management of bronchiectasis?

A

correct underlying cause

Prophylaxis: physio, pul rehab
smoking cessation
bronchodilators
immunisations 
prophylactic rescue packs (abx) and education

Acute exacerbation:
Abx
bronchodilators

106
Q

What are the complications of bronchiectasis?

A

local: haemorrhage, lobar collapse, T2RF
systemic: pul HTN, cachexia

107
Q

What is ABPA

A

Allergic response to aspergillum spores

108
Q

What are the Ix of ABPA?

A 
Eosinophils
CXR
\+ve RAST
Raised IgE
\+ve igG
109
Q

What is the management of ABPA?

A

Oral glucocorticoids

itraconazole

110
Q

What is cystic fibrosis ?

A

Defective CFTR chloride channel (chromosome 7)

111
Q

What is the incidence and carrier rate of CF?

A

1 in 25000 live births

1 in 25 carrier

112
Q

What is the most common gene mutation in CF?

A

F508

113
Q

What are the S/S of CF?

A 
Meconium ileus
Recurring chest infections
ABPA, nasal polyps, sinusitis
Diarrhoea or constipation
Male sterility
Faltering growth
Jaundice
Diabetes
Clubbing
114
Q

What are the investigations for CF?

A

Guthrie heel prick test for immunoreactive trypsinogen
Sweat test for NaCl
Genetic testing
CXR

115
Q

What signs of cystic fibrosis may be seen on CXR?

A

Hyperinflation
peri-bronchial shadowing
bronchial wall thickening
ring shadows

116
Q

What is the management of CF?

A

MDT - routine reviews

Resp:
physio 2x a day
encourage physical activity
mucolytic: dornase alfa/rhDNase + saline
lumacaftor with ivacaftor may be effective in prolonging life by F508

Infection
Abx prophylaxis (fluclox + azithromycin)
Rescue packs

Nutrition
High calorie and fat diet
Fat soluble vitamin supplements
Creon (pancreatic enzyme replacement) with every meal

General:
DM therapy
Urso - for liver and bile problems 
intracytoplasmic sperm injection 
laxatives
117
Q

what are some common organisms for CF infection?

A

S.aureus, P. Aeruginosa, Burkholderia cepacia complex

118
Q

Types and incidence of Lung cancer?

A 
Small cell lung cancer (15%)
Non small cell lung cancer (85%)
- adenocarcinoma (30%)
- SCC (30%)
- Large cell carcinoma (20%)
- alveolar cell carcinoma
- bronchial adenoma
119
Q

What are the features of SCLC?

A 
Smokers
central 
SIADH
ACTH
LEMS
120
Q

What are the features of adenocarcinoma?

A 
non smokers
peripheral 
early mets
gynaecomastia
HPOA (hypertrophy pulmonary osteoarthropathy)
121
Q

What are the features of SCC?

A 
Smokers
central
spread locally
late mets
PTHrp, ectopic TSH, HPOA
122
Q

What are the features of large cell carcinoma?

A

peripheral, poor prognosis, beta HCG,
anaplastic
poor differentiation

123
Q

Where do lung cancers commonly metastasise to?

A 
prostate
testicular
bones
kidney
breast
124
Q

What are some signs and symptoms of Lung Ca?

A 
Cough 
WL
Haemoptysis
Anorexia
SOB
Hoarseness (pan coast)
Chest pain
SVCO
125
Q

What paraneoplastic syndromes may SCLC cause?

A

SIADH - hyponatraemia
ACTH - cushings
LEMS (anti VGCC) - MG like but improves with activity

126
Q

What paraneoplastic syndromes may SCC cause?

A

PTHrp - hypercalcaemia, HPOA
Ectopic TSH - hyperthyroid
Clubbing

127
Q

What paraneoplastic syndromes may adenocarcinoma cause?

A

gynaecomastia, HPOA

128
Q

What is HPOA?

A

Proliferative periostitis involving the long bones - often painful

129
Q

What are the local and systemic complications of lung ca?

A

local: lung collapse, pleural effusion, haemorrhage, phrenic/recurrent laryngeal nerve palsy, horners, SVCO

systemic: ectopic hormone production –> SIADH, ACTH, LEMS, PTH
gynaecomastia
dermatomyositis

130
Q

Management of NSCLC?

A
  1. surgery
  2. curative/palliative radiotherapy
  3. nivolumab is approved to treat NSCLC
131
Q

When is surgery contraindicated for NSCLC?

A
  • Poor health
  • Mets
  • FEV1 <1.5
  • Malignant effusion
  • Hilum tumour
  • Vocal cord paralysis
  • SVCO
132
Q

What is the management of SCLC?

A
  • Early stages (T1-2a,N0,M0) -> surgery
  • non early stages/limited disease -> combination chemo
  • non early stages/extensive disease -> palliative chemo
133
Q

what is sarcoidosis?

A

multisystem disorder involving non caveatting granulomas

134
Q

What are the features of sarcoid?

A

polyarthralgia
erythema nodosum
bilateral hilar lymphadenopathy

135
Q

What may cause widening of mediastinum on CXR

A

Goitre
lymphoma
thoracic aneurysm
thymus tumour

136
Q

When should someone be assessed for LTOT?

A

Assess patients if any of the following:

  • very severe airflow obstruction (FEV1 < 30% predicted). - - Assessment should be ‘considered’ for patients with severe airflow obstruction (FEV1 30-49% predicted)
  • cyanosis
  • polycythaemia
  • peripheral oedema
  • raised jugular venous pressure
  • oxygen saturations less than or equal to 92% on room air
137
Q

What needs to be done before offering LTOT?

A

do not offer LTOT to people who continue to smoke despite being offered smoking cessation advice and treatment, and referral to specialist stop smoking services.

NICE suggest that a structured risk assessment is carried out before offering LTOT, including:
the risks of falls from tripping over the equipment
the risks of burns and fires, and the increased risk of these for people who live in homes where someone smokes (including e‑cigarettes)

138
Q

What is the most appropriate test prior to starting azithromycin for COPD?

A

ecg to rule out prolonged Qt interval

LFTs also advised

139
Q

When should you keep someone in hospital for pneumonia?

A 
NICE recommend that patients are not routinely discharged if in the past 24 hours they have had 2 or more of the following findings:
temperature higher than 37.5°C
respiratory rate 24 breaths per minute or more
heart rate over 100 beats per minute
systolic blood pressure 90 mmHg or less
oxygen saturation under 90% on room air
abnormal mental status
inability to eat without assistance.

They also recommend delaying discharge if the temperature is higher than 37.5°C.

140
Q

What should all patients have 6 weeks after pneumonia?

A

CXR

141
Q

Which autoantibodies may be seen in IPF?

A

ANA positive in 30%, rheumatoid factor positive in 10%

142
Q

What is seen on CXR of IPF?

A

sub-pleural reticular opacities that increase from the apex to the bases of the lungs

143
Q

What are the investigation findings in pneumoconiosis?

A

Chest x-ray: upper zone fibrosis

Spirometry: restrictive lung function tests - a normal or slightly reduced FEV1 and a reduced FVC

144
Q

What is the management of pneumoconiosis?

A

Avoid exposure to coal dust and other respiratory irritants (e.g. Smoking).
Manage symptoms of chronic bronchitis
Patients may be eligible for compensation via the Industrial Injuries Act.

145
Q

What can cause a metabolic acidosis with normal anion gap?

A 
= hyperchloraemic metabolic acidosis)
Gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula
Renal tubular acidosis
Drugs: e.g. acetazolamide
Ammonium chloride injection
Addison's disease
146
Q

What can cause a metabolic acidosis with raised anion gap?

A

Lactate: shock, hypoxia
Ketones: diabetic ketoacidosis, alcohol
Urate: renal failure
Acid poisoning: salicylates, methanol

147
Q

How can metabolic acidosis with a raised lactate be categorised?

A

Metabolic acidosis secondary to high lactate levels may be subdivided into two types:
Lactic acidosis type A: (Perfusion disorders e.g.shock, hypoxia, burns)
Lactic acidosis type B: (Metabolic e.g. metformin toxicity)

148
Q

Causes of metabolic alkalosis?

A 
Vomiting / aspiration (e.g. Peptic ulcer leading to pyloric stenosis, nasogastric suction)
Diuretics
Liquorice, carbenoxolone
Hypokalaemia
Primary hyperaldosteronism
Cushing's syndrome
Bartter's syndrome
Congenital adrenal hyperplasia
149
Q

Causes of respiratory acidosis?

A

COPD
Decompensation in other respiratory conditions e.g. Life-threatening asthma / pulmonary oedema
Sedative drugs: benzodiazepines, opiate overdose

150
Q

Causes of respiratory alkalosis?

A

Psychogenic: anxiety leading to hyperventilation
Hypoxia causing a subsequent hyperventilation: pulmonary embolism, high altitude
Early salicylate poisoning*
CNS stimulation: stroke, subarachnoid haemorrhage, encephalitis
Pregnancy

*Salicylate overdose leads to a mixed respiratory alkalosis and metabolic acidosis. Early stimulation of the respiratory centre leads to a respiratory alkalosis whilst later the direct acid effects of salicylates (combined with acute renal failure) may lead to an acidosis

151
Q

what is the most common cause of occupational asthma

A

isocyanates

example occupations include spray painting and foam moulding using adhesives

152
Q

What should pleural tap fluid be sent for?

A

pH, protein, lactate dehydrogenase (LDH), cytology and microbiology

153
Q

When should a chest drain be placed in pleural effusion?

A
  • if the fluid is purulent or turbid/cloudy a chest tube should be placed to allow drainage
  • if the fluid is clear but the pH is less than 7.2 in patients with suspected pleural infection a chest tube should be placed
154
Q

what is alpha 1 anti trypsin deficiency?

A

Alpha-1 antitrypsin (A1AT) deficiency is a common inherited condition caused by a lack of a protease inhibitor (Pi) normally produced by the liver
causes emphysema in young non smokers

155
Q

Features of A1AT?

A

patients who manifest disease usually have PiZZ genotype

lungs: panacinar emphysema, most marked in lower lobes
liver: cirrhosis and hepatocellular carcinoma in adults, cholestasis in children

156
Q

Ix A1AT?

A

A1AT concentrations

spirometry: obstructive picture

157
Q

mX A1At?

A

no smoking
supportive: bronchodilators, physiotherapy
intravenous alpha1-antitrypsin protein concentrates
surgery: lung volume reduction surgery, lung transplantation

Year 6 Medicine (18 decks)

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