Flashcards in PT 2 - RESP Deck (14)
1. Q. How should COPD exacerbations be treated?
A. Mild - treated with short acting bronchodilators only
B. Moderate - treated with SABDs plus antibiotics and/or oral corticosteroids
C. Severe – hospitalization (20% of cases) or visits the emergency room. Severe exacerbations may also be associated with acute respiratory failure.
D. Commonly caused by: S.Pneumoniae (RUSTY SPUTUM), H.influenzae and M.catarrhalis
1. How might a patient with Pneumocystis Pneumonia (PCP) present? Tx?
A> Dry cough, EXERTIONAL dyspnoea (often profound), fever, often insidious onset. Co-existing opportunistic infections may also be present.
B> Form of [numonia caused by yeast-like fungus pneumocystis jirovercii – opportunistic infection (chemo, HIV)
C> Antibiotic of choice for PCP?High dose SEPTRIN (co-trimoxazole). Prophylaxis = co-trimoxazole or neb. pentamidine.
D> Fever, non-productive cough (sputm is too viscous to be productive), SOBOE, weight loss night sweats
1. Q. 5 complications of severe pneumonia?
A. Septicaemia – spread from lung parenchyma, can lead to metastatic infection e.g. endocarditis
B. Lung abcess – look for swinging fever, foul-smelling sputum, weight loss, haemoptysis, pleuritic chest pain
C. Atrial fibrilation esp. in elderly, may require beta-blocker
D. Pericarditis/myocarditis may complicate pneumonia
E. Hypotension – may be due to dehydration and sepsis-induced vasodilatation
F. Empyema – if recurrent fever, yellowish pleural effusion aspirated
G. Respiratory failure – type 1 is common, act if PaCO2 >6kPa
H. Other: worsening of pre-existing HF
1. Q. What % of CAP will have no identifiable pathogen?
A. Around 30%
1. Q. Describe the steps of asthma management
A. Step 1. SABA e.g. salbutamol (1 daily), if more or night symptoms +
B. Step 2. Inhaled corticosteroid e.g. beclomethasone
C. Step 3. LABA e.g. salmeterol
D. Step 4. High dose corticosteroid– consider leukotriene receptor antagonist e.g. monteleukast
E. Step 5. Daily oral corticosteroid e.g. prednisolone and refer to asthma clinic
1. Q. What symptoms are seen in sarcoidosis?
A. ‘SARCOID’ – multisystem chronic inflammatory condition usually presents with bilateral hilar lymphadenopathy (BHL) +- pulmonary infiltrates, +- skin/eye lesions – unknown cause, often affects middle age/young adults
B. Symptoms: fatigue, cough, stiffness/pain in joints/hands, seizures, wheeze
C. Skin – erythema nodosum
D. Arthritis esp. of feet, hands
E. Respiratory – bilateral hilar lymphadenopathy (BHL), pulmonary infiltrates
F. Cardiac – heart block, VT, heart failure
G. Ocular – anterior uveitis, can lead to blindness
H. Intracranial (brain) – chronic meningitis, seizures, neuropathy
I. Derangement of liver and renal function – hepatic granuloma (70% patients), hypercalcaemia (can lead to kidney stones and nephrocalcinosis)
J. *LOFGREN Syndrome – acute form of sarcoidosis = BHL + erythema nodosum + arthralgia
1. Q. What investigations can be done for sarcoidosis?
A. Diagnosis: biopsy – non-caseating granulomas (usually of lymph nodes, skin leisons, trans bronchial biopsy
B. High res CT: pulmonary infiltrations, lymph node identification (and CXR – cardiac involvement?)
C. Also: pulmonary function tests (decreased FVC, FEV1, gas transfer)
D. Check renal and liver: LFTs, creatinine, FBC etc etc, check bone profile!! (hypercalaemia, sarcoid macrophages produce 1,25-dihydroxyvitamin)
E. Specific tests: ACE usually raised, tuberculin test 80% +ve, raised ESR
A. Others: Mantoux test to rule of TB (langhan’s giant cells) = +ve in 80%
B. *Raised ESR (65% of cases) and raised serum ACE (limited use clinically and NOT for monitoring disease progression – secreted by NCGs)
C. *HISTOLOGY – non-caseating granulomas (NCGs) . Granuloma definition – a collection of epithelioid histiocytes (macrophages).
Q. Describe the treatment of sarcoidosis
A. No treatment = pts with hilar lymphadenopathy (bilateral lymph node enlargement of pulmonary hila) and no other evidence of lung involvement on CXR or LFTs – spontaneous remission within 2 years for 2/3s of pts
B. Stage IV (pulmonary fibrosis) ~ prednisolone 4-6wks (40mg/day) +/- bone protection, when there is infiltration or abnormal LFTs that persist for 6 months+
C. Immunosuppressant’s: methotrexate, azathioprine, cyclophosphamide: may be used in patients needing long-term steroids for disease control
1. Pt presents with bilateral hilar lymphadenopathy – what is the cause?
Pt presents with non-caseating granulomas – what is the cause?
A. Sarcoidosis, Bilateral hilar lymphadenopathy – lymphoma, pulmonary tuberculosis, bronchial carcinoma with secondary spread
B. Sarcoidosis, lymphoma, fungal infection, tuberculosis, and in response to foreign bodies and occupational exposure to beryllium
Q. Name an oral steroid, what SE are associated?
A. Prednisolone, SE = weight gain, mood swings, osteoporosis
Q. What are signs and symptoms of asthma
A. Symptoms: intermittent dyspnoea, wheeze, chest tightness, soutum, cough (nocturnal) – diurnal
B. Signs: tachypnoea, polyphonic wheeze, hyper inflated chest, hyper resonance
C. RCP3: daytime symptoms, effect on daily life, sleep (nocturnal waking, cough)
1. Q. Investigations for asthma
A. Peak expiratory flow- diurnal variation >20% on >3days/week for 2-4 weeks, OBSTRUCTIVE
B. Bronchodilator reversibility testing: baseline spirometry → salbutamol → repeat spiro after 15min → ↑FEV1 by >15%
C. Spirometry: decreased FEV1/FVC less than 0.7
1. Q. What score accesses probability of pulmonary embolism? What Ix? What tx?
A. Leg swelling/pain/vein enlargement, HR > 100bpm, immobilisation/surgery, previous DVT/PE, haemoptysis, malignancy
B. Ix: D-dimer, CTPA (alternative V/Q radio-nucleotide scan)
C. Tx: LMWH or fondaparinux (if renal failure, bleeding risk, haemodynamically unstable – unfractionated heparin)