respiratory Flashcards
drugs causing fibrosis
methotrexate amiodarone sulfasalazine gold nitrofurantoin
COPD - general management
smoking cessation
annual flu jab
one-off pneumococcal
LTOT, lung volume reduction surgery in selected pts
first line bronchodilator for COPD?
how do you determine next step?
SABA or SAMA
next step determined by FEV1
2nd line COPD inhaler if FEV1 > 50%
LABA (eg salmeterol), or LAMA (eg tiotropium)
what kind of drug is salmeterol?
LABA
what kind of drug is tiotropium?
LAMA
2nd line COPD inhaler if FEV1 < 50%
LABA + ICS (combo inhaler), or
LAMA
when to use theophylline for COPD?
if bronchodilators don’t work or if they can’t use inhalers
what can you use in COPD patients with a chronic productive cough?
mucolytics
symptoms of cor pulmonale
peripheral oedema
raised JVP
systolic parasternal heave
loud P2
management of cor pulmonale
loop diuretic for oedema
consider LTOT
ACEis, CCBs NOT recommended
what is a saddle embolus characteristic of?
PE
what are common symptoms of PE?
tachypnoea
crackles
tachycardia
low-grade fever
textbook triad of PE symptoms
pleuritic chest pain
dyspnoea
haemoptysis
but can present with any cardioresp symptom/sign
investigations if PE is ‘likely’
immediate CTPA - if delayed give LMWH in meantime
investigations if PE is ‘unlikely’
D dimer
if positive then immediate CTPA - if delayed give LMWH in meantime
PE wells scores
5+ - likely
0-4 - unlikely
CURB-65
confusion urea 8+ RR 30+ BP 90/60- 65+
care of CAP based on CURB65
0-1 - low - home care
2+ - intermediate - hosp
3+ - high - ICU
pneumonia - investigations
CXR
CURB65 2+ - blood + sputum cultures; pneumococcal + legionella urinary antigen tests
CRP monitoring to determine response to treatment
management of low-severity CAP (CURB65 0-1)
amoxicillin 5 days
management of moderate-high severity CAP (CURB65 2+)
dual abx: amoxicillin + macrolide (-mycin) 7-10 days
potential PE - investigations
CXR to rule out other causes
if still suspected then do wells
where does reactivation of TB tend to occur?
apex of lungs
what triggers reactivation of TB?
becoming immunocompromised
what type of cancer makes up the majority of non-small cell lung cancers?
squamous - 35%
adenocarcinoma - 30%
(non-small cell is more common than small cell)
what is obstructive lung disease?
hard to exhale air - comes out slower + some may linger
what is restrictive lung disease?
hard to expand lungs with air
pulmonary function tests in obstructive lung disease
FEV1 - v reduced
FVC - reduced or normal
FEV1/FVC - reduced
pulmonary function tests in restrictive lung disease?
FEV1 - reduced
FVC - v reduced
FEV1/FVC - normal or increased
when is BIPAP used?
type II resp failure
esp COPD exac
when is CPAP used?
type I resp failure
esp pulmonary oedema
organism that most commonly causes COPD exacerbation?
haem influenzae
diagnosis of asthma
FeNO (fractional exhaled nitric oxide) + spirometry with bronchodilator reversibility (BDR) test
relationship between asthma and NO (nitric oxide)
NO is made by 3 types of NOsynthases. one of the types’ levels rises in inflammatory cells, esp eosinophils. thus NO levels correlate with inflammation levels.
when to give objective tests for asthma?
age 5+
age < 5 - clinical diagnosis
asthma - diagnosis age 17+
ask if better away from work
spirometry with BDR
FeNO test
asthma - diagnosis age 5-16
spirometry with BDR
FeNO test if normal/obstructive spirometry with a negative BDR
asthma management - if SABA isn’t working?
add low dose ICS
asthma management - if SABA + ICS isn’t working?
add leukotriene receptor antagonist (eg montelukast)
what are the options for first line smoking cessation therapy?
nicotine replacement therapy
varenicline
bupropion
to last 2 weeks after target stop date
what is used to categorise COPD severity?
FEV1
RFs for pneumothorax
Marfan’s
asthma
pneumothorax - presentation
sudden onset dyspnoea + pleuritic chest pain
Pancoast’s syndrome - what is it? features?
T1 root lesion with: horner's upper lobe carcinoma wasting of hand small muscles, claw hand axilla pain
3 causes of obstructive picture in resp
asthma
COPD
bronchiectasis
what constitutes obstruction? (resp)
FEV1/FVC <75%
interstitial lung disease - spirometry
FEV1 and FVC reduced, ratio normal or increased
what is interstitial lung disease?
disorders that cause scarring (fibrosis) of the lungs
bronchiectasis - main 2 features
chronic cough with mucopurulent sputum
what tends to cause pneumonia following flu?
staphylococcus
complications of pneumonia
sepsis
lung abscess
pleural effusion
empyema
sarcoidosis - acute presentation + prognosis
erythema nodosum
joint pains - typ ankle + knee
+- fever
hilar lymphadenopathy on CXR
benign + self-limiting in 90%
takes 4-6wk to settle
generally doesn’t progress to chronic illness
sarcoidosis - chronic presentation
restrictive lung disease - hilar lymphadenopathy + fibrotic lung disease due to a lymphocytic alveolitis tender swellings of fingers +- bone cysts facial rash anterior uveitis attacks retinal problems parotitis facial nerve palsy hypercalcaemia
causes of erythema nodosum
sarcoidosis strep infection TB IBD sulphonamides, OCP
LDH in LP - significance?
high - bacterial
low - viral
what is total gas transfer? (TLCO)
when is it affected?
measure of gas transfer from alveoli to capillaries
raised in asthma - as problem isn’t affecting alveoli directly, or gas exchange, so lungs try to compensate by improving gas exchange
reduced in COPD, fibrosis, pulmonary oedema etc
transfer coefficient (KCO) - what is it?
transfer factor corrected for lung volume
total gas transfer/alveolar volume
measures how efficient gas exchange is in relation to the alveolar-capillary surface-volume ratio
increased in asthma due to increased pulmonary blood flow
what is transfer factor?
the rate at which a gas will diffuse from alveoli into blood
