resp Flashcards
adult (>16) asthma investigations
1st= eosinophil (raised)+ FeNo (50 or >)
2nd= Spirometry + reversible bronchodilator (salbutamol)
-10% raise FEV1 from predicted OR 12% or more increase FEV1 + increase volume 200mls or more
Spirometry not available= PEF twice daily for 2 weeks
-diagnose if 20% variability
still not confirmed:
-refer for bronchial challenge test
-diagnose asthma is hyper responsiveness present
5- 16 year old investigations asthma
1st= FeNO (35 or >)
not raised/ not available= spirometry + reversible bronchodilator
-diagnose if 12% or more increase in FEV1 OR
-1-% FEV1 raise from predicted FEV1
spirometry not available= PEF twice daily for 2 weeks
-diagnose if 20% variability
still not diagnosed= Skin prick test for house mite dust or total IgE
Still not diagnosed= refer to paeds + bronchial challenge test
investigations asthma <5 years
clinical
signs of moderate asthma attack
PEF 50-75% best or predicted
normal speech
RR<25
pulse <110
signs of severe asthma attack
PEF 50-33
Can’t complete normal sentences
RR >25
Pulse >110
life threatening
PEF <33
Confused, exhausted, coma
Silent chest, cyanosis, feeble resp effort
O2 <92%
Normal pCO2 (4.6- 6.0)
Bradycardia, dysrhyhthmia or hypotension
signs of a near fatal asthma attack
raised pCO2 and/or requiring mechanical ventilation with raised inflation pressures
asthma attack pO2 <92% -what investigation
ABGs
increased pCO2- life threatening asthma attack
normal pCO2- near fatal asthma attack
who requires admission asthma attack (7)
-life thretening
-severe if failed to respond to initial treatment
-previous near fatal
-pregnant
-presenting at night
-occuring despite use of oral steroid
management of ashtma attack?
Oxygen
Saba (nebulised)
most common lung cancer?
NON SMALL CELL LUNG CANCER (80%)
-Adenocarcinoma (40%)
-Squamous cell carcinoma (20%)
-Large cell carcinoma (10%)
blood test indicative of lung cancer?
raised platelets
what paraneoplastic syndromes are associated with small cell lung cancer
SCL
SIADH (will be hyponatramic due to excess ADH)
Cushings (excess ACTH)
Lambert eaton
what paraneoplastic syndromes are associated with SCC
Excess PTH production (hypercalcaemia)
what lung cancer may cause horners syndrome?
Pancoast tumour
Will cause a pre ganglion Horners:
-Anhydrosis of the face
-Ptosis
-Miosis
What lung cancer is associated with excess serotonin production?
Bronchial carcinoid tumour (type of large neuroendocrine/ same catergory as Small cell)
most common cancer in non smokers?
adenocarcinoma
signs of adenocarcinoma?
-Effects the peripheries
-Non smokers
-Women
-Hypertrophic osteoarthorpathy (boggy + clubbing fingers)
-Gynaecomastia
what type of lung cancer metastasises earliest + is fastest growing?
Small cell
conditions causing upper lobe fibrosis?
CHARTS
Coal workers pneumonitis
Histocytosis/ hypersensitivty pneumonitis
Ank spond
Radiation
TB
Silicosis/ sarcoidosis
Conditions causing lower lobe fibrosis?
-Asbestosis
-IPF
-Connective tissue disorder (apart from ank spond)
-Drugs (methotraxate, amiodarone, bleomycin + nitrofurantoin)
medications community aquired pneumonia?
Low risk= Amoxicillin 5 days
-score of 0 in community
-score of 0 or 1 in secondary care
Intermediate/ high risk= Amoxicillin + macrolide e.g. azithromycin, clarythomycin for 7 days
scores that class someone in community to be different risk levels and where they need treatment pneumonia
Low risk= 0
-treat at home
Intermediate risk= 1 or 2
-consider hospital admission
High risk= 3 or 4
-Urgent hospital
scores that class pneumonia as different levels of risk in hospital and where they need treatment
Low risk= 0 or 1
-treat at home
Intermediate= 2
-Treat in hospital
High risk= 3 or more
-consider ITU
