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
