Respiratory Flashcards by Megan McStay

Indications for urgent CXR

-Haemoptysis
-Unexplained or present >3weeks;
Cough
Chest/ Shoulder Pain
Dyspnoea
Cervical/SC Lymphadenopathy
Signs of Mets
Weight Loss
Chest signs
Hoarseness
Clubbing

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Peak Flow is best used for?

Monitoring progress and effects of treatment on asthma

overestimates lung function

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When measuring FEV1 and FVC what should you ensure?

2 readings within 100mL or 5% of each other

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Fractional exhaled nitric oxide concentration if normal does not exclude?

A dx of asthma

Should be increased in patients with asthma/inflammatory respiratory conditions

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What are the RCP three questions used to monitor asthma control?

Sleep Symptoms
Daytime Symptoms
Interfered with activity

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FEV1/FVC <70% indicates

Obstructive Lung Disease

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Cough/ Acute Corzya & Bronchitis:

Reasons to prescribe antibiotics immediately?

-Systemically very unwell, signs/symptoms suggestive of serious illness/complications
-Risk factors for developing complications (CF, CCF, Lung, renal, liver, neuromuscular, immunosuppression, premature babies)
->65 (2) or >85 (1);
Hospitalization in last year
T1DM or T2DM
Oral Glucorcorticoids
CCF

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Cough:

What Antibiotics would you prescribe?

Amoxicillin
or Clarithromycin
or Doxycycline

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Causes of haemoptysis/ blood-stained sputum?

Infection: TB, Pneumonia, Bronchitis, Lung Abscess
Bronchiectasis
Malignancy
PE (blood not mixed with sputum)
Iatrogenic
Inhaled Foreign Body
Trauma
Cardiac (Acute LVF)
Blood Dyscrasia
Mycosis (aspergilloma)
Goodpasture’s Syndrome
Wegener’s Granulomatosis

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Urgent chest physician referral?

haemoptysis

Abnormal CXR
Normal CXR w/t persistent haemoptysis
> 40yrs and smoker/exsmoker
high suspicion of malignancy

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Patients with COPD, Asthma, Bronchiectasis, CF, should be advised to get which 2 vaccinations?

Influenza

Pneumococcal

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Pectus Carinatum is associated with?

Chronic childhood asthma

Rickets

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Structural Kyphosis may be caused by?

Osteoporosis
Paget’s Disease
Ankylosing spondylitis
Scheuermann’s Disease (juvenille osteochondrosis)

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Types of pleural effussions?

Simple:
Transudates (protein <30g/L)
Exudates (protein >30g/L)

Complex:
Blood
Lymph
Pus (empyema)

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Causes of Pleural Effussion?

Malignancy
Infection
Infarction (PE)
Heart Failure
Constrictive Pericarditis
Inflammation (SLE, RA, Pancreatitis, Asbestos exp)
Hypoproteinemia
Hypothyroidism

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Referal for CXR (resp disease)

SC or Cervical Lymphadenopathy >3wk
Unexplained neck lump- recent onset, changed over 3-6wks
Unexplained clubbing

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Dysphonia Referal?

Hoarseness >3wk (esp. smokers >50yrs and heavy drinkers)

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Before suggesting long-term use of nebulizer therapy for COPD/asthma, you should?

Review diagnosis, technique, compliance
Try increasing BD dose for 2wks
Perform 2wk trial and monitor results (PEFR)
Prove instructions on use

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Stop steroids abruptly if;

Disease unlikely to relapse

and Tx recieved for <3wk

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Withdraw steroids gradually if

Disease unlikely to relapse and;
-Taken for >3wk
Taken short coarse < 1yr after stopping long term therapy
-Recieved >40mg dose prednisolone
-given repeat doses in eveving 
-recently had repeated steroid courses

What is brittle asthma?

rapid development of acute asthma attacks

Asthma:

Reasons for referral?

Severe asthma exacerbation
monophonic wheeze/stridor
cxr shadowing
unclear dx
unexpected clinical findings (clubbing, crackles, cyanosis)
constant breathlessness
poor response to tx
unexplained restrictive spirometry
suspected occupational asthma 
chronic sputum production
eosinophilia (>1x10-9/L)

MRC Dyspnoea Scale

1: strenuous exercise
2: hurrying/walking uphill
3: level ground
4: stops after 100m
5: dressing

COPD

Referal for specialist care?

Uncertain dx
age <40yrs
severe COPD
Rapid decline in FEV1
Cor Pulmonale
Frequent Infections
Haemoptysis
A1AT def

Assessment for:
Long Term O2 Therapy
Long Term Oral Steroids
withdrawl of steroids
long term nebulizer therapy
pulmonary rehabilitation
surgery

Long Term O2 Therapy, refer if;

``` FEV1<30% O2 sats <92% Cyanosis Polycythaemia peripheral oedema raised JVP ```

The BODE Index takes what parameters into account?

FEV1 Dyspnoea (MRC) BMI Exercise Capacity

Home treatment of acute exacerbations of COPD?

Increase Bronchodilators Antiobiotics- clarithromycin (sputum becomes purulent, signs of pneumonia, consolidation on CXR) Oral Corticosteroids-Prednisolone

immediate Referral for suspected lung cancer?

``` Stridor SVC obstruction (swelling of face/neck, increased JVP) ```

Urgent referal for suspected lung cancer?

Persistent haemoptysis (smokers >40yrs) CXR suggestive of lung ca (pleural effussion and consolidation) High suspicion of lung ca Hx of asbestos exposure and recent onset - chest pain, dyspnoea, or other where a cxr indicates a pleural effussion, pleural mass, etc.

Paraneoplastic Syndrome

clinical syndromes involving nonmetastatic systemic effects that accompany malignant disease E.g: ectopic ACTH, SIADH, hypercalcaemia, hypercoagulability

Most common cause of acute corzya/ rhinopharyngitis?

Rhinovirus (30-50%) | Picornavirus, echovirus, coxsackie virus

Which type of influenza virus causes the complication of viral pneumonia?

Influenza A (Asian Flu)

Chest infections secondary to influenza are usually caused by which 2 pathogens?

S.aureus | Strep. pneumoniae

When should you consider the use of antivirals when treating influenza?

High Risk groups Prevalent in the community *Onset <72hrs

What antivirals should you consider for the management of influenza in adults? and children?

Shortens symptoms Reduces Complications Adults: Zanamivir + Children: Oseltamivir

At Risk groups for severe disease with influenza

``` >/= 65yrs COPD, asthma, MS, MND, CerebroVascularAccident CVD exc. HTN Immunosuppression Chronic Renal Failure DM ```

Indications for Influenza vaccine?

``` >/= 65yrs Pregnant DM Chronic Renal Disease COPD, asthma Chronic Liver Disease Nursing Home Residents Health Professionals CVD Immunocompromised patients ```

Common causative organisms of pneumonia?

``` S.pneumoniae H.influenxae- elderly Influenza A, B- winter *Mycoplasma pneumoniae *C.psittaci - bird contact S.aureus - secondary toinfluenza, acute coryza *Legionella spp. - sept/oct travel ```

CURB-65 Score

Confusion Urea > 7mmol/L RR >30bpm Blood Pressure < 90/60mmHg 1/2 - Consider Hospital Referral 3/4 - Urgent Hospital Referral

Treatment of Pneumonia @ home?

Stop smoking, rest, fluids Amoxicillin or Doxycycline or Clarythromycin Analgesia - Pleuritic Pain Review - 48hrs

Complications of pneumonia?

``` Para-pneumonic effussion Empyema Abscess- swinging fever and worsening Septicaemia Metastatic infection Respiratory Failure Jaundice ```

What dermatological feature is associated with primary TB?

Erythema nodosum

TB sputum sample culture?

Acid-fast bacilli

Tuberculin skin tests can be false negatives under which circumstances?

``` Corticosteroid therapy immunosuppressed Viral infections inc. Glandular fever Live Vaccines <3wks Sarcoidosis Hodgkins ```

Positive Tuberculin Skin Test? Mantoux

Ring of induration with clear centre | 5-14mm may be normal in school children

Treatment of TB?

Asymptomatic: Isoniazid + Rifampicin 3mnths Symptomatic: Isoniazid,(6mnths) Rifampicin, pyrazinamide, Ethambutol (2mnths)

Invasive Aspergillosis?

Immunocompromised | Lungs - Kidneys, Brain, etc

Aspergilloma?

Cavity from TB, Sarcoidosis CXR: round lesion with air halo Haemoptysis

Pneumocystis Jiroveci

Pneumonia in Immunocompromised patients | Tx: Co-trimoxazole, Dapsone