Respiratory Flashcards
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) - What is it?
Features (5)
Small-medium vessel vasculitis asthma blood eosinophilia (e.g. > 10%) paranasal sinusitis mononeuritis multiplex pANCA positive in 60%
Features of mycoplasma pneumoniae pneumonia
flu like symptoms
patchy lower lobe consolidation
features of pseudomonas aeruginosa pneumonia
associated with HAP, VAP, CF, bronchiectasis
‘ground-glass’ attenuation on CT
features of klebsiella pneumonia
associated with increasing age, alcohol use, diabetes, aspiration
cavitating lesions in upper lobes
features of legionella pneumonia
flu like with or without D&V or hepatitis
bi-basal consolidation
Granulomatosis with polyangiitis (Wegener’s granulomatosis)
What is it?
Features?
necrotizing granulomatous vasculitis affecting URT, LRT and renal system.
upper respiratory tract: epistaxis, sinusitis, nasal crusting
lower respiratory tract: dyspnoea, haemoptysis
rapidly progressive glomerulonephritis (‘pauci-immune’, 80% of patients)
saddle-shape nose deformity
also: vasculitic rash, eye involvement (e.g. proptosis), cranial nerve lesions
Bronchodilator therapy for COPD
1st line SABA (or SAMA) 2nd WITH asthma features LABA + ICS (then LAMA as required) WITHOUT asthma features LABA+LAMA Asthmatic features include previous Hx of asthma, FEV1 variation, diurnal variation, eosinophilia
Smoking cessation meds
NRT - patch plus another form recommended
Varenicline - partial nicotine agonist
Bupropion - nicotine antagonist, dopamine and NA reuptake inhibitor
Causes of upper lobe fibrosis
‘CHARTS’
Coal workers’ pneumoconiosis
Histiocytosis
Ankylosing spondylitis/Allergic bronchopulmonary aspergillosis
Radiation
Tuberculosis
Silicosis (progressive massive fibrosis), sarcoidosis
Causative organisms of infective Ex of COPD
Haemophilus influenzae (most common cause)
Streptococcus pneumoniae
Moraxella catarrhalis
Mx of Primary Pneumothorax (no tension)
No SOB and <2cm = discharge and review
SOB or >2cm attempt aspiration
If aspiration fails consider chest drain
Mx of Secondary Pneumothorax (no tension)
SOB or >2cm = chest drain
No SOB 1 to 2 cm = aspiration, if fails chest drain
Less than 1 cm or aspirated = observe for 24 hours
CURB 65
C Confusion (abbreviated mental test score <= 8/10)
R Respiration rate >= 30/min
B Blood pressure: systolic <= 90 mmHg and/or diastolic <= 60 mmHg
65 Aged >= 65 years
Classifying acute asthma attack
Moderate PEFR 50-75% best or predicted Speech normal Severe PEFR 33 - 50% best or predicted Can't complete sentences RR > 25/min Pulse > 110 bpm Life-threatening PEFR < 33% best or predicted Oxygen sats < 92% Silent chest, cyanosis or feeble respiratory effort Bradycardia, dysrhythmia or hypotension Exhaustion, confusion or coma Near-fatal raised PaCO2 requires ventilation
Features of Sarcoidosis Acute (4) Insidious (4) Skin (1) Other (1)
acute: erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia
insidious: dyspnoea, non-productive cough, malaise, weight loss
skin: lupus pernio
hypercalcaemia: macrophages inside the granulomas cause an increased conversion of vitamin D to its active form (1,25-dihydroxycholecalciferol)
Causes of a raised TLCO
asthma pulmonary haemorrhage (Wegener's, Goodpasture's) left-to-right cardiac shunts polycythaemia hyperkinetic states male gender, exercise
Causes of a reduced TLCO
pulmonary fibrosis pneumonia pulmonary emboli pulmonary oedema emphysema anaemia low cardiac output
Pleural Effusion Mx
Chest drain if empyema is present - visibly purulent or pH<7.2
Investigate to determine the cause of the effusion
Bloods, CXR, ECG, ECHO if HF suspected, CT if malignancy is suspected
Biopsy
Transudate
definition
causes
Mx
<30g/L protein
think third spacing or increased pulmonary pressure
Commonly Heart failure, cirrhosis, hypoalbuminaemia
Treat cause
chest drain if effusion persists
Exudate
definition
causes
Mx
> 30g/L protein
Think inflammatory processes - protein is exiting the capillaries
commonly Malignancy, infection
diagnosis and treatment of the cause
if purulent or pH <7.2 then insert chest drain as likely infective.
Purulent effusions - what’s in em?
High protein content - exudate may be visibly purulent low glucose high LDH pH<7.2
Indications for prophylactic axithromycin in COPD
do not smoke, optimised non-pharmacological management and inhaled therapies, relevant vaccinations and (if appropriate) have been referred for pulmonary rehabilitation and continue to have 1 or more of the following, particularly if they have significant daily sputum production:
- 4 or more per year exacerbations with sputum
production
- prolonged exacerbations with sputum production
- exacerbations resulting in hospitalisation.
Features of Kartageners syndrome (4)
dextrocardia or complete situs inversus
bronchiectasis
recurrent sinusitis
subfertility
What is ARDS
non-cardiogenic pulmonary oedema caused by increased permeability of alveolar capillaries
Causes of ARDS (6)
Infection - pneumonia, sepsis massive blood transfusion trauma smoke inhalation acute pancreatitis cardio-pulmonary bypass
Features of ARDS (4)
dyspnoea
tachypnea
hypoxia
bibasal crackles on auscultation
Diagnostic criteria for ARDS (4)
onset within 1 week of trigger
pulmonary oedema on CXR
non-cardiogenic
pO2/FiO2 <40kPa
Mx of ARDS (4)
ITU involvement
oxygenation and ventilation
organ support e.g. vasopressors
treat underlying cause
COPD severity
FEV1 Severity > 80% Stage 1 - Mild** 50-79% Stage 2 - Moderate 30-49% Stage 3 - Severe < 30% Stage 4 - Very severe
