Resp Flashcards by Nadja Auerbach

Classification system for COPD?

GOLD classification

mMRC dyspnoea score
Airflow limitation
Number of exacerbations per year

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Non medical Mx of COPD?

MDT approach, regular review

Smoking cessation

Pulmonary rehab therapy (exercises, education, psychosocial support)

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Medical Mx of COPD?

SABA, then anti muscarinics and LABA, then inhaled corticosteroids

LTOT if low PaO2/cor pulmonale/polycythaemia

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Mx of acute exacerbation of COPD?

Sit up, 24% O2 via venturi mask, keep sats between 88-92%

Salbutamol 5mg/ipratropium 0.5mg nebs

Hydrocortisone 200mg IV/Prednisolone 40mg PO

Antibiotics if evidence of infection

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What is the BODE index?

Used to predict mortality in COPD

BMI
Obstruction: FEV1
Dyspnoea mMRC score
Exercise capacity: 6 min walk

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Define asthma

Episodic, reversible airway obstruction due to bronchial hyper reactivity

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What Ix would you do for asthma?

Bedside: PEFR

Bloods: FBC, IgE, aspergillus serology

CXR: hyperinflation

Spirometry: would show obstructive picture, FEV1:FVC <70%

Atopy: skin prick test

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Non medical asthma Mx

MDT TAME

MDT approach
Technique for inhaler use
Avoidance of triggers and allergens
Monitor with peak flow
Educate

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Medical Mx of asthma

SABA
\+ ICS low dose
\+ LABA
\+ ICS higher dose/LTRA/LAMA
\+ Specialist care, another of above
\+ Steroid tablet

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Example of SABA, ICS, LABA, LTRA, LAMA

Salbutamol - SABA
Budesonide / beclametasone - ICS
Salmeterol - LABA
Montelukast  - LTRA
Tiotropium - LAMA

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Causes of ILD?

UPPER - "TB SPACE"
TB
Sarcoidosis
Pneumoconiosis
Ankylosing spondylitis
Cystic fibrosis
Extrinsic allergic alveolitis

LOWER - "ACID"
Asbestosis
Connective Tissue disease
Idiopathic pulmonary fibrosis
Drugs

DRUGS - “AMEN”
Amiodarone
Methotrexate
Nitrofurantoin

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What would spirometry and HRCT show in ILD?

Restrictive, FEV1:FVC > or equal to 70%

Honeycomb lung

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What is bronchiectasis?

Chronic, permanent dilation of bronchi caused by repeated cycles of airway inflammation and infection

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Causes of bronchiectasis?

Congenital:
CF
Alpha 1 antitrypsin deficiency
Hypogammaglobulinaemia

Infectious:
TB
Pertussis

Rheumatological:
RA
SLE
Sjogren’s

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Ix for bronchiectasis?

Bloods: included RA screen Abs

CXR: tramlines and ring shadows (bunch of grapes)
Signet ring sign

Spirometry: obstructive

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Complications of bronchiectasis?

Cahexia
Pulmonary HTN
T2 resp failure

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Mx of bronchiectasis?

Conservative: MDT, physio

Medical: 
Abx
Bronchodilators
Treat underlying cause
VACCINATIONS (influenza, pneumococcus)

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What is Kartagener’s?

Autosomal recessive defect in ciliary motility
Poor mucociliary clearance
Reduced sperm motility in males
Situs inversus

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Cystic fibrosis pathophysiology and inheritance?

Autosomal recessive
Mutation in CFTR gene
Reduced luminal Cl- secretion and Na reabsorption causing viscous secretions

Dx of cystic fibrosis?

Sweat test, Na and Cl >60mM
Faecal elastase; tests pancreatic exocrine function
Genetic screening

Mx of CF

MDT

Chest:
Physio; postural drainage
Abx
Mycolytics
Vaccinations: flu, pneumococcus

GI:
Pancreatin (creon)
ADEK supplements
Insulin

Pleural effusion causes?

Transudate:
Protein <25
Often bilateral
Causes: CCF, renal failure, low albumin

Exudate:
Protein >35
Often unilateral
Causes: infection, cancer, inflammation (RA, SLE)

Ix for pleural effusion

Sputum: MC+S, cytology
CXR: Homogenous opacification
Volumetric CT

Bloods: look for high creatinine, low albumin, etc

DIAGNOSTIC PLEUROCENTESIS, look for

Chemistry
Bacteriology
Cytology
Immunology

Pleural biopsy if inconclusive

Criteria for Dx of exudative effusion?

Transudate = protein <25g/L

Exudate = protein >35g/L

Between the two, apply Light’s criteria (lactate dehydrogenase and serum protein ratio)

Treatment of pleural effusion?

Rx underlying cause | Drainage if symptomatic

Lung cancer peripheral inspection

``` Hands and face: Cachexia Clubbing Tar staining Horner's syndrome Plethora ``` Chest: Thoracotomy scar Radiotherapy burns/tattoos Acanthosis nigricans Lung: COLLAPSE or EFFUSION

Complications of lung cancer on examination?

SVCO Horner's syndrome Recurrent laryngeal nerve palsy

Pneumonectomy and lobectomy on examination?

Tracheal shift Reduced expansion Reduced (lobectomy) or absent breath sounds (pneumonectomy)

Indication for lobectomy/pneumonectomy?

Bronchial carcinoma Bronchiectasis COPD; lung reduction surgery TB; historic

Types of lung cancer?

Small cell Non small cell: - SCC - Adenocarcinoma - Large cell

Paraneoplastic lung tumours?

ADH → SIADH (euvolaemic ↓Na+) ACTH → Cushing’s syndrome Serotonin → carcinoid (flushing, diarrhoea) PTHrP → 1O HPT (↑Ca2+, bone pain)

Ix for lung cancer?

``` Bloods FBC (anaemia, WCC) U+E (SIADH) LFT (mets) Bone profile (higher Ca) ``` Imaging CXR Contrast volume CT Cell analysis Cytology (pleurocentesis) Histology (FNA) ``` Staging CT PET Radionucleotide bone scan Thoracoscopy/mediastinoscopy ```

Mx of lung cancer?

General: smoking, MDT, nutrition NSCLC: Surgery (wedge resection, lobectomy) and chemo (platinum based and biologics) SCLC: Usually disseminated at presentation, chemo my have benefit Palliative: Radiotherapy (haemoptysis or bone mets), anagesia, stent for SVCO

Prognosis for lung cancer?

NSCLC: 50% 5ys w/o spread; 10% with spread SCLC: 1-1.5yrs median survival treated; 3mo untreated

HAP vs CAP? Microbes?

CAP: - Pneumococcus, mycoplasma, haemophilus HAP: (>48 hours after admission) - Pseudomonas, MRSA

How to assess severity of pneumonia?

CURB65 score ``` Confusion Urea Resp rate BP >65 years old ``` Determines whether they need home, hospital or ITU management (>3)

TB medical treatment?

Rifampicin Isoniazid Pyrazinamide Ethambutol RIPE for 2 months, RI for 4 months

Side effects of rifampicin and isoniazid?

Rifampicin: orange secretions, liver enzyme inducer Isoniazid: peripheral neuropathy, agranulocytosis, liver enzyme inhibitor

Where to insert a chest drain?

“triangle of safety”: anterior to mid axillary line, posterior to pectoral groove, above 5th intercostal space

Define COPD

Chronic bronchitis (productive cough most days of >3 months on 2>years) Emphysema

Peripheral signs of COPD

Bounding pulse CO2 retention flap Tar staining Plethora

Complications of Lung Cancer

SVCO Pancoast's tumour causing Horner's syndrome Recurrent laryngeal nerve palsy

Follow up pneumonia

CXR after 6 weeks to look for underlying cancer and resolution

Primary TB

Ghon focus then forms Ghon complex Latent TB can be reactivated to secondary TB

Ix for active TB

CXR; if suggestive, take >3 sputum samples Microscopy for acid fast bacilli (Ziehl Neelsen stain) Culture in Lowenstein-Jensen media

What is alpha-1-antitrypsin deficiency?

Genetic disorder, onset 20s-50s Results in not enough A1AT Associated with COPD, cirrhosis, cancer Vaccines recommended Tx with bronchodilators, steroids, Abx