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Yr 5 - Respiratory > Corrections 2 > Flashcards

Corrections 2 Flashcards

1
Q

What type of hypersensitivity reaction is an asthma attack?

A

IgE type 1

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2
Q

What type of asthma attack does an inability to speak in full sentences indicate?

A

Severe

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3
Q

Give features of a life-threatening asthma attack

A

1) PEFR <33%

2) O2 sats <92%

3) Confusion

4) Silent chest

5) ‘Normal’ PaCO2

6) Exhaustion

7) Cyanosis

8) Bradycardia

9) Hypotension

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4
Q

What are some asthmatic features or features suggestive of steroid responsiveness in COPD?

A

1) previous diagnsois of asthma or atopy
2) diurnal variation in PEFR (>20%)
3) substantial variation in FEV1 (>400 ml)
4) raised eosinophils

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5
Q

Target of antibodies in Lambert-Eaton myasthenic syndrome?

A

It is caused by antibodies against SCLC cells.

These abs also target and damage voltage-gated calcium channels on the PREsynaptic terminals in motor neurones.

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6
Q

Referral criteria for 2ww suspected cancer pathway?

A

1) chest X‑ray findings that suggest lung cancer

2) aged 40 and over with unexplained haemoptysis

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7
Q

Which type of lung cancer is most likely to cause a pleural effusion?

A

Adenocarcinoma (& mesotheliomas)

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8
Q

Prior to discharge, following an acute asthma attack, how long must patients be stable for on their discharge medication (i.e. no nebulisers or oxygen)?

A

12-24h

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9
Q

Stepwise diagnostic testing in asthma (age 5-16 y/o)?

A

1) all children should have spirometry with a bronchodilator reversibility test

2) FeNO test should be requested if there is NORMAL spirometry or obstructive spirometry with a negative bronchodilator reversibility test

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10
Q

Stepwise diagnostic testing in asthma (age ≥17 y/o)?

A

1) patients should be asked if their symptoms are better on days away from work/during holidays. If so, patients should be referred to a specialist as possible occupational asthma

2) ALL patients should have spirometry with a bronchodilator reversibility (BDR) test

3) ALL patients should have a FeNO test

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11
Q

Does a negative result on spirometry exclude asthma as a diagnosis?

A

No - refer for FeNO testing

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12
Q

What anaesthetic agents are patients with myasthenia gravis very sensitive to?

A

Non-depolarising agents e.g. rocuronium

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13
Q

Why should you be cautious of using EllaOne (Ulipristal acetate) in severe asthma?

A

Due to the anti-glucocorticoid effect of ulipristal acetate

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14
Q

Describe Light’s criteria for establishing an exudative effusion

A

1) Fluid protein/serum protein >0.5

2) Fluid LDH/serum LDH >0.6

3) Pleural fluid LDH >2/3 of normal upper limit of serum LDH

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15
Q

What 2 medications are licensed that can slow the progression of pulmonary fibrosis

A

1) Pirfenidone
2) Nintedanib

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16
Q

What should be done before prescribing Abx in bronchiectasis?

A

Sputum culture

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17
Q

What is the Abx of choice for bronchiectasis exacerbations caused by Pseudomonas aeruginos?

A

Ciprofloxacin

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18
Q

When is Abx prophylaxis required in COPD patients?

A

≥4 excacerbations requiring steroids in past year, and 1 requiring hospitalisation

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19
Q

Pleural fluid findings of low glucose may indicate what?

A

1) RA
2) TB

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20
Q

Pleural fluid findings of raised amylase may indicate what?

A

1) pancreatitis
2) oesophageal perforation

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21
Q

What does lung abscess most commonly form 2ary to?

A

Aspiration pneumonia

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22
Q

What is silicosis a risk factor for?

A

Developing TB

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23
Q

Is post-exposure prophylaxis for HIV recommended following human bites?

A

No (even if the individual has known HIV/AIDS) due to low risk of transmission

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24
Q

Who is prone to developing endocarditis secondary to Viridans streptococci e.g. Streptococcus sanguinis?

A

Patients with poor dental hygiene

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25
Q

Post-exposure prophylaxis for HIV routine?

A

Treat within 72h
4 weeks of ART
HIV testing at 12 weeks

26
Q

What is the most common cause of death in measles?

A

Pneumonia

27
Q

How can the risk of oral candidiasis be reduced in inhaled steroid use?

A

Take ICS using a large volume spacer –> less drug deposition in mouth

28
Q

Why are dry powder asthma inhalers better for the environment than metered dose inhalers?

A

Metered dose inhalers use hydrofluorocarbon propellant (a greenhouse gas).

Dry powder inhalers do not
use propellants.

29
Q

Location of consolidation if it is above the R horizontal fissure?

A

R upper lobe

30
Q

Mx of persistent air leak or recurrent episodes in pneumothorax?

A

consider referral for VATS to allow for mechanical/chemical pleurodesis +/- bullectomy

31
Q

Symptom control in non-CF bronchiectasis?

A

Physiotherapy for inspiratory muscle training and postural drainage

32
Q

Why are combination inhalers recommended where possible?

A

to increase medication compliance

33
Q

Gold standard for diagnosis of mesothelioma?

A

Thoracoscopy & histology

34
Q

What should be considered if a lung abscess is not improving with intravenous antibiotics?

A

Percutaneous drainage

35
Q

When draining a pneumothorax, if after 3-5 days there is persistent air leak (e.g. bubbling chest drain) or failure of the lung to re-expand, what should you do?

A

Seek a thoracic surgical opinion

36
Q

Spirometry results in idiopathic pulmonary fibrosis?

A
  • restrictive picture
  • reduced transfer factor
  • reduced coefficient
37
Q

What is transfer factor?

A

The transfer factor describes the rate at which a gas will diffuse from alveoli into blood.

38
Q

How can results for transfer factor be given?

A

a) as the total gas transfer (TLCO)

or

b) that corrected for lung volume (transfer coefficient, KCO)

39
Q

Causes of a raised TLCO?

A
  • asthma
  • polycythaemia
  • male gender, exercise
  • pulmonary haemorrhage
40
Q

Causes of a lower TLCO?

A
  • pulmonary fibrosis
  • pneumonia
  • pulmonary emboli
  • pulmonary oedema
  • emphysema
  • anaemia
  • low cardiac output
41
Q

Pleural fluid results in an empyema?

A
  • low pH
  • low glucose
  • high LDH
42
Q

TLCO in pulmonary fibrosis?

A

Reduced

43
Q

What type of shock can tension pneumothorax cause?

A

Obstructive shock

44
Q

Patients with COPD with a pH in the range of what will achieve the most benefit of BiPAP?

A

pH 7.25-7.35

If pH is <7.25 then invasive ventilation should be considered if appropriate

45
Q

What is the p/f ratio?

A

PaO2 / FiO2

46
Q

What can the p/f ratio be useful for?

A

Checking if the patient’s O2 has responded adequately to the supplemental oxygen.

47
Q

What is the normal P/F ratio?

A

55kPa or 400mmHg (depending on whether PaO2 is measured in kPa or mmHg).

48
Q

What is myasthenic crisis?

A

An acute respiratory failure characterised by:

a) FVC <1
b) negative inspiratory force ≤20cm H20
c) the need for ventilatory support

49
Q

What is the most appropriate test to monitor respiratory function in a myasthenic crisis?

A

FVC

50
Q

When should all cases of pneumonia have a repeat CXR?

A

6 weeks after clinical resolution

51
Q

What variation in FEV1 over time indicates steroid responsiveness in COPD?

A

At least 400ml

52
Q

What picture does asbestosis given on pulmonary function testing?

A

Restrictive

53
Q

What are the indications for steroid treatment in sarcoidosis?

A

1) hypercalcaemia

2) parenchymal lung disease

3) uveitis

4) neurological or cardiac involvement

54
Q

In bacterial infections, does the WCC or CRP return to normal first?

A

White cells back into normal ranges faster than the CRP as the CRP response ‘lags.’

55
Q

How is assessment for LTOT done?

A

Measuring ABG on 2 separate occasions at least 3 weeks apart in patients with stable COPD on optimal mx.

56
Q

Define a substantial diurnal variation in peak flow

A

≥20%

57
Q

What type of lung cancer are cavitating lesions more common in?

A

Squamous cell

58
Q

WHat does a raised pulmonary wedge pressure indicate?

A

Cardiogenic pulmonary oedema

59
Q

Can sarcoidosis cause enlargement of the parotid glands?

A

Yes - Mikulicz syndrome

60
Q

Prior to the availability of blood gases, which venturi mask should be used in COPD patients who are known retainers?

A

28% venturi mask 4L/min

61
Q
A

Yr 5 - Respiratory (5 decks)

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