Respiratory Flashcards
(186 cards)
1
Q
What is seen on spirometry in restrictive airways disease?
A
FEV1/FVC ratio>0.7
2
Q
What is seen on spirometry for obstructive airways disease?
A
FEV1/FVC ratio < 0.7
3
Q
Which conditions cause restrictive airways disease?
A
Pulmonary fibrosis Asbestosis Sarcoidosis ARDS Ankylosing spondylitis Neuromuscular disorders (e.g. Myasthenia gravis/MND) Obesity
4
Q
Which conditions cause obstructive airways disease?
A
COPD
Asthma
Bronchiectasis
Cystic fibrosis
5
Q
What is pulmonary fibrosis?
A
Diseases which cause interstitial lung damage and eventually fibrosis
6
Q
How does pulmonary fibrosis present?
A
Dry cough Shortness of breath Fatigue Arthralgia Weight loss Fatigue
7
Q
What are signs seen in pulmonary fibrosis?
A
Cyanosis
Clubbing
Fine end-inspiratory crackles
Reduced chest expansion
8
Q
What are causes of pulmonary fibrosis?
A
Lung damage - pneumonia, TB, infarction Irritants - e.g. coal dust, silica Idiopathic Extrinsic allergic alveolitis Connective tissue diseases Hypersensitivity pneumonitis
9
Q
How is pulmonary fibrosis diagnosed?
A
CT showing ground glass opacification
10
Q
What are causes of upper lobe fibrosis? (Non drug)
A
CHARTS
Coal workers pneumonitis, hypersensitivity pneumonitis, ankylosing spondylitis, radiation, tuberculosis, sarcoidosis
11
Q
What are causes of lower lobe fibrosis?
A
Idiopathic
Asbestosis
All other connective tissue disorders (except ankylosing spondylitis)
Drugs - eg. Amiodarone/Methotrexate
12
Q
Which drugs can cause pulmonary fibrosis?
A
MADNeSs
Methotrexate, Amiodarone, dopamine agonists, Nitrofurantoin, sulfasalazine
Amiodarone
Methotrexate
Sulfasalazine
Nitrofurantoin
Dopamine agonists (bromocriptine/cabergoline)
13
Q
What is type 1 respiratory failure?
A
Low oxygen, co2 normal
14
Q
Why does type 1 respiratory failure occur?
A
Ventilation-perfusion mismatch (V/Q mismatch)
Asthma, congestive heart failure, PE, pneumonia, pneumothorax
15
Q
What is type 2 respiratory failure?
A
Low oxygen, high co2
16
Q
Why does type 2 respiratory failure occur?
A
Alveolar hypoventilation
COPD, pulmonary fibrosis, opiates, neuromuscular disease
17
Q
What is acute respiratory distress syndrome (ARDS)?
A
Non cardiogenic pulmonary oedema and diffuse lung inflammation, usually secondary to an underlying illness
18
Q
What are pulmonary causes of ARDS?
A
Chest sepsis
Aspiration
Inhalation injury
Pulmonary contusion (bruise in or on lungs caused by force to the chest)
TRALI
19
Q
What are non-pulmonary causes of ARDS?
A
Sepsis from a non-pulmonary cause
Acute pancreatitis
DIC
Drug overdose
20
Q
How does ARDS present?
A
Acute onset respiratory failure which does not respond to supplementary oxygen
Dyspnoea
Tachypnoea
Bilateral crackles
Low sats
21
Q
What shows on chest x-ray in ARDS?
A
Bilateral infiltrates (pulmonary oedema)
22
Q
What is asthma?
A
A condition of reversible airway obstruction
23
Q
What are symptoms of asthma?
A
Wheeze
Dyspnoea
Cough
Diurnal variation of 20%
Personal or family history of atopy
24
Q
What are signs of asthma?
A
Tachypnoea
Hyper-inflated chest
Wheeze on auscultation
Reduced PEFR
SOB
25
How is asthma diagnosed?
Spirometry - obstructive picture (low FEV1)
fractional exhaled inhaled nitric oxide (FeNO) - high result
Bronchodilator reversibility of at least 12% on spirometry
26
What is the step-wise management for asthma? (NICE guidance)
1) SABA (salbutamol)
2) low dose ICS (Beclometasone/mometsone etc)
3) Montelukast
4) LABA (Salmeterol)
5) increase ICS to moderate dose
6) increase ICS to high dose
27
What is a moderate exacerbation of asthma?
PEFR 50-75% of predicted
28
How is a moderate exacerbation of asthma managed?
Salbutamol inhaler with spacer (short pause between puffs)
If worsening despite Salbutamol - consider admission
Quadruple ICS dose for 14 days (or add oral prednisolone)
If not admitting to hospital - follow up in 48 hours
29
How does a severe exacerbation of asthma present?
PEFR = 33-50% of predicted
Resp rate >25
Heart rate >110
Inability to complete sentences or accessory muscle use
Oxygen sats of at least 92%
30
When is oxygen given in an acute asthma exacerbation and what oxygen is given?
If sats drop below 94%
15L via non-rebreather mask
31
How is a severe exacerbation of asthma managed?
1. Initial bronchodilator treatment (use of SABA Inhaler)
2. If no improvement -> admit to hospital
3. Nebulised salbutamol + Nebulised ipratropium bromide
4. IV Magnesium sulphate if no response
Oral prednisolone (to everyone)
If low sats -> oxygen
32
What is the management of acute asthma exacerbations in hospital?
Everyone who is admitted gets salbutamol nebs, ipratropium bromide nebs + oral pred
If needed - oxygen
If no improvement - senior review for consideration of IV mag sulphate/ IV hydrocortisone
33
What is a life threatening asthma exacerbation?
```
PEFR = <33%
Silent chest
Altered consciousness
Exhaustion
Cardiac arrhythmia
Hpotension
Cyanosis
Oxygen sats less than 92%
```
ONLY NEED ONE OF ABOVE TO BE LIFE THREATENING
34
How is a life threatening asthma exacerbation managed?
Needs admission
Oxygen if needed
Salbutamol and ipratropium bromide nebs
Quadruple ICS
If no improvement - IV hydrocortisone/IV magnesium sulphate
35
What suggests a near fatal exacerbation of asthma?
Normal or raised CO2
36
What is Samter’s triad?
Asthma
Nasal polyps
Aspirin sensitivity
37
What should you not prescribe in a patient with a history of asthma and nasal polyps?
Aspirin
38
What is COPD? What are the two components?
COPD is an umbrella term which includes conditions which cause irreversible airway obstruction
Comprising of chronic bronchitis (hypertrophy and hyperplasia of the mucus glands in the bronchi) --> Chronic cough + sputum
And emphysema (enlargement of the air spaces and destruction of alveolar walls) --> Chronic SOB
39
What are symptoms of COPD?
Productive cough
Wheeze
Dyspnoea
Reduced exercise tolerance
40
What are signs of COPD?
Tachypnoea
Hyperinflated chest
Reduced chest expansion
Wheeze
Cyanosis
Cor pulmonale (heart failure caused by pulmonary hypertension)
Hyperresonant percussion
41
What is seen on spirometry in COPD?
Obstructive picture (ratio <0.7)
FEV1 = less than 80% of predicted
42
What is seen on chest x-ray in COPD?
Hyperinflated chest (can see more than 6 ribs)
Decreased peripheral markings
Flattened diaphragm
Bullae
43
What is the stepwise management of COPD?
1) SABA or SAMA
2) if asthmatic features - add LABA and ICS
2) if no asthmatic features - add LABA and LAMA (if on a SAMA, switch to SABA)
3) SABA + LABA + LAMA + ICS
44
What can you do if someone is still having continued exacerbations for COPD despite being on SABA + LABA + LAMA + ICS?
Specialist referral for Azathioprine
45
What are indications for long term oxygen in COPD?
PaO2 < 7.3 on two readings more than 3 weeks apart
PaO2 7.3-8 plus one of:
Nocturnal hypoxia, polcythaemia, peripheral oedema, pulmonary HTN
PATIENT NEEDS TO BE A NON-SMOKER
46
What vaccines are needed in COPD?
Annual influenza vaccine
One off pneumococcal vaccine
47
What antibiotic prophylaxis can be given in COPD?
Azithromycin (make sure to check ECG to exclude long QT as Azithromycin can prolong QT)
48
What is the most common organism responsible for COPD exacerbations?
Haemophilius influenzae
49
How are COPD exacerbations managed?
If patient is well enough to be at home - 30mg prednisolone, inhalers, and antibiotics ( only if sputum is purulent)
If sputum is not purulent - oral prednisolone only
If admission is needed - nebulisers, oxygen is <94%
Choice of Abx = Doxycycline/Amoxicillin/Clarithromycin
50
Which are first line antibiotics for COPD exacerbations?
Amoxicillin/doxycycline/Clarithromycin
51
Which are second line antibiotics for COPD exacerbation?
Co-amoxiclav/levofloxacin
52
What is pulmonary hypertension?
Hypertension of the pulmonary arteries
53
What are features of pulmonary hypertension?
Shortness of breath
Fatigue
Syncope
Raised JVP
Pansystolic murmur (tricuspid regurgitation)
End-diastolic murmur (pulmonary regurgitation)
54
What are causes of pulmonary hypertension?
COPD, Asthma, interstitial lung disease, Bronchiectasis, cystic fibrosis
Idiopathic
PE
Sleep apnoea
Neuromuscular conditions
Heart problems
55
What is seen on ECG in pulmonary hypertension?
P pulmonale (increased amplitude of P wave)
Right axis deviation
56
How is pulmonary hypertension diagnosed?
Right heart catheterisation
57
What is cor pulmonale?
Right sided heart failure caused by respiratory disease
Respiratory disease -> pulmonary hypertension -> RV cannot pump blood into pulmonary arteries -> leads to backflow into the vena cava
58
What are causes of cor pulmonale?
Most common = COPD
Others = PE, cystic fibrosis, idiopathic pulmonary HTN
59
How does cor pulmonale present?
Same as right sided heart failure
Peripheral oedema
Raised JVP
Hepatomegaly
Cyanosis
SOB
60
What is Bronchiectasis?
Permanent dilation of the bronchi and bronchioles - usually due to chronic infection
61
How does Bronchiectasis present?
Productive cough with purulent sputum
Haemoptysis
Finger clubbing
Coarse inspiration crackles
Wheeze
62
What is seen on spirometry in Bronchiectasis?
An obstructive pattedn
63
How is Bronchiectasis managed?
Chest physio
Antibiotics
Bronchodilators
Prednisolone
64
What is acute bronchitis?
A self-limiting chest infection which is usually viral
65
How does acute bronchitis present?
Cough - may be productive
Sore throat
Rhinorrhoea
Wheeze
66
How is acute bronchitis managed?
Supportive mainly
If CRP >100 = doxycycline (Amoxicillin in pregnancy)
If systemically unwell or any co-morbidities also give antibiotics
67
What organisms most commonly cause pneumonia?
Strep pneumonia / haemophilius influenzae
In alcoholics/diabetics - klebsiella pneumoniae
Hospital-acquired - pseudomonas/staph aureus
68
What is suggestive of a klebsiella cause of pneumonia?
Red currant sputum
69
What are symptoms of pneumonia?
Fever, malaise, rigours
Cough with purulent sputum
Pleuritic chest pain
May be haemopytsis
70
What are signs of pneumonia?
Tachycardia
Tachypnoea
Pyrexia
Hypotension
Confusion
71
What cause of pneumonia should you consider if LFTs are deranged?
Legionella or Mycoplasma
72
Which risk score is used to determine management of pneumonia?
CURB-65
```
Confusion - 1
Urea >7 - 1
Resp rates >30 - 1
BP <90 systolic or <60 diastolic - 1
Aged >65 - 1
```
73
How is pneumonia managed?
Low Severity
CRB65 of 0 or CURB65 of 0/1 = Oral Amox/Doxy/Clarithro/Erythro (outpatient care)
Moderate Severity
CRB65 of 1/2 or CURB65 of 2 = Amox + Clarithro/Erythro (consider admission)
High Severity
CRB65 of 3/4 or CURB65 of 3-5 = IV Co-amox + Clarithro/Erythro (admission)
74
What causes aspiration pneumonia?
Occurs in patients with an unsafe swallow
Stroke
Myasthenia gravis
Bulbar palsy
Achalasia
75
Which lobes are most commonly affected by aspiration pneumonia?
Right lower lobe
76
How is aspiration pneumonia treated?
IV Cephalosporin (Cefotaxime/Ceftriaxone/Cefuroxime)
And IV Metronidazole
77
What are the two main subtypes of lung cancer?
Small cell and non small cell
78
What is the most common type of non-small cell lung cancer? What is the most common type in NON SMOKERS?
Squamous cell carcinoma
In non-smokers = Adenocarcinoma
79
What are symptoms of lung cancer?
Cough
Haemoptysis
Dyspnoea
Chest pain
Weight loss
80
What are signs of lung cancer?
Finger clubbing
Anaemia
Lymphadenopathy
Evidence of paraneoplastic syndromes
81
Where does lung cancer most commonly metastasise?
Brain
Breast
Bone
Adrenals
82
What might be seen on an x-ray in lung cancer?
Nodules
Pleural effusion
Consolidation
Lung collapse
Hilar lymphadenopathy
83
How is non-small cell lung cancer treated?
Lobectomy
84
How is small cell lung cancer treated?
Palliative chemo
85
Which lung cancer has the worst prognosis?
Small cell
86
What paraneoplastic syndromes are associated with small cell lung cancer?
Raised ACTH -> Cushing’s symptoms
Raised ADH -> hyponatraemia due to water retention
Lambert Eaton syndrome (leg and arm weakness)
87
What paraneoplastic features are associated with squamous cell lung cancer?
Hypercalcaemia due to raised PTH
HPOA (Hypertrophic pulmonary osteoatrhopathy) -> clubbing, arthropathy
88
What paraneoplastic feature is associated with Adenocarcinoma of the lung?
Gynaecomastia
HPOA
89
What does a hoarse voice in lung cancer suggest?
Laryngeal nerve palsy
90
What does facial swelling, difficulty breathing and distended veins in lung cancer suggest?
Superior vena cava obstruction
91
What are symptoms of a pulmonary embolism?
Sudden onset SOB
Pleuritic chest pain
Haemoptysis
Tachypnoea
92
What are signs of a pulmonary embolism?
Tachypnoea
Tachycardia
Respiratory alkalosis (due to tachypnoea)
93
What is the textbook ECG finding seen in a PE?
S1Q3T3
Deep S in lead I
Pathological Q in lead III
Inverted T in lead III
Main finding = sinus tachycardia
94
What is found on chest x-ray in PE?
Normal
95
How do you investigate a suspected PE?
Well’s score >4 = CTPA (V/Q scan in renal failure)
Well’s score of 4 or less = D-dimer -> CTPA if positive
If D-dimer = raised but CTPA = negative, stop anticoagulation and recheck CTPA in 1 week
96
What do you do whilst the patient is waiting for a CTPA in PE investigation?
Start anticoagulation (apixaban/rivaroxaban)
97
Should you do a CTPA in renal impairment?
No, do a V/Q scan insteac
98
How long should you continue anticoagulation for in a confirmed PE?
Identifiable cause - 3 months
No identifiable cause - 6 months
99
What anticoagulation is used in PE?
If outpatient - DOAC
If inpatient - Heparin
If any contraindications to DOAC - Warfarin usually used instead
Pregnancy - LMWH
100
What is a pneumothorax?
Air within the pleural space
101
What is a primary pneumothorax?
Pneumothorax with no history of any respiratory disease
102
What is a secondary pneumothorax?
Pneumothorax with previous diagnosed respiratory disease - asthma/COPD/pneumonia/TB
103
How does a pneumothorax present?
Shortness of breath
Pleuritic chest pain
Tachypnoea
104
How is a pneumothorax seen on chest x-ray?
Absence of lung markings
105
How is a primary pneumothorax managed?
Patient not SOB and pneumothorax <2cm -> no treatment needed
Patient SOB or pneumothorax >2cm -> aspiration with 16-18G cannula. If this fails - chest drain
106
How is a secondary pneumothorax managed?
If patient not SOB and pneumothorax <1cm -> observe for 24 hours
If patient not SOB and pneumothorax 1-2cm -> aspiration
If patient SOB / pneumothorax >2cm -> chest drain
107
What is a tension pneumothorax?
Air can get into the pleural space but can’t get out, pressure will lead to a cardiac arrest
108
How does a tension pneumothorax present?
Worsening symptoms (SOB, chest pain)
Reduced breath sounds
Hyperresonance to percussion
Tracheal deviation (AWAY from site of pneumothorax)
109
How is a tension pneumothorax treated?
Insert a large bore cannula into the second intercostal space in the midclavicular line
110
Where do you place the needle to decompress a pneumothorax?
2nd intercostal space at the mid-clavicular line
111
What is a pleural effusion?
Abnormal build up of fluid in the pleural cavity
112
What are the two types of pleural effusion?
Exudative (high protein) or transudative (low protein)
113
What are exudative causes of pleural effusion?
Exudative = due to increased capillary permeability (usually due to inflammation). Usually unilateral
Infection = Pneumonia, TB
Malignancy
Trauma
Connective tissue disease = SLE, RA
114
What are transudative causes of pleural effusion?
Transudative = due to imbalance of forces. Usually bilateral
CHF, CKD, Nephrotic syndrome
115
What is seen on CXR in pleural effusion?
A white out
Meniscus
Blunting of the costophrenic angle
116
How can you differentiate between an exudative and transudative pleural effusion?
Pleural fluid analysis = >35 = exudative, <25 = transudative
For 25-35, use Light's criteria
Fluid to serum protein ratio >0.5 = exudative
Fluid to serum LDH ratio >0.6 = exudative
117
How does pleural effusion present?
Dyspnoea
Chest pain
Reduced/absent breath sounds over effusion
Dull to percussion
May be signs of underlying cause
118
How is a pleural effusion managed?
If obvious heart failure - furosemide
Aspirate under ultrasound and do a culture to rule out infection
If large/infected/organisms found on culture - chest drain
119
What is an empyema?
An infected pleural effusion
120
How does an empyema often present?
Patient with improving pneumonia but new/ongoing fever
121
What are causes of bilateral hilar lymphadenopathy?
Sarcoidosis
TB
Bronchial carcinoma
122
What is sarcoidosis?
A multi system disease characterised by non-caseating granuloma formation
123
Who is most affected by sarcoidosis?
Black females
124
What lab results are seen in sarcoidosis?
Raised ACE
Raised calcium
Raised CRP
Raised serum soluble interleukin-2 receptor
125
What is seen on CXR in sarcoidosis?
Bilateral hilar lymphadenopathy
126
What is seen on tissue biopsy in sarcoidosis?
Non-caseating granulomas with epithelioid cells
127
How does acute sarcoidosis present?
Fever
Polyarthralgia
Erythema nodosum
Cough
Bilateral hilar lymphadenopathy
128
How does chronic sarcoidosis present?
Pulmonary: cough, Dyspnoea
Systemic: fatigue, weight loss, Arthralgia, fever, lymphadenopathy
Ocular: uveitis, conjunctivitis, optic neuritis
Dermatological: erythema nodosum, lupus pernio (purple rash on face)
129
How is sarcoidosis managed?
If mild symptoms only - no treatment
If hypercalcaemia or eye/heart/neuro involvement - oral steroids
Acute sarcoidosis - NSAIDs
130
How is sarcoidosis staged?
```
0 = Normal
1 = Bilateral hilar lymphadenopathy
2 = BHL + interstitial infiltrates
3 = diffuse infiltrates
4 = diffuse fibrosis
```
131
What organism is responsible for tuberculosis?
Mycobacterium tuberculosis
132
What is primary TB?
There is a small lung lesion called the Ghon focus
Encapsulated by granulation tissue
133
What is secondary TB?
When primary TB becomes active
In immunocompromised patients
Presents with classical symptoms of TB
Can also present in other organs
134
What is miliary TB?
When the primary TB is not contained and it disseminates via the bloodstream
135
How does pulmonary TB present?
Cough with purulent sputum and possibly Haemoptysis
Night sweats
Fever
Weight loss
136
How can active TB be diagnosed?
Ziehl-Neelsen stain
Sputum culture -- for PCR and smear
137
How can latent TB be diagnosed?
Mantoux test
Interferon gamma release assay
138
How is active TB treated?
RIPE
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
For 2 months
Continue rifampicin and isoniazid for another 4 months
139
What are adverse effects of rifampicin?
Hepatitis
Red bodily secretioms
140
What are adverse affects of isoniazid?
Peripheral neuropathy
141
What are adverse effects of pyrazinamide?
Hyperuricaemia -> gout
Arthralgia
Myalgia
142
What are adverse effects of ethambutol?
Optic neuritis (check visual acuity before and after treatment)
143
How are pleural plaques managed?
No follow up needed, benign
144
What is obstructive sleep apnoea?
Apnoea episodes during sleep due to collapse of pharyngeal airway
145
How does obstructive sleep apnoea present?
Snoring
Morning headache
Waking up unrefreshed from sleep
Daytime sleepiness
146
How is obstructive sleep apnoea diagnosed?
Epworth sleepiness scale
Sleep studies - Polysomnography
147
What are features of eosinophilic granulomatosis with polyangitis? (Churg-Strauss Syndrome)
Asthma
Raised eosinophils
Paranasal sinusitis
Mononeuritis multiplex
Pulmonary infiltrates
Nasal polyps
148
Which marker is raised in eosinophilic granulomatosis with polyangitis?
pANCA
149
What are features of granulomatosis with polyangitis? (Wegener’s)
Kidney and respiratory tract problems
Chronic sinusitis
Epistaxis
Saddle-nose deformity
Cough
Haemoptysis
Pleuritic
Haematuria
Proteinuria
150
What are long term complications of pulmonary fibrosis?
Respiratory failure
Increased risk of lung cancer
Pulmonary hypertension and cor pulmonale
151
What is seen on CXR in pulmonary fibrosis?
Interstitial shadowing
May be normal
152
What is seen on CT in pulmonary fibrosis?
Ground-glass pacification
Honeycombing
Mosaicism
153
Which markers may be raised in pulmonary fibrosis?
Depends on cause of pulmonary fibrosis....
ESR
Rheumatoid factor
ANA
154
Someone with lung cancer presents with muscle weakness?
Lambert Eaton Syndrome
155
Someone with lung cancer presents with symptoms of Cushing’s ?
Most likely to be increased ACTH due to Small cell lung cancer
156
What causes hyponatraemia in small cell lung cancer?
SIADH
157
How is COPD staged?
By FEV1
>80% = stage 1, mild (symptoms needed)
50-79% = stage 2, moderate
30-49% = stage 3, severe
< 30% = stage 4, very severe
158
Who needs admitting during an acute asthma exacerbation?
Anyone with life-threatening asthma attack
Severe asthma attack persisting after initial bronchodilator treatment
Moderate asthma attach with worsening symptoms despite bronchodilator treatment or who heave had a previous newr fatal asthma attack
159
What is interstitial lung disease? how is it seen on CT?
Umbrella term of conditions which affect lung tissue causing inflammation and fibrosis.
CT = Ground-glass appearance.
160
What is hypersensitivity pneumonitis?
Type II Hypersensitivity reaction
Causes upper lobe lung fibrosis
Dry cough, dyspnoea
161
What is cryptogenic organising pneumonia?
Presents similarly to pneumonia
Type of lung fibrosis
Not infectious
162
What is atelectasis? What can cause it?
Basal alveolar collapse
Common post-operative complication
Dyspnoea + Hypoxia at around 72 hrs post-op
163
What is Kartagener's syndrome?
AKA Primary ciliary dyskinesia
Complete sinus invertus
Bronchiectasis
Recurrent sinuitis
Subfertility
Right testicle hangs lower than left
164
What are contraindications to a DOAC?
```
Pregnancy/Breastfeeding
Metallic heat valve
Liver disease
Active malignancy
Antiphospholipid syndrome
```
165
What type of oxygen therapy is used in an AECOPD?
1. Non-rebreather
2. NIV - BiPAP
Venturi??
166
What is the most common cause of an exudative pulmonary effusion?
Pneumonia
167
What is the most common cause of transudative pulmonary effusion?
Heart failure
168
What is Kyphoscoliosis?
A cause of restrictive airways disease
Hunched posture
Caused by Ankylosing spondylitis
169
What is a possible complication of COPD seen on FBC?
Secondary polycythaemia
170
Why does polycythaemia occur in COPD?
To compensate for long term hypoxaemia
171
How long should deep sea diving be avoided after pneumothorax?
Indefinitely
172
Pneumonia with red currant jelly sputum?
Klebsiella
173
Which patients should have Abx therapy for acute bronchitis? Which Abx should be given?
Systemically very unwell
Pre-existing co-morbidites
CRP >100
Abx = Doxycycline (Amoxicilin if CI)
174
Gold standard diagnosis for Asthma?
FeNO + Spirometry with bronchodilator reversibility
175
What are features that suggest steroid responsiveness in COPD?
Previous diagnosis of asthma/atopy
Eosinophilia
Diurnal variation
176
Where should a chest drain be placed?
5th intercostal space midaxillary line
177
What is the correct inhaler technique?
Remove cap and shake
Breathe out gently
Put mouthpiece in mouth, as you begin to breathe in , slow and deep, press canister down and continue to inhale steadily
Hold breath for 10 seconds
For a second dose wait for approx 30 seconds
178
What can worsen a tension pneumothorax?
Ventilation
| Acute deterioration following ventilation
179
How to calculate pack years?
1 pack = 20 cigaretts
| 1 pack year = 20 cigarettes per day for 1 year
180
What are Cis to lung cancer surgery?
SVC obstruction
FEV <1.5
Malignant pleural effusion
Vocal cord paralysis
181
How is SVC obstruction managed?
Sit them up
Stat dose of steroids
Stenting
182
What is the 2WW criteria for lung cancer?
Any age with CXR findings suggestive of lung cnacer
| >40 with unexplained haemoptysis
183
Which pleural effusions need draining with a chest drain?
If the fluid is purulent or turbid/cloudy
| if the fluid is clear but the pH is less than 7.2
184
How is atelectasis managed?
Chest physio
185
What is the stepwise progression of care in acute asthma?
1. Oxygen
2. Salbutamol nebulisers
3. Ipratropium bromide nebulisers
4. Hydrocortisone IV OR Oral Prednisolone
5. Magnesium Sulfate IV
6. Aminophylline/ IV salbutamol
186
What does a blood gas look like in metabolic alkalosis due to hyperventilation
Low pH
Low co2
Normal oxygen
Type 1 resp failure
(V/Q mismatch)
