Respiratory Flashcards
How long should an unprovoked PE be treated for?
6 months
What can happen as a result of prolonged intubation?
physical communication between the trachea and oesophagus due to proximity of structures and inflammation around the tube in the trachea. Knows as a tracheooesophageal fistula
What is Barrett’s oesophagus?
Metaplasia of the lower oesophageal mucosa, with the usual squamous epithelium being replaced by columnar epithelium
Where is an inhaled foreign body most likely to be found?
Right main bronchus
what are contraindications to insertion of a chest drain?
INR >1,3
platelet count < 75
Pulmonary bullae
Pleural adhesions
what are indications for inserting a chest drain?
pleural effusion
pneumothorax
empyema
haemothorax
hemopneumothorax
chylothorax
in some cases of penetrating chest wall injury in ventilated patients
How should patients with suspected PE be treated?
DOAC i.e. apixaban or rivaroxaban
What are characteristic features of streptococcal pneumonia?
rapid onseet
high fever
pleuritic chest pain
herpes labialis (cold sores)
what antibiotic is given in non-severe community acquired pneumonia that can be managed as an outpatient?
oral amoxicillin
what investigation should be done to confirm SIADH?
paired urine and plasma osmolalities
what is allergic bronchopulmonary aspergillosis?
complex hypersensitivity reaction often in patients with asthma or cystic fibrosis that occurs when bronchi become colonized by Aspergillus species
Repeated episodes of bronchial obstruction, inflammation and mucoid impaction can lead to bronchiectasis, fibrosis and respiratory compromise
what is allergic bronchopulmonary aspergillosis?
complex hypersensitivity reaction often in patients with asthma or cystic fibrosis that occurs when bronchi become colonized by Aspergillus species
Repeated episodes of bronchial obstruction, inflammation and mucoid impaction can lead to bronchiectasis, fibrosis and respiratory compromise
what are the features of allergic bronchopulmonary aspergillosis?
bronchoconstriction: wheeze, cough, dyspnoea
bronchiectasis - proximal
What is seen on investigation in allergic bronchopulmonary aspergillosis?
- eosinophilia
- flitting CXR changes
- positive RAST test to aspergillosis
- positive IgG precipitins
- raised IgE
What is the management of allergic bronchopulmonary aspergillosis?
oral glucocorticoids
itraconazole sometimes introduced second-line
What are the signs of life-threatening asthma?
PEFR < 33% Best or predicted
oxygen sats < 92%
normal PCO2
silent chest, cyanosis or feeble respiratory effort
bradycardia, dysrhythmia, hypotension
exhaustion, confusion, coma
How is pneumocystic jirovecci treated?
co-trimoxazole
what are the CURB65 criteria?
C = confusion
U = urea > 7mmol/L
R = respiration rate >/= 30
BP = systolic </=90 and/or diastolic </=60
65
what is a transudative effusion and what could cause it?
<30g/L protein:
- heart failure - most common transudate cause
- hypalbuminaemia - liver disease, nephrotic syndrome, malabsorption
- hypothyroidism
what is an exudative effusion and what could cause it?
> 30g/L protein:
- infection: pneumonia - most common exudate cause, TB
- connective tissue disease - RA, SLE
- neoplasia - lung cancer, mesothelioma, metastases
- pancreatitis
- pulmonary embolism
- Dressler’s syndrome
What are the features of carcinoma on needle biopsy?
nuclear enlargement, hyperchromasia, pleomorphism
what should you do if you have a strong suspicion of PE but there is a delay in performing a scan?
start patient on treatment dose apixaban whilst awaiting scan
what are pleural plaques?
change that can be seen on CXR in people with asbestos exposure
pleural plaques are benign and do not undergo malignant change - therefore don’t require any follow-up
what are the indications for BIPAP/NIV in patients with COPD?
- COPD with resp. acidosis pH 7.25-7.35
- type II respiratory failure 2ndary to chest wall deformity, neuromuscular disease or OSA
- cardiogenic pulmonary oedema unresponsive to CPAP
- weaning from tracheal intubation
