Respiratory Flashcards Preview

Year 5 Notes > Respiratory > Flashcards

Flashcards in Respiratory Deck (66):
1

ARDS:
Features

Cyanosis
Tachypnoea
Peripheral vasodilation
Bilateral fine end respiratory crackles

2

ARDS:
Diagnostic criteria

= lung damage with (non cardiogenic) pulmonary edema +/- multi organ failure
Either from direct lung injury or from systemic illness
- acute onset
- CXR bilateral infiltrates
- low PCWP/no CHF
- refractory hypoxaemia

3

CURB65

Confusion
Urea >7
Respiratory rate >30
BP sys 65

4

CURB65:
Management

0-1 community ABx
2 admission
3-5 potential ICU admission

5

Hypercapnic drive:
At risk groups

1. COPD
2. CF
3. Restrictive chest disorders (e.g muscular, neuromuscular)
4. Morbid obesity >40

6

Hypercapnic drive:
Management

1. Aim for 88-92% sats
2. Decrease but don't stop O2 2-4l
3. Look for previous ABG for baseline

7

Pleural Effusion:
X Ray features

Blunt costophrenic angle
Blunt cardio phrenic angle
Fluid in fissures
Meniscus
Large one sided effusion --> mediastinal shift

8

Transudate vs Exudate

Transudate = low protein, low LDH, low specific gravity
Exudate = high protein, high LDH, low specific gravity

Transudate - from increased hydrostatic pressure or decrease capillary oncotic pressure e.g HF, nephrotic syndrome, cirrhosis

Exudate - lung ca, PE, pneumonia, TB, mesothelioma

9

Consolidation:
Causes

Infection - pus
Haemorrhage - blood
Cancer - cells
Pulmonary edema - fluid

10

Consolidation:
X Ray features

Air bronchogram - homogenous opacity with dark lines running through

11

PE:
Risk factors

Cancer
Fracture
Immobility
Thrombophilia
Pregnancy/HRT

12

PE:
Sx

Tachycardia
Tachypnoeic
Raised JVP
Breathlessness
Pleuritic chest pain
Haemoptysis
Syncope/dizziness

13

PE:
Management

O2 100%
Morphine 10mg+ anti emetic
Critically ill --> thrombolysis alteplase /surgery
Or LMWH
Colloid infuse if hypotensive




ECG, CXR, ABG
D dimer
CTPA

14

Type I respiratory failure

Low O2 but normal CO2
From lung tissue damage; pneumonia, asthma, COPD, pneumothorax, PE, fibrosis, edema

15

Type II respiratory failure

Low O2 and high CO2
From poor ventilation eg: COPD, asthma, OD, MG, neuromuscular disorders, obesity

16

Bronchiectasis:
Definition/cause

Chronic infection of bronchi and bronchioles leading to permanent dilation of airways. From Hib, strep pneumoniae, staph A, pseudomonas

17

Bronchiectasis:
Symptoms

Persistent cough
Copious purulent sputum
Intermittent haemoptysis
Coarse inspiratory creps

Tram line CXR

18

Bronchiectasis:
Management

Postural drainage BD
Physio
ABX if needed
Surgery if severe haemoptysis

19

Pneumonia types:
Pneumococcal

Most common
Everyone
CXR: lobar consolidation
Amox/benpen/cephalosporin

20

Pneumonia types:
Klebsiella

Rare
Elderly, diabetics and alcoholics
Cavitating, upper lobes
Drug resistant
Tx: cefotaxime, imipemen

21

Pneumonia types:
Staphylococcal

From flu, young, elderly, IVDU, existing disease
Bilateral cavitating bronchopneumonia
Tx: fluclox

22

Pneumonia types:
Pseudomonas

Common in bronchiectasis
Cause HAF
Tx: anti pseudomonal penicillin

23

Pneumonia types:
Mycoplasma pneumoniae

Occurs in epidemics
Flu symptoms followed by dry cough
CXR: reticular shadowing, patchy consolidation worse than symptoms suggest
Can cause haemolytic anaemia, meningitis, guillain-barré
Tx: tetracycline, clarithromycin

24

Pneumonia types:
Legionella

Water tanks eg air con
D+v, hepatitis, anorexia, renal failure, confusion, haematuria
Tx: clarithromycin +-rifampicin

25

Types of pneumonia:
Chlamydophilia pneumoniae

Pharyngitis (hoarseness), otitis, then pneumonia
Tx: tetracycline or clarithromycin

26

Pneumonia types:
Pneumocystis pneumonia

HIV
Exertional cough and dyspnoea
CXR: bilateral creps and shadowing
Tx: high dose co-trimoxazole

27

Pleural effusion:
management

CXR to assess size
Depends on how symptomatic it is
Don't drain emergency patients
Aspirate 1-2 spaces below top of effusion (from percussing) above rib
Send off for lab trans vs exudate

28

Ix for ?PE with renal impairment?

VP

29

Step 1 Asthma BTS guidelines

SABA

30

Step 2 Asthma BTS guidelines

Steroid inhaled 200-800mcg

31

Step 3 Asthma BTS guidelines

LABA (assess respond and up steroid up to 800mcg)

32

Step 4 Asthma BTS guidelines

Increase steroid to 2000mcg
Add theophylline or LRA eg montelukast

33

Step 5 Asthma BTS guidelines

Oral steroid tablet

34

Pneumothorax:
Findings

⬇️ expansion
⬇️ air entry affected side
Hyper resonant percussion
⬇️ vocal resonance

35

COPD:
Findings

Hyper inflated chest
⬇️ expansion
⬇️ air angry bilateral
Hyper resonant percussion
Wheeze, exploratory/polyphonic
⬇️ vocal resonance

36

Pulmonary fibrosis:
Findings

⬇️ expansion
⬇️ air entry bilaterally
Resonant to percussion
Mid/end inspiratory fine crackles don't clear on coughing
Resonance normal/⬇️

37

Bronchiectasis:
Findings

⬇️expansion
⬇️ air entry
Fine expiration you crackles that change on coughing
Normal/⬇️ resonance

38

Asthma:
Findings

⬇️ expansion
⬇️ air entry
Hyper resonant
Expiratory polyphonic wheeze

39

Pneumonia:
Findings

⬇️ everything on affected side
Increased vocal resonance

40

Pulmonary edema:
Findings

Stony dull to percussion
Mid-late coarse crackles don't clear on coughing

41

Pleural effusion:
Findings

⬇️ everything inc vocal resonance
Stony dull to percussion

42

Spirometery:
Obstructive defect

FEV1⬆️ more reduced than FVC
FEV1/FVC ratio is

43

Spirometery:
Restrictive

FVC⬇️
FEV/FVC ratio normal/⬆️ I.e >75%
E.g sarcoidosis, pneumoconiosis, pleural effusion, obesity, neuromuscular

44

Spirometery:
KCO/DLCO

KCO is CO diffusing capacity. DLCO is adjusted for volume.
⬇️ in emphysema, interstitial lung disease
⬆️ alveolar haemorrhage

45

Emphysema

Needs histological diagnosis
Enlarged distal air spaces, with destruction of alveolar walls

46

Pulmonary fibrosis:
Signs, symptoms

Symptoms:
Dry cough, externational dyspnoea, malaise, weight⬇️, arthralgia
Signs: cyanosis, clubbing, fine end inspiratory velcro creps
Respiratory failure (type 1), ⬆️ risk of lung cancer

47

Pulmonary fibrosis:
Investigations + findings

ABG: ⬇️O2 ⬆️CO2
Bloods: CRP⬆️, immunoglobulins⬆️, ANA, rheumatoid factor
CXR: ⬇️ lung volume, bilateral lower zone reticulo-nodular shadowing, honeycomb
CT essential
Spirometry: restrictive
Lung biopsy

48

Pulmonary fibrosis:
Management

O2 therapy
Pulmonary rehab
Opiates
Palliative care
Clinical trial/lung transplant

49

Spontaneous primary pneumothorax

OPD discharge and r/v

50

Spontaneous primary pneumothorax >2cm +/ SOB:
Management

Aspirate 2nd ICS midclavicular large bore needle

51

Spontaneous secondary pneumothorax

Aspirate 2nd ICS midclavicular
Success - admit high flow O2
Fail - chest drain

52

Spontaneous pneumothorax bilateral/unstable

Chest drain 4-6th ICS mid axillary, above rib, clamp when bubbling finished+CXR shows re inflation 24h

NEVER CLAMP BUBBLING TUBE

53

Tension pneumothorax:
Management

Needle Aspirate first 2nd ICS midclavicular - don't delay with CXR
Then when aspirated, CXR, then chest drain 4-6th mid axillary

54

Acute Asthma management

OSHITME
O2
Salbutamol
Hydrocortisone 100mg IV (/40mg oral pred)
Ipratropium 0.5mg
Theophylline
Mag sulphate 1.2-2g IV
Escalate care

55

Cor pulmonale

Right heart failure caused by chronic pulmonary HTN

From chronic lung disease, pulmonary vascular disorders etc

56

Cor pulmonale:
Signs

Dyspnoefatigue
Syncope
Cyanosis
Tachycardia
Raised JVP (a and v waves)
Pan systolic tricuspid regurg murmur/ graham steell murmur

57

Cor pulmonale:
Ix

⬆️ hb and haematocrit
Hypoxia
CXR: enlarged right heart w/ prominent pulmonary arteries

58

PE ECG

S1Q3T3


Large S wave lead 1
Q wave in lead 2
Inverted t wave lead 3

59

Acute severe asthma signs

Unable to complete sentences
RR>25
HR >110
PF

60

Life threatening asthma features

33-92-chest

Less than

61

Indications for home oxygen

PaO2

62

Indications for NIV

COPD + respiratory acidosis 7.25-35
Neuromuscular, sleep apnoea, chest deformity
Cardiogenic pulmonary edema unresponsive to CPAP
Weaning from tracheal intubation

63

Fibrosis affecting upper zones

Sarcoidosis
Coal workers
TB

64

Fibrosis affecting lower zones

Idiopathic pulmonary fibrosis
Drug induced
Asbestos
RA

65

Extrinsic Allergic Alveolitis

Farmers, bird, malt workers
Upper-mid zone fibrosis

66

Most common organism infective exacerbation COPD

Hib