respiratory Flashcards
what are the symptoms of lofgren’s syndrome?
sarcoidosis sx encompassing - fever, joint pain, erythema nodsum, lymphadenopathy and bilateral hilar lymphadenoapthy
what is the treatment for lofgren’s syndrome?
good prognosis and does not usually require treatment
when do you consider immunosuppresive therapy in pt.s with sarcoid?
splenic/hepatic/renal/cardiac involvement
lupus pernio
hypercalcemia
eye/CNS involvement
deteriorating pulmonary function tests deteriorating chest x-ray changes
what are the features associated with poor prognosis in sarcoid?
insidious onset, symptoms > 6 months
absence of erythema nodosum
extrapulmonary manifestations: e.g. lupus pernio, splenomegaly
CXR: stage III-IV features
black people
what are the features of COPD that may be predict steroid responsiveness?
- previous diagnosis of asthma and atopy
- raised blood eosinophil count
- substantial variation in FEV1 over time (atleast 400 ml)
- substantial diurnal variation in PEFR (at least 20%)
what are the pre-requisites for oral prophylactic antibiotic therapy?
azithromycin
- should not smoke ad have standard treatemnts and continue to have exacerbations
- should have had a CT thorax (to exclude bronchiectasis)
- LFTs and ECG to exclude QT prolongation
what does it mean with the oxygen dissociation curve shifts to the left?
for given oxygen tension , there is increased saturation of Hb with oxygen i.e. decreased oxygen delivery to the tissues.
(more affinity)
what are the some of the causes of the oxygen curve shifting to the left?
The L rule
Shifts to L → Lower oxygen delivery, caused by
Low [H+] (alkali)
Low pCO2
Low 2,3-DPG
Low temperature
HbF, methaemoglobin, carboxyhaemoglobin
what are the causes of oxygen curve shifting to the right?
‘CADET, face Right!’ for CO2, Acid, 2,3-DPG, Exercise and Temperature
what are some of the obstructive lung diseases?
Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans
what are some of the restrictive lung conditions?
Pulmonary fibrosis
Asbestosis
Sarcoidosis
Acute respiratory distress syndrome
Infant respiratory distress syndrome
Kyphoscoliosis e.g. ankylosing spondylitis
Neuromuscular disorders
Severe obesity
what is the discharge criteria for asthma?
- been stable on their discharge medication (i.e. no nebulisers or oxygen) for 12–24 hours
- inhaler technique checked and recorded
- PEF >75% of best or predicted
what are the features of ARDS?
- acute onset dyspnoea (within 1 week of a known risk factor)
- pulmonary oedema: bilateral crackles/ 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) - elevated RR
- pO2/FiO2 < 40kPa (300 mmHg)
low oxygen saturations
what are the causes of ARDS?
- infections : sepsis, pneumonia
- massive blood transfusion
- trauma
- smoke inhalation
- acute pancreatitis
- COVID
- cardio-pulmonary bypass
what are the common organisms causing bronchiectasis exacerbations?
- Haemophilus influenzae (most common)
- Pseudomonas aeruginosa
- Klebsiella spp.
- Streptococcus pneumoniae
what is the main-stay of treatment for non-CF bronciectasis?
inspiratory muscle training and postural drainage
what are the causes of respiratory alkalosis?
- anxiety leading to hyperventilation
- pulmonary embolism
- salicylate poisoning*
- CNS disorders: stroke, subarachnoid haemorrhage, encephalitis
- altitude
- pregnancy
*salicylate overdose leads to a mixed respiratory alkalosis and metabolic acidosis. Early stimulation of the respiratory centre leads to a respiratory alkalosis whilst later the direct acid effects of salicylates (combined with acute renal failure) may lead to an acidosis
what are the findings of allergic bronchopumonary aspergillosus?
- eosinophilia
- flitting CXR changes
- positive radioallergosorbent (RAST) test to Aspergillus
- positive IgG precipitins (not as positive as in aspergilloma)
- raised IgE
what is the treatment for allergic bronchopulmonary aspergillosis?
- oral prednisolone
- itraconazole
what paraneoplastic conditions are small cell cancers associated with?
ADH (hyponatraemia), ACTH (cushing’s syndrome), Lambert-Eaton syndrome
what paraneoplastic conditions are squamous cell cancers associated with?
PTHrP
HPOA - Hypertrophic pulmonary osteoarthropathy (HPOA)
when is aspiration attempted in primary pneumothorax?
defined as > 2 cm or still short of breath - chest drain inserted
when is chest drain inserted in secondary pneumothrax?
patient is > 50 years old and the rim of air is > 2cm and/or the patient is short of breath then a chest drain should be inserted.
when is aspiration attempted in secondary pneumothorax?
1-2cm - If aspiration fails
