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Respiratory Flashcards

1
Q

resp failure

A

p02 < 8kPa

type 1 CO2 normal

type 2 pCO2 > 6.0 due to hypoventilaition

  • acidotic
  • careful ox therapy - NIV (bipap)
  • may see headahce, tachy, tremor/flap, bouding pulse
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2
Q

asthma mgmt

A

1) saba
2) +steroid

3)+laba (continue if benefitial)
inc steroid to 800
consider other options (luek, theoph)

4) steroid to 2000
5) oral steroid

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3
Q

Inhalers

A

Symbicort - budesonide + formeterol
- turbohaler

Seretide - purple mdi
- fluticasone + salmeterol

Spiriva= tiotroprium

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5
Q

asthma attack

severe vs life threat

A

SEVERE
pulse >110
resp>25
pefr 33-50%

LIFE THREAT
silent chest, cyanosis, bradycard
pef<33%
confusion, exhaustion

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6
Q

asthma attack initial mgmt

A

100% O2 (15L nrb)

nebs: iprat (0.5mg) and salb (5mg)
steroids: iv hydro (100mg) +/- pred (40mg)

do cxr

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6
Q

asthma attack treat (early)

A

O SHIT ME

100% O2 (15L nrb)
Salbutamol 5mg neb (back to back)
Ipratroprium 0.5mg neb
Hydrocortisone 100mg IV +/- prednis 40mg po

do CXR (rule out pn.th)

life threat: IV mg sulfate 1.2g iv over 20mins
escalate ?ICU

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7
Q

Samters triad

A

Asthma
Aspirin sensitivity
Polyps

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8
Q

eosinophilic asthma

A

abpa

churg strauss

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9
Q

abpa

A

main type of ‘eosinophilic asthma’

type 1 and 3 (IgG) hypersens
early bronchoconst, recurrent pneumonia,

eventual bronchiectasis
upper lobe fibrosis

sputum, skin test
eosinophilia, IgE

T: prednisolone, bronchodilat

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9
Q

abpa

A

main type of ‘eosinophilic asthma’

type 1 and 3 (IgG) hypersens
early bronchoconst, recurrent pneumonia,

eventual bronchiectasis
upper lobe fibrosis

sputum, skin test
eosinophilia, IgE

T: prednisolone, bronchodilat

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10
Q

PE Wells Score

general risks:

  • immob, surgery
  • thrombophilia
  • malig
  • oestrogen - hrt, pil, preg
A

DVT suspicious 3
alt diag less likely 3

tachycardia 1.5
hx immob or sugery 1.5
previous 1.5

haemoptysis 1
malignancy 1

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11
Q

blood gas in PE

ecg in PE

A

resp alkalosis

tachy, rbbb/rad, s1,q3,t3 (rare)

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13
Q

PE Mx

A

over 4 points
CTPA

under 4 points d dimer then ctpa if positive

ecg S1,Q3,T3
tachy, RBBB

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16
Q

PE Mx

A

over 4 points
CTPA

under 4 points d dimer then ctpa if positive

ecg S1,Q3,T3
tachy, RBBB

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16
Q

COPD exacerbation

A

give prednis and abx

if consolidation present likely strep pne
if no conolidation haemoph inlf

if frequent then keep pred and abx at home

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17
Q

copd diagnosis

A

ratio under 0.7 post bronchodilator

fev1 determines severity
mild >80
mod 50-80
sev 30-50
v sev <30

invest: CXR, FBC (polycyth)

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18
Q

copd: emphys vs chron bronch

A

chron bronch

  • clinical diag
  • prod cough 3m, 2y

emphy
- histolog def: enlarged airspaces, destruc of alveolar walls

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18
Q

copd comps

A 
exacerbations - may be infective
polychyth
cor pulmonale
pneumothorax risk
carcinoma risk
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19
Q

COPD exacerbation

A

give prednis and abx

if consolidation present likely strep pne
if no conolidation haemoph inlf

if frequent then keep pred and abx at home

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20
Q

copd treat

A

stop smoking, vaccines

mild: ipratro/salb prn

mod: regualar tiotr/salm
?inhaled steroid

pulm rehab
LTOT (may inc survival)

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21
Q

copd comps

A 
exacerbations - may be infective
polychyth
cor pulmonale
pneumothorax risk
carcinoma risk
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22
Q

restrictive spirometry

A

FEV1 low but FVC also low

so ratio is normal

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23
Q

causes of interstitial lung disease

A

occupational casues: coal, silic, abest
extrinsic allergic alveolitis
(upper zone appart from asbest)

drugs: methotrexate, amiodarone etc
(lower zone)

w/ systemic conds
- sle, ra, sarcoidosis, UC
(lower zone apart from sarc)

IDIOPATHIC PULM FIBROSIS
-most common
(lower zone)

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24
Q

idiopathic pulmonary fibrosis

A

commonest cause of interstitial lung disease

inflam infiltrate and fibrosis

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25
drugs causing lung fibrosis
methotrexate amiodarone bleomycin sulfasalazine nitrofurantoin busulfan
26
asbestosis
fibrotic industrial lung disease LOWER ZONE severity prop to exposure risk ca pleural plaques = benign
27
silicosis
fibrotic industrial lung disease upper zone risk tb egg shell hilar nodes
28
extrinsic allergic alveolitis
acutely: fever rigors myalgia dry cough crackles chronically: granuloma formation, bronchiolitis sob, t1rf, cor pulmonale CXR: upper zone fibrosis tx: O2, steroids ``` bird/pigeon fancier farmers lung - mycropolyspora faeni mushroom workers lung - thermoactinomyces vulgaris malt worker - aspergillus clavatus sugar worker - hermoactinomyces sacchari ```
28
haemoptysis
``` lung ca -wl, smoking pulm oed - sob, crackle tb - fever, night sweats, wl aspergil - prev tb, severe haemopt PE - pleauritic pain, tachy, sob bronchiect - chronic picture ``` goodpastures -system unwell, kidney probs wegeners -kidneys, saddle nose
29
pleural effusion
exudate - high protein >35 - infec (pneumonia), inflamm, malig transudate - low protein <25 - heart, renal, liver failures between 25-35 use lights criteria also test for ph (low in empyema) cytology, culture
30
pneumothorax mgmt
primary >2cm sob -----aspirate secondary >50yrs >2cm sob ----chest drain secondary but <1cm ----give oxygen and observe
30
lights criteria
pleural: serum protein 0.5 pleural: serum ldh 0.6 pleural ldh 2/3 more than upper normal
31
haemoptysis
``` lung ca -wl, smoking pulm oed - sob, crackle tb - fever, night sweats, wl aspergil - prev tb, severe haemopt PE - pleauritic pain, tachy, sob bronchiect - chronic picture ``` goodpastures -system unwell, kidney probs wegeners -kidneys, saddle nose
31
CF
chro 7 delta f508 get infec w staph and pseudom early: fail to thrive, meconium infections, wheeze, cough. diarrhoea, pancreatitis. later: bronchiectasis, diabetes, gallstones other: infertile, osteoporo ∆ sweat test
32
pleural effusion
exudate - high protein >35 - infec (pneumonia), inflamm, malig transudate - low protein <25 - heart, renal, liver failures between 25-35 use lights criteria also test for ph (low in empyema) cytology, culture
33
lights criteria
pleural: serum protein 0.5 pleural: serum ldh 0.6 pleural ldh 2/3 more than upper normal
34
CF
chro 7 delta f508 get infec w staph and pseudom early: fail to thrive, meconium infections, wheeze, cough. diarrhoea, pancreatitis. later: bronchiectasis, diabetes, gallstones other: infertile, osteoporo ∆ sweat test
35
kartegeners
dextrocardia bronchiectasis sinusitis subfertile
36
bronchiectasis
causes - cf, post infection (severe), abpa (test aspergillus precipitans) - youngs/kartageners (ciliary dyskinesia) - hypogammaglob (test serum immonoglobs) - RA, UC ``` persistent cough (haemop) sputum + clubbing ``` cxr - tramline and ring shadows - bronchia thickening tx - physi/postural drain, abx, bronchodialtors abpa - prednis
36
most common CAPs
strep - amox - may see herpes - rusty sputum - classic lobar consolidation haemoph influ - amox - in copd w no consolidation mycoplasma - clarith - epidemics - often young, living close ie halls - presents fluey then dry cough - mild chest symtpoms but bad cxr (widespread consol) - comps: heamolytic anaemia, erythema multiforme, SJS, GBS
37
conditions assoc w bronchiectasis
cystic fibrosis alpha1 antitrypsin defic RA Marfans - aortic dissection, valve regurg (esp aortic), lens dislocation, joint hypermobile kartegeners - situs inversus youngs syndrome - viscous mucus - infert, rhinosnus, bronchiect
38
kartegeners
dextrocardia bronchiectasis sinusitis subfertile
39
abpa
type 1 and 3 (IgG) hypersens early bronchoconst, recurrent pneumonia, eventual bronchiectasis upper lobe fibrosis sputum, skin test eosinophilia, IgE T: prednisolone, bronchodilat
39
most common CAPs
strep - amox - may see herpes - rusty sputum - classic lobar consolidation haemoph influ - amox - in copd w no consolidation mycoplasma - clarith - epidemics - often young, living close ie halls - presents fluey then dry cough - mild chest symtpoms but bad cxr (widespread consol) - comps: heamolytic anaemia, erythema multiforme, SJS, GBS
40
legionella pneumonia
- dodgy water - presents fluey, dry cough - extrapulmonary: anorexia, d+v, liver/renal, confu - blood: lymphopenia, hyponatraemia, deranged lft
41
other CAP bugs
staph - fluclox - post flu, iv user - bilat pathcy consol - cavitating/abscess klebsiella - alcoholics, aspiration - big abscess - gram -ve rod - faeculent sputum or red current pseudomonas - CF and bronchiectasis - often returns legionella - water supply, abroad - fluey pres - conf, diarrh, hyponatraemia chlamydia psittaci - parrots TB - apical abscess, cavitate - may devel aspergilloma - zn(afb) and auramine stain Q fever - sheep - coxiella burnetti
43
rarer pneumonias
pneumocystis pneumoia / pneumocystis jiroveci - HIV/immunocom - septrin - cotrimoxazole chlamdydia pneumonia ``` chlamydia psittacosis (rarer) - from parrots ``` viral - influenza
44
viral pneumonia/pneumonitis
h1n1, h5n1, sars cmv - post transplant herpez zoster pneumonitis - widespread microcalcification
45
CURB 65 and treat for CAP
CURB 65 0/1: amoxi (500tds) 2 hospital, amox + clarith (500bd) 3 severe: augmentin (625tds) + clarith
46
lung abscess
causes - pneumoia (staph, kleb, tb), septic emboli, aspiration - swinging fever, purulent sputum, pain
47
pulmonary hypertension causes and signs
primary - idiopath/familial 2ndr to lungs - obstr or restric 2ndr to heart - LH fail, mitral (see orthop/pnd) 2ndr to thrombo embo - PE sob, syncope, cp, tachy congestion - asc, ankle, hepat parasternal heave, murmur
49
lung cancer mets, staging and treat
METS: brain, bone, liver, kidney TNM t1 3cm and 2cm from carina or pleural inv t3 adjacent structures, closer to carina t4 at mediastinal structures/carina, effusion n2 ipsi mediastinum/subcarinal n3 contralat nsclc: surgery if poss sclc: often disseminated, so chemo/rx
50
pleural effusions
transudate 35% leaky capills | - infection, inflam, malig
51
management of pleural effusions
transudate - treat cause if exudate - chest drain - pleurdesis if malignant/recurrent - ct chest abdo if ?malignant - consider thoracoscopy and pleural biopsy
52
KCO: corrected for volume DLCO: gas transfer
decreased in things affecting - ventilation (extrathoracic, obstructive, restictive, infection, collapse, pneumonectomy) - diffusion (ILD) - perfusion (PE, pulm htn) nb if DLCO red but KCO normal --> think extrathoracic _ something limiting volume of expansion - NMJ prob, kyphoscoliosis increased in alveolar haemorrhage
53
acute respiratory distress syndrome
following injury or systemic illness bilateral infiltrates on cxr resp and circ support reen for sepsis 50-75% mortality
54
coal workers pneumoconiosis
fibrotic industrial lung disease upper zone assoc w/ chronic bronchitis may progress to PMF (progressive massive fibrosis)
55
obstructive sleep apnoea
mornign headache, libido low, daytime somnolecence comp: pulm htn, t2rf tx: lose wt, avoid smoking alc cpap, ? surgery
56
cpap and bipap
cpap - most work of breathing still done by patient - keeps collapsing lung units open - used in * pulmonary oedema * sleep apnoea bipap (niv) - bilevel - higher level drives inspiration, lower level keeps airway open in expiration - used in acute respiratory failure - eg infective exac of copd with sats not improving
57
meigs syndrome
unilateral pleural effusion ovarian tumour ascites
58
abg derangements
respiratory alkalosis - hyperventilation - PE respiratory acidosis - t2rf - may be compensated if chronic - copd metabolic acidosis - dka - ketoacidosis from alcohol - lactic acidosis - renal failure (uraemia) - renal tubular acidosis (normal anion) - toxin: salicylate, methanol metabolic alkalosis - vomiting ++ aspirin poisoning - initially alkalosis (?resp) but then progressive metabolic acidosis w anion gap

Progress test packs (16 decks)

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