Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Final Prep > AS PACES Resp > Flashcards

AS PACES Resp Flashcards

1
Q

Clinical diagnosis of hyper expansion

A

Reduced cricosternal distance
Loss of cardiac dullness
Palpable liver edge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pathophysiology of COPD

A

Chronic bronchitis / bronchiectasis with emphysema
Chronic bronchitis - cough productive of sputum on most days >3mo on consecutive years
Emphysema - histological alveolar wall destruction with airway collapse and air trapping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

COPD - investigations

A

Bedside - PEFR, BMI, sputum MC+S
Lung function - spirometry obstructive (increased TLC and RV, FEV1:FVC <0.7, FEV1 <80% predicted
Blood - FBC, ABG (TIIRF), CRP, albumin, a1 AT levels if FH and young
Imaging - CXR, Echo (cor pulmonale), ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

mMRC dyspnoea score

A
  1. SOB on vigorous exertion
  2. SOB on hurrying / stairs
  3. Walks slowly or has to stop for breath
  4. SOB <100 yrd / few min
  5. Too breathless to leave house
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

COPD exacerbation - scale

A

Mild - FEV1 >80% but FEV1/FVC <0.7
Mod - FEV1 50-79%
Sev - FEV1 30-49%
V. Sev - FEV1 <30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

COPD management

A

Principal therapies: LAMA/SAMA, SABA/LABA, corticosteroids
Other: theophylline, carbocysteine (mycolytic)
Home emergency pack
LTOT: aim PaO2 >8 for >15h/day, but be non smoker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Mx Acute Exacerbation COPD

A
  1. Controlled O2: sit up, 24% O2 venturi mask target SpO2 88-92%. Aim PaO2 >8 and increased in PCO2 of no more then 1.5 kPa
  2. Nebulised (air driven): Salbutamol 5mg/4h; Ipratropium 0.5mg/6h
  3. Steriods: Hydrocortisone 200mg IV; Pred 40mg PO 7-14d
  4. Abx: Doxy 200mg PO STAT + 100mg OD PO 5/7
  5. Consider aminophylline IV
  6. Consider NIV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Asthma: Ix

A 
Bedside: PEFR
Blood: FBC (eosinophilia), IgE, 
CXR: hyperinflation
Spirometry: obstructive (reduced FEV1, increased RV, improvement with B agonist trial)
PEFR diary: diurnal variation
Atopy: skin sprick test, RAST
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Severe asthma attack

A

PEFR <50%
Can’t complete sentence in one breath
RR >25
Hr >110

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Life threatening asthma attack

A 
PEFR <33%
SpO2 <92%, PCO2 >4.6 kPa, PaO2 <8kPa
Cyanosis
Hypotension
Exhaustion / Confusion
Silent chest, poor resp effort
Tachy/brady/arrythmias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Acute Asthma Attack: Mx

A
  1. Sit-up, 100% O2 via non-rebreathable mask (aim 94-98%), nebulised salbutamol 5mg and ipratropium 0.5mg, hydrocortisone 100mg IV
  2. ?Inform ITU, MGSO4 2g IVI over 20 min, nebulised salbutamol every 15min (monitor ECG)
  3. If improving: monitor SaO2, PEFR, continue pred 50mg OD 5/7; nebulised salbutamol /4hrs
  4. If no improvement: nebulised salbutamol /15min, continue ipratropium 0.5mg 4-6hrs, MgSO4 2g IVI over 20 min, salbutamol IVI 3-20ug/min), consider aminophylline, ITU
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

DDx pulmonary fibrosis

A

Upper: aspergillosis, pneumoconiosis (coal, silica), extrinsic allergic alveolitis, TB
Lower: sarcoid, toxins, aspestosis, IPF, RA, SLE, SS, Sjogren’s
Drugs –> Bleomycin, Amiodarone, Nitrofurantoin, Sulfasalazine, Methotrexate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Ix Pulmonary Fibrosis

A 
Bedside: PEFR, ECG (RVH)
Blood: FBC (anaemia), ABG, ESR/CRP (+ IPF), ANA (30%), RF (10%)
CTD: C3/C4, CCP, scl-70, centromere
Sarcoid: ACE, Ca
CXR / HRCT (firbosis, honeycomb)
Spirometry: restrictive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

IPF: Mx

A 
MDT
Smoking cessation
LTOT
Pulmonary rehab
Symptoms: Anti tussives (codeine), CCF 
Surgical: Lung Tx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Causes of bronchiectasis

A

Congenital: CF, PCD/Kartagener’s, Hypogammaglobulinaemia
Acquired: Idiopathic, post infectious (TB, pertussis, measles), obstruction (FB, tumour), other (RA, IBD, amyloidosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Bronchiectasis Ix

A

Bedside: PEFR, dipstick, sputum MC+S
Blood: FBC, serum Ig, FR/antiCCP
CXR - tramlines and ring shadows (bunch of grapes)
HRCT - signet ring sign (thickened dilated bronchi + smaller adjacent vascular budge
Spirometry - obstructive
Bronchoscopy + biopsy

17
Q

CF: pathophysiology

A 
1/25 carrier, AR d508 CFTR chr 7
Decreased luminal Cl secretion and increased Na reabsorption leads to very viscous secretions = bronchiectasis, DM, malabsorption, gallstones/cirrhosis, infertility
Sweat test = pilocarpine + Na/CL >60mM
Immunoreactive trypsinogen (neonates), faecal elastase (pancreatic exocrine function)
18
Q

CF pt: Mx

A 
MDT
Physio 
Abx
Mucolytics 
Vaccination
Heart lung Tx
Creon + ADEK supplements ± Insulin
Fertility
DEXA
19
Q

Kartagener’s syndrome triad

A

Situs inversus + Chronic sinusitis + Brnochiectasis

20
Q

Young’s Syndrome triad

A

Bronchiectasis + Rhinosinusitis + Azoospermia

21
Q

Light’s criteria for Exudative Effusion

A

Effusion:serum protein ratio >0.5
Effusion:serum LDH ratio >0.6
Effusion LDH =0.6xULN

22
Q

Complications of Lung Ca

A

Invasion: SVCO, RLNP, Pancoast, dermatomyositis

Paraneoplastic

23
Q

Pneumonectomy vs Lobectomy

A

Lateral thoracotomy scar - look
Pneumonectomy: tracheal + apex shift to abnormal side - reduced expansion, dull percussion, NO breath sounds
Lobectomy: tracheal shift to abnormal side, reduced expansion, dull percussion, reduced breath sounds
Indications: 90% non-disseminated bronchial Ca, bronchiectasis, COPD, TB

24
Q

Lung Ca: pathology

A

NSCLC 80% (SCC 35%, smokers, central, ++Ca; AC 25%, F, non smokers, peripheral, 80% present mets; LCLC 10%
SCLC 20% (Highly related to smoke, central, paraneoplastic)

25
Q

Lung Ca: Paraneoplastic syndromes

A 
AHD: SIADH (euvolaemic hyponatraemia)
ACTH: Cushing's syndrome
Serotonin: Carcinoid (flushing, diarrhoea)
Dermatomyositis 
Cerebrllar degeneration
Acanthosis nigricans
Thrombophlebitis migrans
26
Q

Lung Ca Ix

A

Blood: FBC, U&E, LFTs, Bone profile
CXR: coin lesion, effusion, consolidation/collapse, hilar LN
Contrast enhanced volumetric CT thorax
Percutaneous FNA, endoscopic transbronchial biopsy
Staging: CT, PET
Lung function tests to assess suitability for surgery

27
Q

SIRS criteria

A

Temperature >38 or <36
HR >90
RR >20 / PaCO2 <4.6 kPa
WCC >12 or <4

28
Q

SE of TB meds

A

Rifampicin - orange secretions
Isionizid - peripheral sensory neuropathy
Ethambutol - optic neuritis
Pyrazinamide - hepatitis

29
Q

Tuberculin skin test in TB

A

Intradermal injection of purified protein derivative
Induration measured @48-72h
False +ve = BCG, prev exposure, other mycobacteria
False -ve = HIV, sarcoid, lymphoma

30
Q

DDx Pulmonary Fibrosis

A

ESCHART (upper) RASCO (lower)

EEA, Sarcoid, Coal pneumoconiosis, Histiocytosis, Ank Spond, Rx, TB

RA, Asbestosis, Scleroderma, Cryptogenic (IPF), Drugs (methotrexate, nitrofurantoin, bleomycin, amiodarone)

Final Prep (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions