Respiratory Medicine Flashcards
Normal pH
7.35-7.45
Normal PaO2
75-100 mmHg
Normal PaCO2
35-45 mmHg
Normal HCO3
22-26 meq/L
Unprocessed raw cotton + bacterial endotoxin
Byssinosis
doesn’t cause COPD
FEV1/FVC ratio
0.75-0.85
List of restrictive diseases
- pulmonary fibrosis
- pneumothorax
List of obstructive diseases
- asthma
- COPD
FEV1/FVC ratio > 0.85
Restrictive airway disease
FEV1/FVC ratio < 0.75
Obstructive airway disease
Residual lung volume increased
obstructive disease
Residual lung volume decreased
restrictive disease
CURB-65 Score
– Confusion of new onset.
– Urea greater than 7 mmol/l.
– Respiratory rate of 30 breaths per minute or higher.
– Blood pressure less than 90 mmHg systolic or diastolic blood pressure 60 mmHg
or less.
– Age 65 or older
CURB-65 score equal or >3, an
inpatient treatment for community acquired pneumonia is necessary.
Difference between crackles associated with alveolar fluid vs interstitial lung disease
Egophony
(fever, malaise, cough + acute SOB + bilateral crackles + asymptomatic between exacerbations
hypersensitivity pneumonitis (alveolitis)
dyspnea + cough + fever + productive sputum +
occasionally pleuritic chest pain
pneumonia
Treatment for community acquired pneumonia
IV benzyl penicillin and azithromycin
periodontal disease + cough + foul-smelling sputum + immobilised (hiatal, post-op)
Aspiration pneumonia
Aspiration pneumonia pathogen
oral streptococci
Aspiration pneumonia treatment
1st line: ampicillin-sulbactam (1.5 to 3 g IV ampicillin-sulbactam (1.5 to 3 g IV every 6 hours)
abdominal / trans-thoracic procedure post-op + cough and fever + within 48 hours
Postoperative atelectasis
Postoperative atelectasis management
- Removal of impacted secretions by coughing, managed by physiotherapists, and involves active chest percussion and breathing exercises.
2, oxygen supplementation - Passive postural drainage.
- bronchoscopy if px still hypoxic
cough + mucopurulent sputum lasting for months to years + finger clubbing
bronchiectasis
Bronchiectasis investigation of choice
High-res CT
Bronchiectasis treatment
IV ticarcillin-clavulanate
latent tuberculosis (LTB) treatment
Isoniazid (5mg/kg up to a maximum 300mg daily) for 9 months
middle/older age + high grade fever + dry cough + severe headache + diarrhoea/vomiting/confusion + hyponatremia + deranged liver function tests
Legionnaires disease
recurrent asthma exacerbations + patchy opacities + central bronchiectasis + eosinophilia+ elevated immunoglobulin E
allergic bronchopulmonary aspergillosis
clubbing of nails can be found in
– Cystic fibrosis.
– Interstitial pulmonary fibrosis.
– Lung cancer
– Interstitial lung disease
IV drug abuse + dyspnoea + bilateral pleuritic chest pain + multiple partners sex hx + hypoxemic
Pneumocystis jiroveci pneumonia
smoker + pulmonary nodule + hypercalcemia (increased thirst, abdominal pain, constipation, and polyuria)
squamous cell carcinoma
pigmentation of skin + lung mass + hypokalaemia + hirsutism
Small cell lung carcinoma
-Ectopic production of adrenal corticotropin (ACTH)
X-ray pleural thickening + significant weight loss + plural effusion
mesothlioma
Small cell lung carcinoma complication
Ectopic production of ACTH can lead to Cushing’s syndrome
- hypokalaemia
Small cell lung carcinoma treatment
chemotherapy and radiation
cough + weight loss + lung nodule in X-ray
adenocarcinoma
adenocarcinoma investigation
FNAC gold standard
superior vena cava syndrome investigation
chest CT angiogram
Most common causes pulmonary hypertension and cor-pulmonale
Chronic obstructive pulmonary disease Emphysema
Types of asthma
mild:
moderate:
severe:
Asthma causes
emotional changes
gord
allergies
pregnancy
occupational hazards
dust mites
Exercised induced asthma management
Cromolyn
physical symptoms that are not indicated in assessing severe asthma
- wheezing
- respiratory rate
4 hallmark indicators of severe asthma
altered mental state +effort on breathing + struggling to talk + <94% oxygen saturation
role of oral steroids in asthma
can only be used in exacerbation, not for long term
prolonged use of oral steroids (prednisolone):
- Cushing syndrome,
- osteoporosis,
- immunosuppression
Asthma dx
triad: dyspnoea + wheeze + cough
fev1/fevc ratio < 75
PEF: improvement in fev1 more > 12% after medication (salbutamol)
- prolonged expiration
- resonant
- expiratory wheeze
respiratory acidosis
best bed-side measure to assess the severity of asthma
Use of accessory muscles upon inspiration
pleural fluid analysis
- pH always below 7.30
- Pleural/serum protein ratio greater than 0.5
- Pleural/Serum lactic dehydrogenase ratio of greater than 0.6
- Glucose concentration (30-50 mg/dL)
- Bloody pleural fluid is strongly suggestive of malignancy
High altitude pulmonary oedema caese
Hypoxic pulmonary vasoconstriction
family hx of emphysema/liver disease + + weight loss, + jaundice + dyspnoea
Alpha-1 antitrypsin (AAT) deficiency
idiopathic pulmonary fibrosis (IPF) treatment
Antifibrotic therapy
black + 20-30 years + erythema nodosum + arthritis + hilar lymphadenopathy
Sarcoidosis Lofgren syndrome
black + 20-30 years + fever + parotid gland enlargement + uveitis + facial palsy
Sarcoidosis
pneumothorax in the absence of trauma and no history of lung disease
Primary spontaneous pneumothorax (PSP)
Pneumothorax as well as other lung disease
Secondary spontaneous pneumothorax (SSP)
Pneumothorax management
PSP < 15%: observation
PSP > 15%: needle aspiration
SSP: mechanical ventilation (can’t put needle into an already damaged lung)
Symptomatic SSP: Catheter drainage/water sealed thorcostomy
Most common finding in plural effusion
Dyspnoea
Most effective preventative therapy for asthma
ICS
- fluticasone
- beclomethasone
- budesonide
Montelukast if ICS contraindicated
NOTE: Montelukast is associated with nightmares in children
when to add preventer
using preventer if they use salbutamol more than 3x week
