resp Flashcards
(42 cards)
prophylactic Abx used in COPD
marcolides (azithromycin)
what does A1AT increase the risk of?
hepatocellular carcinoma
Management of acute bronchitis
oral doxycycline (if NOT pregnant- if pregnant use amoxicillin)
COPD- if the patient has raised eosinophils (regardless of FEV1) what therapy should be commenced?
ICS
most common organism causing infective exacerbations of COPD
Haemophilus influenzae
what are blue bloaters/ pink puffers?
blue bloater= chronic bronchitis
pink puffer= emphysema
diagnosis of COPD
spirometry- obstructive patter:
FEV1/FVC= 0.7
no change on reversibility testing
treatment pathway in COPD (non-acute management)
lifestyle- stop smoking, flu vaccinations
1- SABA (salbutamol/ terbutaline) or SAMA (ipratropium bromide)
2- if no asthmatic features= LABA (formeterol) + LAMA (tiotropium bromide)
- if asthmatic features (or raised eosinophils)= LABA + ICS
management of an acute COPD exacerbation
- nebulised bronchodilators (salbutamol an ipratropium)
- 02 sats 88-92%
- prednisolone
- ABx if infection
what is cor pulmonale?
right sided heart failure caused by chronic pulmonary arterial hypertension
commonly caused by COPD
clinical features of cor pulmonale
dyspnoea, fatigue, syncope
cyanosis, tachycardia, raised JVP
tricuspid regurgitation (pansystolic murmur)
what organs does A1AT affect?
lungs (bronchiectasis and emphysema- think breakdown of elastase)
liver (cirrhosis)
diagnosis of A1AT
low serum A1AT
liver biopsy- acid-Schiff-positive staining globules
pulmonary function tests- obstructive lung disease pattern and causes
FEV1 reduced
FVC reduced/ normal
FEV1/FVC ratio <0.7
causes:
- asthma
- COPD
- bronchiectasis
pulmonary function tests- restrictive lung disease pattern and causes
FEV1 reduced
FVC significantly reduced
FEV1/ FVC= normal/ increased
causes:
Pulmonary fibrosis
Asbestosis
Sarcoidosis
Acute respiratory distress syndrome
Infant respiratory distress syndrome
Kyphoscoliosis e.g. ankylosing spondylitis
Neuromuscular disorders
Severe obesity
what is sarcoidosis?
multisystem granulomatous disorder
presentation of sarcoidosis
lungs- mediastinal lymphadenopathy, pulmonary fibrosis, pulmonary nodules
systemic- fever, fatigue, weight loss
liver- nodules, cirrhosis, cholestasis
eyes- conjunctivitis, uveitis, optic neuritis
skin- erythema nodosum
sarcoidosis- bloods
hypercalcaemia
raised serum ACE
raised CRP
Sarcoidosis- CXR
hilar lymphadenopathy
sarcoidosis- gold standard investigation
histology- biopsy via bronchoscopy
sarcoidosis- treatment
only if symptomatic/ eye involvement
long term prednisolone (prescribe bisphosphonates alongside to protect bones)
methotrexate/ azathioprine second line
Describe a tension pneumothorax
Tension pneumothorax is caused by trauma to the chest wall that creates a one-way valve that lets air in but not out of the pleural space. The one-way valve means that during inspiration air is drawn into the pleural space and during expiration, the air is trapped in the pleural space. Therefore, more air keeps getting drawn into the pleural space with each breath and cannot escape. This is dangerous as it creates pressure inside the thorax that will push the mediastinum across, kink the big vessels in the mediastinum and cause cardiorespiratory arrest.
presentation of a tension pneumothorax
Tracheal deviation away from side of the pneumothorax
Reduced air entry on the affected side
Increased resonance to percussion on the affected side
Tachycardia
Hypotension
management of a tension pneumothorax
Insert a large bore cannula into the second intercostal space in the midclavicular line
