Respiratory Flashcards
Stage I Sarcoidosis
- what is it?
- management
CXR involvement only (nil biochemical abnormalities)
Monitor with PFTs
What can you do on pleural fluid to determine if it is an empyema?
Centrifuge
What do you see in investigations for bronchiectasis?
Signet ring sign on CT
Normal pulmonary function tests
Unilateral pleural effusion in liver cirrhosis
- differential
- how to diagnose
- physiological basis
Hepatic hydrothorax
Pleural effusion >500ml + cirrhosis
= -VE intrathoracic pressure sucks fluid through diaphragmatic defects
Recurrent pneumonia
Slow growing tumour
Well differentiated
Proximal airway
= diagnosis
Bronchial carcinoid
- lower rates of carcinoid syndrome (compared to gut tumours - don’t produce as much serotonin)
Drugs that can cause pleural effusion (3)
Nitrofurantoin - triggers cellular damage and hypersensitivity reaction
Methotrexate
Amiodarone
Histopathology from broncholavage
- lymphocytosis
- increased CD4/8 ratio
- non caseating granuloma
Sarcoidosis
Assessment of COPD severity
FEV1% of predicted
Transudate effusion
- causes (4)
<30g/L protein
Heart failure
Hypothyroidism
Meig’s syndrome
Hypoalbuminaemia
Exudate effusion
- causes (7)
Infection
Rheumatoid Arthritis
SLE
Malignancy
Pancreatitis
PE
Dressler’s
(>30)
Light’s criteria
For when protein 25-35
Exudate more likely:
Fluid/serum protein >0.5
Fluid/serum LDH >0.6 (think Susan and Kerry)
Pleural effusion
- low glucose (2)
- high amylase (2)
Low glucose = RA, TB
High amylase = pancreatitis, perforation
Blood stained pleural effusion (3)
PE
TB
Mesothelioma
Criteria for chest drain based on pleural fluid
Turbid fluid
pH <7.2
Advice following pneumothorax
Smoking cessation
Can fly 1 week after if CXR shows resolution
Scuba diving - permanently avoid
Relative contra-indications to chest drain
INR >1.3
PLT < 75
Bullae
Adhesions
Complication if chest drain drains too quickly
- avoidance
Re-expansion pulmonary oedema
= cough and shortness of breath
- Must clamp the chest drain
- Aiming for output not >1L over 6 hours
Removal of chest drain
- collection
- PTX
Collection = nil output >24 hours + resolution of collection
PTX = when not bubbling/CXR evidence of resolution
Initial management decision RE PTX
No symptoms = conservative (regardless of size)
Symptomatic = assess for high risk features
High risk features in PTX (6)
Haemodynamic compromise
Significant hypoxia
Bilateral PTX
Underlying lung disease
>= 50 AND smoker
Haemothorax
Assessing safety to place drain in PTX
Must be at least 2cm on assessment or via CT
Management of PTX
- high risk + safe
- not high risk + safe
High risk = chest drain
Not = choice of conservative management, ambulatory device, needle aspiration
Follow up if needle aspiration or chest drain
Follow up in 2-4 weeks time
Orthodeoxia
- pathophysiology (2)
Decrease in SATs when going from sitting to upright
- Anatomical shunting R>L worse on standing, deoxygenated blood bypassing the lungs
- Functional - lungs with V/Q defects e.g. fibrosis, uneven V/Q across the lung, blood flow moved to less well ventilated areas, poor O2 delivery
COPD + exacerbations + nil RHF
- example
PDE4 inhibitor
e.g. Roflumilast
Criteria = maximal medical therapy, FEV <50%, >1 exacerbation
S1Q3T3 =
S wave lead I
Q wave lead III
T wave inversion lead III
Testing for LTOT
- see rise in pCO2 when using oxygen
Need nocturnal ventilatory support
e.g. BiPAP
BiPAP starting settings in COPD
15 IPAP
3 EPAP
Black sputum =
= coal workers pneumoconiosis
Positive anti-Hu antibodies
Paraneoplastic cerebellar syndrome
- secondary to small cell lung cancer
Flight advice for pneumothorax
1 week after CXR demonstrates resolution
Association with PCP
Pneumothorax
Pulmonary Hypertension - vasodilator
Positive response = oral CCB for management (suggests will respond to more NO)
Negative response = prostacyclins, endothelin antagonists, phosphodiesterase
COPD + features of asthma
ICS + LABA inhaler
Management of erythrocytosis secondary to OSA
Venesection
