Respiratory Flashcards
Mx of chlamydia pittsaci?
Tetracycles 1st line (doxycyline)
Macrolides 2nd line (erythromycin)
When to give abx in exacerbation of COPD?
‘if sputum is purulent or there are clinical signs of pneumonia’
When to admit for COPD exacerbation?
severe breathlessness
acute confusion or impaired consciousness
cyanosis
oxygen saturation less than 90% on pulse oximetry.
social reasons e.g. inability to cope at home (or living alone)
significant comorbidity (such as cardiac disease or insulin-dependent diabetes)
Which medication needs to be avoided in those with Esinophillic granulomatosis with polyangiitis (Churg-Strauss)?
Leukotriene receptor antagonists (eg montelukast)
Organisms in bronchiectasis?
Haemophilus influenzae (most common)
Pseudomonas aeruginosa
Klebsiella spp.
Streptococcus pneumoniae
What are some CIs for surgical managament of non-small cell lung ca?
assess general health
stage IIIb or IV (i.e. metastases present)
FEV1 < 1.5 litres is considered a general cut-off point*
malignant pleural effusion
tumour near hilum
vocal cord paralysis
SVC obstruction
CI for lung transplant in CF?
Burkholderia cepacia chronic infection
asthma
blood eosinophilia (e.g. > 10%)
paranasal sinusitis
mononeuritis multiplex
pANCA positive in 60%
What condition?
Eosinophillic granulomatosis with polyangitis (Churg-Strauss)
Causes of upper zone fibrosis?
CHARTS
C - Coal worker’s pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis
Causes of lower zone fibrosis?
idiopathic pulmonary fibrosis
most connective tissue disorders (except ankylosing spondylitis) e.g. SLE
drug-induced: amiodarone, bleomycin, methotrexate
asbestosis
Lights criteria - what is it used for?
To distinguish between transudative and exudative pleural effusion
Prove please, please please this fluid is an exudate
P - pleural fluid
Pro - protein
Prove - 5 letters
pleural fluid protein divided by serum protein >0.5
P - pleural fluid
L - LDH
Please - 6 letters
pleural fluid LDH divided by serum LDH >0.6
PL L - Pleural and LDH
please please - 66 letters -> 0.66 (2/3)
pleural fluid LDH more than two-thirds the upper limits of normal serum LDH
If one of these is met suggests exudate
Sarcoidosis - what normally happens
The majority of patients with sarcoidosis get better without treatment
Key indications for NIV?
COPD with respiratory acidosis pH 7.25-7.35
type II respiratory failure secondary to chest wall deformity, neuromuscular disease or obstructive sleep apnoea
cardiogenic pulmonary oedema unresponsive to CPAP
weaning from tracheal intubation
Type 1 v Type 2 resp failure?
Type 1 - low o2
Type 2 - high co2
When for BiPAP v CPAP?
BiPAP - Type 2 resp failure
CPAP - Type 1 resp failure
radiographic evidence of dilated bronchi and thickened walls in the lower zones - what is this sign? which condition?
This is tram-track sign as seen in bronchiectasis
Conditions to fulfil before prophylactic abx in COPD and which abx?
Conditions:
- Optimised standard tx
- Not smoke
- CT Thorax - exclude bronchiectasis
- LFTs and ECG prior to abx due to risk of QT prolongation
Abx - Azithromycin
Inhaled corticosteroids during pregnancy?
Safe to use
progressive exertional dyspnoea associated with clubbing and a restrictive picture on spirometry
Suggestive of what?
Idiopathic pulmonary fibrosis
combination of parotid enlargement, fever, and anterior uveitis.
Diagnosis?
Heerfordt’s syndrome (uveoparotid fever) = subset of sarcoidosis
What increases and decreases TLCO?
raised: asthma, haemorrhage, left-to-right shunts, polycythaemia
low: everything else
Acute mountain sickness - prophylaxis?
Acetazolamide - carbonic anhydrase inhibitor
How to remember the indications for steroid use in sarcoidosis?
Mnemonic PUNCH
P - Parenchymal Lung Disease
U- Uveitis
N- Neurological Involvement
C- Cardiac Involvement
H - Hypercalcaemia