- smoking - α1-antitrypsin deficiency

Respiratory Flashcards by Harry Nuttall

Wells Score

Signs and symptoms DVT (+3)
PE is most likely diagnosis (+3)
HR >100 (+1.5)
Immobilization >3d or surgery within previous 4wks (+1.5)
History of DVT or PE (+1.5)
Haemoptysis (+1)
Malignancy within previous 6mo (+1)

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PE: investigation in low probability cases (Wells Score <3)

CXR to rule out other causes
D dimer

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PE: investigation in high probability cases (Wells Score >3)

CXR to rule out other causes
CTPA

If poor renal function: V/Q scan

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PE: management in provoked cases

DOAC for 3mo

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PE: management in unprovoked cases

DOAC for 6mo

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PE: management in cardiovascularly compromised patients

thrombolysis

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PE: ECG changes

Sinus tachycardia
RBBB and/or RAD
S1 Q3 T3 pattern (S wave in lead 1, Q wave and T inversion in lead 3)

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PE: ECG changes

Sinus tachycardia
RBBB and/or RAD
S1 Q3 T3 pattern (S wave in lead 1, Q wave and T inversion in lead 3)

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bronchiectasis: causes

idiopathic (50%)
impaired mucociliary clearance (CF, Kartagener’s syndrome, immunoglobulin deficiency)
post-infectious
obstruction
GORD
inflammatory disease (e.g. RA)

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bronchiectasis: causes

idiopathic (50%)
impaired mucociliary clearance (CF, Kartagener’s syndrome, immunoglobulin deficiency)
post-infectious
obstruction
GORD
inflammatory disease (e.g. RA)

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bronchiectasis: causes

idiopathic (50%)
impaired mucociliary clearance (CF, Kartagener’s syndrome, immunoglobulin deficiency)
post-infectious
obstruction
GORD
inflammatory disease (e.g. RA)

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common opportunistic infections in bronchiectasis

Haemophilus influenzae

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common opportunistic infections in cystic fibrosis

Pseudomonas, Aspergillosis

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bronchiectasis: complications

haemoptysis
persistent infection (Haemophilus)
empyema
respiratory failure
cor pulmonale

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bronchiectasis: management

inhaled corticosteroids
bronchodilators
chest physiotherapy
flu vaccination

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COPD: risk factors

smoking
α1-antitrypsin deficiency

COPD: diagnosis

FEV1:FVC <0.7

COPD: stratification

FEV1 >80% = mild
FEV1 <80% = moderate
FEV1 <50% = severe
FEV1 <30% = very severe

COPD: management

smoking cessation
bronchodilators
inhaled corticosteroid
pneumococcal and influenza vaccine

COPD: complications

infective exacerbation
acute respiratory failure
pulmonary hypertension and right heart failure
pneumothorax
secondary polycythaemia

COPD: common opportunistic infections

Strep pneumoniae
Haemophilus influenzae

asthma: features of moderate attack

PEFR 50-75%

asthma: features of severe attack

PEFR 33-50%
RR > 25/min
HR > 110/min
Can’t complete full sentences

asthma: features of life-threatening attack

PEFR <33%
SaO2 < 92%
Silent chest, cyanosis

asthma: features of near fatal attack

PEFR <33% PaCO2 - raised

asthma: management of asthma attack

1. Admit if life-threatening OR non-responsive to initial therapy 2. O2 3. Bronchodilator (SABA) 4. Oral prednisolone Consider other bronchodilators (ipratropium bromide, magnesium sulfate IV, aminophylline IV)

pneumonia: CURB-65 criteria

Confusion Urea >7 RR >30 BP (Systolic) <90 Age >55

interstitial lung disease: causes associated with upper zone disease

*PENTA* - pneumoconiosis (coal workers, silicosis) - extrinsic allergic alveolitis (farmers, Pigeon fanciers) - aNkylosing spondylitis - TB - Aspergillus

interstitial lung disease: causes associated with lower zone disease

*STAIR* - sarcoid - toxins - asbestos - idiopathic - Rheumatoid

interstitial lung disease: drug causes

- amiodarone - methotrexate - sulfasalazine - nitrofurantoin

interstitial lung disease: spirometry findings

restrictive pattern reduced FEV1 and FVC with preserved ratio

interstitial lung disease: management

allergic disease = steroids, trigger avoidance, immunosupression (cyclosporine) idiopathic disease = fibrinolytics, vaccination, smoking cessation, pulmonary rehabilitation

pleural effusion: transudative causes

- kidney failure - heart failure - hypoalbuminaemia (liver failure, nephrotic syndrome) - hypothyroidism - Meig's syndrome (ovarian mass)

pleural effusion: exudative causes

- haemothorax - mesothelioma - pneumonia (abscess or empyema) - TB - PE

pleural effusion: Light's Criteria for an exudate

Effusion:serum protein >0.5 Effusion:serum LDG >0.6 Effusion LDH <2/3rds ULN

pleural effusion: distinguishing exudate from transudate

protein < 25 = transudate protein >35 = exudate intermediate = Light's Criteria

pleural effusion: management

1. treat underlying cause 2. chest drain 3. pleurodesis

primary pneumothorax: management

Asymptomatic = discharge <2cm = 2wk OPD follow-up >2cm = needle aspiration