Respiratory Flashcards
severe obesity causes what kind of lung function test?
Restrictive lung function test
as the forced vital capacity is reduced
mechanically compresssed chest
VATS pleurodesis?
is what?
what is is treatment for?
primary spon pneumothorax
video assisted thoracoscopic surgergy pleurodesis
drainage of air/fluid
bullae are excised
talc used to promote adhesion
mx options for pneumothorax
conservative ; 2-4 days as outpatient
inpatient if secondary pneumothorax
ambulatory
8FG catheter mounted to an 18G needle and pigtail catheter
first line Mx of COPD?
SABA / SAMA
short acting bronchodilator
salbutamol
ipratropium
Oral theophylline
methylxanthines
bronchodilator
anti-inflammatory
modulates respiratory function
Churg strauss disease
allergy
asthma / allergic rhinitis
nasal polyps
eosinophilia
vasculitis
pANCA
granulomatosis with polyangitis
renal failure
epistaxis
vasculitis
sinusitis
dyspnoea
cANCA
3 criteria for discharge for an asthma attack?
stable for 12-24 hours
ensure good inhaler technique
how long does metabolic compensation take?
days/ weeks
is prednisolone ok in breastfeeding?
30mg yes
Mx of acute asthma attack?
admit
>Life threaten
>severe and not responding
> pregnant
>prev near fatal
O2 - 15l via non rebreath mask
94-98%
bronchodilate:
SABA; inhaled/neublised
pMDI / o2 driven nebuliser
corticosteroid
40/50mg
Ipratropium bromide
IV magnesium sulphate
IV aminophylline
intubate / ventilate
ECMO
Diagnostic Criteria for ARDS?
clinical and
CXR and
po2/fiO2 <40kPa
what is ARDS?
non cardiogenic pulmonary oedema
pulmonary capillary wedge then is normal <19mmHg
Mx of ARDS?
principles
ITU
o2/ventilate
general organ support
Tx underlying abx
prone positioing
rare but important complication of pleural effusion?
if drained too quickly
re expansion pulmonary oedema
Extrinsic allergic alveolitis
mx
avoid trigger
oral glucocorticoids
Ix for Extrinsic allergic alveolitis
imaging: upper/mid-zone fibrosis
lavage: lymphocytosis
IgG
no eosinophilai tho
A1AT deficiency
causes an emphysema like illness
lack of protease inhibitor
When using an inhaler, for a second dose you should wait for approximately?
30 seconds
_____ paraneoplastic feature of SCLC?
SIADH
hyponatraemia
localised wheeze ; bronchial obstruction
upper lobe zone fibrosis
CHARTS
coal workers pneumonconiosis
histiocytosis
ankylosing spondylitis
radiation
TB
silicosis
sarcoid
nasogastric tubes are safe to use when pH is?
<5.5
asthma diagnosis
adults
eosinophil count / fractional nitric oxide
FeNO
1) bronchodilator reversibility with spirometry
FEV1 >12%
PEF variability
asthma diagnosis in children
feNO
>35 ppb
acute asthma
1st line management
nebulised salbutamol w o2
15l non rebreath mask
mx of acute asthma principles?
Deliver o2
give salbutamol nebulised
give steroids - oral prednisolone 40-50
nebulised ipratropium bromide
IV magnesium sulphate
IV aminophylline
Bupropion should not be used in epilepsy why?
reduces seizure threshold
noradrenaline and dopamine reuptake inhibitor, shares structural similarities with amphetamines, which can increase neuronal excitability and thereby risk seizures
Non-invasive ventilation - key indications
copd respiratory acidosis 7.25-7.35
pH <7.25
cardiogenic pulmonary oedema
T2RF
Recommended initial settings for bi-level pressure support in COPD
EPAP
IPAP
4-5 cm H2O
10 cm H20
12-15 cm H2O (BTS suggest)
1:3 inspiration to expiration ratio
Bupropion
norepinephrine-dopamine reuptake inhibitor and nicotinic antagonist
Varenicline
nicotinic receptor partial agonist
12 weeks
___________ are the treatment of choice for allergic bronchopulmonary aspergillosis
Oral glucocorticoid
Atelectasis
basal alveolar collapse
> bronchial secretions
>dyspnoea
reduced TLCO what does this mean?
transfer factor for CO - monoxide
how much oxygen diffuses from lung > capillaries
reduced in any condition where the surface area is reduced
what is an example of a SAMA?
ipratropium inhaler
= reduces bronchoconstriction and improves symptoms such as wheezing and breathlessness
asthma diagnosis requires what change in FEV1?
12%
200mL post bronchodilator
why does haemoptysis occur in mitral stenosis?
rupture of bronchial veins
caused by left atrial pressure
aspergilloma
rounded opacity
TB hx
haemoptysis
main 2 indications for surgery in bronchiectasis
uncontrollable haemoptysis
localised disease
why does bronchiectasis occur?
permanent dilatation of the airways
> chronic infection
> inflammation (smoker / COPD ect)
Lung Cancers
Gynaecomastia is associated with?
adenocarcinoma
oestrogen / androgen ratio
SCLC - associated wiht?
lambert eaton
SIADH
ACTH - cushing
Squamous cell carcinoma associated?
pTHr hypercalcaemia
what are pleural plaques?
asbestos related lung changes
localized thickening / scarring on the pleura
what is mesothelioma?
malignant disease of the pleura
> chest pain
pleural effusion
SOB
Mx. of mesothelioma?
palliative chemo
median survival 8-14 months
step down treatment for asthma
ICS
decrease dose by 25-50%
BTS reccomen every 3 month review
prophylaxis of exarcebations in COPD?
Azithromycin
first line mx for exarcerbations of COPD?
amoxicillin
doxy
clarithromycin
when does CO2 start to worry you with an asthma attack and why ?
RR of 33 or raised you expect the CO2 to be low due to it being lost when you are hyperventilating
so if they have asthma and their CO2 is raised or normal that is worrying as theyre tiring and hypoventilating
suggests impending respiratory failure
use of ambulatory devices in pneumothorax management?
Recent intervention
>portable chest drainage systems
severe asthma RR is above?
25/min
PEFR - severe / life threatening?
PEFR 33-50 % is severe
<33% is life threatening
how to manage allergic bronchopulmonary aspergillosis
aspergillus spores
1) bronchocostriction
2) bronchiectasis
eosinophilia
CXR findings
positive radioallergosorbent test
IgG
raised IgE
oral glucocrticoids
itraconazole
contraindications for lung cancer
SVC obstruction
FEV <1.5
malignant pleural effusion
vocal cord paralysis
tumour near hilum
oxygen requirements in COPD
88-92%
adjust to 94-98 if pCO2 is normal
low severity pneumonia
amoxicillin 5 days
moderate - high pneumonia?
dual antibiotic therapy
amoxicillun and macrolide
7-10 day course
NICE recommends for suspected lung cancer?
CXR
contrast enhanced CT scan
bronchoscopy- biopsy and histology
PET scan
NSCLC
18-flurodeoxygenase
transfer factor
rate which gas will diffuse from alveoli into blood
carbon monoxide used to test the rate of diffusion
Silicosis
mining
upper zone fibrosis
egg shell calcification of hilar nodes
what is silicosis?
lung disease caused by breathing tiny bits of silica
- stuck in lungs cause damage
- hard to breath
- permanent scarring
what is silica found in?
mineral found in sand
rock
clay
