Respiratory Flashcards
important Q’s to ask about in asthma
triggers
smoking
key aspects to diagnose asthma
- obstruction: FEV1/FVC ratio <0.7
- reversibility: after bronchodilation FEV1 increase by 12%
- peak flow diurnal variation (>20%)
- FeNO >40 ppb in adults
- blood tests = inc eosinophil
- hyperreactivty: bronchial challenge tests
possible differentials for asthma
COPD
ABPA
Bronchiectasis
Bronchiolitis
ABPA features
- bronchiectasis + eosinophils
- hypersensitivity to aspergillus fumigatus
ABPA management
steroids
antifungals
chest physio
COPD definition
airway abnormalities (bronchitis) +/- alveoli abnormalities (emphysema)
= persistent airflow obstruction
how to diagnose COPD
spirometry
obstruction post-bronchodilation
how is severity of COPD measured?
FEV1
<30% = very severe
30-49 = severe
50-79 = moderate
management of COPD
symptoms
exacerbation
smoking
vaccination history
pulmonary rehab
T1RF findings and causes
low oxygen, normal CO2
cause: pneumonia, effusion, fibrosis
treat T1RF
oxygenate
T2RF findings and causes
low oxygen, high CO2
cause: COPD, resp muscle weakness, CNS depression
treat T2RF
ventilate (NIV)
interstitial lung disease key history findings
occupation
hobbies
asbestos
smoking
connective tissue disease
investigations in ILD
high res CT
pulmonary function tests
AI screen
management of ILD
oxygen
antifibrotics
stop smoking
vaccination
exercise
squamous cell appearance on CXR
mass, can cavitate
treatment of SCLC
chemo and radiosensitive
causes of bronchiectasis
idiopathic
post-infection
CF
congenital
asthma
COPD
transudate definition and causes
normal serum protein and pleural protein <30g/L
LVF
CLD
nephrotic syndrome
PE
exudate definition and causes
think eggs –> protein
normal serum protein and pleural protein >40g/L
malignancy
pneumonia
TB
when is Light’s criteria used?
if pleural protein between 30-40g/L
to determine if exudate
what is Light’s criteria?
exudate if:
- pleural fluid protein/serum protein ratio >0.5
- pleural fluid LDH/serum LDH ratio >0.6
- pleural fluid LDH >2/3 upper limit of normal serum LDH
diagnosing asthma in 5-16 year olds
-spirometry with BDR test +/- FeNO test
diagnosing asthma in adults
FeNO test
spirometry +/- BDR
what to counsel asthma patient on before discharge?
TAME
Technique (inhalers)
Avoidance (of triggers_
Monitor (PEFR)
Educate
common pneumonia in pre-existing lung disease
H. influenzae
flail chest x-ray features
rib fractures
subcut emphysema
pneumothorax
mediastinal shift if tension
when to insert a chest drain in pleural effusion?
aspirate:
- if turbid/cloudy
- if tests +ve on MC&S
- if pH < 7.2
causes of upper lobe pulmonary fibrosis
TAPE
- TB
- ABPA
- pneumoconiasis
- EAA
causes of lower lobe pulmonary fibrosis
STAIR
- sarcoidosis
- toxins
- asbestosis
- idiopathic PF
- rheumatological
triad of Kartagener’s syndrome
situs inversus
bronchiectasis
chronic sinusitis
triad of Young’s syndrome
bronchiectasis
chronic sinusitius
male infertility
CF CXR findings
hyperinflation
peri-bronchial shadowing
bronchial wall thickening
ring shadows
lung cancer that causes gynaecomastia
adenocarcinoma
lung cancer that releases beta HCG
large cell cancer
2ww referral guidelines in <40s
2 in smokers, 1 in ex/current smokers
- cough
- chest pain
- fatigue
- weight loss
2ww referral guidelines in >40s
least one of INTEL
- infections (recurrent chest)
- nail clubbing
- thrombolysis
- exam signs
- lympahdenopathy
treatment of late stage small cell lung cancer
limited = combo chemorad
extensive =palliative chemo
treatment of non-small cell not suitable for surgery
palliative/curative radio
(poor chemo response)
GIT causes of clubbing
cirrhosis
Chron’s/UC
Coeliac
Cancer: GI lymphoma
signs of pneumonia on examination
dec expansion
bronchial breathing
inc vocal resonance
3 causes of bronchiectasis
idiopathic
congenital
post-infection
CXR in bronchiectasis
thickened bronchial walls
(tramlines and rings)
which lung cancer can release PTHrP
squamous CC
ARDS definition
non-cardiogenic pulmonary oedema
inc capillary permeability
management of ARDS
admit to ITU for organ support and treat underlying cause
pulmonary causes of ARDS
pneumonia
aspiration
inhalation injury
systemic causes of ARDS
shock
sepsis
trauma
pancreatitis
DIC
issue in T1RF
V/Q mismatch and diffusion failure
causes of T1RF
Vascular (PE)
Asthma (early)
Pneumothorax
Atelectasis
issue in T2RF
alveolar hypoventilation
causes of T2RF
obstructive (COPD, Asthma, Bronchiectasis)
restrictive (dec resp drive e.g. CNS sedation, NM disease)
chronic bronchitis definition
cough and sputum production on most days for 3 months over 2 successive years
emphysema definition
histological diagnosis of enlarged air spaces distal to terminal bronchioles with destruction of alveolar walls
severity of COPD
FEV1
mild: >80%
moderate: 50-79%
severe: 30-49%
very severe: <30%
indications for LTOT
PaO2 < 7.3
or 7.3-8 with complication
antibiotic for bacterial exacerbation of COPD
Doxy
pleural effusion transudate vs exudate
<25g/L = transudate
>35g/L = exudate
what are Light’s criteria?
exudate if
effusion: serum protein ratio >0.5
effusion: serum LDH ratio >0.6
effusion LDH = 0.6 x ULN
exudative effusion causes
infection
neoplasm
inflammation (RA, SLE)
infarction
ILD causes
Env: asbestosis
Drugs: Bleomycin, amiodarone
Hypersensitity: EAA
Infection: TB, viral
Systemic: sarcoid, RA
Idiopathic
cause of EAA
acute allergen exposure in sensitised patients
chronic exposure = granuloma formation and obliterative bronchiolitis
acute and chronic symptoms of EAA
acute: fevers, malaise, dry cough
chronic: SOB, weight loss, T1RF, cor-pulmonale
symptoms and signs of idiopathic pulmonary fibrosis
dry cough, SOB, malaise, arthralgia
clubbing, crackles, cyanosis
honeycombing
causes of pulmonary HTN
- L Heart disease: mitral stenosis/regurg, LVF
- L parencyhmal disease: COPD, asthma, ILD
- pulomonary vascular disease: idiopathic, vasculitis, PE
- hypoventilation: OSA, MND
investigations in pulmonary HTN
R heart catheterisation
cause of cor-pulmonale
RHF due to chronic pulmonary HTN
symptoms of cor pulmonale
dyspnoea
fatigue
syncope
management of cor pulmonale
dec pulmonary vascular resistance (LTOT, sildenafil, CCB)
treat cardiac failure
complications of pneumonia
hypotension
pleural effusion
empyema
signs of CF on exam
clubbing
cyanosis
bilateral coarse creps
what hormone does squamous CC release?
PTHrP (inc Ca)
small cell Ca treatment
very chemosensitive but very poor prognosis