Respiratory Flashcards
Spirometry FEV severity’s (as % predicted) to classify COPD
<30%
30-50%
50-70%
<30 is life threatening
33-50 is severe
50-70 is moderate
Causes of haemoptysis?
Lunayag cancer
TB
PE
LRTI
Bronchiectasis
Mitral stenosis (increased back pressure)
Goodpastures (systemically unwell with glomerulonephritis)
Wegener’s granulomatosis with polyangiitis
Why are you at risk of aspegilloma following TB?
TB causes structural lung changes such as lung cavities, which are susceptible to fungal infection.
How do you determine if a pleural effusion is exudative?
Use Light’s criteria
i.e pleural lactate dehydrogenase (LDH) > 0.6 of serum LDH
What are the investigations to diagnose asthma?
1st - FeNO
2nd - Spirometry with bronchodilator reversibility (FEV1 12% increase pre and post; or FEV1 10% increase of expected)
3rd - diurnal PEFR for 2 weeks
How does atypical pneumonia present, what does it show on CXR, what is treatment?
dry cough
bilateral infiltrates on CXR
Treat with doxy (mycoplasma)
What is treatment of anaphylaxis? When is it considered refractory?
Anaphylaxis is allergic reaction involving ABC compromise (drop in BP, difficulty breathing)
500 micrograms IM Adrenaline 1 in 1000
Repeat dose after 5mins
If no improvement after 2 doses = refractory
Management of lung abscess?
IV Abx (for some reason, they do usually penetrate lung abscesses)
However, if doesn’t work, CT-guided percutaneous drainage (NOT BRONCHOSCOPY)
When should you always aspirate and test a pleural effusion?
If pleural effusion is associated with pneumonia or sepsis
In which scenarios should pleural effusion have a chest drain placed?
If pleural aspiration shows purulent fluid OR bacterial growth on culture OR pH<7.2
(essentially if infective pleural effusion)
What might Small cell lung cancers secrete ectopically?
ACTH -> Cushing’s
ADH -> Low Na
How to treat Small cell lung cancer?
Chemotherapy and radiotherapy
If very limited (i.e. T1-2, N0, M0) - surgery
Prognosis and management of mesothelioma?
poor prognosis (up to 14 months)
No cure - palliative chemotherapy
In CF, what is the most common organism causing pneumonia?
Pseudomonas
(nb// also implicated in malignant otitis externa)
What are the two main types of atypical pneumonia, differences between them.
What’s their management?
Both have foreign travel risk factor, dry cough, lethargy etc
Mycoplasma - erythema multiforme, ITP sometimes, SEROLOGY
Legionella - AC units
pleural effusions seen in 30%, hyponatraemia, URINARY ANTIGEN TEST
(easier to remember the specifics of legionella)
Both treated with macrolide - clarithromycin
What lung sound might you bronchitis? What is treatment of acute bronchitis?
Ronchi (low pitch sound on expiration, due to secretions in large airways)
Usually viral, so only give doxycyline if comorbidities such as HF, COPD, diabetes and older age.
Which aspects of COPD management increase long term survival?
Smoking cessation
Long term oxygen therapy
Lung volume reduction surgery
Most common bacteria causing infective COPD exacerbation?
Haemophilus influenza
(followed by Moraxhella and Streptococcus pneumoniae)
(HMS, same as otitis media)
Most common bacteria causing pneumonia in alcoholics, IVDU, diabetics, immunocompromised?
Kliebsella
Most common bacteria causing pneumonia after Influenza infection?
S.Aureus
What is bronchiectasis?
Permanent airway dilatation following chronic infection or chronic inflammation
In non-CF bronchiectasis, what is the most common bacteria?
Haemophilus influenza B (same as IECOPD)
(note in CF, it is pseudomonas)
What is the best management for long term symptom control in non-CF bronchiectasis?
Inspiratory muscle training + postural drainage (aim to keep lung segments above trachea to aid drainage of mucus - i.e tilt bed feet up)
Aetiology of lung white out if trachea pulled towards it?
Lung collapse or pneumonectomy
Aetiology of lung white out if trachea pushed away from it?
Pleural effusion
Large Thoracic mass
Diaphragmatic hernia
Aside from NRT, what other option is there for smoking cessation?
Varenicline (partial nicotine receptor agonist)
(NB// smoking cessation in pregnancy is by motivational interviewing)
1st line management of chronic COPD?
SABA or SAMA (ipratropium)
For COPD, after SABA/SAMA, what inhalers can you add on?
If asthma features -> add on ICS + LABA
If no asthma features -> add on LABA, LAMA. If still not controlled after this, add on ICS after.
If patient’s asthma controlled currently, how should you try reducing inhaled steroids?
Reduce inhaled steroid dose by 25-50%
What’s the timeframe for a follow up CXR post pneumonia?
Follow up CXR in 6 weeks time
What are the new BTS guidelines for management of pneumothorax?
What is the management of lung cancer?
If no nodal and metastatic disease, and tumour is small (T1 or T2), you can do SURGERY
OTHERWISE, NO SURGERY
ONLY CHEMO AND RADIO
