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
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
diagnostic testing of asthma?
patients >/= 17 - patients should be asked if symptoms are better on days away from work/during holidays, if so, patients should be referred to a specialist as possible occupational asthma, all patients should have spirometry with a bronchodilator reversibility test, all patients should have an FeNO test
children 5-16 years: all children should have spirometry with bronchodilator reversibility testing, FeNO should be requested if normal spirometry
patients < 5 years: diagnosis should be made on clinical judgement
How is an acute exacerbation of COPD treated?
- increase frequency of bronchodilator use and consider giving nebs
- give prednisolone 30mg daily for 5 days
- oral abx are recommended if sputum is purulent or there are clinical signs of pneumonia
- BNF recommends one of following oral antibiotics first line: amoxicillin/clarithromycin/doxycycline
in what cancer are ‘cavitating lesions’ most commonly seen?
squamous cell lung cancer
what is flail chest?
chest wall disconnects from thoracic cage
multiple rib fractures - at least 2 fractures per rib in at least 2 ribs
associated with pulmonary contusion
abnormal chest motion
avoid over hydration and fluid overload
what is flail chest?
chest wall disconnects from thoracic cage
multiple rib fractures - at least 2 fractures per rib in at least 2 ribs
associated with pulmonary contusion
abnormal chest motion
avoid over hydration and fluid overload
what is the long-term management of COPD?
1: short-acting bronchodilators - salbutmaol/terbutaline or short acting antimuscarinics (ipratropium)
2a: if they do not have asthmatic or steroid responsive features they should have a combined LABA and LAMA
2B: if they have asthmatic or steroid responsive features they should have a combined LABA and ICS - e.g. fostair/symbicort - if this does not work they can be stepped up to a LABA,LAMA and ICS - “trimbo”
3. In more severe cases additional options are:
- nebulisers (salbutamol and/or ipratropium)
- oral theophylline
- oral mucolytic therapy to break down sputum
- long term prophylactic antibiotics
- long term oxygen therapy at home - used for severe COPD that is causing problems such as chronic hypoxia, polcythaemia, cyanosis or heart failure secondary to pulmonary hypertension (cor pulmonale)
