Respiratory Flashcards
What would FEV1, FVC and FEV1/FVC ratio be in a RESTRICTIVE disease?
FEV1 and FVC reduced. But FEV1/FVC ratio is normal or increased
Management of Primary Pneumothorax
If less 2cm and asymptomatic- discharge
If less 2cm and symptomatic- aspirate
If over 2cm- chest drain
Management of Secondary Pneumonthorax
If less than 1cm- oxygen and admit
1-2cm- Aspiration
If over 2cm, and over 50 yo, and SOB- Chest drain
How would a CXR differ in mesothelioma vs asbestosis?
Mesothelioma is the cancer- associated with peripheral Masses and pleural plaques.
Asbestosis- fibrosis and pleural plaques. Doesn’t cause big masses.
What are the components of CURB 65
Confusion
Urea >7
RR >30
BP 90/60
At what pH should a suspected pleural effusion that’s infected have a chest drain inserted?
pH less 7.2
What is a restrictive pattern look like on spirometry?
FEV1 reduced
FVC more reduced
FEV1/FVC normal > 70%
What/ how does Aspergillioma present?
Past history of TB/ rounded opacity surrounded by air. History of haemopytsis.
What is the antibiotic for prophylaxis in COPD?
Azithromycin
In obstructive respiratory disease what happens to the FEV1/ FVC ratio?
Obstructive ratio = under 0.7 eg 0.49 would = obstructive picture.
What is the first line management of COPD?
SABA/SAMA as required
LABA/ LAMA
If a patient has COPD with asthmatic features what is the management?
SABA/SAMA as required
LABA + ICS
What are the general drug principles of Asthma management- in adults?
SABA
SABA + ICS
SABA+ICS / Monteluekast
LABA
Alpha anti 1 defiency causes what type of lung disease, obstructive or restricitive?
Obstructed
What would the ABG show in COPD with chronic CO2 retention?
Normal pH, High co2 and high bicarbonate.
What is the acute management of asthma?
- Neb salbutamol
- Neb ipratropium
- Prednisolone PO
- Magnesium IV
- Amiophylline IV
Pneumocystis jiroveci pneumonia is treated with?
Co-trimoxazole
What is the PESI score useful for ?
Determining which patients with a PE can be management as an outpatient.
What is the second line management of COPD?
2nd line- if asthma features LABA+ICS.
If no asthma features then LABA+LAMA
When would a child say ‘mama’?
9 months
What are the findings in asbestosis?
Diffuse intersistial fibrosis
What are the findings in mesothelioma?
Pleural thickening
What are the features of Klebsiella pneumonia?
Alcoholics/ diabetics.
Gram neg
Red current jelly sputum
Cavitating lesions
Side effect of Pyrazinamide? and what is the drug used for?
TB drug
Can cause arthralgia/ flare of gout (raising urate)
Side effect of Infiximab?
Decompensated of HF. therefore contraindicated in CCF
What rash is associated with Sarcoidosis ?
Lupus Pernio- described as blue rash on nose
What are the features of idiopathic pulmonary fibrosis?
Clubbing, End respiratory creps, RESTRICTIVE DISEASE
What circumstances can lead to a Staph aureus pneumonia?
- IVDU
- Post influenza infection
What is a moderate dose steroid for Asthma in adults?
= 400 micrograms budesonide or equivalent = low dose
400 micrograms - 800 micrograms budesonide or equivalent = moderate dose
> 800 micrograms budesonide or equivalent= high dose.
Summarise Asthma guidelines adults
- SABA
- SABA + ICS
- SABA+ ICS + LRTA
- ICS + LABA (+/- LRTA)
- ICS (mod dose) + LABA (+/- LRTA)
What is the spectrum of disease for asbestos exposure?
- Pleural plaques- benign
- Pleural thickening
- Asbestosis- lower lobe fibrosis + restrictive disease. (conservative management)
- Mesothelioma- malignant ca of pleural
- pal chemo - Lung ca.
Histoplasmosis - caused by ?
Caused by inhalation of fungus spores-commonly a/w bat droppings
What is the COPD stable management (no asthmatic features)
SABA/ SAMA PRN
LAMA+ LABA
LAMA+ LABA+ ICS
What is the COPD stable management (WITH asthmatic features)
SABA/ SAMA PRN
LABA+ ICS
LABA+ LAMA+ ICS
What are the different types of lung ca and which ones are a/w smoking?
Non small cell (non smokers)- most common adenocarcinoma
Small cell carcinoma -(smoking).
What are some examples of Extrinsic allergic alveolitis?
bird fanciers’ lung: avian proteins
farmers lung: spores of Saccharopolyspora rectivirgula (formerly Micropolyspora faeni)
malt workers’ lung: Aspergillus clavatus
mushroom workers’ lung: thermophilic actinomycetes*
What are the investigations for idiopathic pulmonary fibrosis?
Spirometry AND diffusion testing
CXR
CT thorax including high resolution
What is a radiological feature of pulmonary fibrosis?
Honeycombing
What makes up Lights criteria?
Protein, glucose and LDH of the pleural fluid and serum.
NB pleural pH is NOT part of lights criteria!- but still important**
Non small cell lung ca vs small small- treatment principles?
Non small cell= surgery! and chemo/ radio. Remember non small cell= non smokers.
Small cell= chemo and radio (NOT SURGERY)
Colours of sputum:
Streptococcus pneumonia
Psudeomonas aurgenisoa
Haemophilus Influenza
Klebsiella
Streptococcus pneumonia - red coloured/ rust
Psudeomonas aurgenisoa - green
Haemophilus Influenza- green
Klebsiella- red currant jelly
Silicosis- what are the radiological features?
Bilateral hilar lymphadenopathy calcification
AND
upper lobe zone fibrosis
Complications of Lung ca.
How does Pancoast tumour present?
Pancoasts- destruction of brachial plexus. Tinging in hands and wasting of muscles of hand.
Severity of asthma: how do you characterise severity according to PEF?
Life threatening- less than 33%
Severe: 33-50%
Moderate 50-75%
ABG- what happens to the CO2 in respiratory acidosis/alkalosis
Respiratory acidosis = CO2 raised
Respiratory alkalosis= CO2 low
What are the causes of a respiratory alkalosis?
Hyperventilation
Panic attack
PE
Pneumothorax
What is seen in acute respiratory acidosis and causes?
pH LOW (acidosis)
CO2 high
HCO3 low
Exacerbation of COPD
What is seen on respiratory alkalosis?
PH high (alkalosis)
CO2 low
HCO3 low/ normal
What are the bloods for metabolic acidosis ?
pH low
CO2 low
Bicarb low
What is the definitive diagnosis for Sarcoidosis?
Tissue biopsy: non-caseating granulomas
What pH on a pleural tap is diagnostic for empyema?
Less than 7.2
What test is diagnostic in COPD?
POST bronchodilator therapy spirometry
Obstructive disease FEV1/FVC less than 0.7
Causes of OBSTRUCTIVE lung disease?
COPD/ Asthma/ Emphysema/ Bronchiectiasis/ CYSTIC FIBROSIS
What causes a restrictive disease? FEV1/FVC > 0.7
Pregnancy/ Pulmonary oedema/ Pulmonary fibrosis/ Neuromuscular diseases/ Interstitial lung disease
SIADH - what are the bloods/ urine investigations?
Inappropriate ADH secretion
- Hyponatraemia
- Concentrated urine (high urine osmolality)
- Decreased serum osmolality
What are the lung complications a/w methotrexate
Pulmonary fibrosis
Pneumonitis (acute reaction. usually during first year. cough/ dyspnoea and fever)
CAP Abx
Amoxillin for low/ moderate severity
Doxcycline if pen allergic
High severity CURB 3+- co amoxiclav+ Clarithromycin/ erythromycin
Paraneoplastic features of lung ca (small cell vs squamous cell)
Small cell (NON smokers) ACTH and ADH
Squamous cell- HYPERCALCAEMIA (PTH like peptide)
What are the features of Mycoplasma pneumonia?
Children (innate immune systems)
Atypical pnuemonia
Haemolytic anaemia
Thrombocytopenia
COLD agglutinins
COLD autoimmune haemolytic anaemia
Tx) Doxycycline/ erythromycin
Pnuemocystits Jirovi is what type of organism?
Fungus
How to diagnose an exudative effusion?
Exudative pleural effusion due to pneumonia/ malignany
Increased protein ratio
Increased LDH ratio
Features of alpha anti1 tripysin?
Affects lungs and liver
Obstructive disease
Deranged LFTs
(similar symptoms to COPD)
Management of exacerbation of COPD?
Increase short acting bronchodilator
Prednisolone 30mg 5/7
If Abx indicated Amoxicillin first line (5 days)
How is the wells score used for Ix of PE?
Score of 4 is the cut off!
Over 4= straight to CTPA
Under 4= Ddimer
Antibiotics for atypical CAP eg legionella
Amoxicillin with macrolide (clarithromycin/ erythromycin)
Facts about: Pneumocystis jiroveci
Most common infection in immuncompromised
Dry cough, fever, bilateral pulmonary infiltrates.
May not be cultured on sputum sample
BUT would be sampled with bronchoalveolar lavage
TX- COTRIMOXAZOLE
Classic features of each of these types of pnuemonia
- Streptococcus pnumonia
- HIB
- Mycoplasma pneumonia
-Legionella
- Klebsiella
- Staph aureus
-Pnuemocystitis Jirovi
- Pseudomonas aurginosa
- Streptococcus pneumonia- most common. Rust colour sputum
- HIB - common in COPD exacerbations- green sputum
- Mycoplasma pneumonia - LFTs/haemolytic anaemia/ erythema multiforme- treat with macrolide
-Legionella- Hyponatraemia. Treat with macrolide - Klebsiella - alocholics or diabetics. Red sputum
- Staph aureus- common in CF/ post influenza. Flucoxacillin
-Pnuemocystitis Jirovi - HIV. Co trimoxazole - Pseudomonas aurginosa - CF. Green sputum
What pneumonia is associated with bullous myringitis?
Mycoplasma pneumonia (atypical pnuemonia)
Needs treatment with macrolide.
What scale measures breathlessness in COPD?
MRC scale of breathlessness
Stage 1-5
Stage 1: Not troubled by SOB unless strenuous exercise
Stage 5:Cannot leave the house
When do you need to add extra asthma management/ what is considered inadequate control?
If using SABA (Salbutamol) more than 3 times a week!!
