Respiratory Flashcards
What respiratory complication can methotrexate give you?
Pneumonitis - presents like a fibrosis
People with RA take this drug
Which Gauge do you use for tension pneumothorax? and which
14G
Indications for corticosteroid treatment for sarcoidosis are…
Indications are PUNCH
- Parenchymal Lung Disease
- Uveitis
- Neurological involvement or
- Cardiac involvement
- HyperCa
In an acute severe asthma management, after 100% oxygen, nebulised salbutamol and ipratropium bromide nebulisers and IV hydrocortisone are given - what do you give?
IV Magnesium sulphate
What respiratory presentation does alpha-1 antitrypsin deficiency? obstructive or restrictive picture?
Causes emphysema in patients who are young and non-smokers
- gives obstructive picture
- in lower lobes
Additional info: get cirrhosis and hepatocellular carcinoma in adults
COPD management: after Salbutamol inhaler what do you give?
COPD - still breathless despite using SABA/SAMA and no asthma/steroid responsive features → add a LABA + LAMA
What surgery can be used in treatment of alpha-1-antitrypsin?
Lung volume reduction surgery
CURB score
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
What is an emphysematous bullae
Bullae are air spaces in the lung measuring >1cm in diameter when distended. The most common cause of bullae is cigarette smoking and emphysema. Large bullae in COPD can frequently mimic a pneumothorax
Causes of a raised TLCO
The transfer factor describes the rate at which a gas will diffuse from alveoli into blood. Carbon monoxide is used to test the rate of diffusion. The problem is not affecting the alveoli directly or gas exchange and so the lungs try to compensate for the problem by improving gas exchange.
asthma pulmonary haemorrhage (Wegener's, Goodpasture's) left-to-right cardiac shunts polycythaemia hyperkinetic states male gender, exercise
Causes of a lower TLCO
pulmonary fibrosis pneumonia pulmonary emboli pulmonary oedema emphysema anaemia low cardiac output
Difference between type 1 and type 2 respiratory failure
type 1 - 1 abnormality (low PaO2)
type 2 - 2 abnormalities (low PaO2 and high PaCO2)
Adenocarcinoma
gynaecomastia
hypertrophic pulmonary osteoarthropathy (HPOA)
Small cell carcinoma
ADH
ACTH - not typical, hypertension, hyperglycaemia, hypokalaemia, alkalosis and muscle weakness are more common than buffalo hump etc
Lambert-Eaton syndrome
Squamous cell carcinom
parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia
clubbing
hypertrophic pulmonary osteoarthropathy (HPOA)
hyperthyroidism due to ectopic TSH
The causes of upper lobe fibrosis can be remembered with
The mnemonic ‘CHARTS’
Coal workers’ pneumoconiosis
Histiocytosis
Ankylosing spondylitis/Allergic bronchopulmonary aspergillosis
Radiation
Tuberculosis
Silicosis (progressive massive fibrosis), sarcoidosis
mild, mod, severe, very severe COPD classification
FEV1 > 80% Stage 1 - Mild** 50-79% Stage 2 - Moderate 30-49% Stage 3 - Severe < 30% Stage 4 - Very severe
Pneumothorax management
Primary and secondary
Primary pneumothorax
if the rim of air is < 2cm and the patient is not short of breath then discharge
otherwise aspiration should be attempted
if this fails (defined as > 2 cm or still short of breath) then a chest drain should be inserted
Secondary pneumothorax
Recommendations include:
if the patient is > 50 years old and the rim of air is > 2cm and/or the patient is short of breath then a chest drain should be inserted.
otherwise aspiration should be attempted if the rim of air is between 1-2cm. If aspiration fails (i.e. pneumothorax is still greater then 1cm) a chest drain should be inserted. All patients should be admitted for at least 24 hours
if the pneumothorax is less the 1cm then the BTS guidelines suggest giving oxygen and admitting for 24 hours
1 pack year =
1 pack year is defined as 20 cigarettes per day for 1 year
Asthma
pANCA
Eosinophillia
+ Nasal polyps, vasculitis
Churg-Strauss syndrome
What lung cancer is most associated with asbestos exposure? What is the definitive way to diagnose it?
Mesothelioma
Thoracoscopy and histology
First line management when you have a CXR of pleural effusion is…
Aspiration
Features of sarcoidosis
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)
Evidence of lower zone fibrotic shadowing?
DR CIA
Drugs: amiodarone, methotrexate
Rheumatoid arthritis
Connective tissue disease
Idiopathic pulmonary fibrosis
Asbestosis
Features of Kartageners
dextrocardia or complete situs inversus
bronchiectasis
recurrent sinusitis
subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)
Examples of conditions causing FEV1/FVC < 75
Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans
