Respiratory Flashcards
Asthma exacerbation- criteria for admission: (5)
- Anyone with life-threatening presentation
- Severe presentation which fails to respond to first line
3 Pregnant and severe presentation- even if resolved!
4.previous near fatal attack - An exacerbation whilst on oral prednisolone
CAP
What should you have done post-discharge and when?
CXR at 6weeks after resolution to check consolidation has gone and no underlying secondary pathology
CAP management
Mild=
If allergic =
Moderate =
Severe =
Low severity = Amoxacillin 5 days course
If allergic = tetracycline eg. Clarythromgcin
Or macrolide
Moderate = dual amoxicillin + macrolide 7-10 day course
Severe = considering a beta-lactamase stable penicillin such as co-amoxiclav, ceftriaxone or piperacillin with tazobactam AND a macrolide
What’s the rash seen in sarcoidosis
?
lupus pernio, a rash cutaneous manifestation of sarcoidosis.
consists of a raised purple plaque of indurated skin that affects the tip of her nose and the skin around the right nostril.
It most frequently affects the nose, cheeks, lips, ears, and digits. It is not normally itchy or painful but can be disfiguring.
Which condition would contraindicate the prescription of bupropion?
smoking cessation drug
Bupropion should not be used in a patient with epilepsy as it reduces seizure threshold
Azithromycin is given as prophylactic abx in COPD
what investigations (2) do you need to do first and why?
ECG to rule out prolonged QT interval
LFTs
Causes of Acute Resp. Distress Syn (7)
Presentation (4)
infection: sepsis, pneumonia
massive blood transfusion
trauma
smoke inhalation
acute pancreatitis
Covid-19
cardio-pulmonary bypass
Presentation
dyspnoea
elevated respiratory rate
bilateral lung crackles
low oxygen saturations
What do you see in SIADH due to paraneoplastic syn of small cell cancer?
euvolaemic hyponatraemia
Acute asthma attack management
B- B2 agonist (Neb SABA)
I- Ipratropium (Musc. Antagonist) back 2 back
C- Corticosteroid (Oral pres or IV hydrocortisone if bad)
M- MgSO4
A- Aminothyline?
S- Salbutamol IV
Also recheck ABG!!
Indications for BiPAP in COPD (4)
- pH 7.25- 7.35
- Type 2 resp failure due to chest wall deformity
- Neuromuscular disease
- cardiogenic pul oedema unresponsive to CPAP
Criteria for Azithromycin prophylaxis in COPD (2)
more than three exacerbations requiring steroid therapy and at least one exacerbation requiring hospital admission in the previous year.
Management for sarcoidosis
- First line don’t need management/ NSAID supportive only
Indications for oral prednisolone:
2. patients with chest x-ray stage 2 or 3 disease who are symptomatic. Or hypercalcaemia
eye, heart or neuro involvement
What electrolyte change can sarcoidosis cause?
Hypercalcaemia + bilateral hilar lymphadenopathy → ?sarcoidosis
In a pleural effusion what is the criteria for a chest tube drainage straight away?
Everyone with…. needs ….
- 2
All patients with a pleural effusion in association with sepsis or a pneumonic illness require diagnostic pleural fluid sampling:
- if the fluid is purulent or turbid/cloudy a chest tube should be placed to allow drainage
- if the fluid is clear but the pH is less than 7.2 in patients with suspected pleural infection a chest tube should be placed
Features of Kartagener’s syndrome (also known as primary ciliary dyskinesia) 4
dextrocardia or complete situs inversus
bronchiectasis
recurrent sinusitis
subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)
Alpha-1 antitrypsin deficiency is a risk factor for which cancer?
Alpha-1 antitrypsin deficiency produced in the liver is a risk factor for hepatocellular carcinoma
asthma stepping down treatment rules with steroids
consider stepping down treatment every 3 months or so.
When reducing the dose of inhaled steroids the BTS advise us to do this by 25-50% at a time.
What rash do you get in sarcoidosis and how is different to SLE?
Features = A GRUELLING DISEASE:
lupus pernio is a purple nodule or plaque found on the nose, cheek, or lips.
A GRUELLING DISEASE:
ACE increase
Granulomas
aRthritis
Uveitis
Erythema Nodosum
Lymphadenopathy (B/L Hilar)
Lupus pernio
Idiopathic
Noncaseating
Gammaglobulinaemia
vit D increase (hypercalcaemia)
Aspergilloma presents with episodic haemoptysis, what do you see on CXR?
Also a past history of…
Chest x-ray shows a rounded opacity in the right upper zone surrounded by a rim of air.
PM Hx of TB
3 categories and their underlying pathology
category 1 (3)
category 2 (3)
Category 3 (3)
assess the position of the trachea - is it central, pulled or pushed from the side of opacification.
Trachea pulled toward the white-out
- Pneumonectomy
- Complete lung collapse e.g. endobronchial intubation
- Pulmonary hypoplasia
Trachea central
- Consolidation
- Pulmonary oedema (usually bilateral)
- Mesothelioma
Trachea pushed away from the white-out
- Pleural effusion
- Diaphragmatic hernia
- Large thoracic mass
Indications for corticosteroid treatment for sarcoidosis
- parenchymal lung disease
- uveitis
- hypercalcaemia 4. neurological or cardiac involvement
In suspected lung cancer should you do contrast or non-contrast CT?
contrast-enhanced CT scan of the chest, liver and adrenals.
What smoking cessation drugs CAN be given in preg and CANNOT
nicotine replacement therapy should be offered,
varenicline and bupropion are contraindicated
ARDS- what is it?
Causes (5/7)
Key investigations? (2)
Acute, diffuse, inflammatory lung injury and life-threatening condition in seriously ill patients, characterized by poor oxygenation, pulmonary infiltrates, and acute onset
Infection: sepsis, pneumonia
massive blood transfusion
trauma
smoke inhalation
acute pancreatitis
Covid-19
cardio-pulmonary bypass
Investigations
chest x-ray and arterial blood gases
-
-
- pO2/FiO2 < ….
Management- usually ITU
- acute onset (within 1 week of a known risk factor)
- pulmonary oedema: bilateral infiltrates on chest x-ray (‘not fully explained by effusions, lobar/lung collapse or nodules)
- non-cardiogenic (pulmonary artery wedge pressure needed if doubt)
- pO2/FiO2 < 40kPa (300 mmHg)
- oxygenation/ventilation to treat the hypoxaemia
- general organ support e.g. vasopressors as needed
- treatment of the underlying cause e.g. antibiotics for sepsis
- Put them in a prone position when ventilating (increasing bilteral lung inflation) and muscle relaxation have been shown to improve outcome in ARDS
2ww for lung cancer (2)
Offer urgent CXR (within 2 weeks)
—– and from the follwing list (6)
Consider urgent CXR (within 2 weeks) in anyone >= 40 with any of the following: (5)
- have chest x-ray findings that suggest lung cancer
- aged 40 and over with unexplained haemoptysis
offer CXR:
>= 40yo with 2 or more from the following list, or if they have ever smoked and have 1 of the following unexplained symp
- cough
- fatigue
- SOB
- chest pain
- weight loss
- appetite loss
Consider CXR
- persistent or recurrent chest infection
- finger clubbing
- supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
- chest signs consistent with lung cancer
- thrombocytosis
What would you see on a CXR with COPD? (3)
- Hyper-inflated chest
- Flattened hemidiaphragms
- Hyper-lucent lung fields
What standard blood results may be raised in lung cancer?
Increase platelets- hypercoag state
Features of Kartageners syndrome? (4)
- Dextrocardia
- Bronchiectasis
- Recurrant Sinusitis
- Male subfertility
Lung cancer Surgery contra-indications (7)
- poor general health
- stage IIIb or IV (i.e. metastases present)
- FEV1 < 1.5 litres is considered a general cut-off point*
- malignant pleural effusion
- tumour near hilum
- vocal cord paralysis
- SVC obstruction
Varenicline mech of action
nicotinic receptor partial agonist
