Respiratory Flashcards
lung cancer associated with Cushings/paraneoplastic syndromes
very fast growing
small cell lung cancer
lung cancer associated with gynacomastia, in women
adenocarncinoma
lung cancer most associated with smoking, and causes hypercalcaemia
squamous cell carcinoma
progressively worsening dyspnoea, cough in older men, smoker
fine end inspiratory crackles
pulmonary fibrosis
pulmonary fibrosis Ix
CT chest, honeycomb appearance
unilateral pleural effusion, protein level >30, causes????
exudative
cancers; SLE, rheumatoid, pancreatitis, infection
bilateral pleural effusion, protein <30
transudative
due to increased cap pressure (CHF); damaged basement membrane (renal dysfunction)
bilateral pulmonary infiltrates/opacities
bibasal crackles
diffuse alveolar damage
hyaline membrane formation
Acute respiratory distress syndrome
pathophys of ARDS
severe inflammatory response in lungs, 2ndary to lung illness
non cariogenic pulmonary oedema
damage to alveolar-capillary membrane causes fluid to move into the lung -> pulmonary oedema
general signs of sarcoidosis
dry cough, dyspnoea
lymphadenopathy, enlarged parotid gland
bilateral bells palsy
anterior uveitis
erythema nodosum
vena cava syndrome diagnostic tool
positive pembertons sign
peripheral cyanosis, dyspnoea, cough, systemically unwell
epigastric pain, high lipase
ARDS associated with pancreatitis
Mx of acute bronchitis
avoid empirical ABs
CRP 20-100: delayed prescription
CRP >100: doxycycline
ECG in COPD
P pulmonale, high P waves in inf leads, right axis deviation, low voltage QRS
chronic asthma Mx
- inhaled ICS + LABA as AIR (anti-inflammatory reliever)
- low dose MART (maintenance and reliever - used regularly and as required)
- moderate dose MART
- check blood eosinophils.
if raised: refer to resp specialist
if normal: LTRA / LAMA trial for 8-12 weeks
acute asthma Mx
- salbutamol
- oral prednisolone
croup Px and Mx
barking cough, infection of upper airway
dexamethasone
Mx of lung abscess
IV then oral ABs for 8 weeks. clindamycin + ceftriaxone
Mx of chronic COPD
- salbutamol
- ICS (beclometasone)
- LABA + LAMA
Dx of CF in newborns and adults
Newborns = heel prick
Adults = sweat test
Px of pneumocystis pneumonia, Ix, Mx
associated with HIV/immunocompromised
bifilar infiltrates on CXR
Mx: co-trimoxazole
Px and Ix of TB
fever, weight loss, night sweats, S asians
patchy opacifications in upper lungs on CXR
progressive cough, large amounts of yellow sputum, haemoptysis
bronchiectasis
lung cancer associated with hypercalcemia
squamous
lights criteria is used for…
classifying pleural effusions
lights criteria
pleural fluid : serum protein = >0.5
pleural fluid : serum LDH = >0.6
pleural fluid LDH is >2/3 of upper limit
stony dullness on percussion/auscultation
pleural effusion
hyper-resonant percussion
COPD
worsening renal function after starting on ACE inhibitor
flash pulmonary edema
aspiration pneumonia Mx
antibiotics (similar to CAP)
swallowing assessment
if no known cause of dysphagia -> upper GI endoscopy
where do adenocarcinomas grow in the lung
commonly present as lesions in the peripheries of the lung
where do squamous cell carcinomas grow in the lung
central cavitating lesions
productive cough, mucopurulent and blood tinged, recurrent episodes of pneumonia throughout their life
suspect…?
bronchiectasis
Dx with CT
sudden cough and SOB, fine crackles in lung bases. has cardiac risk factors (HTN and hyperlipidaemia)
suspect…?
flash pulmonary edema (from taking ACEIs)
stoney dullness
pleural effusion
protein level of >x is exudative
25
Silent chest shows…
Found in asthma. Their chest is so hyper inflated and there is so much residual air that they can’t breathe, so not breathing sounds
Stridor
Noise originating from outside the thoracic cavity, noisy inhalation, quiet exhalation
Foreign body
Wheeze
Inside thoracic cavity
Exhalation is noisier
Target o2 sats for co2 retainers
88-92
When are reservoir masks used
Emergency
10-15 l min
Adverse reactions of beta 2 agonists
Sinus tachycardia, fine tremor
Adverse reactions of muscarinic antagonists
Dry mouth
Blurred vision
Urinary retention
Constipation
two symptoms that are highly suggestive of sarcoidosis
bi hilar lymphadenopathy
erythema nodosum
symptoms of moderate asthma exacerbation
PEF 50-75% of expected
symptoms of acute severe exacerbation
PEF 33-50% of expected
can’t speak full sentences
sats 92%
accessory muscle use
symptoms of life threatening asthma
PEF < 33%
exhaustion
confusion
altered consciousness
silent chest
what is the CURB65 score
confusion
urea >7
resp rate >30
blood pressure <90/60
age > 65
management of curb score 0-1
5 days of amoxicillin
management of curb score 2
oral amoxicillin and clarithromycin
Mx of curb score 3-5
in hospital
IV co amoxiclav
what to give for pseudomonas bronchiectasis
ciprofloxacin
klebsiella pneumonia is found where and what is the Tx
upper lobe pneumonia
meropenem
What is meigs syndrome
Benign ovarian tumour
Transudative pleural effusion
Ascites
Smoker presents with cough, eyelid drooping, dryness on one side of face
Could be pancoast tumour (apical region) causing compression of sympathetic nerves
Chest x ray !
Bronchoscopy vs cxr for lung cancer
Bronchoscopy for central lesions
Cxr for general / peripheral lesions
wheeze sounds like ..? and indicates..?
noisy exhalation
issue inside the thoracic cavity
stridor sounds like..? and indicates..?
noisy inhalation
issue outside thoracic cavityq
cause of unequal air entry
foreign object aspiration
4 drugs for TB + 2 continuation drugs
RIPE
rifampicin
isoniazid (add B6 pyroxidine to prevent peripheral neuropathy)
pyrazinamide
ethambutol
for 2 months
continue: rifampicin + isoniazid
for 4 more months
wheezing, shortness of breath after exposure to irritant fumes
what is it
Ix
Mx
reactive airway dysfunction syndrome (RADS)
positive methacholine challenge test
inhaled bronchodilators
Mx of reactive airway dysfunction syndrome
inhaled bronchodilators
cromolyn sodium
pneumonia
very bad breath
cause???
mixed anaerobes
most common cause of pneumonia
gram stain
catalase
strep pneumonia
gram +
catalase -
staphylococcus aureus gram? coagulase?
gram +
coagulase +
Mx of acute COPD exacerbation
nebulised bronchodilators + O2
aminophylline if no response
feverish
cough
clear sputum
bronchitis
white out of the hemithorax after aspiration of foreign body…
atelectasis due to bronchial obstruction
mediastinal shift towards the CXR opacification is…
atelectasis
mediastinal shift away from the CXR opacification is…
pleural effusion or tension pneumo
what is plastic bronchitis
accumulations of fluid and mucus in the shape of the airways
when the patient coughs they cough up gelatinous tubular structures
most common causative agent of common cold
rhinovirus
diagnostic investigation for empyema
thoracocentesis
which organism renders a CF pt ineligible for lung transplant
burkholderia
lower lobe pneumonia ….
aspiration pneumonia
currant jelly sputum….
klebsiella
over administration of O2 in a COPD patient leads to what acid base abnormality
respiratory acidosis with compensatory metabolic alkalosis
emphysema in lower lobes …
alpha 1 antitrypsin deficiency
emphysema in upper lobes….
COPD
allergic bronchopulmonary aspergillosis Mx 1st and 2nd line
1st prednisolone
2nd itraconozole
Pneumonia and cold sore is what organism?
Streptococcus pneumonia
4 most common organisms of bronchiectasis infection
haemophilus influenza
pseudamonas
strep pneumonia
stash aureus
indications for LTOT
pao2 between 7.3 - 8 and
secondary polycythemia
or
pulmonary hypertension
or
peripheral oedema
length of time they need to be on LTOT
15hours daily
when should all cases of pneumonia receive a chest x ray?
6 weeks
which cancers are assoc with asbestos exposure. what is more common
small cell lung cancer (more common)
mesothelioma
fever. initial dry cough and now productive. what is this
bronchitis
PE Ix + Mx. Wells < 4
d dimer. if + do ctpa
PE Wells >4
CTPA. if + give DOAC
if - do proximal leg vein Ultrassound
DVT Wells < 2
d dimer
if + do leg vein ultrasound in 4 hrs
if - consider another diagnosis
DVT Wells >2
leg vein ultrasound
if + start DOAC
DVT Mx in oregnancy
lowe molecular weight heparin
features of COPD steroid responsiveness
any previous, secure diagnosis of asthma or of atopy
a higher blood eosinophil count
substantial variation in FEV1 over time (at least 400 ml)
substantial diurnal variation in peak expiratory flow (at least 20%)
Target O2 sats for non COPD retainer
94-98
first line Ix for children aged 5-16 with suspected asthma
FeNO testing
empyema
collection of pus in the pleural cavity
Mx of empyema
chest drain and antibiotics
