Respiratory key points Flashcards
Questions to ask about breathlessness
MRC score, exercise tolerance, triggers, relieving factors, diurnal variation, Orthopnoea, PND
Questions to ask about chest pain
Site, severity, radiation, triggers, relieving factors, associated symptoms
Questions to ask about wheeze
Triggers, relieving factors, diurnal variation, associated cough
Questions to ask about cough
Dry or productive, triggers, relieving factors, diurnal variation, association with eating or dyspepsia, positional, nasal secretions, associated fever
Questions to ask about sputum
How much over 24 hours, colour, consistency
Questions to ask about haemoptysis
Quantity and frequency, fever/night sweats, appetite, weight loss
What appearance of CT scan suggests infection
Ground glass
How do you treat pseudomonas
Piperacillin
Principles of PE treatment
Look for cause, lifelong anticoagulants, check for cancer
Can you see pulmonary hypertension on CT scan
Yes
What drug can help bad ILD
Morphine
Features of bronchiectasis
Airway dilatation and mucous plugs
What can help people cough up mucous
Mucolytics e.g. NaCl nebulised and Carbocisteine, salbutamol helps as can dilate airways further to increase amount of mucous coughed up
Tips for resp exam
Don’t need to percuss in more than 3 areas, chest expansion important for thumbs to hover, with tracheal deviation check for empty space either side of trachea before localising centrally, ensure when auscultating back you are not listening over spine or scapula, check for clubbing by lowering down to height of nails, check RR tricking for pulse, remember lymph nodes
What usually causes COPD/ILD
COPD usually smoking, ILD more commonly occupational or allergy related
Examination in ILD
Fine crackles, especially at lung bases, inspiratory
Explanation of ILD appearance on spirometry
Restrictive pattern due to fibrosis as less air able to enter lungs
FEV1/FVC ratio normal as both are proportionately lower
Causes of delirium
M is also metabolic
target O2 sats
92%
Gold standard answer for giving oxygen
Controlled oxygen and assess patient response
How to present investigations
Start with bedside and do most invasive at the end
What 2 asthma drugs should not be given together in acute asthma attack
IV aminophylline and IV salbutamol
Why is hyperventilation a good sign in asthma
Shows good respiratory muscle function (CO2 is low), as time goes on the respiratory muscles begin to fatigue and the CO2 increases or becomes normal which is a worry as clearly the patient no longer has the physiological reserve to compensate
SOB and pleuritic chest pain key differentials
Pericarditis and pneumothorax, PE
What clinical finding defines a tension pneumothorax
Hypotension (haemodynamic instability). hemidiaphragm depressed
COPD exacerbation investigations
CXR and ABG (to check for high CO2 indicating type 2 respiratory failure especially if GCS not normal)
What do you call respiratory acidosis if not compensated
Acute rather than chronic
NIV is only for
T2 respiratory failure in context of respiratory acidosis and after you gave tried with medical therapy. CPAP is next step before intubation
Type 1 and 2 resp failure modes of oxygen as final step before intubation
T1 needs CPAP T2 needs BIPAP
Contraindications to NIV
Untreated pneumothorax, impaired conscious level, upper airway secretions, facial injury, life threatening hypoxia, vomiting, agitated
How does fibrosis show on CXR
Fine reticular Nodular shadowing
What should you check before you send someone for a CT scan
Us and Es for kidney function to check they can handle contrast
PE classification
PE can be provoked or unprovoked, haemodynamically stable or unstable
Treatment for different PE types
Thrombolysis for haemodynamically unstable, routine anticoagulation if stable