Flashcards in Interactive cases - Resp Deck (32)
how does COPD predispose to a sudden pnemothorax?
bulla form in COPD and then burst
what are the MoA of symbicort and tiotropium (2 drugs used in pt with COPD)?
Symbicort: steroid and long acting beta 2 agonist
what do you always ask about in pt who present as breathless?
PE or pneumothroax?
- signs of DVT?
- previous DVT/PE
- immobility, surgery, malignancy
what are the causes of SOB that have an onset of seconds?
- foreign bodies
what are the causes of SOB that have an onset of mins/hours?
- airways (inflammation/obstruction)
- chest infection (pus)
- acute HF (fluid)
what are the causes of SOB that have an onset of days/weeks?
- above that are not resolving so become chronic
- large pleural effusion
what is the management of a primary pneumothorax?
- <2cm: discharge, repeat CXR
- >2cm/SOB: aspirate and chest drain
what is the management of a secondary pneumothorax?
due to underlying lung disease
- <2cm: aspirate
- >2cm: chest drain
how does a pleural effusion look on a CXR?
how does fibrosis present on a CXR?
what is a fluffy air space shadowing?
caused by fluid or pus
pus takes longer to form
what is the acute management of PE?
- administer high flow O2
what is a consequence of a PE?
right heart strain
leads to heart axis deviation and a bundle branch block
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
how do you identify ECG BBBs?
- M in V1, W in V6 = RBBB (MaRRoW)
- W in V1, M in V6 = LBBB (WiLLiaM)
what is the management of an acute PE?
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)
what is the summary of care in a PE?
1. administer PE
2. CTPA or CXR
3. warfarin (once diagnosis is confirmed)
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
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
what is the presentation of pulmonary fibrosis?
- dry cough
- progressive SOB
- restrictive FEV1/FVC ratio
what are the DDx of pulmonary fibrosis?
- idiopathic fibrosing alveolitis
- connective tissue disease, RA
what is asbestosis?
pulmonary fibrosis due to asbestos
have to have fibrosis
what are the restricitve and obstructive FEV1/FVC ratios?
> 70%: restrictive (fibrosis)
< 70%: obstructive (COPD, asthma)
what is the typical presentation of COPD?
- chronic SOB
- no clubbing
- FEV1/FVC ratio <70%
- hyperinflation on chest Xray (diaphragm flattened, more than 7 posterior ribs)
what is the presentation of pulmonary TB?
- prone to growing in upper lobes
- weight loss
- night sweats
what is the presentation of extrinsic allergic alveolitis (Bird Fancier's Lung)?
- bi-lateral reticulonodular shadowing
- keeps pigeons
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)
6. circulation (heart)
8. everything else