Respiratory Conditions Flashcards
What conditions cause fibrosis of the upper lobe?
C - coal worker pnuemoconiosis
H - hypersensitivity pneumonitis
A - Ank Spond
R- Radiation
T - tuberculosis
S - sarcoidosis
Common causes of Respiratory Alkalosis
- hyperventiliation
- PE
- Salicylate overdose
- Stroke, subarachnoid, encephalitis
-altitude
Moderate Asthma attack criteria
PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
Pulse < 110 bpm
Severe Asthma attack criteria
PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm
Life- threatening asthma attack criteria
PEFR < 33% best or predicted
Oxygen sats < 92%
‘Normal’ pC02 (4.6-6.0 kPa)
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
What is the criteria for high risk pneumothorax?
- bilateral pneumothorax
- hemodynamically unstable (tension)
- severe hypoxia
- haemothorax
- > = 50 yo and smoker
- underlying lung disease
What two things do you need to assess when a patient presents with pneumothroax?
- symptomatic or not
- high risk or not
What is conservative management of pneumothorax?
primary - outpatient follow up every 2-3 days
secondary - monitor inpatient
What are the paraneoplastic features of small cell lung cancer?
SIADH
Ectopic Cushing syndrome
Lambert- eaton syndrome
What is lambert eaton syndrome?
antibodies against the calcium channels in the presynaptic membrane
causes less acetylcholine
How does Lambert - Eaton syndrome present?
weakness that getters better with movement
What are the paraneoplastic features of squamous cell lung cancer?
PTHrP ( hypercalcaemia)
Clubbing
ectopic TSH
Hypertrophic pulmonary osteoarthropathy
What are the paraneoplastic features of adenocarcinoma?
gynaecomastia
Hypertrophic pulmonary osteoarthropathy
Causes of upper zone lung fibrosis
Coal workers pneumoconiosis
Hypersensitive pneumonitis
Ank spond
Radiation
TB
Silicosis/ sarcoidosis
Causes of lower zone lung fibrosis
Idiopathic
Connective tissue disorders
drugs
asbestosis
Whats the investigation of choice for a PE + renal impairment?
V/Q scan as the contrast on CTPA is nephrotoxic
What is first line treatment for Allergic bronchopulmonary aspergillosis in CF?
oral glucocorticosteroids
What is second line treatment for Allergic bronchopulmonary aspergillosis in CF?
itraconazole
What are the clinical features of Allergic Bronchopulmonary aspergillosis?
Bronchoconstriction
bronchiectasis
What are the investigations for Allergic Bronchopulmonary Aspergillosis?
eosinophilia
flitting CXR changes
positive radioallergosorbent (RAST) test to Aspergillus
positive IgG precipitins (not as positive as in aspergilloma)
raised IgE
What type of bacteria causes cavitating lesions in the upper zones?
Klebsiella
mainlys in diabetics and alcoholics
What is the gram staining of klebsiella?
gram negative rod
What does the sputum classically look like with a klebsiella infection?
red current jelly
What is first line in management of COPD?
SABA or SAMA
need to determine if patient has asthmatic features because if they do then can prescribe steroids
What criteria suggest a COPD patient has a cross over with asthma?
- previous history of asthma or atopy
- high eosinophil count
- variation in FEV1 over time
- diurnal variation in peak flow
What is normal FEV1/FVC?
70-80%
What does Total gas transfer (TLCO) measure?
measures gas transfer from alveoli into lungs
(essentially looking at how much oxygen enters RBC)
What causes raised TLCO?
asthma
pulmonary haemorrhage (e.g. granulomatosis with polyangiitis, Goodpasture’s)
left-to-right cardiac shunts
polycythaemia
hyperkinetic states
male gender, exercis
What causes lowered TLCO?
pulmonary fibrosis
pneumonia
pulmonary emboli
pulmonary oedema
emphysema
anaemia
low cardiac output
When do you place a chest tube in patients with effusion?
1) fluid is purulent
2) fluid is clear but pH<7.2
What is a contraindication for the use of Bupropion?
past medical history of Epilepsy
reduces seizure threshold
Management of Acute COPD exaceration
- 5 day course of oral prednisolone
if clinical signs of infection ( change in colour of sputum, etc)
1st line - amoxicillin or clarithromycin or doxcycline
Manifestations of sarcoidosis
uveitis
hypercalcaemia
erythema nodosum
bilateral hilar lymphadenopathy
lupus pernio
dyspnoea
cough
malaise
weight loss
What type of lung cancer is most associated with cavitating lesions?
squamous
What is another name for Kartagener’s?
Primary ciliary dyskinesia
What are features of Kartageners?
sinusitis
dextrocardia
bronchiectasis
subfertility
What does a lymphocyte pleural effusion mean?
chronic pleural process
malignancy
TB
What does a neutrophil pleural effusion mean?
acute
What is commonly the FEV1/FVC ratio in restrictive disease?
FEV1/FVC>0.7
What type of pH abnormality does opiate overdose cause?
Respiratory acidosis
What may be seen in a blood test for lung cancer?
Raised platelets
What does a Wells score of 4+ mean?
PE is likely
What is the management process if WELLS score is 4+?
- organise CTPA
- if CTPA delayed, give a DOAC in interim (apixaban or rivaroxaban)
- if CTPA negative, do US to check for DVT
What to do if WELLS score is <4?
- perform D-Dimer test
- positive D-Dimer –> do CTPA
- negative D-Dimer –> stop anticoagulation and consider other diagnosis
What can fast aspiration of pneumothorax cause?
re-expansion pulmonary oedema
What do you prescribe alongside isoniazid to prevent peripheral neuropathy?
Vitamin B6
Pyridoxine
What is a parapneumonic effusion?
effusion associated with pneumonia
What to do if D-Dimer is positive but US is negative in suspected DVT?
stop anticoagulation
repeat scan 1 week later
What is diagnostic for mycoplasma?
mycoplasma serology
Complications of mycoplasma
erythema multiforme
GBS
HA cold
pericarditis
bullous meringitis
What pH range should NIV be considered in a COPD patient?
7.25-7.35
If patient is steroid responsive in COPD what do you add?
ICS + LABA
Management for CAP
Amoxicillin
What is used to treat legionella?
Mcarolides
What pneumonia is known to reactive herpes simplex virus?
strep pneumonia
What is the cause of rapid deterioration of a patient on NIV?
tension pneumothorax
