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1

how does COPD predispose to a sudden pnemothorax?

bulla form in COPD and then burst

2

what are the MoA of symbicort and tiotropium (2 drugs used in pt with COPD)?

Symbicort: steroid and long acting beta 2 agonist
Tiotropium: anti-muscarinic

3

what do you always ask about in pt who present as breathless?

WBC
Wheeze
Breathlessness
Cough

4

PE or pneumothroax?

- signs of DVT?
- previous DVT/PE
- immobility, surgery, malignancy

5

what are the causes of SOB that have an onset of seconds?

- pneumothroax
- PE
- foreign bodies

6

what are the causes of SOB that have an onset of mins/hours?

- airways (inflammation/obstruction)
- chest infection (pus)
- acute HF (fluid)

7

what are the causes of SOB that have an onset of days/weeks?

- above that are not resolving so become chronic
- ILD
- malignancy
- large pleural effusion
- NM
- anaemia
- thyrotoxicosis

8

what is the management of a primary pneumothorax?

- <2cm: discharge, repeat CXR
- >2cm/SOB: aspirate and chest drain

9

what is the management of a secondary pneumothorax?

due to underlying lung disease
- <2cm: aspirate
- >2cm: chest drain

10

how does a pleural effusion look on a CXR?

pleural effusion

11

how does fibrosis present on a CXR?

reticulo-nodular patterm

12

what is a fluffy air space shadowing?

caused by fluid or pus
pus takes longer to form

13

what is the acute management of PE?

- administer high flow O2
- CXR
- ECG

14

what is a consequence of a PE?

right heart strain
leads to heart axis deviation and a bundle branch block

15

how do you interpret the ECG axis?

- Lead 1 +ve, lead 2 -ve = L deviation
- Lead 1 -ve, lead 2 +ve = R deviation
- if lead 1 and 2 are most -ve there is an axis deviation
- look at aVL - most +ve = L deviation
- look at aVL - most -ve = R deviation

16

how do you identify ECG BBBs?

- M in V1, W in V6 = RBBB (MaRRoW)
- W in V1, M in V6 = LBBB (WiLLiaM)

17

what is the management of an acute PE?

LMWH

18

what other managements are there?

- Bi-level Positive Airway Pressure (used in pt with a T2 resp failure)
- Warfarin: only when confirmed a PE diagnosis
- Thrombolysis: only used if pt is haemodynamically unstable (hypotensive)
- furosemide (for pleural effusions)

19

what is the summary of care in a PE?

1. administer PE
2. CTPA or CXR
3. warfarin (once diagnosis is confirmed)

20

what is oligaemia?

- happens in 2% of pt with PE
- is a collapse of vessels distal to clot
- shows a black patch in hilar region of R lung in CXR

21

What is a bulla>

- thin walled air filled space within the lung
- arises congenitally or in emphysema (idiopathic giant bullous emphysema)
- may rupture into pleural space causes pneumothorax
- DON'T put a tube into a bulla

22

what is the presentation of pulmonary fibrosis?

- dry cough
- progressive SOB
- clubbing
- restrictive FEV1/FVC ratio

23

what are the DDx of pulmonary fibrosis?

- idiopathic fibrosing alveolitis
- connective tissue disease, RA
- drugs
- asbestosis

24

what is asbestosis?

pulmonary fibrosis due to asbestos
have to have fibrosis

25

what are the restricitve and obstructive FEV1/FVC ratios?

> 70%: restrictive (fibrosis)
< 70%: obstructive (COPD, asthma)

26

what is the typical presentation of COPD?

- sputum
- chronic SOB
- no clubbing
- FEV1/FVC ratio <70%
- hyperinflation on chest Xray (diaphragm flattened, more than 7 posterior ribs)

27

what is the presentation of pulmonary TB?

- prone to growing in upper lobes
- cough
- sputum
- weight loss
- night sweats

28

what is the presentation of extrinsic allergic alveolitis (Bird Fancier's Lung)?

- SOB
- bi-lateral reticulonodular shadowing
- keeps pigeons

29

what are the steps to CXR interpretation?

1. AP/PA film
2. Name, DOB, date and time
3. quality of film (rotation --> spinous processes, inspiration, penetration)
4. airways
5. breathing
6. circulation (heart)
7. diaphragm
8. everything else

30

what causes the trachea to deviate?

- deviated away: pleural effusion
- deviated towards: lung collapse