Respiratory Flashcards
Management of acute asthma exacerbation
O - Oxygen
S - Salbutamol 5m Nebs
H - Hydrocortisone 100mg IV (or pred 40mg PO)
I - Ipratropium 500mcg Neb
T - Theophylline = aminophylline infusion 1g in 1L 0.5ml/kg/hr
M - Mag Sulph 2g IV over 20 mins
E - Escalate care (anaesthetist)
Normal FEV1/FVC raion
> 70%
Management of exacerbation of COPD
Antibiotics only if increased sputum purulence
- Amoxicillin 500mg tds
- Doxy 200mg on day 1 ten 100mg OD for 5 days
Pred 30mg for 7-14 days
Oxygen
Management of CAP
0-2 (mild/mod) = Amoxicillin 1g tds (5 days)
3-5 (sev) = co-amoxiclav IV + doxycycline PO (7 days)
ICU or NBM = co-amoxiclav IV + clarithromycin IV (7 days) Step down = doxycyline
Management of HAP
Non-severe = PO Amoxicillin (5 days) Severe = IV Amox + Gent (if allregic - IV co-trim + Gent) - 7 days step down = PO co-trim
Management of aspiration pneumonia
Non-severe = PO amox + met (5 days) Severe = IV amox + met + gent (7 days)
Cause + management of pneumonia after influenza A infection
Staphylococcal
Mx = cefotaxime or impenum
Cause + management of pneumonia with ‘red jelly sptum’
Klebsiella
Mx = meropenem
Cause of pneumonia n CF patients + management
Pseudomonas
Mx= Ciprofloxacin
Management of chlamydia pstiacci pneumonia
Doxycycline
Presentation, diagnosis + management of mycoplasma pneumonia
P x = insidious onset, flu-like symptoms, dry cough
Dx = serology
Mx = macrolide (clarithromycin, erythromycin)
Diagnosis + management of Legionella Pneumonia
Dx = urine antigen
Mx = Fluroquinolone (2-3wks) or clarithromycin
Management of PCP
Co-trimoxazole
3 paraneoplastic syndrome assoc with SCLC
ADH (SIADH)
ACTH (Cushing’s)
Lambert-Eaton = antibodies to voltage-gated Ca channels
Paraneoplastic syndrome for squamous cell lung cancer
PTH-related protein (Hypercalcaemia)
Clubbing
Hypertrophic pulmonary osteoarthropathy
Paraneoplastic for adenocarcinoma
Gynaecomastia
Hypertrophic pulmonary
Management of primary spontaneous pneumothorax
if <2cm + assymptomatic = discharge
if >2cm + symptomatic = admit for aspiration (if this fails = chest drain)
Management of secondary spontaneous pneumothorax
if 0-1cm = oxygen + admit for 24hr
if 1-2cm + asymptomatic = aspiration (if fails - chest drain)
if >2cm = chest drain
Mx of tension pneumothorax
Large bore cannula 2nd IC, MC line
then CXR
then chest drain
Site of chest drain
5th IC space
MID-AXILLARY line
Management of PE
Warfarin within 24hrs of diagnosis + LMWH (until INR 2 or more)
Provoked PE = anticoag for 3 months
Unprovoked PE = anticoag 6 months
Active cancer = LMWH for 6 months
Most common causative organism infective exacerbations of COPD
Haem influenzae
Causes of transudate pleural effusion (<30 gl/l)
Increased venous pressure (HF, constrictive pericarditis, fluid overload)
Hypoalbuminaemia (cirrhoses, malabsorption, nephrotic syndrome)
Hypothyroidism
Meigs syndrome
Causes of exudative pleural effusion (> 30g/l)
Pneumonia
SLE
TB
Malignant mets
TB drug that inavtivates COCP
Rifampicin
Side effects of isoniazid
Deranged LFTs
Raised WCC
Neuropathy (stop + give pyrodoxine)
‘egg shell calicfication of hilar lymph nodes’
Silicosis
Progression of coal workers pneumonitis
CXR - small round opacities in upper zones
Progresses to
- large round opacities
- emphysema +++
- black sputum
Progresses to
- pulmonary HTN
- cor pulmonale
Drug causes of lung fibrosis
Nitrofuratoin
Amiodarone
Sulfasalazine
What is Caplan’s syndrome?
RA + Pneumoconiosis + Pulmonary rheumatoid nodules
Blood results for sacroidosis
ACE (sensitive 60%, specific 70%)
Hypercalcaemia
Raised ESR
Investigations for CF
Sweat test
- positive = >60mmol/L
- normal = <30 mmol/L
(if intermittent range - genetic testing)
What is atelectasis + how should it be managed?
Common post-op complication
Basal alveolar damage leads to breathing difficulties
Caused when airways become blocked by bronchial secretions
Suspect in pts with breathlesness 72hrs post-op
Mx = chest physio
Features of Kartageners syndrome
Defect resulting in immotile cillia
Dextrocardia or complete sinus inversus
Bronchiectasis
Recurrent sinusitis
Subfertility
