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Sheff 91 core clinical problems > 48 - cough / sputum, 49 - cyanosis, 50 - haemoptysis > Flashcards

48 - cough / sputum, 49 - cyanosis, 50 - haemoptysis Flashcards

1
Q

Which cells produce sputum

A

goblet

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2
Q

Dx of asthma

A

spirometry

diurnal variations in peak flow

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3
Q

What non pharmalogical mx of asthma

A

No smoking

annual flu and pneumonia vaccine

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4
Q

which class of drug contraindicated in asthma

A

b blockers

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5
Q

Acute asthma mx

A 
Oxygen!
Nebbed salbutamol
Oral prednisolone
Ipratropium bromide
Magnesium Sulphate
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6
Q

Chronic asthma stepwise progression

A

SABA: salbutamol – important to assess technique if treatment has failed

Inhaled corticosteroid: beclomethasone

LABA: salmeterol.

Leukotriene receptor antagonist: monteleukast. Or theophylline

Oral steroids: prednisolone

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7
Q

FEV1 in COPD

A

<30%

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8
Q

causes of COPD

A

smoking
cooking fires
air pollution
genetic - alpha 1 antitrypsin deficiency

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9
Q

mx of COPD

A

Reduce risk factors.

May need oxygen, nebs or long term corticosteroids.

Salbutamol if breathless and exercise limited. Then to SABA or LAMA – tiotropium. Can add on aminophylline or theophylline, which improve lung function but not symptoms.

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10
Q

When to admit for acute COPD

A

breathless, confused, cyanosed, acopia, low sats

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11
Q

Mx acute COPD

A

Increase SABAs, pred, Abx if signs of pneumonia (amoxicillin 500mg TDS 5d)

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12
Q

Eg causes of cor pulmonale

A

COPD, CF, pulm HTN

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13
Q

Sx / signs of cor pulmonale

A

SOB, wheeze, cyanosis, ascites, jaundice, raised JVP, third heart sound.

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14
Q

is latent TB contagious

A

no

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15
Q

Dx of TB

A

CXRs and culture and microscopy in active disease (acid fast and Ziehl Neelsen stain)

Latent disease with tuberculin skin test.

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16
Q

What can activate latent TB

A

Silcosis, smoking, infection and malnutrition

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17
Q

Mx of TB

A

Arrange hospital admission

Notify public health authorities

RIPE therapy: 6/12 isoniazid and rifampicin, 2/12 pyrazinamide and ethambutol. Compliance is vital.

Contract tracing.

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18
Q

Side effects of 4 tb drugs

A

Rifampicin – orange bodily secretions, liver toxicity, flu-like symptoms

Isoniazid – peripheral neuropathy, elevated liver enzymes

Pyramidazine –joint pains, gout, hepatoxicity,

Ethambutol – optic neuritis, peripheral neuropathy, hepatoxicity

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19
Q

Lung Ca Sx

A

Coughing up blood, wheeze, SOB, weight loss, weakness, clubbing of fingers, hoarse voice, palmar wasting (Pancoast tumours),

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20
Q

Rfs for Lung ca

A

smoking, radon gas, asbestos, air pollution

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21
Q

which 2 paraneoplastic syndromes can happen in Lung Ca

A

Lambert-Eaton myasthenic syndrome
LEMS
->muscle weakness due to neuropathy

SIADH

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22
Q

organs affected in CF

A

lungs, pancreas, liver, kidneys, intestine, genitals

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23
Q

Sx of CF

A

Failure to thrive, dyspnoea, repeat lung infections, fatty stool, male infertility, finger clubbing, productive cough, diabetes.

24
Q

Pathology of CF

A

AR

Mutations in cystic fibrosis transmembrane conductance regulator (CFTR) controls flow of chloride and water into mucus.

25
Q

Dx of CF

A

Diagnose with sweat test and genetic screening. Heel prick testing (trypsinogen levels).

26
Q

Mx of CF

A

No cure,

Creon for pancreatic enzyme replacement,
physiotherapy
fat soluble vitamin replacement (ADEK).

Lung transplant may become necessary.

Long term Abx therapy.

27
Q

Ix in pneumonia

A

CXR, CRP, sputum culture to identify cause

28
Q

Abx mx of pneumonia

A

amoxicillin 500mg TDS for 5d. If no improvement after 3d, extend tx to 7-10d.

If CRB score 1-2 then add clarithromycin

29
Q

Parts of CURB65 ? What does it do?

A

Confusion
Urea (blood 7mmol/l)
Respiratory rate of 30 breaths per minute
Blood Pressure less than 90 systolic or 60 diastolic
65 or older

Evaluates death risk and is the basis for treatment and admission

30
Q

What is pulm oedema

A

Fluid accumulation in the lungs. Impairs gas exchange and leads to respiratory failure.

31
Q

Associations with pulm oedema

A

CHF

fluid overload

32
Q

Sx /signs of pulm oedema

A

Pink frothy sputum, dyspnoea, sweating, orthopnea, PND, raised JVP, third heart sound.

low SaO2, CXR

33
Q

Mx of cardiogenic pulm oedema? non cardiogenic?

A

If cardiogenic, furosemide, position upright, oxygen, GTN, morphine,
Consider NIV.

non cardiogenic
treat underlying cause and provide oxygen.

34
Q

preventitive anticoagulation following PE?
monitoring?
other Ix?

A

3 months of heparin at least, however longer if risk factors remain.

Target INR 2.5 (2.0-3.0)

Investigate for undiagnosed cancer if PE unprovoked.

35
Q

What is bronchiectasis? obstructive / restirctive?

A

Permanent airway dilation (obstructive lung disease

36
Q

Sx of bronchiectasis?

A

Chronic cough (productive, haemoptysis), SOB, wheezing, clubbing, frequent infection.

37
Q

Cause of bronchiectasis?

A

Can result from CF and lung infections.

May also be congenital

38
Q

Dx of bronchiectasis?

A

CT / cultures

39
Q

prevention of bronchiectasis?

A

immunisations / sno smoking

40
Q

Mitral stenosis sx?

A

Chest pain, palpitations, haemoptysis, weakness, malar flash and fatigue

41
Q

Dx of MS

A

Echocardiography

42
Q

Mx of MS

A

Treat if symptomatic: valve replacement/balloon dilation. Manage symptoms (i.e. angina with GTN etc.)

43
Q

Common cause of MS

A

Rheumatic fever

44
Q

What is goodpastures? 2 key organs

A

Autoimmune disease attacking basement membrane in kidneys and lungs.

Produces haemoptysis and renal failure.

45
Q

Sx of good pastures bar lung / renal

A

usual autoimmune symptoms of weakness, fatigue, fever and joint aches.

46
Q

Dx for goodpastures?

A

Anti-GBM antibodies

47
Q

Mx goodpastures

A

steroids
cyclophosphamide and plasmapheresis.

Damage to organs may necessitate transplant

48
Q

Association with goodpastures

A

HLA-DR2

49
Q

What is sarcoidosis?

A

Inflammatory disease producing diffuse granulomas in all organs

50
Q

Sarcoidosis sx

A

Dry cough, wheezing and chest pain if there is lung involvement. Lungs, skin and lymph nodes usually present first

you can basically get any sx as it affects everything

51
Q

Whats seen on CXR of sarcoid ? bloods?

A

CXR shows hilar lymphadenopathy and basal nodularity.

Bloods show hypercalcaemia with normal PTH.
Raised ACE in circulation.

52
Q

Mx of sarcoid

A

depends on severity anything from ibuprofen to DMARDS

53
Q

2 bleeding disorders that could -> haemoptysis

A

haemophilia A/B

VW disease

54
Q

haemophilia A vs B

A

A is a Factor VIII deficiency.

B is a Factor IX deficiency.

55
Q

Complications of haemophilia

A

haemarthrosis, internal bleeding, CVA, blood infections.

56
Q

What is von willirand factor

A

Von Willibran Factor is a blood glycoprotein aiding clotting.

It is present normally in the epithelium basement membrane and its exposure is a sign of tissue injury.

It binds to clotting factors and platelets, holding them to the site of the injury.

Sheff 91 core clinical problems (51 decks)

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