Respiratory Flashcards
what is a healthy FEV1/FVC
70-80%
FEV1/FVC in obstructive and restrictive conditions
increased in restrictive and reduced in obstructive
what is TLCO
what happens to it in asthma
overall measure of gas transfer
increased in asthma as the issue is not in the alveoli so the lungs compensate
what is KCO
TLCO / alveolar volume
measures gas exchange efficiency
what are the 4 stages of COPD related to their FEV1
Stage 1 - mild - FEV1 above 80% (need sx to diagnose)
Stage 2 - moderate - FEV1 50-79%
Stage 3 - severe - FEV1 30-49%
Stage 4 - very severe - FEV1 below 30%
can FVC be normal in COPD and asthma
Yes
But the FEV1/FVC ratio is reduced
target saturations in COPD
88-92
BUT 94-98 if CO2 normal on ABG
15L in COPD
IN EMERGENCY YES
Vaccinations for COPD
once pneumococcal
annual flu
when would you consider NIV/invasive ventilation in COPD
NIV if pH 7.25-7.35
invasive ventilation if pH less than 7.25
most common organism causing infective exacerbation in COPD and bronchiectasis
H.influenzae
auscultation in COPD
wheeze and reduced breath sounds
what 2 things can increase survival in COPD
- smoking cessation
- LTOT
requirements for LTOT in COPD
2 pO2 readings below 7.3kpa
what must you stop if you commence a LABA in COPD
stop SAMA and switch it to a SABA
are mucolytic drugs e.g. carbocystine routinely prescribed in COPD
no
criteria for moderate, severe and life threatening asthma attack
moderate: PEFR 50-70%, normal speech, RR below 25, HR below 110
severe: PEFR 33-50%, can’t complete sentences, RR above 25, HR above 100
life threatening, PEFR below 33%, sats below 92%, CO2 normal, silent chest, cyanosis, reduced resp, HR and BP, exhaustion, confusion, coma
what must the PEFR be before discharge in asthma
75% predicted
how long must you wait inbetween inhaler puffs
30 seconds
mag sulphate then aminophylline
MOA of montelukast
leukotrine receptor antaginist
MOA of montelukast
leukotriene receptor antagonist
most common cause of occupational asthma
isocyantes
how do you step down the treatment in asthma
25-50% reduction in ICS dose
are pleural plaques concerning
no they’re benign
imaging for pulmonary fibrosis
high resolution CT
auscultation in IPF
fine end inspiratory crepitations
auscultation in asbestosis
inspiratory crackles
2 causes of lower zone fibrosis
amiodarone
asbestosis
cause of upper zone fibrosis
coal workers pneumonitis
causative organism of pneumonia in bird keepers
chlamydia psittari
treatment of allergic bronchopulmonary aspergillus
oral glucocorticoids (eosinophilia)
gold standard investigation for mesothelioma
thorascopic biopsy
platelets in lung cancer
increased
most common cancer in non smoker
adenocarcinoma
which lung cancer causes gynaecomastia (nipple discharge)
adenocarinoma
which lung cancer causes paraneoplastic syndromes
SCLC
4 contraindications to surgery in lung cancer
SVC obstruction
FEV less than 1.5
malignant pleural effusion
vocal cord paralysis
4 causes of an anterior mediastinum mass
Teratoma
Terrible lymphadenopathy
Thymic mass
Thyroid mass
major cause of a widened mediastinum (which conditions?)
bilateral hilar lymphadenopathy
TB/LYMPHOMA
how do you calculate pack years
20 x years
MOA of bupropion
nicotinic antagonist and norepinephrine and dopamine reuptake inhibitor
contraindication for bupropion
epilepsy (reduces seizure threshold)
MOA of varenicline
nicotinic partial receptor agonist
management of smoking in pregnancy
nicotine replacement therapy
drugs are contraindicated
what can prevent pneumothoraxx
smoking cessation
CURB-65 score
Confusion
Urea above 7
Resp rate above 30
BP below 90/65
Age above 65
auscultation in pneumonia
bronchial breathing
low severity CAP 1st line Abx
amoxicillin
CXR post pneumonia
repeat 6w after clinical resolution
most common cause of aspiration pneumonia and which lobe does it affect
lower lobe
klebsiella
loss of left heart border on CXR
left lingual consolidation
ABx in bronchitis?
determined by CRP
ABx in sinusitis?
no
auscultation in bronchiectasis
coarse crackles and high pitched inspiratory squeaks
CXR in bronchiectasis
parallel line shadows
subacute productive cough, foul smelling sputum and night sweats
lung abscess
borders of a chest drain insertion
base of axilla
lateral edge of pectoralis major
5th intercostal space
anterior border of latissimus dorsi
swinging chest drain - inspiration/expiration
RISE on inspiration
FALL on expiration
3 indications for chest tube in pleural effusion
turbid/cloudy fluid
presence of organism
pH below 7.2
3 criteria in meig’s syndrome
ascites
pleural effusion
benign ovarian tumour
complication of draining an effusion too quickly
re-expansion pulmonary oedema
auscultation of pulmonary oedema
bilateral fine crackles
tracheal deviation in:
pneumonectomy
pulmonary hypoplasia
complete collapse (endobronchial intubation)
trachea deviates towards the white out
tracheal deviation in:
consolidation
mesothelioma
pulmonary oedema (bilateral)
trachea central
tracheal deviation in:
pleural effusion
diaphragmatic hernia
large thoracic mass
trachea deviates away from the white out
management of a primary pneumothorax
less than 2cm and no SOB: discharge and review
otherwise: Aspiration
failure of aspiration/SOB/more than 2cm: CHEST DRAIN
management of secondary pneumothorax
increased 2cm and SOB
CHEST DRAIN 1ST LINE
less than 1cm admit for 24 hrs with oxygen
management of tension pneumothorax
immediate needle decompression with a large bore cannula into the 2nd intercostal space midclavicular line
do NOT wait for the CXR
dextrocardia, bronchiectasis, recurrent sinusitis, subfertility
Kartagener’s
(primary ciliary dyskinesia)
SOB, cough, sinusitis, epistaxis and renal sx
granulomatosis with polyangitis (cANCA)
obstructvie lung disease with lower lobe emphysema
liver cirrhosis, hepatocellular carcinoma, cholestasis
alpha 1 antitrypsin deficiency
management of alpha 1 antitrypsin deficiency
stop smoking
bronchodilators
physio
transplant
surgery to reduce lung volume
fever, arthralgia, lymphadenopathy and lupus pernio
Sarcoidosis
what is lupus pernio
red purple rash on face
CXR in sarcoidosis
bilateral hilar lymphadenopathy
pulmonary infiltrates
levels of Ca and ACE in sarcoidosis
increased
management of sarcoidosis
supportive
steroids if increased Ca, neuro/cardiac complications, uveitis, parenchymal disease
management of atelectasis
chest physio, mobilisation, breathing exercises
name one complication of acute pancreatitis
acute respiratory distress syndrome
do neuromuscular disorders cause obstructive or restrictive disease
resitrictive
ABG in DKA
metabolic acidosis with raised anion gap
ABG in cocaine overdose
respiratory acidosis due to hypoventilation
scale to assess sleep apnoea
epworth sleepiness scale
management of sleep apnoea
weight loss
CPAP
can sleep apnoea cause HTN
yes
signs of heart failure on CXR
Alveolar oedema (bat wings)
kerley B lines
Cardiomegaly
Dilated upper lobe vessels
Effusion (pleural)