Respiratory Flashcards
What is the most common organism in bronchiectasis?
H. Influenzae
What are the causes of upper lobe fibrosis?
CHARTS
Coal workers ppeumoconiosis
Histiocytosis
Ankylosing spondylitis/allergic bronchopulmonary aspergillosis
Radiation
Tuberculosis
Silicosis, sarcoidosis
What are the spirometry findings in pulmonary fibrosis?
Reduced FVC, normal fev1/fvc
What is the second line investigation for asthma if spirometry is normal?
Fraction of exhaled nitrous oxide testing
FeNO
What medication causes lower zone lung fibrosis?
Amiodarone (and bleomycin, methotrexate)
What are the features of acute sarcoidosis?
Erythema nodosum
Bilateral hilar lymphadenopathy
Swinging fever
Polyarthralgia
What investigations are required before starting azithromycin?
ECG (and LFTs)
What is first line mgt of COPD?
SABA or SAMA PRN
What is the second line mgt of COPD?
Asthmatic features/steroid responsiveness: LABA and ICS
NO asthmatic features - LABA and LAMA (if on SAMA switch to SABA)
what is the investigation of choice for idiopathic pulmonary fibrosis?
high res CT
what are the features of kartagener’s syndrome?
dextrocardia
bronchiectasis
recurrrent sinusitis
subfertility
in step down tx of asthma, what reduction of corticosteroid tx are you aiming for?
25-50%
most common pathogens causing IECOPD?
haemophilus influenzae
strep pneumoniae
moraxella catarrhalis
investigation of pleural effusion?
PA CXR
US guided pleural aspiration (sent for pH, protein, LDH, cytology and microbiology)
contrast CT to investigate underlying cause
how to differentiate transudate and exudate in pleural effusion?
exudate if: pleural fluid protein/serum protein >0.5
pleural fluid LDH / serum LDH >0.6
pleural fluid LDH more than two thirds the upper limits of normal serum LDH
when should a chest drain be placed in pleural effusion?
if fluid is purulent or turbid/cloudy chest tube should be placed
if fluid is clear but pH less than 7.2 in patients with suspected pleural infection chest tube should be placed
mgt of recurrent pleural effusion?
- recurrent aspiration
- pleurodesis
- indwelling pleural catheter
- drug mgt to alleviate sx eg opioids to relieve dyspnoea
acute asthma management escalation?
- oxygen
- salbutamol nebs
- ipratropium bromide nebs
- hydrocort IV or oral pred
- mag sulf IV
- aminophylline/IV salbutamol
fev1/fvc ratio <0.7?
obstructive
fev1/fvc ratio >0.7?
restrictive
restrictive spirometry picture and impaired gas exchange?
pulmonary fibrosis
features of silicosis?
upper zone fibrosing lung disease
‘egg-shell’ calcification of the hilar lymph node
ABG measurements indicating LTOT in COPD?
two ABG measurements with pO2 <7.3kPa
(while stable on optimal med mgt)
mnemonic for upper lobe fibrosis?
CHARTS
Coal workers pneumoconiosis
Histiocytosis
Ankylosing spondylitis
Radiation
TB
Sarcoidosis/silicosis
mnemonic for lower lobe fibrosis?
DIAL at the base of the lungs
Drugs
Idiopathic
Asbestosis
Lupus
COPD - still breathless despite using SABA/SAMA and asthma/steroid responsive features?
add LABA and ICS
bronchiectasis features?
persistent productive cough
dyspnoea
haemoptysis
key sign on HRCT in bronchiectasis?
signet ring sign
gold standard investigation for mesothelioma?
thoracoscopic biopsy
what is the safe triangle for chest drain insertion>
Bounded by latissimus dorsi,
pectoralis major,
line superior to the nipple
and apex at the axilla
features of acute sarcoidosis?
erythema nodosum
bilateral hilar lymphadenopathy
swinging fever
polyarthralgia
investigation for occupational asthma?
serial peak flow measurements at work and at home
deficiency of what protein is a risk factor for hepatocellular carcinoma?
alpha-1 antitrypsin
causes of acute respiratory distress syndrome?
infection: sepsis, pneumonia
massive blood transfusion
trauma
smoke inhalation
pancreatitis
covid 19
cardio-pulmonary bypass
what is acute respiratory distress syndrome?
inc permeability of alveolar capillaries
-> leading to fluid accumulation in alveoli ie non-cardiogenic pulmonary oedema
smoking cessation in pregnancy?
NRT patches
-»> bupropion and varenicline CI’d
score used for sleep problems?
epworth sleepiness scale
