Flashcards in Respiratory Deck (56):
Which are the most common organisms causing pneumonia?
What are the CURB 65 criteria?
Resp rate at least 30
BP systolic no more than 90 or diastolic no more than 60
Age 65 or over
How does the CURB 65 score inform management?
If scoring 0, then manage in community
If 1, do sats and CXR. If sats lower than 92 or multiple areas of shadowing then admit to hospital
If 2 or above then admit to hospital
What antibiotics should be used for mild pneumonia?
What antibiotics should be used for sever pneumonia?
Clarithromycin plus either benzylpenicillin, co amoxiclav, cefuroxime or cefotaxime
Give 3 complications of pneumonia?
What are the criteria for starting long term oxygen therapy in COPD?
pO2 <7.3 on 2 separate occasions or
between 7.3 and 8 if there is also one of:
What are the criteria for starting non-invasive ventilation?
COPD with respiratory acidosis
Type 2 respiratory failure secondary to neuromuscular disease, chest wall deformity, or OSA
Cardiogenic pulmonary oedema unresponsive to CPAP
Weaning from tracheal intubation
What is the difference between CPAP and BIPAP?
CPAP is not ventilatory support but splints open airways with constant pressure of oxygen
BIPAP has different pressures for inspiration and expiration with rescue breaths set up so it acts as ventilatory support
Give 3 risk factors for obstructive sleep apnoea
Alcohol before bed
Neck circumference >43 cm
What are the two main causes of Obstructive Sleep Apnoea?
Small pharyngeal size with normal relaxation eg large tonsils or fatty infiltration
Normal size with excessive narrowing on relaxation eg with alcohol and increasing age
What are the general principles of managing obstructive sleep apnoea?
Conservative measures eg weight loss
Mandibular advancement devices
What are the spirometry results in COPD?
Reduced FEV1/FVC (<70& predicted)
What is MRC dyspnoea scale stage 1?
Untroubled by breathlessness except on strenuous exercise
What is MRC dyspnoea scale stage 2?
Breathlessness when hurrying or walking up slight hill
What is MRC dyspnoea scale stage 3?
Unable to keep up with contemporaries on the flat due to shortness of breath
Having to stop for breath when walking at own pace
What is MRC dyspnoea scale stage 4?
Having to stop for breath after walking for 100m or a few minutes on the flat
What is MRC dyspnoea sclae stage 5?
Breathlessness on dressing or being unable to leave the house due to breathlessness
What medical management is used for stable COPD FEV1 >50% predicted?
Either SABA or SAMA
Either add LABA or swap SAMA for LAMA
If on a LABA and its not enough, add combined ICS or a LAMA
Triple therapy: LABA+ICS and LAMA
What medical management is used for stable COPD FEV1<50% predicted?
SABA or SAMA
Add either LABA+ICS or LABA+LAMA or have LAMA alone
Triple therapy: LABA+ICS and LAMA
When should someone be sent for an assessment of oxygen therapy?
If sats <92% on air
If FEV1<30% predicted
If secondary polycythaemia
If peripheral oedema
What is the purpose of pulmonary rehabilitation?
Improve quality of life
Safely increase exercise capacity
Give 3 causes of a pleural transudate
Give 3 causes of pleural exudate
What is light's criteria?
Way of distinguishing between transudate and exudate in a pleural effusion if protein content is borderline. Looks at serum and effusion LDH and protein
What is the difference between a primary and secondary spontaneous pneumothorax?
Primary occurs when there is no underlying lung disease present
Give three risk factors for developing a pneumothorax
Underlying lung disease
Trauma or chest procedure
How should a primary pneumothorax be managed?
Aspirate and give oxygen if rim of air is >2cm and patient is symptomatic
If rim of air is <2cm and patient is asymptomatic then discharge
If unsuccessful then insert a chest drain
What patient advice should be given on discharge from a pneumothorax
Avoid flying until complete resolution
How should a secondary pneumothorax be managed?
If patient is over 50 with rim of air over 2cm or symptomatic then insert a chest drain
If rim of air is <2cm then aspirate
Admit for at least 24 hours
Give 3 causes of type 1 respiratory failure
Asthma (Life threatening)
Give 3 causes of type 2 respiratory failure
Reduced respiratory drive eg CNS lesion
Neuromuscular disease eg Guillain Barre
Give 3 features of hypoxia
Polycythaemia if chronic
Give 3 features of hypercapnia
How is type 1 respiratory failure managed?
Controlled oxygen therapy
NIV if still hypoxic despite oxygen
How is type 2 respiratory failure managed?
Controlled oxygen, guided by CO2 levels on ABG
NIV if retaining CO2 still
Intubation if NIV fails
How is a pulmonary embolism managed?
Oxygen if hypoxic
Fluid resuscitation if hypotensive
If massive PE, then 10,000 units unfractionated heparin IV and thrombolyse with alteplase
If not a massive PE, then LMWH
start warfarin andCOntinue herparin therapy until INR = 2
What are the features of a massive pulmonary embolism?
Hypotension or signs of imminent cardiac arrest
Signs of right heart strain
What ECG changes may be seen in pulmonary embolism?
S1 = large s wave in lead 1
Q3 = large q wave in lead 3
T3 = inverted T wave in lead 3
+RBB and right axis deviation
What is bronchiectasis?
Chronic dilatation of one or more bronchi, secondary to chronic infection or inflammation. There is poor mucus clearance and so are predisposed to recurrent or chronic bacterial infections
Give 3 causes of bronchietasis?
Post-infective eg from pneumonia or TB
Genetic eg cystic fibrosis
Mucociliary clearance deficit eg primary ciliary dyskinesia
Obstruction eg by foreign body
Toxic insult eg gastricaspiration
Allergic bronchopulmonary aspergillosis
What investigations are done in suspected bronchiectasis?
What chest x ray findings are there in bronchiectasis?
Thickened bronchial walls
What are the features of bronchiectasis?
Persistent purulent sputum
Coarse inspiratory crepitations
How is bronchiectasis managed?
Treat underlying cause
Training of inspiratory muscles
Antibiotics according to sensitivities
Pulmonary rehab if MRC >/= 3
What are the features of Horner's syndrome?
How is non-small cell lung cancer managed?
Radiotherapy (curative or palliative)
How is small cell lung cancer managed?
Surgery if T1-T2
Chemo and radiotherapy (curative or palliative)
What is the WHO cancer status 0?
Normally and fully active with no restrictions
What is the WHO cancer status 1?
Difficulty with strenuous activity but able to carry out light work
What is the WHO cancer status 2?
Ambulatory. Able to self care but can't carry out work. Active for >50% of the day
What is the WHO cancer status 3?
Only able to carry out limited self care. In bed/chair for >50% of the day
What is the WHO cancer status 4?
Completely disabled. Can't self care and fully confined to bed or chair
What impact does the WHO cancer status have on management?
Generally, radical therapy or chemotherapy won't be considered if stage 3/4
Give 3 contraindications for surgery in lung cancer?
Poor general health ie performance status 3 or above
Vocal cord paralysis
Malignany pleural effusion