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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
Q

drugs causing lung fibrosis

A

methotrexate
amiodarone
bleomycin

sulfasalazine
nitrofurantoin
busulfan

26
Q

asbestosis

A

fibrotic industrial lung disease
LOWER ZONE
severity prop to exposure
risk ca

pleural plaques = benign

27
Q

silicosis

A

fibrotic industrial lung disease
upper zone
risk tb
egg shell hilar nodes

28
Q

extrinsic allergic alveolitis

A

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
Q

haemoptysis

A 
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
Q

pleural effusion

A

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
Q

pneumothorax mgmt

A

primary >2cm sob
—–aspirate

secondary >50yrs >2cm sob
—-chest drain

secondary but <1cm
—-give oxygen and observe

30
Q

lights criteria

A

pleural: serum protein 0.5
pleural: serum ldh 0.6

pleural ldh 2/3 more than upper normal

31
Q

haemoptysis

A 
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
Q

CF

A

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
Q

pleural effusion

A

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
Q

lights criteria

A

pleural: serum protein 0.5
pleural: serum ldh 0.6

pleural ldh 2/3 more than upper normal

34
Q

CF

A

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
Q

kartegeners

A

dextrocardia
bronchiectasis
sinusitis
subfertile

36
Q

bronchiectasis

A

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
Q

most common CAPs

A

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
Q

conditions assoc w bronchiectasis

A

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
Q

kartegeners

A

dextrocardia
bronchiectasis
sinusitis
subfertile

39
Q

abpa

A

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

eventual bronchiectasis
upper lobe fibrosis

sputum, skin test
eosinophilia, IgE

T: prednisolone, bronchodilat

39
Q

most common CAPs

A

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
Q

legionella pneumonia

A
  • dodgy water
  • presents fluey, dry cough
  • extrapulmonary: anorexia, d+v, liver/renal, confu
  • blood: lymphopenia, hyponatraemia, deranged lft
41
Q

other CAP bugs

A

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
Q

rarer pneumonias

A

pneumocystis pneumoia / pneumocystis jiroveci

  • HIV/immunocom
  • septrin - cotrimoxazole

chlamdydia pneumonia

chlamydia psittacosis (rarer)
- from parrots

viral - influenza

44
Q

viral pneumonia/pneumonitis

A

h1n1, h5n1, sars

cmv
- post transplant

herpez zoster pneumonitis
- widespread microcalcification

45
Q

CURB 65 and treat for CAP

A

CURB 65
0/1: amoxi (500tds)
2 hospital, amox + clarith (500bd)
3 severe: augmentin (625tds) + clarith

46
Q

lung abscess

A

causes

  • pneumoia (staph, kleb, tb), septic emboli, aspiration
  • swinging fever, purulent sputum, pain
47
Q

pulmonary hypertension

causes and signs

A

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
Q

lung cancer

mets, staging and treat

A

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
Q

pleural effusions

A

transudate 35% leaky capills

- infection, inflam, malig

51
Q

management of pleural effusions

A

transudate - treat cause

if exudate

  • chest drain
  • pleurdesis if malignant/recurrent
  • ct chest abdo if ?malignant
  • consider thoracoscopy and pleural biopsy
52
Q

KCO: corrected for volume

DLCO: gas transfer

A

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
Q

acute respiratory distress syndrome

A

following injury or systemic illness

bilateral infiltrates on cxr

resp and circ support
reen for sepsis

50-75% mortality

54
Q

coal workers pneumoconiosis

A

fibrotic industrial lung disease
upper zone
assoc w/ chronic bronchitis

may progress to PMF (progressive massive fibrosis)

55
Q

obstructive sleep apnoea

A

mornign headache, libido low, daytime somnolecence

comp: pulm htn, t2rf

tx: lose wt, avoid smoking alc
cpap, ? surgery

56
Q

cpap and bipap

A

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
Q

meigs syndrome

A

unilateral pleural effusion
ovarian tumour
ascites

58
Q

abg derangements

A

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

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