Respiratory Harder Notes Flashcards
‘tram line shadowing’ is associated with what respiratory condition?
bronchiectasis
‘Miliary shadowing’ is associated with?
TB
What atypical pneumonia is associated with ‘birds/parrots’
chlamydia pstacci
p-parrot
What atypical pneumonia is associated with ‘sheep and cattle?’
Q fever
What type of hypersensitivity is ‘hypersensitivity pneumoniae’
Type 3
(*avian proteins/bird fanciers lung)
What type of hypersensitivity is TB and Sarcoidosis?
Type 4
(S and T end of alphabet)
What is the diagnostic investigation for Goodpastures Syndrome
diagnostic- serum antibodies - Anti-GBM
What is the management of Goodpastures Syndrome?
1st line- plasmapheresis
‘canon ball metastases’ is associated with?
metastatic lung cancer
‘blunting of the costraphrenic angle’ is associated with?
pleural effusion
-also meniscus, tracheal deviation
Slow to resolve pneumonia may be associated with?
Empyema
What is the management of Empyema?
1st line- amoxicillin + metronidazole
Frank haematuria + haemoptysis =
Goodpastures Syndrome
What is the management of Latent TB?
(include no.months)
Option1
Rifampicin + isoniazid- 3 months
Option 2:
isoniazid - 6 months
What is the management of active TB?
RIPE then RI - 2 and 6
1st line- RIPE (2 months) then rifampicin and izoniazid (6 months)
What is the management of a recurrent pneumothorax?
1st line- video assisted thoraco-scopic surgery
marfans syndrome increased risk of what lung condition?
pneumothorax
What is the management of Pneumothorax?
a) asymptomatic
b) symptomatic
low risk
high risk
Asymptomatic:
observe and watch
Symptomatic:
low risk- FNA (5th intercostal space mid axillary line- triangle of safety)
high risk:
chest drain
What is the management of a pleural effusion?
a) conservative
b) interventional
c) rapidly occurring
Conservative:
analgesia and supportive
Interventional:
symptomatic relief- US guided pleural effusion
larger effusion- chest drain
Rapidly Occuring :
Recurrent aspiration
Pleurodesis
What is the management of rapidly occurring pleural effusions?
Rapidly Occuring :
Recurrent aspiration
Pleurodesis
What are blood abnormalities in lung cancer
hypercalcemia
What feature in sarcoidosis indicates oral prednisone treatment?
hypercalcemia
What are the CXR features in sarcoidosis?
-pulmonary infiltrates
-non caveating granulomas
What is the 1st line and diagnostic investigation in mesothelioma?
1st line- CXR
diagnostic- CT of pleura
(*pleural damage very common in mesothelioma)
What is an extra-pulmonary feature of bronchiectasis?
finger clubbing
What is the definitive diagnostic investigation in pulmonary fibrosis?
diagnostic- High resolution CT
What is the main investigation for occupational asthma?
1st line- peak flow measurements at home and work
What are features of Acute Respiratory Depression?
-low O2 sats
-recent infection
-bilateral pulmonary crepitations
What is reduced more in obstructive spirometry: FEV1 or FVC?
FEV1 is reduced more- think longer word more to lose
What is the management of acute bronchitis?
1st line- conservative
Co-Morbidities present (e.g COPD)
1st line- oral doxycycline
What is the target Oxygen saturation for COPD patients?
88%–92%
What feature in an asthma attack indicates an ABG should be carried out?
O2 sats <92%
What is the 1st and 2nd line investigation of Pleural Effusion?
1st line- CXR
2nd line- pleural aspiration guided by US
What investigation follows CXR in suspected pleural effusion?
b) what is it guided by?
2nd line- pleural aspiration guided by US
protein/serum protein ratio mean for transudative and exudative effusions?
<0.5 - transudative
>0.5, the effusion is an exudate
This is different to protein G
<30G- transudative
>30- exudative
What are indications for long term oxygen therapy in a patient with COPD?
very severe airflow obstruction (FEV1 < 30% predicted). Assessment should be ‘considered’ for patients with severe airflow obstruction (FEV1 30-49% predicted)
cyanosis
polycythaemia
peripheral oedema
raised jugular venous pressure
oxygen saturations less than or equal to 92% on room air
Management for symptomatic pneumothorax is:
1st line- FNA
2nd line- chest drain
When is a chest drain preferred over FNA?
Assess for high risk characteristics:
haemodynamic compromise (suggesting a tension pneumothorax)
significant hypoxia
bilateral pneumothorax
underlying lung disease
≥ 50 years of age with significant smoking history
haemothorax
What respiratory conditions cause:
-Upper zone fibrosis?
-Lower zone fibrosis?
Upper Zone Fibrosis:
-sarcoidosis
-silicosis
-TB
Lower Zone fibrosis:
-RA
-Idoipathic pulmonary fibrosis
-mesothelioma/asbestosis
-drugs and radiation
What is the management of Kidney Stones?
watchful waiting if < 5mm and asymptomatic
5-10mm shockwave lithotripsy
10-20 mm shockwave lithotripsy OR ureteroscopy
> 20 mm percutaneous nephrolithotomy
What is the management of Gallstones?
laparoscopic cholecystectomy
(*same management as acute cholecystitis - this is elective laporocopic cholecystectomy within 1 week according to NICE guidelines)
What are Interstitial Lung Diseases?
These are conditions characterised by inflammation and fibrosis of the lung parenchyma.
Fibrosis involves replacement of the lung elastic tissue to the non functional fibrotic tissue
What are x3 typical symptoms of suspected ILDs?
Dry cough
Fatigue
SOB
What is the investigation for Idiopathic Pulmonary Fibrosis?
a) 1st line investigation
b) diagnostic investigation
1st- CXR
diagnostic- high resolution CT scan (ground glass appearance)
What is hypersensitivity pneumonitis?
This is type 3 hypersensitivity where environmental allergens (proteins or antigens) causes inflammation of the lungs.
Name X3 examples of hypersensitivity pneumonitis?
-bird fanciers lung- avian proteins trigger
-farmers lung- Saccharopolyspora rectivirgula from wet hay
-malts workers- aspergillum
-mushroom workers lungs- reaction to barley
What protein or antigen is an environmental trigger for these sub types of hypersensitivity pneumonitis?
-bird fanciers lung
-farmers lung
-malt worker
-mushroom worker
-bird fanciers lung- avian proteins trigger
-farmers lung- Saccharopolyspora rectivirgula from wet hay
-malts workers- aspergillum
-mushroom workers lungs- reaction to barley
What type of hypersensitivity reaction is hypersensitivity pnuemonitis?
type 3 hypersensitivity
What is the diagnostic investigation for hypersensitivity pneumonitis and associated findings?
diagnostic - bronchoalveolar lavage- elevated lymphocytes
What is Cryptogenic Organising Pneumonia?
This is a focal area of lung tissue inflammation, type of ILD
Cryptogenic Organising Pneumonia:
a) What is the 1st line investigation
b) What is the diagnostic investigation?
a) CXR
b) lung biopsy
What is coal minors lung disease also known as?
-coal minors pnuemocosis
-black lung disease
Where is fibrosis on a CXR for coal minors pneumonocosis
upper lung fibrosis
What is Coal minors pneumoconiosis?
Coal worker’s pneumoconiosis*, sometimes referred to as ‘black lung disease’, is an occupational lung disease caused by long term exposure to coal dust particles. I
What is the management of coal minors pneumoconiosis?
Management:
Avoid exposure to coal dust and other respiratory irritants (e.g. Smoking).
What is Pneumoconiosis?
Pneumoconiosis = accumulation of dust in the lungs and the response of the bodily tissue to its presence, most commonly used in relation to coal worker’s pneumoconiosis.
What does ‘honeycombing’ on a high resolution CT scan indicate?
very late stage- idiopathic pulmonary fibrosis
Name types of ILDs (interstitial lung diseases)
-mesothelioma/asbestosis
-hypersensitivity pneumonitis- birds fanciers lung, mushroom workers lung, malt worker
-coal minor pneumonococisis
-cryptogenic organising pneumonia (very rare)
What is the mnemonic used to name all conditions which causes upper lobe fibrosis on CXR?
CHARTS
C - Coal worker’s pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis
