Respiratory Flashcards
COPD - still breathless despite using SABA/SAMA and asthma/steroid responsive features –>
add a LABA + ICS
COPD - still breathless despite using SABA/SAMA and no asthma/steroid responsive features –>
A LAMA/LABA inhaler would be a suitable option if the patient has no asthmatic features, or features suggesting steroid responsiveness. However, the diurnal variation with raised eosinophil count does suggest this may be the case.
patients with asthma who are not controlled with a SABA + ICS should first have a… added
Leukotriene receptor antagonist added, not a LABA (due to cost-effectiveness)
How do we dx pulmonary fibrosis?
HR CT
How does idiopathic pulmonary fibrosis present?
a male patient aged 50-70 years presenting with progressive exertional dyspnoea associated with clubbing and a restrictive picture on spirometry,
What are Light’s criteria?
Effusion lactate dehydrogenase (LDH) level greater than 2/3 the upper limit of serum LDH
Pleural fluid LDH divided by serum LDH >0.6
Pleural fluid protein divided by serum protein >0.5
When do we use Light’s criteria?
In the assessment of a pleural effusion, it is important to ascertain whether the effusion is a transudate or exudate. This can sometimes be ascertained quite easily by looking at the protein content of the pleural fluid (transudate protein content < 25g/L and exudate protein content > 35g/L). However, in some cases (i.e. protein content 25-35g/L) Light’s criteria need to be applied.
What is aspergilloma?
Aspergilloma is a fungal growth affecting immunocompromised patients or those with underlying cavitating lung disease such as tuberculosis or emphysema. Symptoms of include fever, cough and haemoptysis. Treatment is with anti fungal medications such as itraconazole.
What is the most common organism causing IE COPD?
The most common organism causing infective exacerbations of COPD is Haemophilus influenzae
Where do you see parallel-line shadows?
Bronchiectasis
What is seen on CXR in HF?
Alveolar oedema (bat’s wings), Kerley B lines (interstitial oedema), Cardiomegaly, Dilated prominent upper lobe vessels, Effusion (pleural) are features of heart failure on a chest x-ray
What is budesonide
ICS inhaler
What ix do we do in suspected lung ca?
CT w/ contrast
Do we give NIV in acute severe asthma?
No - IV mag sulph
Which abx prophylaxis can be given in COPD?
Azithromycin
What is the first-line mx in COPD?
A SABA or SAMA is the first-line pharmacological treatment of COPD
What is the Mantoux test for?
TB
Give a RF for mesothelioma
Asbestos exposure
What are the four commonest causes of anterior mediastinal mass
teratoma, terrible lymphadenopathy, thymic mass and thyroid mass
Which CT scan would you request in myasthenia gravis
In cases of myasthenia gravis, it is important to perform a CT chest in order to look for a thymoma. Removal of a thymoma may improve the condition in certain patients and prevents malignant transformation.
What is a restrictive pattern on spirometry?
Restrictive patterns are characterized by reduced lung volumes and a normal or increased FEV1/FVC ratio (>0.70).
What is an obstructive pattern on spirometry?
The post-bronchodilator FEV1/FVC ratio of 0.70 indicates an obstructive pattern.
Additionally, the FEV1% predicted value of 60% = moderate severity
What is the difference between stage one and stage two COPD?
According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, stage 2 COPD is characterized by an FEV1% predicted value between 50% and 80%.
COPD (stage 1 - mild) does involve an obstructive pattern, but it requires an FEV1% predicted value greater than or equal to 80%.
What are the signs of life-threatening asthma attack?
PEFR < 33% best or predicted
Oxygen sats < 92%
‘Normal’ pC02 (4.6-6.0 kPa)
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
Which electrolyte abnormality is seen in sarcoidosis?
Hypercalcaemia
What are pleural plaques?
Pleural plaques are the most common form of asbestos-related lung disease and are benign. They are benign and are not associated with an increased risk of lung cancer or mesothelioma. This patient should be reassured and advised that no follow-up of these specific plaques is necessary, although an ongoing review of his lung disease is encouraged.
You are reviewing a patient with chronic obstructive pulmonary disease. Which vaccinations should they receive?
‘Annual influenza + one-off pneumococcal
The pneumococcus vaccine is a single-dose lifetime vaccine
A 30-year-old man who has asthma presents with a 5 day history of cough and wheeze. He currently takes salbutamol prn and beclometasone 200mcg bd. His peak flow is 70% of normal. Mx?
5/7 oral pred
What is alpha-1-antitrypsin deficiency?
Alpha-1 antitrypsin (A1AT) deficiency is a common inherited condition caused by a lack of a protease inhibitor (Pi) normally produced by the liver. The role of A1AT is to protect cells from enzymes such as neutrophil elastase. It classically causes emphysema (i.e. chronic obstructive pulmonary disease) in patients who are young and non-smokers.
How does klebsiella pneumoniae present?
Klebsiella pneumoniae is a gram-negative rod that causes an atypical pneumonia that is more common in those with a history of diabetes and alcohol excess.
Klebsiella pneumoniae more commonly causes cavitation in the upper lobes and the presence of upper zone crackles is another indicator of Klebsiella pneumoniae infection.
What is bupropion, and what is it used for?
Norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist. Bupropion is an atypical antidepressant and smoking cessation aid.
It also acts as a non-competitive antagonist of nicotinic acetylcholine receptors, which is thought to contribute to its efficacy in smoking cessation.
How would we manage a pts corticosteroid dose in a pt with well controlled asthma?
In the step-down treatment of asthma, aim for a reduction of 25-50% in the dose of inhaled corticosteroids every three months
What is ipratropium?
SAMA
What is salmeterol?
LABA
What is tiotropium?
LAMA
What are COPD standby medication?
In the 2010 NICE guidelines, there is a recommendation that patients who have frequent exacerbations of COPD should be given a home supply of corticosteroids and antibiotics. It is, of course, good practice to ask the patient to contact you if they are required to use them, at least to ensure that no further action is required. An antibiotic should be only be taken if the patient is coughing up purulent sputum.
How do we treat lung abscesses?
Percutaneous drainage should be considered if a lung abscess is not improving with intravenous antibiotics
How does bronchiectasis show on spirometry?
Obstructive pattern
How does neuromuscular disorder show on spirometry?
Restrictive pattern
What is varenicline?
Nicotinic receptor partial agonist. Varenicline works as a nicotinic receptor partial agonist. It selectively binds to α4β2 nicotinic acetylcholine receptors in the brain, thereby reducing the pleasure and satisfaction associated with smoking. This action helps decrease nicotine cravings and withdrawal symptoms in individuals trying to quit smoking.
What are the segments of the curb-65 score?
C Confusion (abbreviated mental test score <= 8/10)
U Urea over 7
R Respiration rate >= 30/min
B Blood pressure: systolic <= 90 mmHg and/or diastolic <= 60 mmHg
65 Aged >= 65 years
What are the asthma/steroid responsive features?
Features suggestive of steroid-responsiveness include a previous asthma diagnosis, blood eosinophilia, and diurnal variation in symptoms
What is the last line treatment for alpha-1-antitrypsin deficiency?
Lung volume reduction surgery removes the worst affected part of the lungs in order to improve airflow and alveolar gas exchange in the remaining portion of the lung.
What is silicosis?
Silicosis is an example of a pneumoconiosis, a class of lung disease characterised by inhalation of (usually occupational) dust
How does silicosis present?
Silicosis classically presents in miners/pottery workers with prolonged exposure to aerosolised dust particles, usually over decades. Patients may report progressive exertional dyspnoea and dry cough due to chronic inflammatory changes.
How does silicosis present on XR?
Radiographic features include upper zone fibrosis and ‘egg-shell’ calcification of the hilar nodes, so-called due to the peripheral calcific changes.
What are the main indications for placing a chest tube in pleural infection?
Patients with frankly purulent or turbid/cloudy pleural fluid on sampling should receive prompt pleural space chest tube drainage.
The presence of organisms identified by Gram stain and/or culture from a non-purulent pleural fluid sample indicates that pleural infection is established and should lead to prompt chest tube drainage.
Pleural fluid pH < 7.2 in patients with suspected pleural infection indicates a need for chest tube drainage.
Why can I not take bupropion?
Lowers seizure threshold
How do we control sx in bronchiectasis?
Postural drainage is a technique that uses gravity to help clear mucus from the lungs by positioning the patient so that the affected lung segments are above the trachea. This facilitates mucus clearance and helps reduce the frequency of infections, ultimately improving the patient’s quality of life.
Also inspiratory muscle training
How does granulomatosis with polyangiitis present?
pulmonary haemorrhage (haemoptysis), renal impairment (rapidly progressive glomerulonephritis) and flat or saddle nose (due to a collapse of the nasal septum) is characteristic of granulomatosis with polyangiitis.
How does we manage acute exacerbation of COPD?
5 day course oral pred
NICE only recommend giving oral antibiotics in an acute exacerbation of COPD in the presence of purulent sputum or clinical signs of pneumonia
