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Year 5 Notes > Respiratory > Flashcards

Respiratory Flashcards

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1
Q

ARDS:

Features

A

Cyanosis
Tachypnoea
Peripheral vasodilation
Bilateral fine end respiratory crackles

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2
Q

ARDS:

Diagnostic criteria

A

= 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

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3
Q

CURB65

A

Confusion
Urea >7
Respiratory rate >30
BP sys 65

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4
Q

CURB65:

Management

A

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

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5
Q

Hypercapnic drive:

At risk groups

A
  1. COPD
  2. CF
  3. Restrictive chest disorders (e.g muscular, neuromuscular)
  4. Morbid obesity >40
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6
Q

Hypercapnic drive:

Management

A
  1. Aim for 88-92% sats
  2. Decrease but don’t stop O2 2-4l
  3. Look for previous ABG for baseline
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7
Q

Pleural Effusion:

X Ray features

A 
Blunt costophrenic angle
Blunt cardio phrenic angle
Fluid in fissures 
Meniscus
Large one sided effusion --> mediastinal shift
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8
Q

Transudate vs Exudate

A 
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

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9
Q

Consolidation:

Causes

A

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

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10
Q

Consolidation:

X Ray features

A

Air bronchogram - homogenous opacity with dark lines running through

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11
Q

PE:

Risk factors

A 
Cancer
Fracture
Immobility
Thrombophilia
Pregnancy/HRT
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12
Q

PE:

Sx

A 
Tachycardia 
Tachypnoeic
Raised JVP
Breathlessness
Pleuritic chest pain 
Haemoptysis
Syncope/dizziness
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13
Q

PE:

Management

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

ECG, CXR, ABG
D dimer
CTPA

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14
Q

Type I respiratory failure

A

Low O2 but normal CO2

From lung tissue damage; pneumonia, asthma, COPD, pneumothorax, PE, fibrosis, edema

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15
Q

Type II respiratory failure

A

Low O2 and high CO2

From poor ventilation eg: COPD, asthma, OD, MG, neuromuscular disorders, obesity

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16
Q

Bronchiectasis:

Definition/cause

A

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

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17
Q

Bronchiectasis:

Symptoms

A

Persistent cough
Copious purulent sputum
Intermittent haemoptysis
Coarse inspiratory creps

Tram line CXR

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18
Q

Bronchiectasis:

Management

A

Postural drainage BD
Physio
ABX if needed
Surgery if severe haemoptysis

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19
Q

Pneumonia types:

Pneumococcal

A

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

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20
Q

Pneumonia types:

Klebsiella

A 
Rare
Elderly, diabetics and alcoholics
Cavitating, upper lobes
Drug resistant
Tx: cefotaxime, imipemen
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21
Q

Pneumonia types:

Staphylococcal

A

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

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22
Q

Pneumonia types:

Pseudomonas

A

Common in bronchiectasis
Cause HAF
Tx: anti pseudomonal penicillin

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23
Q

Pneumonia types:

Mycoplasma pneumoniae

A

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

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24
Q

Pneumonia types:

Legionella

A

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

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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

Year 5 Notes (19 decks)

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