Respiratory Flashcards
Tests for cause of pneumonia - 3
Bronchoalveolar lavage and legionella stain
IgG pneumonoccal and H influenzae B
Radiocontrast oesophogram for aspiration
Features of life threatening asthma
33, 92, CHEST PEFR <33% O2 <92% Cyanosis Hypotension Exhaustion Silent chest Tachy, brady, arrhythmias
Pathology of asthma
CGPIE
Cytokines amplify inflammatory response
Goblet cell and smooth muscle hypertrophy
Plugging of mucus
Inflammatory factors - Th2, eosinophils, mast cells
Endothelial damage and subendothelial fibrosis
When to do a CT for pneumothorax - 3
1) differentiate from bullae
2) surgical emphysema obstructing X-ray
3) concerned about aberrant drain placing
Causes of transudate pleural effusion
Cirrhosis, HF, low albumin, PE
Constrictive pericarditis
Meig’s syndrome - benign ovarian tumour, ascites and pleural effusion
Hypothyroid - myxoedema
Causes of exudate pleural effusion - 7
Malignancy, infection, inflammation (Dressler’s) Pancreatitis Connective tissue disease PE Asbestos
Differentiate exudate and transudate and diagnosing and when to insert drain
<30g/l = transudate Light’s criteria if 25-35g/l: >0.6 x protein in serum >0.6 x LDH in serum LDH >2/3 upper limit of normal
Drain if pus or pH<7.2 (empyema)
US guided aspirate for cytology, micro and biochem (LDH, protein)
Biopsy if recurrent effusion or thickening - image guided cuttin needle, or Abrams needle for TB
Thoracoscopy
Causes of eosinophilia - 6
Inflammation Parasites Vasculitis SLE Allergic bronchopulmonary aspergillosis Hay fever, allergies
Pneumonia after taking nitrofurantoin or phenytoin?
Acute idiopathic eosinophilic pneumonia:
Fever, unexplained resp failure, hypoxia, diffuse pulmonary shadowing on cxr
TB inv
3x early morning sputum samples for acid fast bacilli and culture Bronchoscope if no cough FBC, LFT, HIV, vit D CXR, CT MRI CNS if military
What is bronchiectasis, causes of bronchiectasis, risks and abx prophylaxis
Chronic dilation of more than 1 bronchi with mucus production and increased infection
Post infective - whooping cough, TB
AI - hypergammalobulinaemia in IBD
ABPA (aspergillosis), RA, HIV - secondary immunodeficiency
Toxic - chemicals, aspiration
Foreign body - tumour, lymph node
Mucociliary dysfunction in CF, Kartagener’s (sinusitis and situs inversus) and Young’s (infertility and sinusitis)
Risks of moraxella, H influenza, pseudomonas
Physio, flu vaccinations, bronchodilators
Give azithromycin prophylaxis 3x/w
When to take COPD rescue meds
Prednisolone if 2 of: SOB, cough, tight chest or phlegm for >24h despite inhaler use
ABx if phlegm is coloured
Causes of massive haemoptysis and management
> 240ml/24h or >100ml/d for 2d
TB, asperillosis
Malignancy, abscess
Bronchiectasis
Less common = PE, AV malformation
A-E, lie on side of lesion Tranexamic acid Abx if infection ?vit K CT aortogram for bronchial artery emboli
Features of assessment for sleep apnoea
Epworth sleepiness scale - 0 for wouldn’t dose and 3 for high chance of dosing, in a list of situations eg tv, traffic lights
STOPBANG Snore Tired Observed choking/stop breathing bP high BMI >35 Age >50yo Neck size large Gender male
When to discharge someone in hospital for asthma
If <1h, when PEFR >75% normal If admitted: - PEFR >75% normal - stable on normal med for 24h - appointment with GP in 2d and resp clinic <4w - assessed inhaler technique - ensure have PEFR measured and action plan - 5d prednisolone - psychosocial
Aspirin sensitive asthma?
Samter’s triad: asthma, aspirin/NSAIDs intolerance, nasal polyps
Features of COPD
- Emphysema
- Chronic inflammation with macrophages and neutrophils
- Ciliary dysfunction
- Mucous gland hyperplasia
Signs of atypical pneumonia and 4 causative organisms
Normal WCC, low sodium, liver and renal dysfunction
Chlamydia psitacci, mycoplasma, legionella, avians precipitans (hypersensitivity)
Causes of non resolving pneumonia
CHAOS Complication eg empyema Host immunocompromisd Antibiotic inadequate or not absorbed Organism atypical or resistant Secondary - PE, cancer
RF for pneumothorax, treatment
Primary: Iatrogenic - central line, biopsy Secondary: >50yo, lung damage, smoker RF: Diving CT disorder eg marfans CF - TB HIV - PCP
Primary and small = nothing
Primary and large (>2cm) = aspirate
Secondary and small = aspirate
Secondary and large = drain
Surgery if:
- persistent leak (>5d)
- bilateral and spontaneous or contralateral to previous
- occupation at risk eg pilot or diver
What is dressler’s syndrome
Pleuritic pain, fever and pericarditis after MI
- molecular mimicry = AI
Effect of methotrexate on lungs
Leucopoenia causing pneumonitis and fibrosis
Increased conc by penicillin
RF for OSA and inv and treat
Overweight Age Tonsils Craniofacial abnormality Myxoedema - submucosal tissue Neuromuscular disease Muscle relaxants
Oximetry alone
Limited sleep study with oximetry, hr, movements, snoring, oronasal flow
Polysomnography - EEG, EMG and limited study
Weight loss, reduce alcohol
Mandibular advancement device, consider pharyngeal surery as last resort
Significant: nasal CPAP and consider bypass/tracheostomy
Severe with CO2 retention: NIV the CPAP if acidotic
Where does lung cancer metastasise to
Liver Pleural Bone Adrenals CNS
Key paraneoplastic sx in lung cancer - 7
Anaemia Clubbing Hypercalcaemia SIADH Lambert-Eaton myasthenic syndrome Cushing’s Thromboembolic
Sx of TB
Fever, malaise, night sweats, weight loss
Resp - cough, purulent sputum, haemoptysis, effusion
Non-resp - lymphadenopathy, erythema nodosum, pericardial effusion, meningitis, abdo, GU, miliary
Treat TB and side effects
RIPE + steroids if meningitis - 1st 2 for 6m, 2nd 2 for 2m Rifampicin - orange secretions and fever Isoniazid - peripheral neuropathy, psychosis - give pyridoxine for neuropathy Pyrazinamide - vomiting and arthalgia Ethambutol - retrobulbar neuritis
RIP - rash and hepatitis
Assessments of breathlessness
MRC Dyspnoea scale: 1 - strenuous exercise 2 - hill or hurrying 3 - SOB on keeping pace with contemporaries on flat 4 - on walking 100m 5 - cannot leave house or dressing
WHO performance status: 0 - normal 1 - can do light work 2 - ambulatory and self care 3 - chair >50% time, limited self care 4 - bed bound
