Resp Flashcards

Question

Bronchiectasis Rx

Answer 1

chest physio Abx for exacerbations - e.g. cipro for 7-10 days bronchodilators (nebulised B agonists) From CF - GI dysfunction give Creon to replace pancreatic enzymes, insulin and UDCA for bile stimulation

Answer 2

``` Local  Recurrent laryngeal N. palsy  Phrenic N. palsy  SVC obstruction  Horner’s (Pancoast’s tumour)  AF ``` Paraneoplastic Endo  ADH → SIADH ( euvolaemic ↓Na+)  ACTH → Cushing’s syndrome  Serotonin → carcinoid (flushing, diarrhoea)  PTHrP → 1O HPT (↑Ca2+, bone pain) – SCC Rheum  Dermatomyositis / polymyositis Neuro  Purkinje Cells (CDR2) → cerebellar degeneration  Peripheral neuropathy Derm  Acanthosis nigricans (hyperpigmented body folds)  Trousseau syndrome: thrombophlebitis migrans

Answer 3

``` Tranusdates: ↑ capillary hydrostatic pressure  CCF  Iatrogenic fluid overload  Renal failure  Relative ↑ in negative pressure pulmonary oedema ↓ capillary oncotic pressure  Liver failure  Nephrotic syndrome  Malnutrition, malabsorption, protein-losing enteropathy ↑ interstitial pressure  ↓lymphatic drainage: e.g. Ca ``` Exudates  ARDS (admit to ITU for organ support and treat underlying cause)

Answer 4

 PaO2<8KPa despite 60% FiO2  PaCO2>6KPa Method  6ml/kg + PEEP (e.g. 10cm H2O)

Answer 5

PaO2 <8kPa and PaCO2 <6kPA; caused by V/Q mismatch which can be vascular (PE, pulmonary shunt); asthma; pneumothorax; atelectasis as well as fluid and fibrosis

Answer 6

PaO2 <8kPa and PaCO2 >6kPA; caused by alveolar hypoventilation from obstructive (COPD, asthma, bronciectasis) or restrictive (GBS, fluid and fibrosis) causes

Answer 7

 PAO2= (95 x FiO2) – (PaCO2/0.8) |  ↑ (PAO2-PaO2) suggests lung pathology

Answer 8

In pts. at risk of hypercapnic resp failure:  Start O2 therapy at 24% and do an ABG – Blue Venturi @ 2-4L/min

Answer 9

Nasal Prongs: 1-4L/min = 24-40% O2 Simple Face Mask Non-rebreathing Mask  Reservoir bag allows delivery of high concentrations of O2.  60-90% at 10-15L ``` Venturi Mask  Provide precise O2 concentration at high flow rates  Yellow: 5%  White: 8%  Blue: 24%  Red: 40%  Green: 60% ```

Answer 10

1. Dyspnoea only on vigorous exertion 2. SOB on hurrying or walking up stairs 3. Walks slowly or has to stop for breath 4. Stops for breath after <100m / few min 5. Too breathless to leave house or SOB on dressing

Answer 11

Spirometry should show FEV1:FVC <0.7 for COPD and usually FEV1 <80% ``` Assess Severity  Mild: FEV1 >80% (but FEV/FVC <0.7 and symptomatic)  Mod: FEV1 50-79%  Severe: FEV1 30-49%  Very Severe: FEV1 < 30% ```

Answer 12

For PE assess probability from Well's score If low probability perform D-dimer (if negative excludes PE, if positive do CTPA) If high probability perform CTPA NB. -ve D-dimer has 95% NPV for PE NB review management of PE

Answer 13

 Effusion protein < 25g/L = transudate  Effusion protein >35g/L = exudate  Between 25-35g/L: apply Light’s Criteria ``` Light’s Criteria  An exudate has one of:  Effusion : serum protein ratio >0.5  Effusion : serum LDH ratio >0.6  Effusion LDH is 0.6 x ULN ```

Answer 14

Diagnostic Tap  Percuss upper boarder and go 1-2 spaces below  Infiltrate down to pleura with lignocaine.  Aspirate with 21G needle Send for:  Chemistry: protein, LDH, pH, glucose, amylase  Bacteriology: MCS, auramine stain, TB culture  Cytology  Immunology: SF, ANA, complement

Answer 15

``` GRANULOMA General (FLAWS) Respiratory - dry cough SOB, chest pain Arthralgia Neurological (Bell's palsy) Urine (renal stones from hypercalcaemia) Low hormones (amenorrhoea) Ophthalmological (uveitis, Sjogren's) Myocardial (restrictive cardiomyopathy) Abdominal (hepatosplenomegaly + cholestatic LFT) Skin (erythema nodosum/lupus pernio) ```

Answer 16

 Stage 1: BHL  Stage 2: BHL + peripheral infiltrates  Stage 3: Peripheral infiltrates alone  Stage 4: Progressive mid-zone fibrosis with bullae

Answer 17

 Infections: TB, leprosy, syphilis, crypto, schisto  AI: PBC  Vasculitis: GCA, PAN, Wegener’s, Takayasu’s  Idiopathic: Crohns, Sarcoid  Interstitial lung: EAA, silicosis

Answer 18

Acute sarcoidosis  Usually resolves spontaneously  Bed rest and NSAIDs Chronic sarcoidosis  Steroids: pred 40mg/d for 4-6wks  Additional immunosuppression: methotrexate, ciclosporin, cyclophosphamide

Answer 19

``` Upper Zone: A PENT  Aspergillosis : ABPA  Pneumoconiosis: Coal, Silica  Extrinsic allergic alveolitis  Negative, sero-arthropathy  TB ``` Lower Zone: STAIR  Sarcoidosis (mid zone)  Toxins: BANS ME (bleomycin, amiodarone, nitrofurantoin, sulfasalazine, methotrextrate)  Asbestosis  Idiopathic pulmonary fibrosis  Rheum: RA, SLE, Scleroderma, Sjogren’s, PM/DM

Answer 20

Referral to NHS stop smoking service Nicotine gum/patches Varenicline (C/I depression) Bupropion (C/I epilepsy)

Answer 21

Daytime Features: morning headache, somnolence, reduced memory, irritability, depression ``` Polysomnography is diagnostic Rx: weight loss, avoid smoking and EtOH CPAP during sleep surgery to relieve obstruction (tonsillectomy or uvulopalatpharyngoplasty) ```

Answer 22

``` Hyperinflation (>6 ant ribs) Decreased cricosternal distnace Flat hemidiaphragms Large central pulmonary arteries Decreased peripheral markings Bullae ```

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