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.
