Respiratory Flashcards
Causes of anterior medistinum masses
4 T’s
1)teratoma
2)terrible lymphadenopathy
3)thymic mass
4)thyroid mass
Causes of respiratory alkalosis
1)anxiety leading to hyperventilation
2)pulmonary embolism
3)salicylate poisoning*
4)CNS disorders: stroke, 5)subarachnoid haemorrhage, 6)encephalitis
7)altitude
8)pregnancy
NOTE: *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 expected lung function tests in obstructive lung disease?
FEV1 - significantly reduced
FVC - reduced or normal
FEV1% (FEV1/FVC) - reduced
What are the expected lung function tests in restrictive lung disease?
FEV1 - reduced
FVC - significantly reduced
FEV1% (FEV1/FVC) - normal or increased
Examples of obstructive lung disease
Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans
Examples of restrictive lung disease
Pulmonary fibrosis
Asbestosis
Sarcoidosis
Acute respiratory distress syndrome
Infant respiratory distress syndrome
Kyphoscoliosis e.g. ankylosing spondylitis
Neuromuscular disorders
Severe obesity
What organism is he most common cause of COPD exacerbation?
Haemophilus influenzae
Others less common:
Strep pneumoniae
Mortadella catarrali
Parameters for mild , moderate, severe and very severe COPD
Stage 1 - Mild - >80% predicted FEV1
Stage 2 - Moderate- 50-79%
Stage 3- Severe- 30-49%
Stage 4- Very severe- <30%
What are the signs of Pulmonary oedema on CXR?
Alveolar oedema
Kelley B lines
Cardiomegaly
Dilated prominent upper vessels
Effusions (pleural)
What would cause low glucose in pleural fluid?
rheumatoid arthritis, tuberculosis
What would cause raised amylase in pleural fluid?
pancreatitis, oesophageal perforation
What would cause heavy blood staining in pleural fluid?
mesothelioma, pulmonary embolism, tuberculosis
What is the management of asthma?
1) SABA
2) SABA + low dose ICS
3) SABA + low dose ICS +LTRA
4) SABA + low dose ICS + LABA (+/- continue LTRA according to response)
5) SABA +/-LTRA +MART (ICS+LABA)
6)SABA +/-LTRA + medium-dose MART (medium dose ICS+LABA)
What is the management of COPD?
1) SABA or SAMA
2) LABA +LAMA OR LABA + ICS
3) SABA PRN + LABA + LAMA + ICS
What is the management of acute exacerbation of asthma?
1) SABA and SAMA
2) IV steroids
3) IV magnesium sulfate
4) IV aminophylline
What is the management of anaphylaxis?
1) IM adrenaline x2 (5mins apart)
If refractory
2) IV adrenaline infusion + IVI
3)chlorphenamine
What is the management of Alpha-1 antitrypsin deficiency ?
1) no smoking
2) supportive: bronchodilators, physiotherapy
3) intravenous alpha1-antitrypsin protein concentrates
4) surgery: lung volume reduction surgery, lung transplantation
What are the features of Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)?
asthma
Eosinophilia
paranasal sinusitis
pANCA
What is the managment of Extrinsic allergic alveolitis (AKA hypersensitivity pneumonitis)?
- avoid precipitating factors
- oral glucocorticoids
What are the features of granulamotosis with polyangitis (Wegner’s)?
Renal failure
Epistaxis/haemoptysis
cANCA
saddle-shape nose deformity
What is the management of idiopathic pulmonary fibrosis?
Pulmonary rehabilitation
many patients will require supplementary oxygen and eventually a lung transplant
What are risk factors for Klebsiella?
more common in alcoholic and diabetics
What are features of Klebsiella pneumoniae?
- may occur following aspiration
- ‘red-currant jelly’ sputum
- often affects upper lobes
- commonly causes lung abscess formation and empyema
What are the different types of lung cancer?
Small cell
Non-small cell:
1) adenocarcinoma
2) squamous
3) large cell
4) alveolar cell carcinoma
5) bronchial adenoma
What is the most common type of lung cancer?
Adenocarcinoma
What are the paraneoplastic features of small cell lung Ca?
ADH-> hyponatraemia
ACTH-> Cushing’s
Lambert-Eaton syndrome
What are the paraneoplastic features of squamous cell lung Ca?
1) parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia
2) clubbing
3) hypertrophic pulmonary osteoarthropathy (HPOA)
4) hyperthyroidism due to ectopic TSH
What are the paraneoplastic features of adenocarcinoma?
1) gynaecomastia
2) hypertrophic pulmonary osteoarthropathy (HPOA)
What is the management of pneumothorax?
1) Assess if symptomatic-> if asymptomatic then no intervention regardless of size
2) Assess for high-risk characteristics
If high risk characteristics and safe to intervene-> chest drain
If none-> conservative, ambulatory or needle aspiration
What is done for patients with persistent or recurrent pneumothorax?
video-assisted thoracoscopic surgery (VATS) should be considered to allow for mechanical/chemical pleurodesis +/- bullectomy.
When can you fly and dive after pneumothorax?
Fly: after 2 weeks if no residual air
Scuba diving: never (unless the patient has undergone bilateral surgical pleurectomy and has normal lung function and chest CT scan postoperatively)
What are the features of silicosis on CXR?
1) upper zone fibrosing lung disease
2) ‘egg-shell’ calcification of the hilar lymph nodes
