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clinical Flashcards

1
Q

what is the treatment for sleep apnoea?

A 
Underlying factors (weight, alcohol, endocrine) 
continuous positive airways pressure
mandibular repositioning splint
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2
Q

OSA Severity scale (desaturation) for sleep apnoea of 0-5 is

A

normal

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3
Q

OSA Severity scale (desaturation) for sleep apnoea of >30 is

A

severe

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4
Q

OSA Severity scale (desaturation) for sleep apnoea of 15-30is

A

moderate

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5
Q

OSA Severity scale (desaturation) for sleep apnoea of 5-15 is

A

mild

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6
Q

what are the investigations for sleep apnoea?

A 
Pulse oximetry
limited sleep study
full polysomnography (EEG, adiuovisual recording, EMG, ECG, PSG)
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7
Q 
what are is this symptomatic of?
 Breathlessness 
orthopnoea 
ankle swelling
morning headaches
recurrent chest infections 
disturbed sleep
A

chronic ventilator failure

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8
Q

what are the signs of chronic ventilatory failure

A 
Elevated bicarbonate
pco2<6.0kPa
normal blood Ph
pO2 <8kPa 
chest wall abnormality
airways disease
respiratory muscle weakness
central hypoventilation
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9
Q

what are the investigations for chronic ventilatory failure

A 
Lung function lying/standing 
mouth pressure
early morning ABG
oximetry
CO2 monitoring 
fluoroscopic screening of diaphragm
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10
Q

what is the treatment for chronic ventilatory failure

A

Non-invasive ventilation
oxygen therapy
t-IPPV

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11
Q

what is the treatment for narcolepsy

A

modafinil
clomipramine
sodium oxybate

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12
Q 
what are these the symptoms of? 
Pleuritic chest pain
cough
haemoptysis
dyspnoea
syncope 
cardiac arrest
A

pulmonary embolism

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13
Q

what are these the symptoms of Dyspnoea, cough

basal crackles, cyanosis, clubbing

A

usual interstitial pneumonitis

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14
Q

what are these the symptoms of Fever, dry cough, myalgia, chills, crackles, tachyopnoea, wheeze, antibody
insidious, malaise, shortness of breath

A

hypersensitivity pneumonitis

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15
Q

what are these the symptoms of Dyspnoea
heart failure
respiratory failure type 1

A

Diffuse alveolar damage

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16
Q 
what are these the symptoms of Acute althralgia
Erythema nodusum
bilateral hilar lymphadenopathy
shortness of breath
cough
A

sarcoidosis

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17
Q

what are these the Chest tightness
exertional dyspnoea
exertional syncope or presyncope
symptoms of

A

pulmonary hypertension

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18
Q 
what are these the symptoms of Malaise 
fever
Chest pain
Cough
rusty sputum 
Dyspnoea
A

pneumonia

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19
Q

what are these the symptoms of Lethargy
Weight loss
high swinging fever

A

lung abscess

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20
Q

what are these the symptoms of Chest pain
absence of cough
swinging fever

A

empyema

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21
Q 
what are these the symptoms of Chronic cough
daily sputum foul smelling 
wheeze 
dyspnoea
tiredness
chest pains
Haemoptysis
A

bronchiectasis

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22
Q 
what are these the symptoms of Recurrent infections
chronic sputum
dypnoea
haemoptysis
pneumothorax
A

cystic fibrosis

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23
Q 
what are these the symptoms of Shortness of breath
wheezing
weight loss 
regular infections 
haemoptysis
 pain
Neurological 
Difficulty swallowing
raspy voice 
haematuria
fatigue
A

lung cancer

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24
Q 
what are these the symptoms of Weight loss
progressive smoker’s cough 
wheeze
chest tightness 
breathlessness
coughing up sputum 
muscle loss
regular chest infections
A

COPD

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25
Q

what are these the symptoms of rhinitis

A

runny nose

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26
Q

what are these the symptoms of ear ache
erythema
bulging ear drum

A

otitis media

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27
Q

what are these the symptoms of Stridor
hoarse voice
signs of common cold
barking cough

A

croup

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28
Q

what are these the symptoms of epiglottis

A

Stridor
hoarse voice
signs of common cold
barking cough

29
Q 
what are these the symptoms of 
Asymptomatic
increasing breathlessness
pleuritic chest pain
dull ache
dry cough
weight loss
malaise, fevers
night sweats
A

pleural effusion

30
Q

what are these the symptoms of
Coughing
sneezing
primary; erythema nodusm, malaise, fever, rarely chest signs.
secondary; Cough, sputum, haemoptysis, pleuritic pain, breathlessness, malaise, fevers, night sweats

A

tuberculosis

31
Q

signs of pulmonary embolism

A 
Recent surgery
trauma
cancer 
cardiopulmonary disease
pregnancy 
thrombophilia 
Pyrexia 
Pleural rub
stony dullness 
tachycardia
tachypnoea 
hypotension
hypoxia
32
Q

treatment for pulmonary embolism

A 
Oxygen
Heparin 
warfarin 
anti-coagulants
Thrombolysis (alteplase)
pulmonary embolectomy
33
Q

investigations for pulmonary embolism

A 
Pre-test wells score and Geneva score 
full blood count, biochemistry and blood gas
CXR
ECG
d-dimer
V/Q
CT scan (angiogram) 
echocardiography
thrombophilia testing
34
Q

investigations for hypersensitivity pneumonitis

A 
Chest x ray
ACE 
biopsy
clinical findings
serum CA
35
Q

investigations for sarcoidosis

A 
Serum Ca 
ACE
Biopsy
X-ray
clinical findings
36
Q

investigations for pulmonary hypertension

A 
ECG
lung function 
chest x ray 
echocardiography
V/Q scan
CTPA
right heart catheter
37
Q

investigations for pneumonia

A 
Serum biochemistry, blood count 
CXR
blood culture
Throat swav
urinary legionella antigen
sputum microscopy and culture 
CURB
38
Q

investigations for lung abscess

A

CT scan

sputum culture

39
Q

investigations for empyema

A

CT thorax
pleural ultrasound
pleural aspiration

40
Q

investigations for bronchiectasis

A 
HRCT thorax 
sputum culture 
serum immunoglobulins
Total IgE and aspergillus precipitins
CF genotyping
41
Q

investigations for cystic fibrosis

A

Antenatal and neonatal screening with Guthrie test, sweat test.

42
Q

investigations for lung cancer

A 
CRX
PET/CT scan
broncho/mediastinoscopy
EBUS
bone scane
blood test
pulmonary function test
spirometry
V/Q scan
ECG
angiogram
biopsy 
thoracotomy
renal and liver function
43
Q

investigations for COPD

A 
FEV1/FVC ratio <80%
PEFR <400-600ml 
carbon monoxide transfer test 
BMI
lung volume
limited response to treatment 
CXR
blood gas test
full blood count 
ECG
sputum culture 
pulmonary function test
44
Q

investigations for pleural effusion

A 
Protein content of fluid (trans/exudate) 
CXR (need 200ml)
CT scan of thorax
aspiration 
blood culture and samples 
look and sniff
blood gas analyser 
biochemistry
microbiology 
cytology 
pleural biopsy (abram, CT) 4 samples in saline and formaldehyde
thoracoscopy
45
Q

investigations for tuberculosis

A

Primary – heaf/tunerclin test of PPD administration.
sputum culture , smear, ziehl neilsen stain. PCR sputum sample. Chest radiograph.
CT scan, bronchoscopy, pleural aspiration and biopsy.

family scan

46
Q

treatment for pulmonary hypertension

A 
Oxygen
anticoagulation 
Diuretics 
calcium channel antagonist
prostacyclin 
endothelin receptor antagonists
phosphodiesterase inhibitors
thrombo-endarterectomy
lung/heart transplant
47
Q

treatment for pneumonia

A 
Curb 1 – amoxycillin or clarithromycin
2 – amoxycillin and clarithromycin
3-5
co-amoxiclav and clarithromycin
Oxygen
I.v. fluids
intubation and ventilation
48
Q

treatment for lung abscess

A

Prolonged antibiotics

drainage if possible either through bronchial tree or percutaneous

49
Q

treatment for empyema

A

Chest drain and antibiotic (6 weeks) maybe intrapleural DNase or surgery worst case

50
Q

treatment for bronchiectasis

A

Chest physiotherapy
antibiotics for infections
inhaled therapy of beta agonist and ICS

51
Q

treatment for cystic fibrosis

A 
Infections from pseudomonas eradication with ciprofloxacin and colomycin 
lung transplant
beta lactam and aminoglycoside antibiotics
subcutaneous ports 
isolation from other CF
ivacaftor 
multi management team
enzyme enteric pills, fat soluble vitamins, Proton pump inhibitors
high energy diet.
vaccinations
mucolytic and airway clearance.
reduce inflammation
palliative care
therapy
fertility assistance
52
Q

treatment for lung cancer

A 
If small enough NSCLC operate
immunotherapy targeting PD1 
chemotherapy 
radiotherapy 
palliativtoe care
53
Q

treatment for COPD

A 
Smoking cessation 
vaccines
pulmonary rehabilitation 
inhalers such as bronchodilators and corticosteroids
long term O2 treatment
psychological support
triple therapy
54
Q

treatment for tonsillitis

A

Either nothing or 10 days penicillin

should last a week

55
Q

treatment for croup

A

Oral dexamethasone

should last 4 days

56
Q

treatment for epiglottis

A

Intubation

antibiotics

57
Q

treatment for pleural effusion

A 
Target underlying cause 
TB chemo
Chemotherapy
corticosteroids
palliative care if malignant 
pleurodesis (4rth intercostal mid axillary)
58
Q

treatment for pneumothorax

A

Tension – cannula in 2nd intercostal space (IS) in mid-clavicular line – chest drain
small primary just observe
large primary aspirate 2nd IS chest drain
secondary; 4rth is
fail to re-inflate visit surgeon
pleurodesis
pleurotomy

59
Q

treatment for tuberculosis

A 
Rifampicin, isoniazid, ethambutol, pyrazinamide 
2 months 
then rifampicin
isoniazid for 
4 months
60
Q

signs of pulmonary hypertension

A 
Heart disease
chronic respiratory disease
thromboembolic 
elevated JVP
right ventricular heave
loud pulmonary heart sound
hepatomegaly
ankle oedema
61
Q

signs of pneumonia

A 
Pyrexia
Central cyanosis
dullness on percussion
tachypnoea
bronchial breath sounds
inspiratory crepitations
increased vocal resonance
62
Q

signs of lung abscess

A

Recent pneumonia

certain organisms like staph. Aureus, or pseudomonas

63
Q

signs of bronchiectasis

A 
Cystic fibrosis
measles
aspergillosis
hypogammaglobulinemia
finger clubbing 
course inspiratory crepitations
64
Q

signs of CF

A

Family history
reoccurring chest infections
nasal polyps, sinusitis, male infertility, failure to thrive

65
Q

signs of lung cancer

A 
Brachial plexus palsy
nodules/masses
pleural effusion
hepatomegaly
smoker 
occupation
age
finger clubbing 
horner’s syndrome
vena cava obstruction
anaemia
66
Q

signs of COPD

A 
Heart disease
smoker
asthma 
A1 antitrypsin deficiency
pursed lips
drug us
barrel chest
CO2 flap
paradoxical chest movement
hepatomegaly
accessory muscles breathing
 peripheral oedema
tachypnoea
67
Q

signs of pleural effusion

A 
Peripheral oedema
liver disease
orthopnoea
PND 
one sided expansion
stony dullness
reduced breath sounds 
Reduced vocal resonance
tar staining, clubbing 
increased JVP
trachea diversion
68
Q

signs of pneumothorax

A 
Pres-existing lung disease 
recent trauma or surgery 
tall thin male <45
surgical emphysema
hyper resonant
trachea diversion
absent breathing sounds
69
Q

signs of Tb

A

Look for diabetes, immunosuppressed, prior tb, alcohol, immigrants, alcohol abuse. Signs of bronchial breathing, crackles, finger clubbing.

respiration (4 decks)

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