Respiratory Flashcards
Fungal growth affecting immunocompromised patients or those with underlying cavitating lung disease such as tuberculosis or emphysema. May present as a mass in the lung?
Aspergilloma
How is severity of COPD categorised? Describe all of the categories
FEV1 (% of predicted)
>80% - Stage 1 - Mild - symptoms should be present to diagnose COPD in these patients
50-79% - stage 2 moderate
30-49% - stage 3 severe
<30% - stage 4 very severe
What is the criteria to determine whether a patient has asthmatic/steroid responsive features in COPD?
Any previous, secure diagnosis of asthma or of atopy
A higher blood eosinophil count - note that NICE recommend a full blood count for all patients as part of the work-up
Substantial variation in FEV1 over time (at least 400 ml)
Substantial diurnal variation in peak expiratory flow (at least 20%)
Why should an ECG be done in a patient who is going to start azithromycin prophylaxis for COPD?
Azithromycin can cause QT prolongation
When asthma has been well controlled for 3 months, what is BTS recommended step down of treatment?
reduction of 25-50% in the dose of inhaled corticosteroids
What is the most common organism causing infective exacerbations of COPD?
Haemophilus influenzae
What is lights criteria?
Light’s criteria state that a pleural effusion is an exudate if:
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
What treatment can be used for a1-antitrypsin deficiency associated emphysema?
Lung volume reduction surgery
The British Thoracic Society (BTS) state that the following 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.
What are the 3 options for smoking cessation? How long is treatment usually for in each case?
nicotine replacement therapy, Varenicline or bupropion
Varenicline - 12 weeks, starting 1-2 weeks before target stop date (currently unavailable)
Bupropion - 7-9 weeks, starting 1-2 weeks before target date
NRT - 8-12 weeks, starting on the quit date
Where is bupropion contraindicated?
Epilepsy (reduced seizure threshold), breastfeeding, pregnancy, relative contraindication to eating disorders
What 2 things increase COPD survivability?
- Stop smoking. 2. LTOT
What is the most common form of asbestos-related lung disease and what is the prognosis of it?
Pleural plaques. These are benign.
People who get spontaneous pneumothorax get a lifelong ban of what?
How long is air travel avoided for?
Deep sea diving.
Note:Air travel only needs to avoided until there has been 1 week since confirmation of the resolution of the pneumothorax
What spirometry result would be seen in pulmonary fibrosis?
Restrictive patter:
FEV1:FVC >70%, decreased FVC and impaired gas exchange (reduced TLCO)
if the ratio is normal, would still expect a decreased FVC
What organism most commonly causes a cavitating pneumonia in the upper lobes, mainly in diabetics and alcoholics?
Klebsiella pneumoniae
Which intervention is most important in the long term control of non-CF bronchiectasis?
Postural drainage (a form of chest physio)
What is the recommended investigation for diagnosing asthma?
NICE recommends spirometry with reversibility testing as the initial test in diagnosing asthma, followed by FeNO to confirm eosinophilic inflammation.
