Respiratory Flashcards
IV salbutamol can cause what electrolyte abnormality? - what monitoring is needed to identify this?
Which of the following would be used in:
a) moderate asthma attack
b) severe asthma attack
c) life threatening asthma attack
- IV aminophylline
- Nebulised salbutamol
- IV magnesium sulphate
- Nebulised ipratropium bromide
- IV salbutamol
- Intubation
Salbutamol causes K to move from serum into cells = hypokalaemia
~need to monitor serum K
Moderate asthma attack:
• Nebulised salbutamol
• Nebulised ipratropium bromide
Severe asthma attack:
• IV aminophylline
• IV salbutamol
Life threatening attack:
• IV magnesium sulphate
• Intubation
List some common symptoms of asthma: (3)
- Wheeze
- Cough (worse at night)
- SOB
What symptoms does COPD commonly present with? (4)
Chronic SOB
Productive cough
Wheeze
Recurrent respiratory tract infections
What is Sarcoidosis?
Sarcoidosis can affect any organ in the body, however which organ is most commonly affected?
~ What symptoms may you see if this organ is affected? (3)
A granulomatous inflammatory condition
Lungs!
~ Bilateral mediastinal lymphadenopathy
~ Pulmonary fibrosis
~ Pulmonary nodules
A diagnosis of COPD is based upon the results of what? (2)
Clinical presentation (symptoms + history)
Spirometry
What condition would the following indicate:
A patient presents with a 2 day history of haemoptysis. Blood results show a raised urea & creatinine.
Goodpasture Syndrome (anti-glomerular basement membrane disease)
~ glomerulonephritis (AKI)
~ pulmonary haemorrhage (haemoptysis)
What is a pneumothorax?
What is the 1st line investigation?
~ If a pneumothorax is too small to be seen, what other investigation can be done?
What is the management:
a) no SOB/ < 2cm
b) SOB / > 2cm
c) unstable patients/ failure of b) twice
Air inside the pleural space separates the lung from the chest wall
- *Investigations:**
1) Erect chest xray
2) CT thorax - *Management:**
a) no treatment - should self resolve (advise follow up 2 - 4 weeks)
b) aspiration of air → reassessment
c) chest drain
What is the gold standard investigation to confirm a diagnosis of sarcoidosis & what would this show?
What other investigations would you do? (2)
What is the treatment of sarcoidosis if:
a) patient is asymptomatic
b) patient has symptoms
Biopsy of mediastinal lymph nodes: non-caseating granulomas with epitheloid cells
Bloods (raised serum ACE & CRP, hypercalcaemia) + chest xray
Treatment:
a) None - commonly self resolves
b) 1st line = oral steroids for 6-24m PLUS bisphosphonates (to protect their bones)
~ 2nd line = methotrexate
~ 3rd line = lung transplant
What is a tension pneumothorax?
~ what is the cause?
List some signs of a tension pneumothorax: (4)
What is the initial management?
What is the definitive management?
Tension pneumothorax: air enters the pleural space through a one way valve - during inspiration, air moves into pleural space, during expiration air cannot leave
~ Caused by trauma to the chest
- SOB
- Tracheal deviation away from side of pneumorthorax
- Reduced air entry on affected side
- Resonant to percussion on affected side
- *Management:**
- Initial*: insert a large bore cannula into the 2nd intercostal space in the midclavicular line
- Definitive*: Chest drain
What is Croup?
What is the commonest causative organism?
What are the common presenting features of croup? (6)
How long does croup usually last for?
What is the management of croup?
An URTI causing oedema & swelling of the larynx.
Parainfluenza virus
~ Increased work of breathing
~ Barking cough (sounds like a seal)
~ cold symptoms
~ hoarse voice
~ +/- stridor
~ +/- mild fever
1 - 2 days
Oral dexamethasone
What 3 symptoms are characteristic of asthma?
WHEEZE
Cough
SOB
What are the 2 criteria’s/ tools that GP’s often use to determine a bacterial or viral cause of a sore throat?
CENTOR & feverPAIN
List some features of a pleural effusion: (3)
List 2 findings seen on a chest xray:
What other investigation would you do in a pleural effusion to determine the cause?
What is the treatment of a small effusion/ large effusion?
What is the name of an infected pleural effusion?
- SOB
- Reduced breath sounds
- Dullness to prescussion over the effusion
Xray findings:
• Blunting of the costophrenic angles
• Fluid in the lung fissures
Pleural fluid aspirate - to determine exudate VS transudate cause
- *Treatment:**
- Small effusion:* conservative management
- Large effusion:* chest drain
Infected pleural effusion = empyema
What is sarcoidosis?
State the ‘buzzword’ features of sarcoidosis: (6)
What results would be seen on:
a) blood tests (3)
b) chest xray
Sarcoidosis: a granulatomas inflammatory condition that can affect the whole body (commonest in young, black females)
Features:
• SOB
• Dry cough
• Erythmema nodosum (nodules on shins)
• Mediastinal lymphadenopathy
• Fatigue & weightloss
Bloods:
• Raised serum ACE (screening tool)
• Hypercalcaemia
• Raised CRP
Imaging:
• Chest xray: hilar lymphadenopathy
A 1 year old girl is brought in to A/E by her parents as they are concerned about her breathing. She has been feeling unwell with the flu over the last few days. The parents describe a barking cough. They think she has had all her immunisations. She has a high grade fever. A constant high-pitched sound on inspiration can be heard and she has a hoarse voice.
Humidified oxygen, dexamethasone and nebulised adrenaline is given. The symptoms do not improve.
What is the most likely diagnosis?
Bacterial Tracheitis
Always consider bacterial tracheitis in a barking cough with continuous stridor that does not resolve.
