Corrections Flashcards
Movement of water seal in a correctly placed chest drain?
Water seal rises on inspiration and falls on expiration
What HR is seen in severe asthma?
> 110 bpm
Mx of atelectasis?
Chest physiotherapy with mobilisation & breathing exercises.
This ensures that the airways are opened maximally and coughing can be performed effectively.
What is myasthenic crisis?
An acute respiratory failure characterised by:
1) FVC <1L
2) Negative inspiratory force ≤20cm H20
3) The need for ventilatory support
What is the most appropriate test to monitor respiratory function in a myasthenic crisis?
FVC
What HR indicates severe asthma?
> 110 bpm
When should all cases of pneumonia have a repeat CXR?
6 weeks after clinical resolution
What is the treatment of choice for allergic bronchopulmonary aspergillosis (ABPA)?
Oral steroids e.g. prednisolone
Prognosis of sarcoidosis?
Most people get better without treatment
When is LTOT indicated in COPD?
LTOT if 2 measurements of pO2 <7.3 kPa
What is next step if needle aspiration of a pneumothorax is unsuccessful?
Chest drain insertion
What RR indicates severe asthma?
> 25/min
What can large bullae in COPD mimic?
A pneumothorax
What aspirate indicates that an NG tube is safe to use?
<5.5
Features of sarcoidosis?
- acute: erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia
- insidious: dyspnoea, non-productive cough, malaise, weight loss
- ocular: uveitis
- skin: lupus pernio
- hypercalcaemia
Cause of hypercalcaemia in sarcoidosis?
Macrophages inside the granulomas cause an increased conversion of vitamin D to its active form (1,25-dihydroxycholecalciferol)
FEV1/FVC in idiopathic pulmonary fibrosis?
Increased
What variation in FEV1 over time indicates steroid responsiveness in COPD?
At least 400ml (substantial)
Pneumothorax & deep sea diving?
It is recommended that patients who have had a pneumothorax avoid deep-sea diving indefinitely as it increases the risk of recurrence due to change in atmospheric pressure.
Does asbestosis cause upper or lower zone fibrosis?
Lower
Do drugs e.g. methotrexate/amiodarone cause upper or lower zone fibrosis?
Lower
When managing patients with COPD, once the pCO2 is known to be normal, what should the target oxygen saturations be?
94-98%
1st line mx of infective exacerbation of COPD?
amoxicillin, clarithromycin or doxycycline
What picture does asbestosis given on pulmonary function testing?
Restrictive
FEV1 reduced, FEV1/FVC increased
What standby medication can be offered in COPD?
Short course of oral steroids and oral abx to keep at home
What level of asthma attack do O2 sats of <92% indicate?
Life threatening
What level of asthma attack does a HR >110bpm indicate?
Severe
What level of asthma attack does a RR >25bpm indicate?
Severe
Features of Kartagener’s syndrome?
1) dextrocardia or complete situs inversus
2) bronchiectasis
3) recurrent sinusitis
4) subfertility
What is the most common cause of occupational asthma?
Isocyanates (found in factories producing spray painting and foam moulding using adhesives).
When can patients with CAP presenting to primary care be managed in the community with oral abx?
If CRB-65 is 0
What is extrinsic allergic alveolitis?
AKA hypersensitivity pneumonitis
Caused by hypersensitivity induced lung damage due to a variety of inhaled organic particles.
E.g. bird fanciers’ lung: avian proteins from bird droppings
Features of extrinsic allergic alveolitis?
acute (occurs 4-8 hrs after exposure):
- dyspnoea
- dry cough
- fever
chronic (occurs weeks-months after exposure)
- lethargy
- dyspnoea
- productive cough
- anorexia and weight loss
Is eosinophilia seen on bloods in extrinsic allergic alveolitis?
NO
mx of extrinsic allergic alveolitis?
- avoid precipitating factors
- oral steroids
Which medication used in smoking cessation lowers the seizure threshold?
Bupropion
What are 2 medications used in smoking cessation?
1) Varenicline
2) Bupropion
What is the most common side effect of varenicline?
Nausea
Contraindications of varenicline?
- pregnancy & breastfeeding
- caution in history of depression/self harm
Contraindications of bupropion?
- epilepsy, pregnancy & breastfeeding
- eating disorder (relative contraindication)
What are the indications for steroid treatment in sarcoidosis?
1) parenchymal lung disease
2) uveitis
3) hypercalcaemia
4) neurological or cardiac involvement
Patients with asymptomatic and stable stage 2 or 3 disease who have only mildly abnormal lung function do NOT require treatment.
In bacterial infections, does the WCC or CRP return to normal first?
White cells back into normal ranges faster than the CRP as the CRP response ‘lags.’
Indications for prophylactic abx in COPD?
1) The patient no longer smokes.
2) Has optimised non-pharmacological management & inhaled therapies.
3) Referred to pulmonary rehab (if appropriate).
4) Had 4 acute exacerbations in the last year (producing sputum), requiring hospital admission at least once.
At what O2 sats is an ABG required?
≤92%
The CURB-65 score is often used to choose Abx therapy.
What Abx is indicated in patients with the following CURB-65 scores:
a) 0-1
b) 2
c) 3
d) 4-5
a) oral amoxicillin or doxycycline
b) amoxicillin + clarithromycin (oral or IV)
c) co-amoxiclav + clarithromycin (IV)
d) co-amoxiclav + clarithromycin (IV)
When is a PE classed as ‘provoked’?
If it occurs WITHIN 3 months of a transient risk factor e.g. surgery
what is d-dimer?
fibrin degradation product
How is assessment for LTOT done?
Measuring ABG on 2 occasions at least 3 weeks apart in patients with stable COPD on optimal mx.
What is hypogammaglobulinaemia?
Hypogammaglobulinemia is a disorder caused by low serum immunoglobulin or antibody levels –> presents with long-lasting or frequent infections.
Mx of necrotising fasciitis?
Surgical debridement + IV abx
What is a common complication of PCP?
Pneumothorax
Who should azithromycin as Abx prophylaxis be considered for in COPD patients?
> 3 exacerbations requiring steroid therapy AND at least 1 exacerbation requiring hospital admission in the previous year.
What should ALL patients with pneumonia who have COPD be given?
Corticosteroids (even if no evidence of COPD being exacerbated)
Define a substantial diurnal variation in peak flow
≥20%
What are some asthmatic features/features suggesting steroid responsiveness in COPD?
1) previous diagnosis of asthma or atopy
2) higher blood eosinophil count
3) substantial variation in FEV1 over time (at least 400ml)
4) substantial diurnal variation in peak expiratory flow (at least 20%)
Mneumonic for upper zone fibrosis: CHARTS
C - coal workers’ pneumoconiosis
H - histiocytosis
A - ankylosing spondylitis
R - radiation
T - TB
S - sarcoidosis/silicosis
Haematocrit conc in COPD?
Increased haematocrit conc –> polycythaemia
What type of lung cancer are cavitating lesions more common in?
Squamous cell
what is the pulmonary capillary wedge pressure?
A measurement that reflects the compliance of the left side of the heart and is used to assess left ventricular filling pressures.
When can ARDS only be diagnosed?
In the absence of a cardiac cause for pulmonary oedema (i.e. the pulmonary capillary wedge pressure must not be raised).
If pulmonary capillary wedge pressure is raised –> cardiogenic pulmonary oedema.
How can obesity affect lung function tests?
Severe obesity may cause restrictive lung function test results
Antibodies in granulomatosis with polyangiitis?
cANCA positive
Can sarcoidosis cause enlargement of the parotid glands?
Yes - Mikulicz syndrome
When are abx offered in the mx of acute bronchitis?
1) systemically very unwell
2) have pre-existing co-morbidities
3) have a CRP of 20-100mg/L (offer delayed prescription) or a CRP >100mg/L (offer antibiotics immediately)
Which side of the lung is aspiration pneumonia more common on?
R side of lung (the R bronchus is more straight and vertically orientated)
Prior to the availability of blood gases, which venturi mask should be used in COPD patients who are known retainers?
28% venturi mask 4L/min
Which TB drug can cause peripheral neuropathy?
Isoniazid (due to B6 deficiency)
