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Year 5 Notes > Respiratory > Flashcards

Respiratory Flashcards

1
Q

ARDS:

Features

A

Cyanosis
Tachypnoea
Peripheral vasodilation
Bilateral fine end respiratory crackles

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2
Q

ARDS:

Diagnostic criteria

A

= lung damage with (non cardiogenic) pulmonary edema +/- multi organ failure
Either from direct lung injury or from systemic illness
- acute onset
- CXR bilateral infiltrates
- low PCWP/no CHF
- refractory hypoxaemia

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3
Q

CURB65

A

Confusion
Urea >7
Respiratory rate >30
BP sys 65

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4
Q

CURB65:

Management

A

0-1 community ABx
2 admission
3-5 potential ICU admission

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5
Q

Hypercapnic drive:

At risk groups

A
  1. COPD
  2. CF
  3. Restrictive chest disorders (e.g muscular, neuromuscular)
  4. Morbid obesity >40
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6
Q

Hypercapnic drive:

Management

A
  1. Aim for 88-92% sats
  2. Decrease but don’t stop O2 2-4l
  3. Look for previous ABG for baseline
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7
Q

Pleural Effusion:

X Ray features

A 
Blunt costophrenic angle
Blunt cardio phrenic angle
Fluid in fissures 
Meniscus
Large one sided effusion --> mediastinal shift
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8
Q

Transudate vs Exudate

A 
Transudate = low protein, low LDH, low specific gravity
Exudate = high protein, high LDH, low specific gravity

Transudate - from increased hydrostatic pressure or decrease capillary oncotic pressure e.g HF, nephrotic syndrome, cirrhosis

Exudate - lung ca, PE, pneumonia, TB, mesothelioma

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9
Q

Consolidation:

Causes

A

Infection - pus
Haemorrhage - blood
Cancer - cells
Pulmonary edema - fluid

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10
Q

Consolidation:

X Ray features

A

Air bronchogram - homogenous opacity with dark lines running through

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11
Q

PE:

Risk factors

A 
Cancer
Fracture
Immobility
Thrombophilia
Pregnancy/HRT
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12
Q

PE:

Sx

A 
Tachycardia 
Tachypnoeic
Raised JVP
Breathlessness
Pleuritic chest pain 
Haemoptysis
Syncope/dizziness
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13
Q

PE:

Management

A 
O2 100%
Morphine 10mg+ anti emetic 
Critically ill --> thrombolysis alteplase /surgery
Or LMWH 
Colloid infuse if hypotensive

ECG, CXR, ABG
D dimer
CTPA

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14
Q

Type I respiratory failure

A

Low O2 but normal CO2

From lung tissue damage; pneumonia, asthma, COPD, pneumothorax, PE, fibrosis, edema

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15
Q

Type II respiratory failure

A

Low O2 and high CO2

From poor ventilation eg: COPD, asthma, OD, MG, neuromuscular disorders, obesity

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16
Q

Bronchiectasis:

Definition/cause

A

Chronic infection of bronchi and bronchioles leading to permanent dilation of airways. From Hib, strep pneumoniae, staph A, pseudomonas

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17
Q

Bronchiectasis:

Symptoms

A

Persistent cough
Copious purulent sputum
Intermittent haemoptysis
Coarse inspiratory creps

Tram line CXR

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18
Q

Bronchiectasis:

Management

A

Postural drainage BD
Physio
ABX if needed
Surgery if severe haemoptysis

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19
Q

Pneumonia types:

Pneumococcal

A

Most common
Everyone
CXR: lobar consolidation
Amox/benpen/cephalosporin

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20
Q

Pneumonia types:

Klebsiella

A 
Rare
Elderly, diabetics and alcoholics
Cavitating, upper lobes
Drug resistant
Tx: cefotaxime, imipemen
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21
Q

Pneumonia types:

Staphylococcal

A

From flu, young, elderly, IVDU, existing disease
Bilateral cavitating bronchopneumonia
Tx: fluclox

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22
Q

Pneumonia types:

Pseudomonas

A

Common in bronchiectasis
Cause HAF
Tx: anti pseudomonal penicillin

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23
Q

Pneumonia types:

Mycoplasma pneumoniae

A

Occurs in epidemics
Flu symptoms followed by dry cough
CXR: reticular shadowing, patchy consolidation worse than symptoms suggest
Can cause haemolytic anaemia, meningitis, guillain-barré
Tx: tetracycline, clarithromycin

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24
Q

Pneumonia types:

Legionella

A

Water tanks eg air con
D+v, hepatitis, anorexia, renal failure, confusion, haematuria
Tx: clarithromycin +-rifampicin

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25
Q

Types of pneumonia:

Chlamydophilia pneumoniae

A

Pharyngitis (hoarseness), otitis, then pneumonia

Tx: tetracycline or clarithromycin

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26
Q

Pneumonia types:

Pneumocystis pneumonia

A

HIV
Exertional cough and dyspnoea
CXR: bilateral creps and shadowing
Tx: high dose co-trimoxazole

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27
Q

Pleural effusion:

management

A 
CXR to assess size
Depends on how symptomatic it is
Don't drain emergency patients
Aspirate 1-2 spaces below top of effusion (from percussing) above rib
Send off for lab trans vs exudate
28
Q

Ix for ?PE with renal impairment?

A

VP

29
Q

Step 1 Asthma BTS guidelines

A

SABA

30
Q

Step 2 Asthma BTS guidelines

A

Steroid inhaled 200-800mcg

31
Q

Step 3 Asthma BTS guidelines

A

LABA (assess respond and up steroid up to 800mcg)

32
Q

Step 4 Asthma BTS guidelines

A

Increase steroid to 2000mcg

Add theophylline or LRA eg montelukast

33
Q

Step 5 Asthma BTS guidelines

A

Oral steroid tablet

34
Q

Pneumothorax:

Findings

A

⬇️ expansion
⬇️ air entry affected side
Hyper resonant percussion
⬇️ vocal resonance

35
Q

COPD:

Findings

A 
Hyper inflated chest
⬇️ expansion 
⬇️ air angry bilateral
Hyper resonant percussion
Wheeze, exploratory/polyphonic
⬇️ vocal resonance
36
Q

Pulmonary fibrosis:

Findings

A 
⬇️ expansion
⬇️ air entry bilaterally
Resonant to percussion
Mid/end inspiratory fine crackles don't clear on coughing
Resonance normal/⬇️
37
Q

Bronchiectasis:

Findings

A

⬇️expansion
⬇️ air entry
Fine expiration you crackles that change on coughing
Normal/⬇️ resonance

38
Q

Asthma:

Findings

A

⬇️ expansion
⬇️ air entry
Hyper resonant
Expiratory polyphonic wheeze

39
Q

Pneumonia:

Findings

A

⬇️ everything on affected side

Increased vocal resonance

40
Q

Pulmonary edema:

Findings

A

Stony dull to percussion

Mid-late coarse crackles don’t clear on coughing

41
Q

Pleural effusion:

Findings

A

⬇️ everything inc vocal resonance

Stony dull to percussion

42
Q

Spirometery:

Obstructive defect

A

FEV1⬆️ more reduced than FVC

FEV1/FVC ratio is

43
Q

Spirometery:

Restrictive

A

FVC⬇️
FEV/FVC ratio normal/⬆️ I.e >75%
E.g sarcoidosis, pneumoconiosis, pleural effusion, obesity, neuromuscular

44
Q

Spirometery:

KCO/DLCO

A

KCO is CO diffusing capacity. DLCO is adjusted for volume.
⬇️ in emphysema, interstitial lung disease
⬆️ alveolar haemorrhage

45
Q

Emphysema

A

Needs histological diagnosis

Enlarged distal air spaces, with destruction of alveolar walls

46
Q

Pulmonary fibrosis:

Signs, symptoms

A

Symptoms:
Dry cough, externational dyspnoea, malaise, weight⬇️, arthralgia
Signs: cyanosis, clubbing, fine end inspiratory velcro creps
Respiratory failure (type 1), ⬆️ risk of lung cancer

47
Q

Pulmonary fibrosis:

Investigations + findings

A

ABG: ⬇️O2 ⬆️CO2
Bloods: CRP⬆️, immunoglobulins⬆️, ANA, rheumatoid factor
CXR: ⬇️ lung volume, bilateral lower zone reticulo-nodular shadowing, honeycomb
CT essential
Spirometry: restrictive
Lung biopsy

48
Q

Pulmonary fibrosis:

Management

A 
O2 therapy
Pulmonary rehab 
Opiates
Palliative care
Clinical trial/lung transplant
49
Q

Spontaneous primary pneumothorax

A

OPD discharge and r/v

50
Q

Spontaneous primary pneumothorax >2cm +/ SOB:

Management

A

Aspirate 2nd ICS midclavicular large bore needle

51
Q

Spontaneous secondary pneumothorax

A

Aspirate 2nd ICS midclavicular
Success - admit high flow O2
Fail - chest drain

52
Q

Spontaneous pneumothorax bilateral/unstable

A

Chest drain 4-6th ICS mid axillary, above rib, clamp when bubbling finished+CXR shows re inflation 24h

NEVER CLAMP BUBBLING TUBE

53
Q

Tension pneumothorax:

Management

A

Needle Aspirate first 2nd ICS midclavicular - don’t delay with CXR
Then when aspirated, CXR, then chest drain 4-6th mid axillary

54
Q

Acute Asthma management

A 
OSHITME
O2
Salbutamol
Hydrocortisone 100mg IV (/40mg oral pred)
Ipratropium 0.5mg
Theophylline 
Mag sulphate 1.2-2g IV
Escalate care
55
Q

Cor pulmonale

A

Right heart failure caused by chronic pulmonary HTN

From chronic lung disease, pulmonary vascular disorders etc

56
Q

Cor pulmonale:

Signs

A 
Dyspnoefatigue
Syncope 
Cyanosis
Tachycardia
Raised JVP (a and v waves) 
Pan systolic tricuspid regurg murmur/ graham steell murmur
57
Q

Cor pulmonale:

Ix

A

⬆️ hb and haematocrit
Hypoxia
CXR: enlarged right heart w/ prominent pulmonary arteries

58
Q

PE ECG

A

S1Q3T3

Large S wave lead 1
Q wave in lead 2
Inverted t wave lead 3

59
Q

Acute severe asthma signs

A

Unable to complete sentences
RR>25
HR >110
PF

60
Q

Life threatening asthma features

A

33-92-chest

Less than

61
Q

Indications for home oxygen

A

PaO2

62
Q

Indications for NIV

A

COPD + respiratory acidosis 7.25-35
Neuromuscular, sleep apnoea, chest deformity
Cardiogenic pulmonary edema unresponsive to CPAP
Weaning from tracheal intubation

63
Q

Fibrosis affecting upper zones

A

Sarcoidosis
Coal workers
TB

64
Q

Fibrosis affecting lower zones

A

Idiopathic pulmonary fibrosis
Drug induced
Asbestos
RA

65
Q

Extrinsic Allergic Alveolitis

A

Farmers, bird, malt workers

Upper-mid zone fibrosis

66
Q

Most common organism infective exacerbation COPD

A

Hib

Year 5 Notes (19 decks)

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