Respiratory Flashcards
COPD long term oxygen if
- FEV1 <30% predicted
- Cyanosis
- Polycythaemia
- Peripheral oedema
- Raised JVP
- O2 <92% on room air
Pneumothorax management
Primary (without apparent cause and absence of lung disease)
- <2cm - discharge (will resolve naturally)
- Aspiration - go into 2nd intercostal space MIDCLAVICULAR line at 90 degrees in skin above rib
- Chest drain
Secondary (in presence of existing lung pathology)
- <1cm - oxygen + admit
- 1-2cm - aspirate
- > 2cm - chest drain
Tension pneumothorax treatment
Chest drain
Tuberculosis most common cause
Mycobacterium tuberculosis
TB active investigation/management
Active - with symptoms
- CXR - upper lobe cavitation
- Gold standard - sputum ZIEHL-NEELSEN STAIN to identify mycobacteria
- RIPE - rifampicin, isoniazid, pyrazinamide, ethambutol
- RIPE for 2 months, RI for 4 months after
TB latent investigation/management
Latent- infected with TB but no symptoms
- MANTOUX TEST
- RI for 6 months or I for 3 months
Cystic fibrosis pres/diagnosis/management
- Neonatal jaundice, recurrent chest infections, steatorrhoea
- Newborn - Heel-prick test (detects immunoreactive trypsinogen) - if positive - sweat test to confirm
- Older - sweat test - high chloride
- Postural drainage to clear chest
- High calorie, high fat diet
- Pancreatic supplementation
Bronchiectasis def/investigation/management
- Permanent dilation of airways
- CXR - KERLEY B-LINES - sign of pulmonary oedema because bronchioles slightly larger so more likely to collect fluid
- Sputum - HAEMOPHILUS INFLUENZAE most common
- Postural drainage
- Prophylactic antibiotics
Pneumonia causes
- CAP - STREP PNEUMONIAE (80%), haemophilus influenzae
- HAP - PSEUDOMONAS AERUGINOSA, e.coli, klebsiella, staph aureus
- Atypical - Legionella pneumophila, chlamydia psittaci, chlamydophila pneumoniae, mycoplasma pneumoniae
Pneumonia pres
- Dyspnoea
- Cough
- Sputum
- Fever
- DULL TO PERCUSS
- Increased RR and HR
- Low BP and O2 sats
Pneumonia investigation
CURB-65
- Confusion
- Urea >7
- RR >30
- BP <90 systolic and/or <60 diastolic
- Age >65
0-1 - outpatient treatment
2 - consider hospital admission or close outpatient
>3 - consider intesive care assessment
Pneumonia management
- Maintain O2 sats at 94-98% (COPD - 88-92%)
- Antibiotics
- Analgesia
- Fluids
CURB-65
0-1 - oral amoxicillin or macrolide if allergic for 5 days
2 - amoxicillin + macrolide 7-10 days
>3 - IV co-amoxiclav + clarithromycin
Sinusitis viral vs bacterial
Viral <10 days
- Clear nasal discharge
- Fever
- Sore throat
Bacterial >10 days
- Purulent nasal discharge
- Nasal obstruction
- Dental/facial pain
- Headache
Lung cancer investigations/treatment
- 1st line CXR - opacified lesion, hilar enlargement, pleural effusion
- Diagnostic - percutaneous or bronchoscopic biopsy
- Treatment depends on cell type
- Non small cell lung cancer - surgery 1st line, lobectomy
- Small cell lung cancer - chemo and radio together
Pleural effusion presentation
- STONY DULL PERCUSSION OVER EFFUSION
- Dyspnoea
- Cough
- Tracheal deviation
