Resp Flashcards
(136 cards)
1
Q
vital capacity
A
the max change possible
IRV + TV + ERV
2
Q
functional residual capacity
A
the volume in the lungs after a normal expiration
RV + ERV
3
Q
FVC
A
total volume expired from max inspiration to max expiration
4
Q
FEV1
A
max volume that can be expired in 1 sec
5
Q
normal FEV1/FVC
A
> 70%
6
Q
obstructive picture on spirometry
A
FEV1 reduced
FVC normal
FEV1/FVC ratio reduced
7
Q
restrictive picture on spirometry
A
FEV1 reduced
FVC reduced
FEV1/FVC ratio normal or increased
8
Q
presentation of SEVERE asthma attack
A
inability to complete sentences in 1 breath
PEF 33-50% of normal
HR > 110
RR > 25/min
9
Q
presentation of LIFE THREATENING asthma attack
A
silent chest altered conscious level exhaustion/poor resp effort cyanosis PEF < 33% of predicated normal PaCO2
10
Q
presentation of NEAR FATAL asthma attack
A
raised PaCO2
11
Q
Ix of asthma
A
spirometry and bronchodilator reversibility
12
Q
why should NSAIDs be avoided in asthmatics
A
NSAIDs inhibit the COX pathway, which is involved in the production of prostaglandins
this induces overproduction by eosinophils, mast cells and macrophages - bronchospasm
13
Q
Mx chronic asthma
A
- SABA
- SABA + ICS
- SABA + ICS + LTRA
- SABA + ICS + LABA +/- LTRA (stop if not working)
- SABA + MART(combo ICS + LABA)
- SABA + increase dose of MART
- SABA + increase dose of MART + refer
14
Q
LTRA
A
montelukast
15
Q
mnemonic for asthma attack Mx
A
OSHIT ME -
Oxygen
Salbutamol 5mg Neb
Hydrocortisone 100mg IV (or pred 40mg PO)
Ipratropium 500 mcg Neb
Theophylline (aminophylline infusion 1g in 1L saline (0.5ml/kg/h)
Magnesium sulphate 2g IV over 20min
Escalate care (intubate and ventilate)
16
Q
how many nebs can be given /hr in asthma attack
A
can be given back to back - max 5-10mg/hr
17
Q
how often can IV steroids be given in acute asthma attack
A
6hrly
18
Q
where is theophylline usually given in asthma attack and why
A
ICU - needs to be monitored as it causes arrhythmias, seizures, GI upset
19
Q
when is Mg sulphate given in asthma attack
A
before theophylline as a once off dose (theophylline can cause seizures)
20
Q
chronic bronchitis
A
a cough productive of green sputum on most days for 3m of at least 2 successive years
21
Q
emphysema
A
enlarged air spaces distal to terminal bronchioles with destruction of the alveolar wall. Causes loss of elastic recoil of the lungs and collapse on expiration.
22
Q
Ix COPD
A
spirometry + bronchodilator reversibility
CXR to rule out lung ca
bloods (exclude secondary polycythaemia)
23
Q
Mx COPD
A
- SABA or SAMA prn
- LABA + LAMA
- LABA + LAMA + ICS
24
Q
should Abx always be given for exacerbation of COPD
A
no- only if increased sputum purulence
25
Abx for infective exacerbation COPD
1. Amoxicillin 500mg tds for 5d
| 2. Doxycycline 200g on day 1 then 100mg OD for 5d
26
target sats for COPD
88-92%
27
CURB 65 score
```
Confusion
Urea >7
Resp Rate >30
BP <90s, <60d
age >65
```
1 point for each
0-1: home Tx poss
2: hop Tx
3 or more: consider ITU
28
pneumonia signs on examination
signs of consolidation
- reduced chest expansion
- dull percussion note
- increased tactile vocal fremitus
- bronchial breathing
- late inspiratory crackles
29
what pneumonia do u get after influenza infection
staphylococcal
30
Mx staphylococcal pneumonia
cefotaxime or imipenem
31
who gets klebsiella pneumonia
alcoholics
| diabetics
32
Mx klebsiella pneumonia
meropenem
33
who gets pseudomonas pneumonia
CF patients
34
Mx pseudomonas pneumonia
Ciprofloxacin
35
pneumonia associated with erythema nodosum
mycoplasma
36
presentation mycoplasma pneumonia
insidious onset
dry cough
flu-like symptoms
37
Ix mycoplasma pneumonia
serology
| - cold agglutinins, can cause haemolytic anaemia
38
Mx mycoplasma pneumonia
macrolide - clarithromycin, azithromycin
39
Mx chlamydia psittaci pneumonia
doxycycline
40
who gets pneumocystis jirovecii pneumonia
HIV/AIDs patients
41
Ix pneumocystis jirovecii pneumonia
bronchoalveolar with lavage
42
Mx pneumocystis jirovecii pneumonia
high dose co-trimoxazole
43
most common cause of CAP
strep pneumoniae
44
Empirical Mx mild/mod CAP (0-2)
Amoxicillin 1g tds for 5d
45
Empirical Mx severe CAP (3-5)
co-amoxiclav IV + doxycycline PO for 7d
46
Empirical Mx severe CAP if in ICU/HDU or NBM
co-amoxiclav IV + clarithromycin IV
47
most common cause of HAP
strep pneumoniae
48
Mx non-severe HAP
Amoxicillin
49
Mx severe HAP
IV Amox + Gent
if allergic: IV co-trim + gent
50
Most common cause of aspiration pneumonia
strep pneumoniae, anaerobes
51
Mx non severe aspiration pneumonia
PO amoxicillin + metronidazole
52
Mx severe aspiration pneumonia
amox + met + gent
53
Ix lung ca
1. CXR
2. CT chest/abdo
3. Pathological confirmation - either bronchoscopy or transthoracic needle biopsy
4. staging: MRI (brain mets), PET-CT
54
small cell lung ca paraneoplastic syndromes
ADH production - SIADH, hyponatraemic
ACTH production - cushings syndrome
Lambert Eaton syndrome - antibodies to voltage gated ca channels
55
squamous cell lung ca paraneoplastic syndromes
PTH-rp production - hypercalcaemia
Finger clubbing
Hypertrophic pulmonary osteoarthropathy
56
where do lung adenocarcinomas tend to be located
peripherally
57
where do large cell lung cancers tend to be located
centrally
58
adenocarcinoma paraneoplastic syndromes
gynaecomastia
hypertrophic pulmonary osteoarthropathy
59
causes of pneumothorax
spontaneous - primary or secondary
secondary to trauma
either can be complicated by tension
60
pathology of pneumothorax
communication develops between alveoli and pleural space, or the atmosphere and the pleural space.
gas then follows the pressure gradient into the pleural space.
61
tracheal deviation in tension penumothorax
AWAY from affected side
62
presentation spontaneous pneumothorax
```
sudden onset SOB
ipsilateral chest pain
ipsilateral hyperinflation
reduced chest expansion
diminished breath sounds
hyper-resonance on percussion
```
63
Mx primary spontaneous pneumothorax
< 2cm + asymptomatic = discharge.
> 2cm + symptomatic = admit for aspiration.
If this fails = chest drain.
64
Mx secondary spontaneous pneumothorax
0-1cm + asymptomatic = oxygen & admit for 24h
1-2cm + asymptomatic = aspiration.
If this fails = chest drain.
>2cm or symptomatic = chest drain.
65
chest drain insertion site
5th IC space mid axillary line in the 'safe triangle'
66
borders of 'the safe triangle' for chest drain insertion
base of axilla
lateral edge of pectoralis major
lateral edge of lat dorsi
5th IC space
67
Mx tension pneumothorax
1. large bore needle with syringe partially filled with saline into 2nd IC space, mid-clavicular line
2. then CXR
3. then chest drain
68
presentation PE
```
SOB
pleuritic chest pain
dizziness
syncope
haemoptysis
```
69
clinical assessment of PE - scoring systems
wells score
| Geneva score
70
1st Ix if PE unlikely
D-dimers
if normal = exclude PE
if raised = CTPA
71
1st Ix if PE likely
CTPA
72
Ix if CTPA contraindicated
V/Q scan
73
ECG appearance in PE
sinus tachy (most common)
S1Q3T3 pattern (uncommon)
74
CXR appearance in PE
wedge-shaped opacities
75
Mx PE if haemodynamically unstable
thrombolysis (alteplase) - NOT if there is a bleeding risk tho!
76
Initial Mx PE
LMWH or Fondaparinux
then once Dx has been confirmed, put on Warfarin (or NOAC).
The heparin can be stopped when anticoagulation with the warfarin has been established (usually 6-10d) or INR >2.0
77
how long should warfarin (or NOAC) be continued in a provoked PE
3m
78
how long should warfarin (or NOAC) be continued in an unprovoked PE
6m
79
long term anticoagulation in malignant PE
LMWH for 6m
80
transudative pleural effusion protein content
<30g/L
81
causes of a transudative pleural effusion
SYSTEMIC FACTORS:
- increased venous pressure (HF, constrictive pericarditis, fluid overload)
- hypoalbuminaemia (cirrhosis, nephrotic synd)
- hypothyroidism
- meigs syndrome
82
exudative pleural effusion protein content
>30gL
83
causes of an exudative pleural effusion
LOCAL FACTORS:
i. e. inflammation of the lung or pleura, causing capillary leakage into the pleural space
- pneumonia
- TB
- SLE
- malignant mets
84
when is light's criteria applied to a pleural effusion
when protein content is between 25-35 g/L
85
light's criteria
exudative is likely if:
- pleural fluid protein / serum protein > 0.5
- pleural fluid LDH / serum LDH > 0.6
- pleural fluid LDH >2/3 serum LDH upper limit of normal
86
presentation of pleural effusion
```
SOB
non-productive cough
pleuritic chest pain
stony dull to percuss
reduced breath sounds
reduced chest expansion
```
87
stony dull to percuss
pleural effusion
88
Ix pleural effusion
1. CXR - blunting of costophrenic angles
2. pleural USS
3. pleural aspiration
89
where is needle inserted for draining pleural effusion
on the upper border of the rub (so to miss nerves)
90
reason for doing pleural USS before aspiration
to increase likelihood of success (know the exact location)
91
pathology of primary TB
infection inhaled by droplets.
most people clear the infection, or it sits dormant as latent TB.
in some, they develop a primary infection of the lung.
92
ghon focus
tubercle-laden macrophages in primary TB,
| the lung lesion is walled off by macrophages and the cells inside die (caseating necrosis)
93
ghon complex
ghon focus + hilar lymph nodes
94
where does secondary TB occur in the lung
apex
95
TB in the vertebral bodies
pott's disease
96
presentation TB
```
cough
haemoptysis
night sweats
wt loss
malaise
pleural effusion
clubbing
erythema nodosum
```
97
latent TB
pt has no symptoms
98
Ix for latent TB
screening tests
- tuberculin skin test
- interferon-gamma test
if either are +ve, do CXR
99
Ix for active TB
CXR
| sputum sample for NAAT and ziehl-neelson staining
100
Ix for active TB if pt unable to provide sputum samples
bronchoalveolar with lavage
101
ziel-neelson staining in TB
acid fast bacilli
102
Mx TB
"4 for 2 and 2 for 4"
- 4 drugs for 8w, then 2 drugs for 16w
- Rifampicin
- Isoniazid
- Pyrazinamde
- Ethambutol
(Rifampicin and Isoniazid for 16w)
103
Mx latent TB
3m - Isoniazid (with pyroxidine) and Rifampicin
or
6m - Isoniazid (with pyroxidine)
104
s/e of Rifampicin
orange discolouration of urine and tears
raised LFTs
reduced platelets
inactivation of the pill
105
s/e of Isoniazid
raised LFTs
reduced WCC
neuropathy (stop and give pyroxidine)
106
s/e of Pyrazinamide
hepatitis
| arthralgia - gout
107
s/e of Ethambutol
optic neuritis
108
what are ILD characterised by
fibrosis of the lung, causing a restrictive pattern on spirometry
109
presentation of the interstitial lung diseases
dry cough
SOB on exertion
finger clubbing
bi-basal inspiratory crackles
110
farmer's lung
hypersensitivity pneumonitis
caused by an allergic reaction to spores in mouldy hay
111
bird fancier's lung
hypersensitivity pneumonitis
caused by reaction to avian proteins in dry droppings
112
occupations causing asbestosis
asbestos
ship building
power stations
113
what type of asbestos is the most and least dangerous
most - blue
| least - white
114
industry causing berylliosis
aerospace industry
115
industries causing silicosis
stonemasons
| pottery workers
116
egg shell calcification of hilar nodes
silcicosis
117
miners lung a.ka. ?
coal workers pneumoconiosis
118
presentation of CWP on CXR
small round opacities in the upper zones
119
what can CWP lead to
Progressive Massive Fibrosis
- large round opacities
- emphysema
- black sputum
leading to pulmonary HTN and cor pulmonale
120
systemic causes of ILD
```
RA
sarcoidosis
SLE
systemic sclerosis
ank spond
psoriasis
```
121
drug causes of ILD
nitrofurantoin
amiodarone
sulfasalazine
122
idiopathic pulmonary fibrosis - area of lung usually affected
lower zones
123
CXR appearance IPF
ground glass / honeycomb appearance
124
Caplan's syndrome
RA
Pneumoconiosis
Pulmonary rheumatoid nodules
125
Mx ILD
remove causative factor
| steroids +/- immunosuppression
126
presentation of sarcoidosis
very non-specific
acute: erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia
insidious: SOB, non-productive cough, malaise, wt loss
skin: lupus pernio
hypercalcaemia
127
Mx sarcoidosis
Asymptomatic + stable stage 2 or 3: no Tx
Stage 2 0r 3 with symptoms: oral steroids
128
CXR stages of sarcoidosis
```
0 = normal
1 = BHL
2 = BHL + interstitial infiltrates
3 = diffuse interstitial infiltrates
4 = fibrosis
```
129
causes of bronchiectasis
GENETIC:
CF
alpha-1-antitrypsin deficiency
POST-INFECTION:
childhood viral infections (haemophilus most common)
CTD:
RA, sjogren's
130
presentation bronchiectasis
```
persistent cough
copious sputum
finger clubbing
course crackles
wheeze
```
131
Ix bronchiectasis
CT - signet ring bronchi
132
Mx bronchiectasis
```
inspiratory muscle training
postural drainage
Abx for exacerbations
bronchodilators
surgery - focal disease
```
133
inheritance of CF
autosomal recessive
134
Ix CF
sweat test - positive if > 60mmol/L
(normal <30)
if in between - do genetic testing
135
most common bacteria to colonise CF pts
pseudomonas
136
Mx CF
2x daily postural drainage and chest physio
high calorie diet, high fat intake
minimise contact with other CF pts
vit supplements, pancreatic enzymes
