Respiratory Flashcards
indication for chest drain in pts with pleural effusion
turbid/cloudy aspirate
aspirate pH <7.2 in association with ?pneumonia
characteristic pleural fluid findings, what is the cause
low glucose
raised amylase
heavy blood staining
low glucose: Rheumatoid arthritis, TB
raised amylase: pancreatitis, oesophageal perf
blood: mesothelioma, PE, TB
what is Light’s criteria?
exudate if >1 of:
pleural protein / serum protein >0.5
pleural LDH / serum LDH >0.6
pleural LDH > 2/3rds upper limit of normal serum LDH
paraneoplastic features of squamous cell lung cancer
PTH-related protein secretion -> hypercalcaemia
clubbing
ectopic TSH production
hypertrophic pulmonary osteoarthropathy (HPOA)
paraneoplastic features of small cell lung cancer
Lambert-Eaton syndrome
SIADH
ACTH
what is the marker for COPD disease progression
FEV1 >80% - mild 79 - 50% - mod 49 - 30% - severe <30% - very severe
Mx of acute asthma
100% O2
neb salbutamol and neb ipratropium
IV magnesium sulphate 1.2-2g IV over 20mins
IV salbutamol
Mx of primary pneumothorax
air rim <2cm and not SOB - ?d/c
aspiration
if failed, chest drain
Mx of secondary pneumothorax
if >50 and SOB +/or rim >2cm –> chest drain
aspiration if 1-2cm rim
all pts should be admitted for 24hours and given O2
alpha-1 antitripsin deficiency
pathology
inheritance - which chrom?
features
lack of protease inhibitor
autosomal recessive - chrom 14
panacinar emphysema worse in lower lobes
liver cirrhosis and hepatocellular carcinoma
Mx of alpha-1 antitripsin deficiency
stop smoking
supportive: physio, bronchodilators
IV A1AT concentrates
volume reduction surgery, transplant.
pathology and features of Kartagener’s syndrome
primary ciliary dyskinesia
dextrocardia or sinus inversus
bronchiectasis
recurrent sinusitis
subfertility
when should HIV patients get PCP prophylaxis
when CD4 count <200
oral co-trimoxazole
features of PCP
dyspnoea dry cough fever few chest signs pneumothorax is a common complication
Ix in PCP
CXR - bilateral intersitial pulmonary infiltrates
exercise induced desaturation
bronchiolavage needed as sputum often fails to show PCP (silver stain)
Mx of PCP
co-trimoxazole
IV pentamidine if severe
steroids if hypoxic
indication of thrombolysis in PE
hypotension
length of warfarin in pts with PE
3 months if identified cause
6 months if unprovoked
long term LMWH if active cancer
when should NIV be considered in COPD
when pH 7.25 - 7.35
if pH <7.25 then invasive ventilation should be considered.
key indications for NIV
resp acidosis in COPD pH 7.25 - 7.35
type 2 RF 2ndary to chest wall deformity, neuromuscular disease or OSA
cardiogenic pulmonary oedema unresponsive to CPAP
weaning from tracheal intubation
indications for steroids in sarcoidosis
hypercalcaemia
worsening lung function
eye, heart or neuro involvement
most common lung cancer in non-smokers
lung adenocarcinoma - normally peripheral lesion
define idiopathic pulmonary arterial hypertension (IPAH)
features
pulmonary pressure >25mmHg at rest, >30 in exercise
more common in females 20-40, progressive SOB, cyanosis, R ventricular heave, loud P2, raised JVP with prominent ‘a’ waves, tricuspid regurg
Mx of idiopathic pulmonary arterial hypertension (IPAH)?
diuretics if RHF
anticoagulate
CCB, bosentan (endothelin-1 r antagonist) [TERATOGENIC], IV prostoglandins
heart-lung transplant.
classical organism causing CAP in alcoholics
Klebsiella
Causes of lower lobe lung fibrosis
drugs
CT disease (except ank spond)
cryptogenic fibrosing alveolitis
asbestosis
The rest is upper lobes (sarcoid, coalminers, EAA, TB, silicosis)
most common type of lung cancer to cause cavitating lesions
squamous cell
DDx for cavitating lung lesion on CXR?
bacterial abscess: (staph, klebsiella, pseudomonas)
infection: TB, fungal (aspergillosis, histoplasmosis, coccidioidomycosis)
ca (most common cavitating is squamous)
inflamm: RA, Wegener’s granulomatosis
PE
What is the expected FEV1/FVC in a restrictive lung disease?
normal or increased (>80%)
reduced FEV1/FVC in obstructive lung disease
examples of obstructive lung disease
asthma
COPD
bronchiectasis
bronchiolitis obliterans (seen in RA)
examples of restrictive lung disease
pulmonary fibrosis asbestosis and Caplan's syndrome (coal dust exposure) sarcoidosis ARDS kyphoscoliosis neuromuscular disorders
mainstay of treatment for small cell lung cancer
chemotherapy +/- adjuvant radiotherapy
What is Lofgren syndrome?
features?
acute sarcoidosis
fever, bilateral hilar lymphadenopathy, polyarthralgia and erythema nodosum (painful shin nodules)
what is the organism responsible for farmer’s lung?
Saccharopolyspora rectivirgula
most common organism for COPD exacerbation?
Haemophilus influenzae
What is the indication for Rivaroxaban?
Treatment and prophylaxis of DVT and PE
15mg BD for 21 days then 20mg OD for 3/6 months
Mechanism of action of rivaroxaban
Factor Xa antagonist therefore decreases likelihood of thrombosis
Factor Xa activates prothrombin -> thrombin
mechanism of action of varenicline
nicotine r partial agonist
start 1 week prior to stop date
SE:nausea, h/a, insomnia, weird dreams
C/I in preg and breastfeeding
mechanism of action of bupropion
NA and dopamine reuptake i and nicotine r antagonist
start 1-2w prior to stop date
small risk of seizures
C/I in epilepsy, preg and breastfeeding, relative C/I in eating disorders.
Mx of smoking in pregnant woman
CBT/structured self help/motivational interviewing 1st line
NRT 2nd line
(bupropion (NA and D reuptake i and nicotine ant) and varenicline (nicotine partial ag) are C/I)
indications for home oxygen in COPD pts
PaO2 <7.3
or PaO2 7.3-8 with:
secondary polycythemia
clinical or echo evidence of pulmonary HTN
features of legionella dz
Dx
Mx
dry cough, few chest signs, hyponatraemia, derranged LFTs
Dx by urinary antigen
Mx erythromycin
How do you diagnose cystic fibrosis?
Sweat sodium level >60mmol/l
causes of raised TLCO
asthma pulmonary haemorrhage (Wegener's, Goodpasture's) left-to-right cardiac shunts polycythaemia hyperkinetic states male gender, exercise
causes of decreased TLCO
pulmonary fibrosis pneumonia pulmonary emboli pulmonary oedema emphysema anaemia low cardiac output
