Respiratory Flashcards
(48 cards)
What are the features of steroid response in COPD?
Blood eosinophilia
FEV1 variation >400ml with time
>20% diurnal variation in peak expiratory flow rate (PEFR)
What are the features of kartegener syndrome?
- dextrocardia or complete situs inversus
- bronchiectasis
- recurrent sinusitis
- subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)
What are the various steps of management for smoking cessation in pregnant women?
- CBT, motivational interviewing or structured self-help and support from NHS Stop Smoking Services
- Nicotine replacement therapy
varenicline and bupropion are contraindicated
What medications cause long QT syndrome?
Anti-arrhythmic medication Antibiotics - macrolides and fluroquinolone Antidepressants - TCA, SSRI, lithium Antipsychotics - haloperidol Antiemetic - ondensetron
What is the typical presentation of Psittacosis?
Flu-like symptoms (90%): fever, headache and myalgia Respiratory symptoms (82%): dyspnoea, dry cough and chest pain
What is the treatment for psittacosis?
1st-line: tetracyclines e.g. doxycycline
2nd-line: macrolides e.g. erythromycin
What is the management of acute exacerbations of COPD?
- increase frequency of bronchodilator use and consider giving via a nebuliser
- Oral prednisolone 30 mg for 5 days
- Oral Antibiotics - amox, clarithro or doxycycline
How do you differentiate sarcoidosis and tuberculosis?
Whilst tuberculosis is usually limited to the lungs and the major presenting complaint is cough, sarcoidosis has a classic systemic presentation, with erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, and polyarthralgia.
What do blood tests results show in sarcoidosis? and how do you monitor the disease?
Hypercalcaemia
Raised ESR
Monitoring - ACE levels
How do you differentiate between ARDS vs cardiogenic pulmonary oedema?
Pulmonary capillary wedge pressure - less than 18 mm Hg - cardiogenic
ARDS - pulmonary cap wedge pressure is normal
What is the step by step management of ARDS?
- Treat the underlying cause
- Antibiotics (if signs of sepsis)
- Negative fluid balance i.e. Diuretics
- Recruitment manoeuvres such as prone ventilation, use of positive end expiratory pressure
- Mechanical ventilation strategy using low tidal volumes, as conventional tidal volumes may cause lung injury (only treatment found to improve survival rates)
What is the discharge advise to be given after a a pneumothorax?
Smoking - cut down
flying - dont fly for a week after pneumothorax
Deep sea diving - avoid lifelong
What is the suspected diagnosis if the patient presents with 3 week h/o cough (productive with clear sputum), intermittent low-grade fever. CXR normal, blood only shows raised CRP?
Acute bronchitis
What is the management of acute bronchitis?
CRP of 20-100mg/L (offer delayed prescription) or a CRP >100mg/L (offer antibiotics immediately)
First line Abx - doxycycline
What are the conditions causing fibrosis in the upper lobe of the lungs?
CHARTS C - Coal worker's pneumoconiosis H - Histiocytosis/ hypersensitivity pneumonitis A - Ankylosing spondylitis R - Radiation T - Tuberculosis S - Silicosis/sarcoidosis
What are the conditions causing fibrosis in the lower lobe of the lungs?
RASIO (lower lober)
- Rheumatoid
- Asbestosis
- Scleroderma
- Idiopathic Pulmonary fibrosis (most common cause overall)
- Other - drug-induced: amiodarone, bleomycin, methotrexate
What are the causes of ARDS?
infection: sepsis, pneumonia massive blood transfusion trauma smoke inhalation acute pancreatitis cardio-pulmonary bypass
Which cancers met to the lungs?
Cancers metastasising to lung = Before Computers People Read Books
Breast Colorectal Prostate Renal Bladder
Breast Bladder Bidney Brostate Brectum
What causes tracheal deviation towards the side of the affected lung?
Atelectasis
Agenesis of lung
Pneumonectomy
Pleural fibrosis
What causes tracheal deviation away from the side of the affected lung?
Pneumothorax
Pleural effusion
Large mass
What blood test may suggest lung cancer in the context of the right history?
Raised platelets
What are some causes of respiratory alkalosis?
High rates of breathing
- Anxiety leading to hyperventilation
- Pulmonary embolism
- Salicylate poisoning (leads to a mixed respiratory alkalosis and metabolic acidosis. Early stimulation of the respiratory centre leads to a respiratory alkalosis whilst later the direct acid effects of salicylates (combined with acute renal failure) may lead to an acidosis)
- CNS disorders: stroke, subarachnoid haemorrhage, encephalitis
altitude - Pregnancy
A 74-year-old female presents to the GP with a 2 week history of increasing weakness of her upper and lower limbs. She also reports dysphagia to solids and liquids. She is currently undergoing chemotherapy for small cell lung cancer. On examination there is weakness of the limbs but this slowly improves with prolonged exertion.
What is the most likely diagnosis?
Lambert Eaton syndrome
What is the criteria for LTOT in COPD patients?
any one of :
- cyanosis
- polycythaemia
- raised JVP
- FEV1 < 30%
- oxygen saturations <92%
- peripheral oedema
ABG is required
- Pa02 < 7.3, the patient qualifies for LTOT
- Pa02 between 7.3-8 in the presence of secondary polycythaemia, pulmonary hypertension or peripheral oedema also qualify the patient for LTOT
