Respiratory Flashcards
What are the types of lung cancer
Non Small Cell Lung Cancer - Squamous Cell Carcinoma & Adenocarcinoma
Small Cell Lung Cancer
Sings and symptoms of lung cancer
SoB
Cough
Haemoptymis
Finger clubing
Pneumonia
Weightloss
Lymphadenopathy
How do you investigate for Lung cancer
Chest xray
Staging CT scan - Chest , abdomen and pelvis with contrast
PET CT
Bronchoscopy with biopsy
Treatment options for lung cancer
Surgery
Radiotherapy
Chemotherapy
What are the extrapulmonary manefistations of lung cancer
Reccurent laryngeal nerve palsy - Hoarse vocie
Phrenic nerve palsy - Diaphram weakness and shortness of breath
Superior vena cava obstruction- facia swelling, distended neck, SOB
SIADH- hyponaturaemia
Cushing syndrome
Hypercalcaemia - ectopic parathyroid hormone
What is Lamber-Eaton myasthenic syndrome
Myasthenia Gravis caused by lungcancer auto antibodies. Progressive weakness of small muscles
What are the two classifications of pnuemonia
Hopsital aquried penumonia and community aquired pneumonia
What will you hear on auscultation in penumonia ?
Bronchial Breath Sounds
Focal Course crackles
Dullness to percussion
What is CURB6573
Confusion
Urea >7
resp rate >30
blood pressure <90
AGE >65
What are the most common pathogens in pneumonia
Streptococcus pneumoniae 50%
Haemophilus influenzae
What is atypical penumonia and how do you treat it?
Atypical penumonia is caused by an organisim which cannot be detected by culture or gram stain. They are penecillin resistant so you need o use clarithromycin, levofloxacin or doxycycline
What is special about legionnares disease?
It can cause SIADH
What is the usual course for antibiotics
Amoxicilin 5 days
What type of pneomnia causes target lesions
mycoplasma pneumoniae
What investigations should you do for penumonia?
Chest Xray
FBC
U&E
CRP
Sputum culture
Blood culture
What is FEV1?
Volume of air blown out in 1 seconds
What are the two common obstructive lung diseases?
Asthma
COPD
What is Force vital capactiy
Total volume of volume exhaled after full inspiration
What spirometry results do you find in restrictive lung disease?
both FEV1 and FVC are reduced. the FEV1:FVC ratio is maintained
What spirometry results would you see in obstructive lung disease
FEV1 is less than 75% of the FVC
What are the examples of restrictive lung disease?
Pulmonary fibrosis
Sarcoidosis
Obesity
Motor neuron disease
Scoliosis
What questions should you ask in asthma?
Episodic
Diurinal
Dry cough with wheese and SOB
Atopy
family history
What is the treatment alogrithim for Asthma
Short action beta 2 agonist
Then
low dose conticosetroid inhaler
then add in eith leukotrine receptor anatgonist or a LABA (Salmetrol)
What are the grades of acute asthma exacerbation?
Moderate - PEFR 50-75%
Severe - <50% PEFR and unable to complete sentences
Life threatening - PEFT <33%
Sats <92%
NO WHEEZE
Treatment for life threatening asthma
Escalate
IV aminophyline, IV salbutamol, IV magnessium
Treatment for severe asthma
nebulsied salbutamol
Nebulised ipratropium bromide
prednisolone
for 5 days
How do you grade breathlessness?
1 - breathless on stenuous exercise
2 - breathless on walking up a hill
3 - breathless slow walking on flat
4- stop to catch breath after 100 meters on flat
5- unable to leave house due to breathlessness
What do people with COPD show on spiromentry?
obstructive picture
FEV1/FVC ration < 70%
What are the drug treatments for COPD
1 - Salbutamol or Ipratropium
2- if not asthma like then combined LABA and LAMA
If asthma like then LABA and steroid (Fostair or Seretide)
What is ipratropium?
short acting antimuscarinic
What are the two types of respiratory failure?
Normal pCO2 and low pO2 = Type 1
Raised pCO2 low pO2 = Type 2
How do you know if the target sats should be >95% or should be 88-92%?
Do an ABG, if there is a very high bicarbonate this suggests they retain CO2 so you should aim for 88-92% to avoid depressing respiratory drive
What is the typical treatment of an exacerbation of COPD?
Prednisolone 30mg OD for 2 weeks
Regular inhaler usage
ABX if infection
What ABX do you use in exacerbation of COPD?
Amoxicillin 500mg tds for 5 days (or doxycycline)
What is intersitial lung disease?
Conditions which cause inflamation and fibrosis to the lung parenchyma
What does intersitial lung disease look like on CT?
ground glass
What are the two types of pleural effusion?
Exudative - high protein
transudative - low protein
What causes exudative pleural effusions?
inflammation causing protein to leak into pleural space
Lung cancer
Pneumonia
Rheuamtoid Arthritis
TB
What causes transudative pleural effusions?
Fluid shifiting into the pleural space
Congestive heart failure
low albumin
hypothyrodisim
What would you see on Xray in a pleural effusion?
blunting of costrophrenic angle
fluid in lung fissures
What is Empyema?
infected pleural effusion
What lab findings are there in empyema?
acidic
low glucose
high LDH
What is the treatment of penumothorax?
if no SOB and less than 2cm rim then leave
If SOB or >2cm then aspiration
if aspiration fails then chest drain
What is the managment of tension pneumothorax
Insert a large bore cannula into the second costal space in the midclavicular line of the affected side
then insert a chest drain
Where do you insert a chest drain?
just above the rib in the Triangle of saftey then xray it
5th intercostal space (below nipple)
border of pec major
mid axillary line (latissumus dorsi)
Risk factors for PE
Stationary
Surgery
Pregnancy or Oestrogen
malignancy
polycythemia
lupus
thrombophilia
What do you do if there is a risk of PE?
prohpylaxis with enoxapaarin (LMWH)
How do you score for risk of PE?
Wells score
What is D Dimer useful for?
it rules out a DVT
How do you definativley diagnose a PE
CT pulmonary angiogram or Ventelation perfusion scan
What do you see in ABG for pulmonry embolisim?
Respiratory alkalosis
What is the inital managment of PE
Oxygen and analgesia
LMWH Enoxaparin or Dalterparin
What is the longer term management for PE
anticoagulation
Warfarin, or DOAC
What do you do if the patient is in real trouble with a PE or LMWH isnt working?
thrombolysis with streptokinase
