Respiratory Flashcards
Chronic COPD investigations
Bedside - sputum culture
Bloods - FBC (secondary polycythaemia from hypoxia)
Imaging - CXR
Post-bronchodilator spirometry FEV1/FVC ratio <0.7
Chronic COPD management
Conservative e.g. prophylactic azithromycin, mucolytics
Medical
1. SABA or SAMA (ipratropium)
2. No asthmatic features: LABA (salmeterol) and LAMA (tiotropium). Asthmatic features: LABA + ICS
3. LABA + (LAMA + ICS)
Signs of Cor pulmonale
Lung disease -> right ventricular hypertrophy
Peripheral oedema
Raised JVP
Systolic parasternal heave
Cor pulmonale treatment
Loop diuretic
Consider long-term oxygen
Asthma diagnosis
Peak flow diary (diurnal variation >20%)
Spirometry with bronchodilator reversibility (FEV1 increase by 12% and 200ml)
Fractional exhaled nitric oxide test - 17+ (biomarker of lung inflammation)
Asthma long-term management
- SABA
- SABA + low-dose ICS
- SABA + low-dose ICS + LABA
- SABA + medium-dose ICS/ keep dose and + LTRA
- Specialist referral
Pneumonia
- expansion
- percussion
- resonance
- auscultation
- trachea
Expansion - reduced
Percussion - dull
Resonance - increased
Auscultation - bronchial
Trachea - central (if moved, could be endobronchial lesion causing collapse)
Pneumonia essential investigations
Bedside - sputum culture
Bloods - blood culture
Imaging - CXR (including lateral, repeat 6 weeks to check for resolution and underlying malignancy)
CURB-65
AMTS 8 or less
Urea > 7
RR 30 or more
BP <90 / <60
Age 65+
1 - home
2 - admit
3 - ITU
Community-aquired pneumonia treatment
Mild/moderate - amoxicillin or clarithromycin
Severe - co-amoxiclav + clarithromycin
H. influenzae treatment
Co-amoxiclav
Atypical pneumonia treatment
Clarithromycin
How to change CAP management if patient becomes septic
Different abx but broad-spectrum
IV fluids
Noradrenaline once JVP visible
Tuberculosis CXR finding
Upper lobe cavitation
Tuberculosis sputum sample method
Lowenstein-Jensen medium for 6 weeks
Ziehl-Neelson stain
Acid fast bacilli (red rods) seen
Auramine stain for screening, also better
What can tuberculin skin test and IGRA show in TB?
TST - exposure + BCG
IGRA - exposure alone
Side effects of TB antibiotics
Rifampicin - orange secretions
Isoniazid - peripheral neuropathy, liver toxicity
Pyrazinamide - liver toxicity
Ethambutol - optic neuritis
Acute bronchitis management
Conservative: drink fluids, analgesia
Doxycycline (if systemically unwell, high CRP)
Causes of exudate and transudate in pleural effusion and the protein level
Exudate >30g protein
- Infection
- Malignancy
- Trauma
- Pulmonary embolism
Transudate <30g protein
- Cirrhosis
- Nephrotic syndrome
- Congestive heart failure
Management for pleural effusion, and when it is turbid/pH<7.2/+veMC&S
- USS pleural aspiration
- Chest drain
Differences on CXR between aspergilloma and ABPA
Aspergilloma - round mass with crescent of air
ABPA - pathc shadows, segmented collapse
Bronchiectasis diagnostic investigation
Hr-CT
Bronchiectasis management
Exercise + airway clearance
Abx (ciprofloxacin)
Which lung cancer is associated with SIADH?
Small cell
Which lung cancer is the most common?
Adenocarcinoma (non-small cell) and also most common in non-smokers
Starts peripherally
Which lung cancer releases PTHrp?
Squamous cell (non-small cell)
Obstructive sleep apnoea diagnosis
Polysomnography
15+ episodes of hypo/apnoae during 1 hour of sleep
Obstructive sleep apnoea management
- Weight loss
- CPAP
- Intra-oral devices
Mesothelioma diagnosis
Thoracoscopy and histology
Lung cancer management
Surgery
Radiotherapy
Chemotherapy
Condition and treatment for:
Erythema nodosum (tender, swollen fat under skin)
Bilateral hilar lymphadenopathy
Polyarthralgia
Hypercalcaemia
Sarcoidosis
Oral corticosteroids
CXR in pneumoconiosis
Honeycombing
Type 1 vs type 2 respiratory failure and examples
Type 1 - low O2, normal/low CO2
ARDS, pneumonia
Type 2 - low O2, high CO2
COPD
Signs of CO2 retention
Flap
Bounding pulse
Narcosis (drowsiness)
