- bronchiectasis + eosinophils - hypersensitivity to aspergillus fumigatus

Respiratory Flashcards by Charlotte cleasby

important Q’s to ask about in asthma

triggers
smoking

How well did you know this?

Not at all

Perfectly

key aspects to diagnose asthma

obstruction: FEV1/FVC ratio <0.7
reversibility: after bronchodilation FEV1 increase by 12%
peak flow diurnal variation (>20%)
FeNO >40 ppb in adults
blood tests = inc eosinophil
hyperreactivty: bronchial challenge tests

How well did you know this?

Not at all

Perfectly

possible differentials for asthma

COPD
ABPA
Bronchiectasis
Bronchiolitis

How well did you know this?

Not at all

Perfectly

ABPA features

bronchiectasis + eosinophils
hypersensitivity to aspergillus fumigatus

How well did you know this?

Not at all

Perfectly

ABPA management

steroids
antifungals
chest physio

How well did you know this?

Not at all

Perfectly

COPD definition

airway abnormalities (bronchitis) +/- alveoli abnormalities (emphysema)
= persistent airflow obstruction

How well did you know this?

Not at all

Perfectly

how to diagnose COPD

spirometry
obstruction post-bronchodilation

How well did you know this?

Not at all

Perfectly

how is severity of COPD measured?

FEV1
<30% = very severe
30-49 = severe
50-79 = moderate

How well did you know this?

Not at all

Perfectly

management of COPD

symptoms
exacerbation
smoking
vaccination history
pulmonary rehab

How well did you know this?

Not at all

Perfectly

T1RF findings and causes

low oxygen, normal CO2
cause: pneumonia, effusion, fibrosis

How well did you know this?

Not at all

Perfectly

treat T1RF

oxygenate

How well did you know this?

Not at all

Perfectly

T2RF findings and causes

low oxygen, high CO2
cause: COPD, resp muscle weakness, CNS depression

How well did you know this?

Not at all

Perfectly

treat T2RF

ventilate (NIV)

How well did you know this?

Not at all

Perfectly

interstitial lung disease key history findings

occupation
hobbies
asbestos
smoking
connective tissue disease

How well did you know this?

Not at all

Perfectly

investigations in ILD

high res CT
pulmonary function tests
AI screen

How well did you know this?

Not at all

Perfectly

management of ILD

oxygen
antifibrotics
stop smoking
vaccination
exercise

How well did you know this?

Not at all

Perfectly

squamous cell appearance on CXR

mass, can cavitate

How well did you know this?

Not at all

Perfectly

treatment of SCLC

chemo and radiosensitive

How well did you know this?

Not at all

Perfectly

causes of bronchiectasis

idiopathic
post-infection
CF
congenital
asthma
COPD

How well did you know this?

Not at all

Perfectly

transudate definition and causes

normal serum protein and pleural protein <30g/L
LVF
CLD
nephrotic syndrome
PE

How well did you know this?

Not at all

Perfectly

exudate definition and causes

think eggs –> protein
normal serum protein and pleural protein >40g/L
malignancy
pneumonia
TB

How well did you know this?

Not at all

Perfectly

when is Light’s criteria used?

if pleural protein between 30-40g/L
to determine if exudate

How well did you know this?

Not at all

Perfectly

what is Light’s criteria?

exudate if:
- pleural fluid protein/serum protein ratio >0.5
- pleural fluid LDH/serum LDH ratio >0.6
- pleural fluid LDH >2/3 upper limit of normal serum LDH

How well did you know this?

Not at all

Perfectly

diagnosing asthma in 5-16 year olds

-spirometry with BDR test +/- FeNO test

How well did you know this?

Not at all

Perfectly

diagnosing asthma in adults

FeNO test spirometry +/- BDR

what to counsel asthma patient on before discharge?

TAME Technique (inhalers) Avoidance (of triggers_ Monitor (PEFR) Educate

common pneumonia in pre-existing lung disease

H. influenzae

flail chest x-ray features

rib fractures subcut emphysema pneumothorax mediastinal shift if tension

when to insert a chest drain in pleural effusion?

aspirate: - if turbid/cloudy - if tests +ve on MC&S - if pH < 7.2

causes of upper lobe pulmonary fibrosis

TAPE - TB - ABPA - pneumoconiasis - EAA

causes of lower lobe pulmonary fibrosis

STAIR - sarcoidosis - toxins - asbestosis - idiopathic PF - rheumatological

triad of Kartagener's syndrome

situs inversus bronchiectasis chronic sinusitis

triad of Young's syndrome

bronchiectasis chronic sinusitius male infertility

CF CXR findings

hyperinflation peri-bronchial shadowing bronchial wall thickening ring shadows

lung cancer that causes gynaecomastia

adenocarcinoma

lung cancer that releases beta HCG

large cell cancer

2ww referral guidelines in <40s

2 in smokers, 1 in ex/current smokers - cough - chest pain - fatigue - weight loss

2ww referral guidelines in >40s

least one of INTEL - infections (recurrent chest) - nail clubbing - thrombolysis - exam signs - lympahdenopathy

treatment of late stage small cell lung cancer

limited = combo chemorad extensive =palliative chemo

treatment of non-small cell not suitable for surgery

palliative/curative radio (poor chemo response)

GIT causes of clubbing

cirrhosis Chron's/UC Coeliac Cancer: GI lymphoma

signs of pneumonia on examination

dec expansion bronchial breathing inc vocal resonance

3 causes of bronchiectasis

idiopathic congenital post-infection

CXR in bronchiectasis

thickened bronchial walls (tramlines and rings)

which lung cancer can release PTHrP

squamous CC

ARDS definition

non-cardiogenic pulmonary oedema inc capillary permeability

management of ARDS

admit to ITU for organ support and treat underlying cause

pulmonary causes of ARDS

pneumonia aspiration inhalation injury

systemic causes of ARDS

shock sepsis trauma pancreatitis DIC

issue in T1RF

V/Q mismatch and diffusion failure

causes of T1RF

Vascular (PE) Asthma (early) Pneumothorax Atelectasis

issue in T2RF

alveolar hypoventilation

causes of T2RF

obstructive (COPD, Asthma, Bronchiectasis) restrictive (dec resp drive e.g. CNS sedation, NM disease)

chronic bronchitis definition

cough and sputum production on most days for 3 months over 2 successive years

emphysema definition

histological diagnosis of enlarged air spaces distal to terminal bronchioles with destruction of alveolar walls

severity of COPD

FEV1 mild: >80% moderate: 50-79% severe: 30-49% very severe: <30%

indications for LTOT

PaO2 < 7.3 or 7.3-8 with complication

antibiotic for bacterial exacerbation of COPD

Doxy

pleural effusion transudate vs exudate

<25g/L = transudate >35g/L = exudate

what are Light's criteria?

exudate if effusion: serum protein ratio >0.5 effusion: serum LDH ratio >0.6 effusion LDH = 0.6 x ULN

exudative effusion causes

infection neoplasm inflammation (RA, SLE) infarction

ILD causes

Env: asbestosis Drugs: Bleomycin, amiodarone Hypersensitity: EAA Infection: TB, viral Systemic: sarcoid, RA Idiopathic

cause of EAA

acute allergen exposure in sensitised patients chronic exposure = granuloma formation and obliterative bronchiolitis

acute and chronic symptoms of EAA

acute: fevers, malaise, dry cough chronic: SOB, weight loss, T1RF, cor-pulmonale

symptoms and signs of idiopathic pulmonary fibrosis

dry cough, SOB, malaise, arthralgia clubbing, crackles, cyanosis honeycombing

causes of pulmonary HTN

1. L Heart disease: mitral stenosis/regurg, LVF 2. L parencyhmal disease: COPD, asthma, ILD 3. pulomonary vascular disease: idiopathic, vasculitis, PE 4. hypoventilation: OSA, MND

investigations in pulmonary HTN

R heart catheterisation

cause of cor-pulmonale

RHF due to chronic pulmonary HTN

symptoms of cor pulmonale

dyspnoea fatigue syncope

management of cor pulmonale

dec pulmonary vascular resistance (LTOT, sildenafil, CCB) treat cardiac failure

complications of pneumonia

hypotension pleural effusion empyema

signs of CF on exam

clubbing cyanosis bilateral coarse creps

what hormone does squamous CC release?

PTHrP (inc Ca)

small cell Ca treatment

very chemosensitive but very poor prognosis

Respiratory Flashcards

(74 cards)