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ICM - OBS > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What investigations are used to diagnose asthma?

A
  1. Spirometry
    - FEV1/FVC ratio < 70 % indicative of obstructive airway disease
  2. Bronchodilator reversibility test
    - FEV1 improvement of 12% - positive
    - + increase in volume of 200 ml
    - + obstructive spirometry for diagnosis of asthma
  3. FeNo
    - > 40 ppb
    - under 17s > 35 ppb
    • positive peak flow variability for diagnosis of asthma
      - if there is diagnostic uncertainty with spirometry + BDR
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2
Q

Diagnosis of asthma in adults with symptoms suggestive of asthma:

A
  1. a FeNO level of 40 ppb or more with either positive BDR or positive peak flow variability or bronchial hyperreactivity, or
  2. between 25 and 39 ppb and a positive bronchial challenge test, or
  3. positive BDR and positive peak flow variability irrespective of FeNO level.
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3
Q

General Ix for COPD

A

Spirometry

Additional investigations:

- CXR: hyperinflation, bullae, flat hemidiaphragm
- FBC - anaemia or polycythaemia
- BMI

If marked improvement in symptoms in response to inhaler therapy - consider alternate diagnosis

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4
Q

Diagnosis of COPD

A
  • performed at diagnosis
  • to reconsider diagnosis
  • monitor disease progression
  • measure post-bronchodilator spirometry to confirm diagnosis of COPD

Post-bronchodilator FEV1/FVC < 0.7

FEV1 (of predicted)
> 80% : Stage 1 - Mild - symptoms should be present to diagnose COPD in these patients

50-79% : Stage 2 - Moderate

30-49% : Stage 3 - Severe

< 30% : Stage 4 - Very severe

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5
Q

DIfferentiating between asthma + COPD

A

When diagnostic uncertainty, identify asthma if:

- a large (over 400 ml) response to bronchodilators
- a large (over 400 ml) response to30 mgoral prednisolone daily for2 weeks
- serial peak flow measurements showing 20% or greater diurnal or day-to-day variability.
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6
Q

What is D-dimer?

A
  • usually used to exclude venous blood clot
    • negative predictive value - if it is negative, extremely unlikely to be a blood clot
    • If it is positive - this could be due to many differentials.
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7
Q

When is D-dimer requested?

A
  1. DVT
    • symptoms of leg pain, tenderness, oedema, discolouration
  2. PE
    • Symptoms: SOB, cough, lung related chest pain
  3. DIC
    • Symptoms: mucosal bleeding, bruising, N & V
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8
Q

Interpret D-dimer

A
  • normal - most unlikely to be clot
  • positive - indicated there is clot but not the location
  • normal range < 0.50 µg/mL
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9
Q

What can result in false negative d-dimer?

A

anticoagulant therapy

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10
Q

Indication for sputum culture

A
  • Respiratory tract bacterial infection

- monitor effectiveness of treatment

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11
Q

When is sputum culture indicated?

A

cough, fever, muscle aches, fatigue, trouble breathing, chest pain, confusion

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12
Q

Sampling procedure of sputum culture

A

cough up phlegm not saliva

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13
Q

Analysis of sputum culture

A
  • indication of which bacteria

- antibiotic sensitivity

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14
Q

Indication for PCR

A

Viral infection

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15
Q

Sampling for PCR

A

Nasal swab

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16
Q

What is sweat chloride testing used for?

A

Diagnos Cystic Fibrosis

17
Q

Indication for sweat chloride testing

A

Infant or child w:

- frequent resp infections
- chronic cough
- persistent diarhoea
- foul-smelling bulky greasy stools
- malnutrition
18
Q

How is sweat chloride test sample taken?

A

Sample - sweat sample collected using special sweat stimulation procedure
- pilocarpine - chemical stimulates the sweat glands is used

19
Q

Result of sweat chloride test in CF carriers

A

Normal

20
Q

What is Acid-fast bacillus smear and culture used for?

A

Diagnosis of TB

  • Identifies mycobacterial infection
  • Monitor effectiveness of treatment
21
Q

Indications for Acid-fast bacillus smear and culture

A
  • long lasting cough
  • sputum contains blood
  • Positive TB skin or blood teat
  • weight loss
  • fever
  • chills
  • weakness
22
Q

Sampling for Acid-fast bacillus smear and culture

A
  • 3 separate spit (sputum) samples

- collected early in the morning on different days

23
Q

What does the Acid-fast bacillus smear and culture look for?

A
  • looks for presence for bacteria called acid-fast bacilli - rod shaped
  • can be seen and counted under microscope
24
Q

What is Bordetella pertussis culture used for?

A

Diagnosis of Whooping cough

25
Q

Indications for Bordetella pertussis culture

A
  • Persistent, shapr spasm or fits of coughing

- symptoms of cold or close contact of pertusis

26
Q

Sampling for Bordetella pertussis culture

how is it taken?

A

nasopharyngeal swab or nasal aspirate

27
Q

What is Alpha-1 antitrypsin used for?

A

Diagnosis of emphysema and/or liver disease

28
Q

Indications for Alpha-1 antitrypsin

A
  • liver disease as an infant

- emphysema < 40 y/o

29
Q

Sampling for Alpha-1 antitrypsin

A

Blood

30
Q

Procedure of bronchoscopy

A
  • procedure to look directly at the airway in the lungs using a thin lighted tube
  • Put through mouth or nose
  • Moves down the throat + windpipe + into the airway
  • View: larynx, trachea, bronchi, bronchiles
31
Q

Indications for bronchoscopy

A
  • tumour
  • airway obstruction
  • stricture
  • inflammation + infections e.g TB, pneumonia
  • causes of persistent cough
  • spots seen on x-ray
  • vocal cord paralysis
32
Q

Diagnostic procedure or treatment with bronchoscopy

what is it used for?

A
  • biopsy
  • collection of sputum
  • removal of secretion or blood or polyps to clear airway
  • control bleeding in the bronchi
  • removing foreign objects
  • placement of stent to keep airway open
  • drainage of abscess
33
Q

Ix during 2WW clinic for resp

A
  • CXR
  • CT scan
  • MRI
  • Bronchoscopy
  • Endobronchial USS
  • Endoscopic USS
  • Biopsy- percutaneous lung biopsy
  • Surgical biopsy
  • neck lymph node USS + biopsy
  • Testing for gene mutation
  • PET-CT scan
34
Q

Urgent CXR indication

A
  • an ongoing or recurrent chest infection
  • a particular type of thickening and broadening of the fingertips, called clubbing
  • enlarged lymph nodes in your neck or above your collarbone
  • chest symptoms such as a cough, shortness of breath or chest pain
  • a high platelet count (thrombocytosis) in your blood
35
Q

PERC criteria

A 
HAD CLOTS:
Hormone
Age >50
DVT/PE history
Coughing blood
Leg swelling
O2 < 95%
Tachycardia 100+
Surgery/trauma <28 days
36
Q

What is CRB-65 criteria?

A
  1. confusion
  2. raised respiratory rate (30 bpm )
  3. low blood pressure (diastolic 60mmHg or less, or systolic less than 90mmHg)
  4. age 65years or more.
37
Q

Results of sputum culture and its indication

A
  1. Bloody (TB) (Hemoptysis).
  2. Rusty colored - usually caused by pneumococcal bacteria (in pneumonia).
  3. Purulent - containing pus:
    a. a yellow-greenish (mucopurulent) color.
    b. a white, milky, or opaque (mucoid).
  4. Foamy white - (obstruction or even Edema)
38
Q

Indications for CT in resp

A
  1. Evaluation of an abnormality detected on a chest X-ray
    Pulmonary mass or nodule
    Mediastinal mass
    Evaluation of aortic disease
  2. Aortic aneurysm/dissection
    Trauma
    Malignant disease
  3. Staging of primary tumour extent and its relationship to adjacent structures
    Detection of lymphadenopathy and metastatic disease
    Evaluation of metastatic disease where there is no known primary
    Assess suitability for biopsy
    Evaluation of pleural disease
  4. Suspected pulmonary embolus

ICM - OBS (18 decks)

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