Respiratory teaching Flashcards
OBSTRUCTIVE AND RESTRICTIVE LD
i) name three obstructive? which type has a large inelastic lung? which has a small fibrotic lung?
ii) what is normal/restric/obstruc fev1:FVC ratio? fev1 % predicted? FVC?
i) obstructive - ashtma, COPD, bronchiectasis
large inelastic is obstructive
small fibrotic is restrictive
ii) fev1:FVC normal 70%, obstruc < 70%, restric > 70%
FEV1% 80-120% normal, reduced in obstruc and restrictive
FVC normal 80-120%, obstructive increased and restrictive decreased
ASTHMA
i) what are the four hallmarks of asthma? what is FEV1:FVC? FeNO?
ii) how much ml and % improvement with BD is there? what is PEFR variability?
iii) name two tests that can be used to dx and what the result is in asthma?
i) bronchial hyperactivity, airway inflam, mucus plugging, sm muscle hypertrophy
FEV1:FVC < 70% and FeNO >40ppb
ii) 12% improve or inc in 200ml PEFR
PEFR variability is diurnal variation of 20%
iii) spirometry - obstructive
FeNO - increased (high inflam = high NO)
ASTHMA TREATMENT
i) what are the 7 steps in chronic mx? what is the aim of chronic mx
ii) what are 7 steps in acute mx - O SHIT ME
i) chronic mx to reduce exacerbations
1) SABA
2) SABA +ICS
3) SABA ICS LTRA
4) SABA ICS LABA (+- LTRA)
5) low dose MART (ICS + LABA), SABA (+- LTRA)
6) med high dose MART + LTRA
7) SABA, high dose MART, LAMA, theo, aminoph
ii) acute mx
O2
SABA
Hydrocortisone (pred 40mg OD 5d)
Ipatropium (SAMA)
Theophylline
Mgso4
Escalate
COPD
i) what is a pink puffer and blue bloater? which type of damage is prominent in each? which one in cyanotic and oedmatous? which is not?
ii) what two things may be seen on CXR? what may be seen pn ECG in relation to P waves? why?
iii) what is the EAB classification? what two things does it use?
iv) what are 5 steps in mx? for asthma and non asthma features
v) name four things that may be given in an exacerbation
i) pink puffer - co2 retainer, not cyanotic, pursed lip breathing, less cough = emphyema
blue bloater - co2 retainer, cough, oedematous, hypoxia, cor pulmonale = chronic bronchitis
ECG - p pulmonale = peaked P wave (tall >2.5mm) due to enlarged RA due to cor pulm
m mitral = prolonged P wave due to LA enlarge
iii) EAB = classification of exacerbation - number of hospitalisations and GOLD grade (FEV1% predicted)
iv) 1) smoking cessation
2) inhaled SAMA/SABA
3) if no asthma feat = LABA + LAMA / if asthma features ICS + LABA
4) uncontrolled on dual therapy = LABA LAMA ICS
v) o2 via venturi mask to control sats if retainer
neb SABA or ipatropium
oral steroid - pred 30mg 5d
amox or doxy if infective
NIV if retainer or acidotic
BRONCHIECTASIS
i) what is it? what are airways susceptible to be colonised with?
ii) mame three congential causes? name three acquired causes?
iii) what is gold standard imaging and what is seen?
iv) name three ways it can be mx
i) abnormal and permanent dilated bronchioles
colonisation with pseudomonas
ii) congenital - primary cilliary dyskinesia, kartageners, CF
acqured - post infective obstruc, allergy (aspergilosis)
iii) High res CT scan - see thick large ariway with small BV (signet sign)
iv) physio, bdil, steroids, abx
RESTRICTIVE LUNG DISEASES
i) what are three causes of intersitial LD? what shift is seen on spiromentry? what type of crackles are heard?
ii) what scan is gold standard? what is seen in ILD? (2) what has a better prognosis?
iii) what two markers are raised in sarcoid? what is seen on LN biopsy? on CXR? how is it tx?
i) exposure related (pneumoconises), systemic assoc, idiopathic
right shift on spiro
fine inspiratory crackles
ii) High res CT scan - honeycombing (poor prog) or ground glass change (better prog)
iii) sarcoid = high serum ACE and calcium
non caseating granulomas on biopsy
bilat hilar lymphado on CXR
tx with systemic CS and immsupp eg MTX, azathioprine, TNFai
i) name 8 apical lung fibroses? (THE SCARS)
ii) name one base of lung fibrosis
TB
HSP
Ext allergic alveolitis
Silicosis
Coal worker
Ank spond
Radiation
Sarcoid
ii) base = asbestos
ARDS
i) what is it? what is it not due to?
ii) what four things define it? (onset, CXR appear, Pao2, explanation)
iii) how is it mx? (3)
i) refractory hypoxaemia with reduced lung compliance and non cardiac pulmonary oedema (not due to HF)
ii) acute onset < 1 week, ground glass appearance on CXR, PaO2 < 300 (not responsive to o2), resp failure not explained by HF
iii) mx by treat UL cause eg sepsis
mech ventilation with low tidal vol
PEEP to prevent airway collapse
PULMONARY EMBOLISM
I) what wells score is high and low risk? what is the PERC rule?
ii) what is done if high risk? what scan?
iii) what is done if low risk? is tx given?
iv) how long is provoked tx for? how long is unprovoked tx?
i) high risk if > 4 and low if 4 or less
PERC - used to rule out PE (< 15% risk)
ii) high risk - interim anticoag with enoxaparin then CTPA for dx
if low risk - do D dimer - if positive - interim anticoag
iv) provoked - 3m tx with lmwh
unprovoked - longer tx eg 6m
