Ques for Resp and Notebook Flashcards
Causes of exudative pleural effusion
Infections – pneumonia or TB (ie. parapneumonic effusion)
Malignancy – bronchial carcinoma, mesothelioma or lung metastases
Inflammatory conditions – rheumatoid arthritis, lupus or acute pancreatitis
Pulmonary infarction – secondary to a pulmonary embolism or following trauma
Chylothorax
Oesophageal perforation
IM COPI
change in permeability of vessels
Causes of transudative pleural effusions
Increase the capillary hydrostatic pressure – forcing fluid out of the pulmonary capillaries into the pleural space (eg. congestive cardiac failure)
Reduce the capillary oncotic pressure – impairing the reabsorption of fluid from the pleural space into the pulmonary capillaries (eg. cirrhosis, nephrotic syndrome/chronic kidney disease, and gastrointestinal malabsorption/malnutrition as seen in coeliac disease)
Imbalance of starling forces
Which lung cancers are sensitive to chemotherapy?
Small cell lung cancers - often have chemo and radiotherapy combined
(non-small cell are not)
Which pneumonia organism causes deranged LFTs and erythemtamous lesions?
Mycoplasma pneumoniae - causes erythema multiforme
What is criteria for exudative pleural effusion?
- Protein >30g/L
- Pleural protein: serum protein >0.5
- Pleural LDH: serum LDH >0.6
Management of acute bronchtiis if patient stable based on CRP
- CRP 20-100 = delayed prescription
- CRP >100 = offer prescription (usually doxycycline for 5 days)
- If no raised CRP and stable, consider analgensia and good oral fluid intake
When to refer to urgent cancer pathway (2WW resp)?
- Have CXR findings that suggest cancer
- 40 or over with unexplained haemoptysis
What is the most common chemical cause for occupational asthma?
Isocyanates - found in factories producing spray paint and foam moulding using adhesives - should measure peak flow at and away from work
Causes of obstructive spirometry pattern
- COPD
- Asthma
- Bronchiectasis
- Bronchiolitis obliterans
Causes of restrictive pattern on Spirometry
- Pulmonary fibrosis
- Asbestosis
- Sarcoidosis
- ARDs
- IRDs
- Kyphoscoliosis (eg ankylosing spondylitis)
- Neuromuscular diseases
- Severe obesity
At what point should you do an ABG in acute asthma exacerbation?
When O2 sats are below 92%
What advice should all pts following a pneumothorax be given?
Stop smoking if they stop - reduces risk of further episodes (can travel 2 weeks after aspiration or 1 week after successful CXR follow up)
Management for primary pneumothorax
- If pneumothorax is <2cm and pt is not short of breath - consider discharge
- If >2cm and/or SOB - aspiration
- If this fails, insert chest drain
Management for secondary pneumothorax
- If pt is >50 and it is >2cm and/or SOB = chest drain
- Aspiration if between 1-2cm - if fails, chest drain
- If less 1cm - oxygen and admit for 24hrs
- ALL pts should be admitted for 24hrs if secondary
What is the only smoking cessation option for women who are pregnant?
Nicotine replacement therpay - vaping is not advised as unknown effects on foetus but NICE says do not discourage if pts have successfully stopped smoking via this
3 most common bacterial causes of COPD exacerbations
Haemophilus influenzae
Moraxella catterhalis
Streptococcus pneumoniae
O2 sats targets for CO2 retainers
88-92%
What pleural characteristics are suggestive of an empyema using Lights criteria?
- Pleural fluid LDH >1000 = empyema
- Exudate crteria - eg pleural:plasma protein ratio >0.5, pleural to plasma LDH ratipo >.06
- Pleural fluid pH <7.3
- Low pleural glucose conc <1.6
Management of empyema
Prompt drainage and commence abx therapy
What primary cancer often causes ‘cannon ball mets’ shown on CXR?
Renal cell cancer - but can be choriocarcinoma and prostate cancer too
Indications for admission for asthma exacerbation
- life-threatening asthma, severe asthma with inadequate response to initial treatment
- previous near-fatal attack
- pregnancy
- presentation at night
What is Wolff Chaikoff effect?
- Body rejects large quantities of iodide so prevents thyroid from synthesising large quantities of thyroid hormone –> hypothyroidism
- Iodine induced hypothyroidism
Cause of Wolff Chaikoff effect?
- Diet excess Iodine
- Amiodarone - contains iodine
- Contrast agent
What is Jod-Basedow effect?
- Hyperthyroidism induced by excess exogenous iodine exposure
