Respiratory 2 Flashcards
Idiopathic pulmonary fibrosis
Age
Gender
50-70yo
M>F
IPF spirometry findings
FEV1 =
FVC =
Ratio =
TLCO
Restrictive picture
FEV1 normal/ decreased, FVC decreased
Ratio increased
TLCO - reduced transfer factor
CXR IPF (3)
Bilateral interstitial shadowing
Ground glass
Honeycombing
IPF gold standard test
high resolution CT
What is Kartagener’s syndrome?
Primary ciliary dyskinesia
Kartagener’s syndrome features (4)
Dextrocardia
Bronchiectasis
Recurrent sinusitis
Subfertility
Name the bacteria:
Typically after aspiration or UTIs
Common in ETOH excess and diabetics
Red currant jelly sputum
Often affects upper lobes
Can cause lung abscess formation and empyema
Klebsiella pneumonia
First line investigation lung cancer
Investigation of choice
CXR
CT
PET scans are offered in patients with which type of lung cancer?
Why?
Non small cell lung cancer
To establish eligibility for curative treatment
Small cell lung cancer paraneoplastic features (2)
SIADH
Lambert Eaton syndrome
Squamous cell lung cancer paraneoplastic features (4)
PTH secretion causing raised calcium
Clubbing
Hypertrophic pulmonary osteoarthropathy
Hyperthyroidism due to ectopic TSH
Adenocarcinoma lung ca paraneoplastic syndrome (2)
Gynaecomastia
HPOA
Lung cancer 2ww pathway referral (2)
CXR findings with lung ca
40 and above with unexplained haemoptysis
RF for obstructive sleep apnoea (6)
Obesity
Acromegaly
Hypothyroidism
Amyloidosis
Large tonsils
Marfan’s syndrome
Gas OSA
Respiratory acidosis
Mx OSA (2)
Weight loss
CPAP
Point of care CRP test for abx for pneumonia interpretation
CRP <20 - no abx
20-100 delayed prescription
>100 abx
CURB65
Confusion AMTS 8/10
Urea >7mmol
RR >30
BP 90/60
65 or more
CURB65 interpretation
0 -1 home based care
2 - consider hospital
3 or more = admission
0 - rx at home
1/2 - hospital assessment
3/4 high urgent admission
Ix pneumonia in intermediate and high risk patients (4)
Blood and sputum cultures
Pneumococcal and legionella urinary antigen tests
Rx pneumonia
low risk
medium risk
high risk
Low risk amoxi
Medium risk double amoxi and clarthro
High risk co-amox or cef or taz
Primary pneumothorax mx
<2cm and no SOB –> discharge
>2cm –> aspiration, if still >2cm or SOB still then for drain
Secondary pneumothorax mx
All patients should be admitted for at least 24 hours
>50yo and >2cm/ SOB –> chest drain
1-2cm –> aspiration, if fails then chest drain
<1cm –> oxygen
Iatrogenic pneumothorax mx
Majority should resolve with observation, if rx is needed then to aspirate unless COPD or requiring ventilation
Obstructive or restrictive
Pulmonary fibrosis
COPD
Asthma
Asbestosis
Sarcoidosis
ARDS
Bronchiectasis
Kyphoscoliosis
Bronchiolitis obliterans
Neuromuscular disorders
R Pulmonary fibrosis
O COPD
O Asthma
R Asbestosis
R Sarcoidosis
R ARDS
O Bronchiectasis
R Kyphoscoliosis
O Bronchiolitis obliterans
R Neuromuscular disorders
Pulmonary function tests
Obstructive
Restrictive
FEV1 sig reduced
FVC reduced or normal
Ratio reduced
FEV1 reduced
FVC sig reduced
Ratio normal or increased
Who may be considered for an immediate abx prescribing approach? (resp infections) (3)
(x2 children cases and centor criteria)
Children <2yo with bilateral acute otitis media
Children with otorrhoea with otitis media
3 or more centor criteria
CENTOR criteria
Cough absent
Exudate
Nodes
Temperature
OR young or old (<15yo +1, >44 -1)
Adult immediate prescribing indications with respiratory infections
>65 with:
>80 with:
(4)
acute cough + 2 (>65yo) or +1 (>80yo) of the following
- hospitalisation in the last year
- on steroids
- diabetic
- CCF hx
Length of symptoms for respiratory infections
Otitis media
Sore throat/ tonsilitis
Cold
Rhinosinusitis
Bronchitis
acute otitis media: 4 days
acute sore throat/acute pharyngitis/acute tonsillitis: 1 week
common cold: 1 1/2 weeks
acute rhinosinusitis: 2 1/2 weeks
acute cough/acute bronchitis: 3 weeks
If centor 3 or more then which bacteria is likely to have caused the sore throat?
Group A beta haemolytic Strep
RA respiratory manifestations (7)
Hint: 6 P’s
Pulmonary fibrosis
Pleural effusion
Pulmonary nodules
Pleurisy
CaPlan’s syndrome
Pneumonitis
Bronchiolitis obliterans
Non caseating granulomas = which condition?
Sarcoidosis
Sarcoidosis is common in:
Age
Ethnicity
Young adults
African descent
Sarcoidosis features
Acute (4)
Swinging fever
Erythema nodosum
Bilateral hilar lymphadenopathy
Polyarthralgia
mining
slate works
foundries
potteries
Occupations that are at risk of which condition
Silicosis
fibrosing lung disease
‘egg-shell’ calcification of the hilar lymph nodes
on CXR = which condition?
Silicosis
CXR findings for silicosis
fibrosing lung disease
‘egg-shell’ calcification of the hilar lymph nodes
Smoking cessation options (3)
NRT
Varenicline
Bupropion
NRT adverse effects (3)
N&V
Headaches
Flu like symptoms
NRT prescribing if high level of dependence
combination of patches and one other form
Varenicline
MOA
When should it be started?
Length of treatment
Nicotinic receptor partial agonist
1 week prior to STOP date
12 weeks
Varenicline adverse effects (3)
Nausea
Abnormal dreams
Insomnia
Bupropion
MOA
Start date
Norepinephrine and dopamine reuptake inhibitor
1-2 weeks before STOP date
Bupropion SE (1)
Increased risk of seizures
Smoking cessation mx in pregnancy (4)
If on NRT - advice that needs to be given
- CBT
- Motivational interviewing
- Structure self help
- NRT
Take off patches prior to bed
