Year 4 Flashcards
What are the 2 classifications of a pleural effusion?
Transudate
Exudate
Relates to the protein content of the effusion.
What is defined as a transudate?
A protein content of <30g/L.
Looks clear on aspiration.
What are the 4 main causes of transudate pleural effusion?
Heart failure (most common)
Hypoalbuminaemia
Hypothyroidism
Meig’s syndrome
What is defined as an exudate?
A protein content of >30g/L.
Looks cloudy on aspiration.
What are 3 common causes of an exudate?
Infection (most common)
Connective tissue disease
Neoplasia
If protein content of pleural effusion is borderline, what can be used to determine if exudate or transudate?
Light’s critera
What are the 3 criteria involved in Light’s criteria for determining if a pleural effusion is an exudate?
Pleural fluid protein/serum protein is >0.5
Pleural LDH/serum LDH is >0.6
Pleural LDH > 2/3rds of the upper limit of normal serum
Low glucose within pleural fluid is suggestive of which 2 diagnoses?
Rheumatoid arthritis
Tuberculosis
Raised amylase within the pleural fluid is suggestive of which diagnoses?
Pancreatitis
Oesophageal perforation
Blood-stained pleural aspirate is indicative of which 3 conditions?
Mesothelioma
PE
Tuberculosis
What occurs in a transudative pleural effusion?
Too much fluid within blood vessels, leading to leakage into the interstitial space.
A result of increased hydrostatic pressure, and decreased oncotic pressure.
What is hydrostatic pressure?
The force that blood exerts on the vessel walls. Normally referred to as blood pressure.
What is oncotic pressure?
The force by which fluid moves from areas of low solute to high - as per osmosis.
Considers fluid level in relation to highly concentrated the solute (proteins) are.
How does a reduction in oncotic pressure affect fluid levels within blood vessels?
As body thinks protein has been diluted, water is removed from vessels into interstitial space.
What causes an exudative pleural effusion?
Inflammation of pulmonary capillaries, resulting in friable, leaky vessels.
Allows large proteins (e.g. LDH) into the interstitial fluid.
What is the procedure of aspirating a pleural effusion called?
Thoracocentesis
Does COPD cause finger clubbing?
No
What is first-line COPD management?
SABA/SAMA
What is second-line COPD management in those WITH asthmatic features?
Add LABA+ICS to first-line therapy.
What is second-line COPD management in those WITHOUT asthmatic features?
Add LABA+LAMA therapy to SABA.
Can LAMA be added to patient on SAMA as first-line management?
No, if adding LAMA, change SAMA to SABA.
What is the purpose of carbocisteine therapy in COPD?
Acts to break down mucus.
Taken orally.
Which antibiotic can be given prophylactically in COPD?
Azithromycin
What does raised bicarbonate, alongside low pH, and raised pCO2 indicate?
Respiratory acidosis with metabolic compensation.
Indicates chronic issues as kidneys take a while to respond.
Which ABG sign is seen in both type 1 and type 2 respiratory failure?
Low pO2
How is type 1 and type 2 respiratory failure differentiated?
Type 1 has low pO2 and NORMAL pCO2.
Type 2 has low pO2 and HIGH pCO2.
How may O2 therapy be disadvantageous in COPD?
In COPD, O2 depletion drives respiration - this cannot be overcome, as always deficient.
When external O2 is introduced, respiratory drive is reduced, thus increasing CO2 retention further.
What severity of asthma attack is suggested by a PEFR of 50-75%?
Moderate
How is speech, pulse and respiratory rate affected in moderate asthma?
Speech normal
RR<25/min
Pulse<110bpm
What severity of asthma attack is suggested by a PEFR of 33-50%?
Severe
How is speech, respiratory rate and pulse affected in a severe asthma attack?
Can’t complete sentences
RR>25/min
Pulse>110bpm
Which form of asthma attack is associated with a PEFR <33%?
Life-threatening
How are O2 saturations affected in life-threatening asthma?
<92%
Silent chest, cyanosis, or feeble respiratory effort are associated with which severity of asthma attack?
Life-threatening
Bradycardia, dysrhythmia or hypotension are associated with which severity of asthma attack?
Life-threatening
Signs of exhaustion or confusion are associated with which severity of asthma attack?
Life-threatening
May lead to coma.
In life-threatening asthma, how is pCO2 affected?
Will be normal.
Suggests failing respiratory effort.
How does salbutamol influence potassium levels?
Can cause this to be taken up by cells more eagerly.
How does acute asthma present on ABG?
Respiratory alkalosis followed by respiratory acidosis.
If normal pCO2, worry about life-threatening severity.
What are 3 smoking cessation therapies available on the NHS?
Varencicline
Bupropion
Nicotine replacement therapy (NRT)
Which smoking cessation therapy is NOT contraindicated in pregnancy?
Nicotine replacement therapy (NRT)
Which smoking cessation therapy is not contraindicated in those breastfeeding?
Nicotine replacement therapy (NRT)
How is smoking cessation managed during pregnancy?
Self-help and CBT - if this fails give nicotine replacement therapy.
What lung manifestation is seen in alpha-1-antitrypsin deficiency?
Emphysema
Seen in young, non-smokers.
How does alpha-1-antitrypsin deficiency affect spirometry?
Produces an obstructive pattern.
What other organ system, outwith the lungs, is affected in alpha-1-antitrypsin deficiency?
Liver
Causes cirrhosis/malignancy in adults and cholestasis in children.
Which organism is most commonly seen in those with bronchiectasis?
Haemophilus influenzaeW
What is the most common form of CXR?
PA
Why is a pneumothorax most likely to be seen at the top of a CXR?
As CXR usually taken with patient erect, and air rises.
What is meant by the meniscus sign on a CXR?
If fluid present within a lobe, the lateral wall will appear higher than anterior/posterior regions - looks like a meniscus.
At which stage of inspiration should a CXR be taken?
At the end of a full inspiration.
What does a flatter than expected diaphragm and smaller than expected heart on a CXR indicate?
Hyperinflation
Is the heart larger on PA or AP CXR?
AP
As it lies more anteriorly.
How does atelectasis impact the trachea?
On CXR, trachea will appear pulled TOWARDS the side of the lesion.
How would a tension pneumothorax impact the positioning of the trachea?
On CXR, will be pulled AWAY from the side of the lesion.
What is the ‘ABCDE’ of pulmonary oedema on a CXR?
Alveolar opacification
Batwing oedema
Cardiomegaly
Diffuse interstitial thickening
Effusion
Which lung hilum should lie higher than the other?
Left
Due to the position of the pulmonary arteries.
What may an enlarged heart border indicate?
Ventricular enlargement
Pulmonary hypertension
Poor inspiratory effort (hyperinflated)
Which diaphragm should lie slightly higher on a CXR?
Right diaphragm
How much fluid should be present if blunted costophrenic angles are seen on a CXR?
Atleast 150ml
What does ‘OSHITMAN’ of acute asthma management stand for?
Oxygen
Salbutamol nebuliser
Hydrocortisone IV/Prednisolone oral
Ipratropium
Theophylline
Magnesium sulphate
Anaesthetic review
