Respiratory Flashcards
Size of normal pneumothorax requiring management and what is management
More than 2 cm. First line aspiration then chest drain (often in secondary)
Drug and conditions causing pulmonary fibrosis
Amiodarone, bleomycin, cyclophosphamide, methotrexate, nitrofurantoin. Alpha 1 antitrypsin, rheumatoid, systemic sclerosis, SLE.
What is sarcoidosis
A disease characterised by granulomatous (granules with macrophage) inflammation causing mediastinal lymlhadenopathy and lung fibrosis.
Signs of sarcoid and initial treatment.
Lupus pernio (raised purple colored skin lesions across nose or cheeks), lofgren syndrome (erythema nodosum, bilateral hilar lymphadenopathy, polyarthralgia) . In small amount of symptoms no treatment. Otherwise long term oral steroids
Management of asthma
First line SABA (salbutamol) when required. Then SABA prn + inhaled corticosteroids.
Second line add LABA, then leukotriene receptor antagonist (montelukast)
Management of acute asthma
If mild or moderate, start SABA every 20min + prednisone + O2.
If severe, nebulised salbutamol + nebulised ipratropium + IV steroids + consider magnesium sulfate
Signs of acute exacerbation of asthma (RR, PEFR, speech, pulse )
Mild: 75-50% PEFR, RR<25, speech normal, pulse <110
Moderate: 50-33% PEFR, RR>25, pulse >110, unable to finish sentence in one breath
Severe: PEFR <33%, hypoxia, bradycardia, haemodynamic instability
Characteristic feature of strep pneumonia and type of bacteria
Following a viral infection, rust coloured sputum. Gram + cocci
Management of viral pneumonia and main cause
Main cause is influenza A + B. Management includes antivirals (aciclovir)
Staph aureus pneumonia characteristics and management
Common post flu and IV drug use. Often associated with GI sx. With MRSA: vancomycin/linezoid/ teicolplanin. Without MRSA flucloxacillin and rifampicin
Legionella pneumonia characteristics (way of infection and symptoms) and type of organism and treatment.
Often caught due to travel (contaminated water), ACs or humidifiers. Gram - bacteria. Causes Neuro and GI Sx. Fluoroquinolone main treatment
What makes mycoplasma and chlamydophillia pneumonia atypical and main treatment.
Resistance to b lactam abx and difficulty to spot on normal gram staining. Follow a pattern of 4 year infection cycles. Mycoplasma has no cell wall.
Nocardia pneumonia type of organism and management
Bacteria of the actinomycete order. Treated with trimethoprim/sulfamethoxazole (septrin)
Pneumocystis jirovecii pneumonia type of organism common population and treatment.
Fungal organism, common in HIV positive patients (CD4 <200), treat with septrin. AIDS defining illness,
Management of pulmonary embolism
If haemodynamically unstable, give unfractionated heparin and IV thrombolysis (altepase/streptokinase).
If haemodynamically stable, give DOAC (apixaban or rivaroxaban) or if not suitable low molecular weight heparin.
In patients with unprovoked PE, offer long term treatment with DOAC / VKA / LMWH.
How to investigate a PE ( and ecg findings)
First perform wells score. If PE likely, perform CTPA. If PE unlikely, first perform D-diner then if positive CTPA. ECG signs are t-wave inversion in leads v1-4 and S1Q3T3 pattern (right heart strain) which is deep S wave in 1, q wave in III, inverted T wave in III.
CURB56 score for Pneumonia
C: confusion? U: urea (BUN) >7mmol/ L R: RR > 30 B: BP ( less than 90/60) 65: age over 65 If 1 or less, outpatient. If 2, inpatient, if 3 or more consider ICU admission.
What is bronchiectasis, signs and x ray findings
Permanent dilation of the airways due to destruction of elastic and muscular component of bronchial wall. Chronic cough with sputum, high pitched inspiratory crackles, X-ray shows tramlines
Spirometry and X-ray findings of COPD patient
Spirometry shows obstructive pattern: FEV/FVC ratio less than 70%, FEV1 reduced. Increased functional residual capacity.
X-ray may show lung hyperinflation with flatter diaphragm
Management of COPD according to gold classification
GOLD 1 (FEV1 >80): SABA/ SAMA / LAMA / LABA GOLD 2/3 (80-50): LABA/ LAMA + inhaled salbutamol or ipratropium GOLD 4 (<30): LAMA or combined LABA/LAMA or combined LABA/ICS
Actually GOLD A-D depending on risk level
Management of acute exacerbation of COPD
- ABCDE controlled oxygen therapy via Venturi mask
- Salbutamol
- If does not work, ipratropium nebulized
- If severe, give corticosteroids PO
- If hypercapnia consider NIV
Investigation of pulmonary TB
- X-ray showing opacities in upper lobes +- cavitation
- Smear test looking for alcohol acid fast bacilli. Do 3 sputums, at least 8h apart 1 of which in morning.
- Culture and sensitivities. ( takes longer)
- Nucleic acid amplification test (for confirmation of diagnosis following smear test, can get results within 8h).
Main type of cancer and it’s main subtype
Non small cell carcinoma (80-85%) - adenocarcinoma most common
Explain small cell carcinoma type of cell and affected population and prognosis
SCC can metastasise early and therefore has a low prognosis. It is believed to arise from neuroendocrine cells called feyrter cells and can lead to ectopic production of hormones like ADH and ACTH. Virtually all patients are smokers
