Respiratory Flashcards
What is the most common causative organism in an infective exacerbation of COPD?
Haemophilus influenzae
Name 3 organisms which commonly cause infective exacerbations of COPD.
Haemophilus influenzae (most common)
Strep pneumoniae
Moraxella catarrhalis
Name the diagnostic investigation for occupational asthma.
Serial peak flow measurements at work and at home
In COPD, what is the main benefit of inhaled corticosteroids?
Reduced frequency of exacerbations
What is first line medical treatment in COPD?
Bronchodilator, one of:
- short acting beta agaonist, e.g. salbutamol
- short acting muscarinic antagonist, e.g. ipratropium
Outline the medical management in COPD.
- Bronchodilator - salbutamol OR salmeterol
- If still breathless but no asthmatic features/no features suggesting steroid responsiveness:
- add long-acting beta agonist, e.g. salmeterol + long-acting muscarinic antagonist, e.g. tiotropium - If breathless after SABA/SAMA and asthmatic features/features suggesting steroid responsiveness:
- add long-acting beta agonist + inhaled corticosteroid, e.g. beclomethasone
If a patient with COPD is developing signs of Cor Pulmonale, what treatment should be added?
Loop diuretic (for oedema)
Outline the medical management of asthma.
- Short-acting beta agonist, e.g. salbutamol
- SABA + inhaled corticosteroid, e.g. beclomethasone
- SABA + ICS + leukotriene receptor antagonist, e.g. montelukast
- SABA + ICS + long-acting beta agonist, e.g. salmeterol
What is acute respiratory distress syndrome (ARDS)?
Increased permeability of the alveolar capillaries leading to fluid accumulation in the alveoli
(non-cardiogenic pulmonary oedema)
Name 6 causes of ARDS (acute respiratory distress syndrome).
Infection: sepsis Massive blood transfusion Trauma Smoke inhalation Acute pancreatitis Cardio-pulmonary bypass
Give 4 clinical features of ARDS (acute respiratory distress syndrome).
Dyspnoea
Elevated respiratory rate
Bilateral lung crackles
Low O2 saturations
Give 2 key investigations (and findings) of ARDS?
CXR - bilateral alveolar shadowing
ABG
What is an empyema?
A pus-filled pocket that most commonly develops in the pleural space.
What is the difference between transudate and exudate?
Light’s criteria
- Transudates have protein level <30g/L
- Exudates have protein level >30g/L
How is a pleural effusion managed?
Diagnostic tap and diagnostic aspiration
When is long-term oxygen therapy given for a patient with COPD?
pO2 <7.3, OR pO2 7.3 - 8 + 1 of: - secondary polycythaemia - peripheral oedema - pulmonary hypertension
What are target O2 saturations in an acutely unwell patient?
94-98%
What are target O2 saturations in a patient with COPD?
88-92%
What is FEV1?
The volume of air exhaled at the end of the 1st second of forced expiration
What is FVC?
Maximum volume of air a person can exhale after maximum inhalation, given as much time as they require.
What is the FEV1/FVC of normal healthy lungs?
70-80%
What is thoracic kyphosis?
A restrictive chest wall disease –> high FEV1 (air can leave quickly) and low FVC (not much air can enter as chest can’t expand)
–> FEV1/FVC is high, 85%
What is Lambert Eaton syndrome?
Weakness in proximal muscle of arms and legs (legs worse affected).
A paraneoplastic feature of small cell lung cancer
When are pulmonary rehabilitation classes indicated in a patient with COPD?
When patients start getting short of breath during regular activities, e.g. walking to the shops
What is the CURB-65 score?
Measure of pneumonia severity to estimate mortality.
Confusion Urea Resp rate Blood pressure Age >65
Name 3 common differentials for post-op SOB.
Atelectasis
PE
Pneumonia
What is atelectasis?
A common post-op complication in which basal alveolar collapse results in difficulty breathing.
It is caused by airways becoming obstructed by respiratory secretions
What is the management of a primary pneumothorax?
If rim of air <2cm and no SOB then discharge
Otherwise aspiration
What is the management of a secondary pneumothorax?
If rim of air <1cm and no SOB then admit and observe for 24hrs
If rim of air 1 - 2cm and no SOB then aspirate
If rim of air >2cm or SOB then chest drain
What is pulmonary capillary wedge pressure a measure of?
Left atrial pressure (ARDS cannot be diagnosed if it is raised)
What is transfusion-related lung injury?
ARDS which occurs within 6hrs of transfusion
Give 4 features which suggest steroid-responsiveness in a patient with COPD.
Dx of asthma/atopy
Higher blood eosinophil count
Substantial variation in FEV1 over time (>400ml)
Substantial diurnal variation in peak expiratory flow (>20%)
What is the causative organism of TB?
Mycobacterium tuberculosis
What is a Ghon focus?
A small lung lesion that develops during primary infection of TB. It is composed of tubercle-laden macrophages
What is a Ghon complex?
The combination of Ghon focus and hilar lymph nodes
Erythema nodosum, non-productive cough, arthralgia and bilateral hilar lymphadenopathy are indicative of what condition?
Sarcoidosis
What is sarcoidosis?
Abnormal collections of inflammatory cells that form granulomas. Commonly begins in the lungs, skin or lymph nodes.
What is the management of atelectasis?
Chest physiotherapy with mobilisation and breathing exercises
Which antibiotics might be given in an acute exacerbation of COPD?
Amoxicillin, tetracycline, or clarithromycin
Which antibiotics are given in an exacerbation of chronic bronchitis?
Amoxicillin, tetracycline or clarithromycin
Which antibiotic is given in an uncomplicated CAP?
Amoxicillin
Which antibiotic is given in pneumonia which is likely caused by atypical pathogens?
Clarithromycin
Which antibiotic is given in a HAP?
<5 days since admission = co-amoxiclav or cefuroxime
>5 days since admission = piperacillin with tazobactam OR b-s cephalosporin (ceftazidime) OR quinolone (ciprofloxacin)
What would the blood gas findings be during a panic attack?
Hyperventilation –> respiratory alkalosis (blows off CO2, O2 normal, no metabolic compensation because short-lived)
Patient with CF and developed a HAP.
Ground glass attenuation seen on CT scan.
What is the causative organism?
Pseudomonas aeruginosa
Alcoholic / diabetic patient with cavitating pneumonia seen in the upper lobes on CXR.
Red-current jelly sputum
What is the causative organism?
Klebsiella pneumoniae
Patient has flu-like symptoms (headache, arthralgia, myalgia) followed by a dry cough.
CXR shows patchy consolidation in one lower lobe.
What is the causative organism?
Mycoplasma pneumoniae
A patient has flu-like symptoms, along with extra-pulmonary symptoms such as hepatitis, D & V. Bi-basal consolidation is seen on CXR.
What is the causative organism?
Legionella pneumophillia
