For IPE Flashcards
(154 cards)
1
Q
Outline the MRC dyspnoea score
A
1 - not breathless unless doing strenuous exercise
2- SOB when walking on the level in a hurry or walking up a slight hill
3- walks slower than most people and stops after walking a mile at own pace
4- stops for a breath after walking about ten yards or after a few minutes of walking on the flat
5- too breathless to leave the house or breathless on getting dressed
2
Q
Define massive haemoptysis
A
> 240ml/ 24 hours
100ml/ day for 3 consecutive days
3
Q
Explain the management of massive haemoptysis
A
A to E assessment
Lie patient on side of the lesion
Oral transxaemic acid 5/7 or IV
stop anything that might be precipitating bleeding
Abx if signs of infection
Consider Vit K
Ct aortogram- may be able to do a bronchial artery embolisation
4
Q
What is the wells score for a DVT?
A
Previous DVT
active cancer or treatment with 6/12
Paralysis or recent immobilisation of the LL
Bedridden or major surgery requiring anaesthetic within the last 12 weeks
unilateral calf swelling >3cm
unilateral swollen superficial veins
unilateral pitting oedema
swelling of the entire leg
localised tenderness along the deep vein system
-2 points if other diagnosis as likely
5
Q
How do you use the wells score to assess for D dimer?
A
<= 1 - do a d dimer >= 2 - d dimer and USS
6
Q
How long is warfarin treatment continued for DVT?
A
3 months if provoked
>3 months if unprovoked
7
Q
What is the wells score for a PE?
A
Clinically suspected DVT +3
Alternative diagnosis less likely than PE -3
Previous DVT of PE 1.5
Active cancer or treatment within 6/12
Recent bedridden within the last 12 weeks
tachycardia > 100 1.5
haemoptysis
8
Q
How should the score of a patient on the Wells score for PE be interpreted?
A
> = 3 - high probability of a PE- CTPA and if delayed give treatment dose LMWH
1-2 - do a d dimer and then escalate if positive
9
Q
What are the sources of a PE?
A
DVT, RV thrombosis post MI, septic emboli, fat, air or amniotic fluid embolus and neoplastic cells.
10
Q
What scan can be used in CKD and why cant a CTPA be used?
A
V;Q matching
Contrast used in CTPA is contraindicated in renal impairment.
11
Q
What are the signs and symptoms of a PE?
A
SOB
Pleuritic chest pain
Cough and haemoptysis
Dizziness and syncope
12
Q
What may be seen on ECG in a PE?
A
tachycardia
RV strain
S1, Q3, T3
RBBB
13
Q
What should be done in the case of an unprovoked PE?
A
Follow up to assess for any underlying malignancies
- CXR and consider CT chest/ abdo and pelvis
urinalysis
14
Q
What is the consequence of multiple unprovoked PEs?
A
Leads to pulmonary hypertension and therefore may lead to right sided heart failure.
15
Q
How is a PE treated?
A
High flow O2 if desaturating
IV access - morphine and antiemetic
LMWH at treatment dose and start warfarin at the same time aiming for an INR of 2-3
16
Q
How does management change in a massive PE?
A
Alteplase can be given if haemodynamically unstable
10mg followed by 90mg infused over 2 hours
17
Q
What are the contraindications to thrombolysis?
A
haemorhagic stroke, CNS neoplasia, recent trauma/surgery, Gi bleed within 1 month, known bleeding disorder
18
Q
What is the definition of pulmonary consolidation?
A
Region of lung parenchyma that is filled with a liquid or solid
19
Q
How can we tell the difference between an effusion and consolidation on an XR?
A
Effusions will start at the bottom and will have a mensical sign
Effusion are homogenous and consolidation are hetergenous
Effusion will cause the costophrenic angle to be lost
20
Q
How can we tell the difference between an effusion and consolidation on physical examination?
A
Vocal fremitus and resonance is increased over consolidation and reduced over efffusion
consolidation is dull on percussion and effusion is stony dull
21
Q
What is an empyema?
A
pus in the pleura
22
Q
What is the treatment of empyema and when is it indicated?
A
Need to do an aspirate on aspirate would find
- pH <7.2
- purulent and turbid colour of the aspirate
Chest drain must be put in patients that meet these criteria
23
Q
What procedure can be done in a patient with recurrent effusions?
A
Pleurodesis- insert medical talc and wait for scarring to occur which reduces the space for a effusion to build up and therefore the chance of a pleural effusion forming.-
24
Q
What criteria is used to assess a pleural effusion and decide if its a transudate or an exudate?
A
Lights
25
What are the criteria looked at in lights criteria?
```
Appearance
protein content
Cholesterol content
Pleural fluid protein to serum protein ratio
LDH content
Pleural fluid LDH to serum LDH content
```
26
What are the causes of a pleural effusion transudate?
```
Left ventricle or congestive cardiac failure
COPD
intersitial lung disease
portal hypertension
SVC obstruction
```
27
What are the causes of a pleural effusion exudate?
```
malignancy
infection
trauma
PE
oesophageal rupture
inflammatory cause
```
28
Where should a needle be inserted with relation to a rib and why?
Upper border due to the neurovascular bundle in the lower border
29
Explain the treatment of a pleural effusion of unknown cause
Diagnosed via USS guided aspiration using cytology, culture and lights
- percuss the upper border and chose ICS 1 or 2 lower
May disappear as the cause is treated
*do not drain until cause is well established*
- bilateral can be assumed to be transudative and can just carryout drain
30
What is a haemothorax?
Bleeding into the pleural space
31
What is a chylothorax?
Chyle in the pleural space - often by disruption of the thoracic duct
32
What are the causes of a chylothorax?
Lymphoma and metastatic carcinoma
Traumatic injury
TB, sarcoidosis, cirhosis and amyloidosis
33
What are the symptoms of a pneumonia?
Cough, SOB, pleuritic chest pain, excess sputum production, fever, cyanosis and confusion
34
What will be found on examination of a patient with pnnuemonia?
```
Dull to percust
Crackles on inspiration
Pleuritic rub if complicated by pleural effusion
Bronchial breathing
Increased vocal resonance
```
35
What investigations should be done in a patient with suspected pneumonia?
CXR - see where is affected and cannot trigger pathway without ECG changes
sputum and blood cultures
Bloods - check for any end organ damage
basic obs - asses general unwellness
36
What score is used prognostically for pneumonia?
```
CURB65
C- confusion
Urea >7
Resp rate >30
BP <90 <60
Over 65y/o
```
37
What are the common micro-organisms in CAP?
Strep pnuemonia
H influenza
Mycoplasma pneumonia
38
What are the common micro-organism in HAP?
Psuedomonas auerginosa
| enterococci
39
What is the management of CURB 65?
1 - PO amoxicillin
2- PO doxycycline and amoxicillin
3+ - Iv co amoxiclav and doxy - should have a HIV screen and urine sample for legionellas and consider ITU referral
If in hospital require a VTE prophylaxis pathway
40
What is the follow up for Pneumonia?
Test for HIV in complicated or recurrent cases
Test for Ig and pneumonococcal and haemophilus IgGs
Out patient clinic in 6 weeks for re XR and make sure fully resolved
41
What are the complications of pneumonia?
```
Abscess
Effusion
Empyema
AF
Septicaemia
T1 respiratory failure
```
42
What are the possible answers as to why treatment for pneumonia is failing?
CHAOS
- Complication
- Host - immunocompromised
-A- antibiotic - wrong dose, poor absorption, incorrect choice for pathogen
- O- organism- resistance to antibiotic, unexpected organism not covered by treatment
S- secondary diagnosis or wrong diagnosis - TB, PE, cancer and COPD
43
What type of pneumonia are heavy drinkers and DM more likely to suffer from?
Klebsiella pneumonia
44
What is the pathophysiology of bronchiectasis?
Permenant enlargement of the airways in the lungs - exhibit more mucus clearance and there is a predisposition to reoccurance or chronic bronchial infection
45
What are the causes of bronchiectasis?
Mainly CF
Primary ciliary dyskinesia or Kartageners syndrome
Damage to the airways from infection and inflammation- Pneumonia, TB and CF
Infection- measles, pertussis
RA and UC
46
What are the signs of bronchiectasis?
Recurrent infections = psuedomonas or haemophilus influenzae
Excessive sputum production = haemoptysis - breathlessness with wheeze
Caused by obstruction of the airways due to scarring of the bronchioles
47
What are the investigation useful in bronchiectasis?
Spirometry will show an obstructive picture
O2 sats reduced
XR
CT will show ring sign and tram tracking on bronchoscopy
48
What is the diagnostic feature on CT on bronchiectasis?
Bronchioles 1.5 times wider than surrounding vessels
49
What is the treatment and management of bronchiectasis?
Treat the symptoms to make life easier
- Abx course - longer than normal and patients should have a rescue pack at home to start if they are feeling unwell.
- patients should have a supply of sputum culture pots for if sputum changes
Physio
Inhaled therapy to make easier to breath and reduce SOB- inhaled saline to break up mucus and make more liquidy
50
What is interstitial lung disease?
Number of different conditions that are characterised by chronic inflammation or fibrosis in the interstitium
51
What are the risk factors for interstitial lung disease?
```
Smoking
Occupation
Keeping birds
Can be drug induced
previous infection
```
52
What are the signs and symptoms of interstitial lung disease?
```
dyspnoea on exertion
non productive cough
abnormal breathing sounds- fine inspiratory crackles
clubbing
reduced chest expansion
May have signs of pulmonary hypertension
```
53
What investigations are carried out on patients who have interstitial lung disease?
```
O2 saturations
Arterial blood gas
Restrictive pattern on spirometry
CXR or CT -
> Diffuse opacificiation throughout affected areas of the lung
> Ground glass appearance on XR
> Honey combing appearance on CT
Biopsy and histology to confirm
```
54
What is the management of interstitial lung disease?
```
Refer to specialist clinic
Stop smoking
pulmonary rehab
O2 for ease of living
pallative care
Prednisolone
N acetylcysteine
```
55
What further testing can be done in those with intersitial lung disease?
- Test for SLE
-RhF
- ANCA and anti-GBM
ACE and IgG to serum precipitants
56
What is pulmonary firbosis?
Fibrosis within the lungs due to previous damage or trauma but may also be idiopathic
57
What are the S&Ss of pulmonary fibrosis?
```
dry cough
exertional SOB
WL
flu like symptoms
cyanosis
finger clubbing
fine inspiratory crackles
```
58
On spirometry what is someone with pulmonary fibrosis likely to have?
Restrictive deficit
59
What is sarcoidosis?
Rare multi organ condition that leads to a non caesating granulomatous infection
Very commonly affects the lungs
60
What are the signs and symptoms of sarcoidosis?
```
Lymphadenopathy
Erythema nodosum
Persistent dry cough
Hepatosplenomegaly
Enlargement of the lacrimal and parotid glands
General malaise and aches in the bones
```
61
What may be seen in blood tests in someone with sarcoidosis?
Increased Ca
Increased ACE
Lymphopenia
62
What changes may be seen on a CXR of a patient with sarcoidosis?
```
Normal
Bilateral lymphadenopathy
Lymphadenpathy and parenchymal lung disease
Parenchymal lung disease
Lung fibrosis
```
63
What would a biospy of a patient with sarcoidosis show?
Non caesating granulomas
64
What investigation should be carried out in a patient with saroidosis suffering from a headache and why?
CT or MRI head
| Risk of neuro sarcoidosis
65
What is the treatment of sarcoidosis and what is the indication for these?
Analgesia - relieve symptoms
Corticosteriods - help suppress the immune system
> indications - parencymal lung disease, uveitis, hypercalcaemia, neurological or cardiac involvement
66
What is asbestosis?
Restrictive lung deficit caused by inhalation of asbestos particles
67
What are the signs and symptoms of asbestosis?
Dyspnoea - progressing to shortness of breath at rest
Bibasal fine inspiratory crackles
Clubbing
May lead to cor pulmonale and heart failure signs
May have pleural effusion
68
What is important about pleural plaques in relation to asbestos?
Benign condition that under goes no malignant change
| Generally seen 20-40 years after exposure
69
What will be seen on lung function testing in a patient with asbestosis?
Restrictive deficit`
70
What will be seen in imaging of a patient with asbestosis?
```
CXR
- Reticular opacities
- may have pleural plaques
CT
- reticulation, honey comb fibrosis and signs of bronchiectasis
```
71
What is the management of a patient with asbestosis?
Smoking cessation
prevent further exposure to asbestosis
Home o2 for hypoxic patients
Vaccinations
72
What are the different types of pneumothorax
```
Spontaneous
- primary
-secondary
Traumatic
Iatrogenic
Tension
```
73
What are the risk factors for a spontaneous pneumothorax?
```
lung disease
smoking
male
diving
connective tissue diseases
```
74
What are the signs and symptoms of a pneumothorax?
```
Sudden onset dyspnoea
Pleuritic chest pain
reduced chest expansion
silent over affected lung
hyper resonant to percussion
```
75
What is the treatment of a spontaneous pneumothorax
look up guidelines
76
When should surgery be considered in a pneumothorax?
Bilateral
| failed to inflate after 48 hours
77
What is the pathophysiology behind a tension pneumothorax??
Air enters the pleural space on inspiration through a tear in the parencyma but cannot exit on expiration leading to pressure building up and compressing the structures in the thorax
78
What are the signs of a tension pneumothorax?
Tracheal deviation away from the affected side
May get movement of the apex beat - mediastinal shift can lead to cardiac arrest
Patients will be haemodynamically unstable with increased HR, respiratory distress, hypotension and SVC obstruction
79
What is the management of a tension pneumothorax?
Remove air as fast as possible
Insert large bore cannula into the 2 ICS MCL
Then place a chest drain into the 5 ICS MAL
80
Define COPD
Progressive, not fully reversible obstructive lung disease associated with smoking
Encompasses chronic bronchitis and emphysema
Doesnt change dramatically day on day
81
Explain the pathophysiology behind COPD
```
Mucus gland hyperplasia
Loss of cilial function
Chronic inflammation
Fibrosis of small airways
Alveolar wall disruption causing irreversible enlargement of air space distal to the terminal bronchioles
```
82
What are the signs and symptoms of COPD?
```
Chronic SOB- minimal diurnal variation
productive cough
wheeze
cyanosis
hypertrophy of the accessory muscles
Barrel chest
reduced lung expansion- decreased breath sounds
May have cor pulmonale
```
83
What does lung function test show in COPD?
Obstructive
| FEV1:FVC = <0.7
84
What is the management of COPD?
Care care bundle for COPD with multidisciplinary team to improve QoL
- Stop smoking
- Encourage exercise and give physio to increase exercise tolerance
- Pulmonary rehab
- Bronchodilators - short acting muscarinics antagonists, Short acting B agonists
- Mucolytic therapies
- Add inhaled corticosteriods
- Add LAMA and LABA
- Surgical volume reduction
85
What are the indications for O2 therapy?
PO2 consistently less than <7.3
Levels <8kPa if signs of heart failure or PHTN
Must not be smoker and Co2 retainers
86
What are the complications of COPD?
```
Acute exaccerbation
polycythemia
Respiratory failure
HF
pneumothorax
```
87
What are the most common infections in COPD?
Haemophilus influenzae
Strep pneumonia
Moraxella Catarrhalis
88
What are the signs and symptoms of infective exaccerbations of COPD?
Increased SOB with reduced exercise tolerance
Increased cough with increased sputum volume and change in colour
Increased wheeze and chest tightness
infective signs - fever, confusion and night tightness
89
What is the treatment for infective exaccerbations of COPD?
Neb Salbutamol and iatropium bromide
steriods - 30mg prednisolone STAT and then 7 days PO
Consider aminophylline
O2 and NIV
Only ABx if sputum culture or infective signs
90
What is the condition associated with early onset COPD?
Alpha 1 anti-trypsin deficiency
91
How does A1ATD present?
May affect liver but always affects the lungs
Lung disease presents in <30y/o (earlier again if smokers)- tends to affect the upper lobe
Liver disease - not all patients
- Neonates - increased risk of hepatitis and jaundice
- Adults - develop liver failure and increased risk of hepatocellular carcinoma
92
What is the treatment A1ATD?
No smoking and reduced alcohol intake
Manage COPD and liver disease - young patients may eventually need a transplant
Hepatocellular carcinoma screening
Recombinant A1AT therapy
93
What is CF?
Auto R disease caused by abnormal genes for the cystic fibrosis transmembrane conductance regulator which would normally allow Cl ions through
94
In what organs does CF present?
Lungs
Pancreas
Bowel
Vas deferens- do not form leading to male infertility
95
What are the problems in the lungs of a patient with CF?
Thick stagnant mucus leads to recurrent infections and the development of bronchiectasis
can get an obstructive picture on lung function testing
96
What sort of acid: base imbalance do people with CF get and why?
Hypokalaemia hypochloraemia metabolic acidosis
> due to the loss of Cl - cannot diffuse back in from the skin and therefore Na is pulled out using the gradient and as a result the kidney absorbs more Na and losses more K
97
What is used in the diagnosis of CF?
Heal prick test at 5-9 days old
Sweat production
Genetic testing can help choose treatment
Faecal elastase reduced in pancreatic insufficiency
98
What is used to measure the severity of an infection in a CF?
Lung function and weight
| > lung function will show when they can be considered for transplant
99
Explain the problems with CF patient's pancreas
Insufficiency of exocrine enzymes - need creon supplements to digest and maintain weight
May get a transient diabetes- diagnosis made by insertion of a device that gives reading over 5 days
Increased risk of pancreatitis
100
What problems occur in the bowel of a patient with CF and how should these be managed?
Intestinal obstruction at the ileocaecal junction- build up of mucus and stop of feacal movement
DIOS- distal intestinal obstruction syndrome - presents with pain in abdomen, vomitting, reduced bowel sounds, tender when palpation the RIF- treated with laxatives
Meconium ileus - blockage of the ileus due to very concentrated meconium- present with vomitting bile and reculance to feed - treated with an enema and may need to drain bile in the stomach.
101
Explain Cf in the liver
Affects the passage of bile from the liver and gall bladder to the intestine
- bile is dehydrated and more acidic than normal
- more likely to get gallstones due to stasis
- Fatty stool
- obstruction of the outflow tracts can lead to fatty liver disease and then cirrhosis
102
What is the management and treatment CF?
Physio
Home nebulisers and mucolytics
Diet and advice on supplements - creon
Prophylaxtic antibiotics and prompt treatment of infections
Vaccines - influenzae and pneumococcal
Stay away from CF patients
Avoid jaccuzzis due to risk of psuedomonas
Supplements of fat soluble vitamins
Increased risk of osteoporosis so consider Vit D and Ca
103
What is primary ciliary dyskinesia?
Auto R inherited condition causing immobility and poor mucus clearance in the lungs
104
What are the features of Kartenger's syndrome?
Primary ciliary dyskinesia
Situs invertus and dextrocardia
Bronchiectasis
Abnormal frontal sinuses leading to chronic sinusitis
105
What are the signs and symptoms of Kartenger's sydnrome?
```
Neonatal respiratory distress
nasal polyps
COPD or bronchiectasis
Infertility in both sexes
Signs of situs invertus
```
106
What is seen on imaging with patient with Kartgeners?`
CXR - detrocardia, lung over inflation, bronchial wall thickening and peribronchial infiltate
CT - bronchiectasis and involvement of the peribronchial sinuses
lung function test - obstructive due to blocking of the airways by mucus
107
What is the management and treatment of Kartgener's syndrome?
Long term ABx
inhaled bronchodilators
Mucolytics and chest physio
Vaccines
108
What are the different types of lung cancer?
- Small cell
- Non small cell
- Mesothelioma
109
What are the signs and symptoms of lung cancer?
Often insipid
Any respiratory symptom- Chronic cough, wheeze, haemoptysis
Chest pain and SOB
SVC obstruction - facial swelling, visible vein in the neck and raised JVP
Horner's syndrome- Miosis, ptosis and ipsilateral anhydrosis
Hoarse voice with or without bovine cough
110
What paraneoplastic syndrome may present with lung cancer?
```
Cushing syndrome
Hypercalcaemia
Thromboembolism
SIADH
Prolactinaemia
```
111
What are the sites that lung cancer common metastasize to?
```
Liver
Adrenal gland
Bone
Pleura
Brain
Other lung
```
112
What are the investigations needed in a patient with suspected lung cancer?
Blood tests - FBC, U&Es, LFTs, Ca and INR
CXR - lymph node enlargement, pleural effusion, collapse, bony secondarys, pulmonary opacificities
Staging CT - spiral CT of thorax, abdomen and pelvis
PET scan for mets
Histology and biospy - Biopsy can be done under USS or CT guidance
113
What is the WHO performance scale?
0- normal
1 -restriction of strenuous activity but able to carry out light work
2 -Ambulatory and capable of all self care but unable to carry out any work activities - up and about >50% working hours
3 - capable of only limited self care - confined ton bed or chair more than 50% waking hours
4 - completely disabled - totally confined to bed or chair
5 - dead
114
What are the palliative management options for lung cancer?
Stenting
Radiotherapy and dexamethasone to shrink cancer
Pleuroadhesis - reduce pleural space to reduce risk of the pleural effusion
chest physio and breathing exercises
115
What is mesothelioma?
tumour of the mesothelial cell of the lung
116
Where do mesothelioma occur?
Peritoneum, pericardium, testes, abdo organs
117
What are the signs and symptoms of mesothelioma?
```
Chest pain - progressive, pleuritic, dull and diffuse
dyspnoea and cough
weight loss and anorexia
pleural effusion
haemoptysis
```
118
What are the investigations for suspected for mesothelioma?
CXR and CT - pleural mass or masses, pleural effusion, damage to the rib cage, lymphadenopathy and sign of asbestos exposure
PET - pick up mets
USS guided biopsy
119
What are the treatment options of mesothelioma?
Surgery - debulking to remove most in pallative
Chemo- cisplatin
Radiotherapy- pain control in large tumours
120
What is atopic triad?
asthma, atopic dermatitis and allergic rhinits
121
What is the pathophysiology of asthma?
Airway damage which leads to shedding and subepithlelial fibrosis with BM thickening
Inflammatory reaction characterised by eosinophils, T lymphocytes and mast cells
Cytokines increase inflammatory response
Increase number of mucus secreting goblet cells and smooth muscle hyperplasia and hypertrophy
122
What are the signs and symptoms of asthma?
Cough with diurnal variation- cough at night indicates poor control
Polyphonic wheeze
SOB triggered by stimuli
123
What are some of the trigger for asthma?
NSAIDs, B blockers, cold weather, exercise, stress allergens and smoking
124
What are the differentials for a wheeze?
Bronchitis, pulmonary oedema, FB, allergic reaction, GORD, COPD. vocal cord dysfunction
125
How is the diagnosis of asthma made?
```
Reduced FEV 1:FVC ratio and reduced peak expiratory flow
FEV1 will increase after salbutamol
Bronchoalevolar challenge
induced sputum - eosinophillia
Skin prick test for atopy
Total IgE
FENO
```
126
What is the management of occupational asthma?
Serial measurement of PEF recommendation at work and at home
Refer to specialist
127
What are the features of well controlled asthma?
```
No exaccerbations
No PRN salbutamol
No night waking
<20% dirunal variation
normal lung fucntion
```
128
What is the management of asthma?
1 - SABA
2 - SABA and ICS
3- SABA, ICS and montelukast
4- Add LABA
129
What are the differentials of eosinophilia?
```
Parasite infection
Atopy
SLE
lymphoma
vasculitis
```
130
How should asthma be managaed?
Every patient should have a care management plan and a PEFR
Quit smoking
Avoid allergens
Weight reduction
Taught about inhaler technique and compliance
131
What are the features of a mild asthma attack?
No features of a severe asthma attack
| PEFR >75%
132
What are the features of a moderate asthma attack?
No features of a severe asthma attack
| PEFR 50-75%
133
What are the features of a severe asthma attack?
PEFR 33-50%
cannot complete a sentence in one breath
HR >110
RR>25
134
What are the features of a life threatening asthma attack?
PEFR <33%
sats <92% or ABG <8kPa
Cyanosis, poor resp effort, near or fully silent chest
Exhaustion, confusion, hypotension and arrhthymia
Normal PCO2
135
What are the features of near fatal asthma attack?
Rising CO2
136
What is the management of asthma attacks?
A to E
Aim for SpO2 94-98% - titrate to needs
5mg neb salbutamol - can be done back to back but be warry of increased HR
40mg prednisolone PO or 100mg Hydrocortisone
IF SEVERE
- neb iatropium bromide
IF LIFE THREATENING OR NEAR FATAL
- Urgent ITU referral
- Portalable CXR
- consider aminophylline
137
What are the features for safe discharge after exacerbation?
```
PEFR >75%
stopped nebs and on TTO for 24 hours
in patient review by asthma nurse
PROVIDE
PEFR meter and written asthma plan
at lead 5 days oral prednisolone
GP follow up within 2 days
Resp clinic follow up within 4 weeks
```
138
What is the bacteria causing Tb?
Mycobacterium Tuberculosis
139
What are the signs and symptoms of TB?
```
Pleuritic chest pain
SOB
Coughing - yellow/green sputum
WL
fever, malaise and night sweats
```
140
What are the non resp symptoms of TB?
Erythema nodosum
Lymphadenopathy
Meningitis
Pericardial effusion
141
How does military Tb spread?
Through the pulmonary venous system
142
What are the investigations for suspected TB?
CXR - areas of consolidation and cavitation
Blood tests - test for HIV
Sputum samples - 3 should be done ideally from morning samples - culture for acid fast bacteria
143
What is the management of TB?
Patient should be quarantined
If unsure treat as pnuemonia until proven otherwise
If suspicious start RIPE treatment - need visual acuity, LFTs and consider directly observed therapy
> Pyridoxine as prophylaxis against peripheral neuropathy
144
What is OSA?
Muscles relax when sleeping and if patients have excess weight on their neck then their airway will collapse which are terminated by partial arousal
145
What are the risk factors for OSA?
Increasing age, neuromuscular disease and use of sedatives
146
What are the signs and symptoms of OSA?
Snoring
Waking in the night
nocturia
excessive day time sleepiness - Epworth scale
147
How is OSA diagnosed?
Sleep studies - overnight pulse oximetry
Limited sleep studies - monitor movement, snoring, O2 sats, heart rate, abdo and chest movement and limb movement
Polysomnography - EEG and EMG to limited sleep study
148
What is the treatment of OSA?
Treatment based on symptoms and QoL rather than investigations
Lifestyle - decreased weight, sleep on side and avoid sedatives
Monitor BP
Treat snoring with mandibular advancement devices
Significant - consider CPAP
149
What is the difference between the 2 types of resp failure?
Type 1 - low O2 only
| Type 2 - Low O2 and high CO2
150
What are some causes of type 1 resp failure?
Pneumonia, PE, pulmonary oedema, asthma, ARDS
| Treat with CPAP
151
What are some causes of type 2 resp failure?
Sedative drugs, flail chest, end stage pulmonary fibrosis
| treat with NIV
152
What is the pathophysiology behind anaphylaxis?
IgE binds to antigen which leads to mast cell and basophil increased leading to increased histamine release and body response
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What are the signs and symptoms of anaphylaxis?
itching, urticaria and angioedema, hoarseness, progressive stridor and bronchial obstruction, monophonic wheeze, chest tightness from bronchospasm
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What is the management of an anaphylaxis?
Remove trigger and maintain airway - 100% sats
IM adrenaline - 1:1000 0.5 grams - can be repeated every 5 minutes
200mg hydrocortisone
10mg IV chlorphenamine
give salbutamol to control bronchospams
