Respiratory Conditions Investigations Flashcards
Chronic Brochitis - Investigations (5/2)
initial 1) spirometry (FEV1<0.8, FEV1/FVC<0.7) 2) pulse oximetry (low) 3) ABG (PaO2<8kPa ± PaCO2>6.7kPa) 4) FBC (high PCV) 5) ECG (RVH) consider 1) chest x-ray (exclusion) 2) chest CT (bronchial wall fibrosis)
Emphysema - Investigations (5/2)
initial 1) spirometry (FEV1<0.8, FEV1/FVC<0.7) 2) pulse oximetry (low) 3) ABG (PaO2<8kPa ± PaCO2>6.7kPa) 4) FBC (normal) 5) ECG (normal) consider 1) chest x-ray (hyperinflation, bullae) 2) alpha-1-antitrypsin level
Asthma - Investigations (3/4)
initial 1) peak expiratory flow (low) —> bronchodilator test peak expiratory flow (>15% improvement) 2) spirometry (FEV1<0.8, FEV1/FVC<0.7) —> bronchodilator test spirometry (>15% improvement) 3) pulse oximetry (attack) consider 1) chest x-ray (exclusion) 2) specific IgE assay 3) skin prick test 4) ABG (attack)
Small Cell Lung Carcinoma - Investigations (3/2)
initial 1) chest x-ray (central mass, pleural effusion, hilar lymphadenopathy) 2) chest CT 3) sputum cytology (malignant cells) (high false negatives) consider 1) bronchoscopy + biopsy 2) adrenal, liver, brain, bone CT (metastasis)
Non-Small Cell Lung Carcinoma - Investigations (3/2)
1) chest x-ray (central mass, pleural effusion, hilar lymphadenopathy) 2) chest CT 3) sputum cytology (malignant cells) (high false negatives) consider 1) bronchoscopy + biopsy 2) liver, adrenal, brain, bone CT (metastasis)
Pulmonary Embolism - Investigations (4/0)
1) pulmonary CT angiogram* 2) D-dimer (negative excludes) 3) ventilation/perfusion scan 4) LFT (normal)
Community Acquired Pneumonia - Investigations (5/6)
initial 1) chest x-ray* (consolidation) 2) FBC (leucocytosis) 3) high CRP + ESR 4) pulse oximetry (prognostic) 5) U+E (prognostic) consider 1) ABG (SaO2<92% or severe) 2) sputum MS+C (common) 3) blood MS+C (severe) 4) diagnostic thoracentesis + pleural fluid MS+C (pleural effusion) 5) bronchoscopy + brush sample MS+C (severe, refractory) 6) urinary Legionella antigen (Leg. pneumophilia)
Hospital Acquired Pneumonia - Investigations (5/3)
initial 1) chest x-ray* (consolidation) 2) FBC (leucocytosis) 3) high CRP + ESR 4) pulse oximetry 5) bronchoscopy + brush border sample MS+C consider 1) ABG (SaO2<92% or severe) 2) diagnostic thoracentesis + pleural fluid MS+C (pleural effusion) 3) procalcitonin (antibiotic choice)
Immunocompromised Pneumonia - Investigations (5/3)
initial 1) chest x-ray* (consolidation) 2) FBC (leucocytosis) 3) high CRP + ESR + LDH 4) pulse oximetry 5) sputum MS+C consider 1) ABG (SaO2<92% or severe) 2) bronchoscopy + brush sample MS+C 3) diagnostic thoracentesis + pleural fluid MS+C (pleural effusion)
Aspiration Pneumonia - Investigations (5/3)
initial 1) chest x-ray* (consolidation) 2) FBC (leucocytosis) 3) high CRP + ESR 4) pulse oximetry 5) sputum MS+C consider 1) ABG (if SaO2<92% or severe) 2) bronchoscopy + brush sample MS+C 3) diagnostic thoracentesis + pleural fluid MS+C (pleural effusion)
Tuberculosis - Investigations (Active) (2/3)
initial 1) chest x-ray (fibronodular shadows, calcification, cavitation —> esp. in upper lobes) 2) FBC (anaemia, leucocytosis) consider 1) sputum nucleic acid amplification test 2) sputum acid-fast bacilli smear 3) sputum culture*
Tuberculosis - Investigations (Latent) (2/0)
initial 1) tuberculin skin test (>5mm induration if risk factors, >15mm if no risk factors) 2) interferon gamma release assay
Type I Respiratory Failure - Investigations (2/7)
initial 1) pulse oximetry (SaO2<80%) 2) ABG (PaO2<8kPa) consider find underlying cause 1) FBC 2) U&E 3) CRP 4) ECG 5) chest x-ray 6) spirometry 7) sputum/blood MS&C (fever)
Type II Respiratory Failure - Investigations (2/7)
initial 1) pulse oximetry (SaO2<80%) 2) ABG (PaO2<8kPa, PaCO2>6.7kPa) consider find underlying cause 1) FBC 2) U&E 3) CRP 4) ECG 5) chest x-ray 6) spirometry 7) sputum/blood MS&C (fever)
