Respiratory Flashcards
(81 cards)
FEV1/FVC cut off for COPD
<0.7
Chronic bronchitis definition
daily sputum production for at least 3 months of 2 or more consecutive years
What FEV1 chances to consider asthma or coexisting asthma and COPD
FEV1 increases >400mL following bronchodilator
What imaging modality if better to detect PEs in COPD
CTPAs. VQ scans may be difficult to interpret in COPD patients because regional lung ventilation may be compromised leading to matched defects
SABA/SAMA combinations in COPD
Provides additional benefits compared to using SAMA alone and decreased need for corticosteroids
GOLD ABCD
A - mMRC 0-1 and 0-1 moderate/severe exacerbation (not leading to hospital admission) B - mMRC 2 or more, 0-1 mod/severe exacerbation C - mMRC 0-1 and 1 or more mod/severe leading to hospital admission or 2 or more mod/severe exacerbation D - more than above
GOLD A management
A bronchodilator of any type
GOLD B management
LABA or LAMA If persistent symptoms then combination LAMA/LABA
GOLD C management
LAMA If further exacerbations, LAMA+LABA combination or LABA + ICS combination
GOLD D management
LAMA ->LAMA+LABA -> LABA + ICS -> LAMA + LABA + ICS Finally if further exacerbations: consider roflumilast if FEV1 <50% predicted and patient has chronic bronchitis Consider macrolide
Pneumococcal vaccination for <65 COPD
PPSV23
How many generations of airways between the trachea and alveoli
23
how to distinguish between inflammation vs persistent airway remodeling components of airway hyperresponsiveness
Indirect and direct challenges. Indirect challenges are mannitol, hypertonic saline, eucapnic voluntary hyperventilation, exercise challenge, adenosine monophosphate- to active mast cells to release histamine and other bronchoconstrictor mediators Direct challenges is with methacholine - to directly constrict airway smooth muscle via receptors on smooth muscle Inflammatory component of AHR has greater responsiveness to indirect stimuli and persistent airway remodeling is more responsive to direct stimuli
Asthma step up therapy for controllers
Low dose ICS -> low dose ICS/LABA -> med/high dose ICS/LABA -> add on treatment (e.g. anti IgE, tiotropium)
Most effective strategy of reducing progression in COPD
Smoking cessation
Light’s criteria
Exudate - at least one of: - ratio of pleural fluid protein to serum protein of >0.5 - ratio of pleural fluid LDH to serum LDH of >0.6 - Pleural fluid LDH >2/3 upper limit of normal serum LDH Increased false positive with people on diuretics
Most likely cause of transudative pleural effusion
cardiac failure
How to confirm diagnosis of heart failure as the cause of pleural effusion?
NT-proBNP >1500 pg/mL (+ve LR 15.2; neg LR 0.06)
Best pleural fluid test for diagnosis of pleural mycobacterium tuberculosis
Adenosine deaminase >50 U/L (sensitivity 95%, specificity 89%) Also as lymphocytes >50% normally Gold standard for TB diagnosis is thoracoscopy histology and AFB stain
Biomarkers in malignant pleural effusion (tumour biomarkers and mesothelioma)
Tumours: CEA, CYFRA 21-1, CA 15-3 Mesothelioma: Mesothelin, fibulin 3
What are the predictors of mortality in a pleural infection
Urea, age, prulence of fluid, infection source (CAP vs HAP), albumin
Indication of ICC insertion in pleural infection without preceding trial of antibiotics
pH < 7.2 Macroscopically purulent or gram stain/culture positive
What is a treatment option in patients with a pleural infection who has failed initial ICC/antibiotic treatment and is not suitable for VATS/surgery
Intrapleural tissue plasminogen activator (tPA) and deoxyribonuclease (DNAse)
how does pleural fluid pH need to be fun?
<1hr on a pH analyser for accuracy
