Resp Flashcards by Sam Naylor

Initial NIV settings

IPAP 10

EPAP 4

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Aerospace engineer gets cough, night sweats fatigue

Reticular cxr changes

Berylliosis

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What test can be performed to assess if the effusion is an empyema?

If visibly pus, then that’s diagnostic

If unsure, centrifuge

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Chronic productive cough, dextracardia

primary ciliary dyskinesia.. a type of bronchiectasis

Diagnose with ciliary function tests - can they taste saccharin 20m after placed in nose?!

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worsening SOB in a middle-aged pt
clear lung fields
diastolic murmur
CXR: enlarged proximal pulmonary arteries

Pulmonary arterial hypertension

Murmur is pulmonary regurgitation

Diagnosis R heart cath

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Management of new pulmonary nodule

=> 8mm urgent CT pet

5-6mm or low risk then CT at 1 year, if 6 or 7 then in three months

Nodule <5mm, or clear benign features, or unsuitable for treatment: discharged

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ARDS, history of exposure to bats and their droppings in Mississippi

Histoplasmosis

Tx Amphotericin or itraconazole

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Pneumothorax, after drain inserted when would you involve surgeons

persistent air leak or failure of the lung to re-expand, an early (3-5 days) thoracic surgical opinion should be sought

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Secondary pneumothorax,1.3cm, breathless, mx

Any secondary pneumo with SOB: Chest drain

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Which lung cancer is assx w gynaecomastia

Adenocarcinoma

Also assx w hypertrophic pulmonary osteoarthropathy (HPOA)

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most common type of lung cancer in non-smokers

Adenocarcinoma, although the majority of patients who develop lung adenocarcinoma are still smokers

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Upper Vs lower zone fibrosis

ACID causes lower, the rest upper

Asbestosis
Connective tissue disorders (except ank spond)
Idiopathic pulmonary fibrosis
Drugs…… (Amiodarone, bleomycin, methotrexate).

Upper:
C -Coal worker's pneumoconiosis
H -Histiocytosis/hypersensitivity pneumonitis
A -Ankylosing spondylitis
R - Radiation
T -Tuberculosis
S -Silicosis/sarcoidosis

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How long can’t you fly for after pneumothorax

1/52 after clear CXR if simple pneumothoraces

Or two weeks after traumatic

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LTOT w NIV

If develop a respiratory acidosis and/or a rise in PaCO2 of >1 kPa (7.5 mmHg) during an LTOT assessment on two repeated occasions, while apparently clinically stable, should only have LTOT w NIV

(Also need PaO2 is < 7.3 kPa)

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Scoring system for PE 30d mortality and long term morbidity

PESI score

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Indications for thrombolysis in PE

systolic <90 or drop off more than 40 for longer than 15 mins
New onset RHF….. Raised JVP/loud P2/ECG abnorm

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Pathogenesis of TRALI

Thought to be due to anti - HLA or anti-neutrophil antibodies

Usually within 6hr of transfusion

More common in patients who are multiparous women, or receiving donors from multipara women

If you’ve previously had TRALI, you can have male donors in future (1-5% antibodies compared to 20% in women)

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CXR changes with aspergilloma

CXR showing round opacity in upper zone with surrounding halo of air

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CXR showing round opacity in upper zone with surrounding halo of air

History of tb

Aspergilloma

Usually asymp but can be large haemoptysis
Manage surgically

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ECG changes in PE

S waves in v1 , q waves and inverted t in v3
S1Q3T3
But only in 20%

RBBB, tachy

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What measure do you use to judge severity of copd

Fev1

80% Stage 1 - Mild - symptoms should be present to diagnose COPD in these patients
50-79% Stage 2 - Moderate
30-49% Stage 3 - Severe
< 30% Stage 4 - Very severe

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Young non smoking female presents with spontaneous pneumothorax on the BG of gradual reduction of exercise tolerance. .

Lymphangioleiomyomatosis (LAM) affects non smoker premenopausal women causing proliferation of atypical smooth muscle cells in the lungs, lymphatics and uterus, most likely caused by oestrogens.. reticulonodular interstitial pattern

Exclude atypical Langerhans cell histiocytosis… Presents in smokers Which also has spontaneous pneumothorax, reduced ET. Can have cranial diabetes insipidus

Purpose of seldinger chest drain Vs surgical chest drain

Surgical is larger, so if just blood aspirated or trauma

If bloodstained fluid then the smaller seldinger is ok

CT chest showing widespread tram-track and signet ring signs

bronchiectasis

Flu like symp dry cough erythema multiforme

Mycoplasma pneumoniae | second most common cause of erythema multiforme after HSV

What resp parameter do you monitor in GBS for ? invasive ventilator support

FVC <15ml/kg

Estimate if appropriate PaO2

2/3 of inspired O2 So 15L is 90% , therefore 60 kPa

Microorganism in CF sputum which has worst prognosis

Burkholderia cepacia has worse prog... can get Capacia Syndrome with necrotising pneumonia Also a contraindication to lung transplantation Pseudomonad also v difficult to eradicate

Important microorganism contraindication to lung transplantation in CF

Burkholderia cepacia

Pharmacological therapy for idiopathic pulmonary fibrosis

Pirfenidone Only other option is lung transplantation

Chest drain inserted for empyema. 5 days later it's bubbling

Bronchopleural fistula Possibly iatrogenic pneumothorax, but the drain would have bubbles throughout then

Diagnosis of whooping cough

In first two weeks nasopharyngeal swab culture After that serology Too late for abx by then though

Indication for LTOT on ABG

Indicated if: pO2 is <7.3, on two separate ABGs 3 weeks apart Or pO2 7.3-8 with secondary polycythaemia, peripheral oedema, nocturnal hypoxaemia or pulmonary hypertension

Features of TB meningitis

``` Risk factor like homeless 6th nerve palsies Siadh Cxr may show upper lobe fibrosis Nodular enhancing lesion on MRI Lymphocytic CSF with low glucose ```

management of bronchiectasis

daily postural drainage and abx for exacerbations

CXR features of coal workers pneumonoconiosis

Simple CWP is multiple small round opacities 1-10mm, mostly upper complicated will have much larger opacities in upper zones, with fibrosis

19y old with sob, Pharyngitis, wheeze rash, muscle tenderness. Cxr lower zone fibrosis which seems worse than OE. diagnosis

Mycoplasma Often affects young Clari

Management for SVC obstruction

Stent insertion

Most specific ECG changes in PE

Simultaneous T wave inversions in the inferior (II, III, aVF) and right precordial leads (V1-4)

Distinguish between ACS and PE

simultaneous T wave inversion in III and V1 are diagnostically significant for PE (only 1% of ACS, 88% w Acute PE) - LITFL ACS rarely tachy

cryptogenic organising pneumonia features

assx w autoimmune / inflammatory conditions like RA, Can mimic bacterial pneumonia on CXR and crackles OE Raised ESR Rheumatoid lung disease tends to be bilat basal opacification CXR - honeycomb/reticulonod on HRCT

cryptogenic organising pneumonia management

corticosteroids (it's non-infectious)

non-small cell bronchial carcinoma (T2a, N1, M0, stage IIB management

if FEV1 >60% and good baseline then pneumonectomy is best (35% 5yr)

pneumonia w hyponatraemia

legionella

pt w diagnosis of asthma, started on monteleukast and gets signif worse. why?

Leukotriene receptor antagonists can precipitate Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)

Ascaris lumbricoides (giant roundworm) on serology, respiratory compromise

pulmonary eosinophilia where the nematode migrate to lung causing Loffler's syndrome can also be due to Strongyloides

Mx of aspergilloma

surgical resection

Investigation to diagnose methothelioma

Thoracoscopy pleural biopsy

PE with haemodynamic instability

IV fluids to increase RV filling pressure | First line: Thrombolysis if not improving after 15-30 minutes

management of PCP

co-trimoxazole w pred if intolerant then Clindamycin and Primaquine w pred or IV Pentamidine w pred

management for cystic fibrosis F508

Lumacaftor/Ivacaftor (Orkambi)

patient presents w sats 90% on 10L, but ABG on RA P02 10.8. Young person, taking ilicit drugs. Cause and management?

Methaemoglobin (Methaemoglobin MetHb levels usually <1.5%) IV methylthioninium chloride (methylene blue) if acquired drugs: sulphonamides, nitrates (including recreational nitrates e.g. 'poppers'), dapsone, sodium nitroprusside, primaquine chemicals: aniline dyes

CT Thorax findings in Anti-glomerular basement membrane (GBM) disease (Goodpasture's syndrome) and Granulomatosis with polyangiitis (Wegener's granulomatosis)

both cause pulmonary-renal syndrome GBM GroundGlass changes Granulomatosis multiple cavitating lesions - usually apical