Resp 2 Flashcards by Lisa Azizi

when does Light’s criteria apply?

pleural fluid
25-35 g/L

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Light’s criteria - pleural effusion

Exudative

Pleural fluid LDH > 2/3 of the upper limit of the serum LDH

pleural fluid LDH / serum LDH >0.6

Pleural protein / serum LDH >0.5

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Ix pleural effusion?

PA CXR
USS
contrast CT

pleural aspiration
21G needle
50ml syringe

pH, protein, LDH, cytology and microbiology

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Exudative causes of pleural effusion?

inflammation

> protein is leaking from tissues into pleura

Infection
Pneumonia / TB
Inflammatory
> RA

Malignancy
Mesothelioma
Lung cancer

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Transudative causes of Pleural effusion?

congestive cardiac failure
HYPO albumin
hypothyroid
Meigs

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Meigs?

Pleural effusion
Ascites
benign ovarian tumour

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escalating life threatening asthma

Urgent intubation and ventilation

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superior vena cava syndrome

intraluminal mass or compression

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when to attempt chest drain compared to needle aspiration? in pneumothorax?

needle
> symptom relief
big enough rim

Chest drain
> high risk features
» haemodynamic instab
» hypoxia
» bilateral
» underlying lung disease
» 50 years of age

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montelukast MOA?

leukotriene receptor antagonist
blocks action of leukotrienes

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what doe leukotrienes do?

narrowing and swelling of the airways in the lungs
= wheezing
SOB
chest tightness
cough

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fostair is?

formoterol and beclometasone

LABA and ICS

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severity of COPD is classified by?

FEV1

<30% is very severe
<49% Severe
<79% Moderate
<80% Mild

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sarcoidosis mx

NSAIDs

steroid treatment : oral prednisolone
> lung disease
> uveitis
> hypercalcaemia
> neuro / cardiac involvement

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Sudden deterioration with ventilation suggests

tension pneumothorax

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what is an empyema formation

pus in a cavity

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klebsiella

gram - pneumonia

alcholics and diabetics
upper lobe

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Obstructive sleep apnoea can cause

HTN
compensated resp acidosis

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COPD second line
if on sama what to do
and no atopy

stop SAMA
> replace with SABA

start LABA
LAMA

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how to manage a tension pneumothorax?

decompress immediately with needle

Perform needle thoracostomy

decompress the pleural space and restore normal respiratory function

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commonest cause of anterior mediastinum mass?

teratoma
terrible lymphadenopathy
thymic mass

thyroid mass

what is 1 pack year?

20 cigs per day for 1 year

chest drain swinging

RISES in inspiration

falls in expiration

chest drain is into the pleural space of the patient
> connect to a bottle
responds to thoracic pressures

safe triangle chest drain

> mid axillary line of 5th intercostal space
edge of latissimus dorsi
lateral border of pectoralis major
line superior to level of nipple

apex below the axilla

example of a LAMA sama?

tiotropium > spiriva Ipratropium bromide atrovent

sama and saba combo

combivent

LTOT indications in COPD

cyanosis polycythaemia raised JVP <30% FEV1 o2 sats of 92% peripheral oedema

when is oral theophylline used in COPD?

when all else fails

aspiration pneumonia from HAP - how to differentiate?

classically RLL > right main brainstem is LARGE and STRAIGHT

what is lung volume reduction surgery?

removal of poorly ventilated but perfused areas of lung so blood can be redistributed

Late stage alpha 1 antitrypsin deficency management?

lung volume reduction surgery

Before starting Azithromycin why is it important to do an ECG?

rule out prolonged QT interval and baseline liver function tests

diagnosis of mesothelioma?

histology and thoracoscopy

indication for corticosteroid use in sarcoidosis?

hypercalcaemia parenchymal lung disease uveitis neuro / cardio involvement

Asthma adults diagnosis?

symptoms spirometry FENO bronchodilator reversibility

bronchodilator reversibilty?

>12% FEV1 increase and 200ml >10% of predicted normal

peak expiratory flow reversibility changes in asthma diagnostic

2 weeks >20%

1st line in children asthma 5-16

FeNO >35 ppb

CRP and WCC in infection

acute phase reactant CRP is more laggy WC is more reflective

Mx of atelectasis?

chest physiotherapy and mobilisation and breathing exercise

what is atelectasis?

basal alveolar collapse airway obstructed by bronchial secretions >dyspnoea >hypoxaemia 72 hours post op

hypoventilation would lead to?

respiratory depression can cause hypoventilation Resp acidosis accumulation of CO2 decrease in blood pH

Lung Cancer Mx SCLC

chemo mainstay adjuvant radiotherapy

kartageneres syndrome

PCD dextrocardia - complete situs invertus chronic sinusitis bronchiectasis

cancers with raised platelets?

lung endometrial gastri oesophageal colorectal il6 stimulate platelet

what is the contraindication to chest drain insertion and bleeding?

INR >1.3

cannonball mets on a CXR

CT abdomen as it is most commonly caused by RCC

acute asthma BTS guidelines for ABG use?

o2 sats <92%

managing a Pleural effusion

Imaging PA chest xray USS> successful pleural aspiration contrast CT ; underlying cause

pleural fluid findings low glucose amylase blood staining

low glucose: rheumatoid arthritis, tuberculosis raised amylase: pancreatitis, oesophageal perforation heavy blood staining: mesothelioma, pulmonary embolism, tuberculosis

Lung cancer referral

CXR findings suggestive of lung cancer >40 and over w unexplained haemoptysis