Corrections pt. 2 - Respiratory Flashcards
What is the investigation of choice to investigate suspected lung cancer?
CT
How can lung cancer affect platelets?
Can cause RAISED platelets
What medications are available for smoking cessation?
1) Nicotine replacement therapy (NRT)
2) Bupropion
3) Varenicline
NICE state that clinicians should not favour one medication over another.
Can you offer NRT, varenicline and bupropion in combination?
NO
Adverse effects of NRT?
nausea & vomiting, headaches and flu-like symptoms
What NRT can be offered to people who show a high level of dependence on nicotine or who have found single forms of NRT inadequate in the past?
NICE recommend offering a combination of nicotine patches and another form of NRT (such as gum, inhalator, lozenge or nasal spray).
What class of drug is varenicline?
a nicotinic receptor partial agonist
When should varenicline be started in smoking cessation?
Should be started 1 week before the patients target date to stop.
Common adverse effects of varenicline?
Nausea is the most common adverse effect.
Other common problems include headache, insomnia, abnormal dreams
Who should varenicline be used with CAUTION in for smoking cessation?
Patients with a history of depression or self-harm.
Contraindications for varenicline?
Pregnancy & breastfeeding.
What class of drug is bupropion?
a norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist
When should bupropion be started in smoking cessation?
should be started 1 to 2 weeks before the patients target date to stop
Contraindications for Bupropion?
1) epilepsy (small risk of seizures)
2) pregnancy
3) breastfeeding
4) (having an eating disorder is a relative contraindication)
1st line interventions for smoking cessation in pregnant women?
1) CBT
2) Motivational interviewing
3) Structured self-help and support from NHS Stop Smoking Services
If fails –> NRT
Describe the weakness in Lambert-Eaton syndrome
1) Weakness in proximal muscles
- commonly seen in lower limbs
- gradually pogresses from proximal to distal muscle groups and in the cranial direction.
2) Weakness improves with prolonged exertion (CONTRAST to myasthenia gravis)
3) Hyporeflexia
4) Autonomic dysfunction: blurry vision, dry mouth, orthostatic hypotension, impaired sweating and constipation.
Persistent productive cough +/- haemoptysis in a young person with a history of respiratory problems?
Consider bronchiectasis
What type of lung cancer are cavitating lesions more commonly seen in?
Squamous cell carcinoma
Give the stepwise management of an asthma attack
1) O2
2) Salbumatol nebuliser
3) Ipratropium bromide nebuliser
4) Hydrocortisone IV or oral Prednisolone
5) Magnesium sulphate IV
6) Aminophylline / IV salbutamol
How many lobes does the right lung consist of?
3: superior, middle, and inferior lobes
How many lobes does the left lung consist of?
2: superior and inferior lobes.
Features of a lung abscess?
1) subacute presentation: symptoms may develop over weeks
2) systemic features such as night sweats and weight loss may be seen
3) fever
4) productive cough: often foul smelling sputum
5) chest pain
6) SOB
7) dull percussion & bronchial breathing
8) clubbing may be seen
What do lung abscesses most commonly form 2ary to?
Aspiration pneumonia –> poor dental hygiene, previous stroke and reduced consciousness are some of the risk factors for this
Give 3 organisms causing lung abscess
1) staph. aureus
2) klebsiella pneumonia
3) pseudomonas aeruginosa
1st step in management of a pleural effusion?
If no are increasing oxygen requirements –> pleural aspirate (to determine the origin)
If increasing oxygen requirements –> chest drain
When should non-invasive ventilation (NIV) be considered in acute COPD exacerbations?
When a respiratory acidosis (PaCO2>6kPa, pH <7.35 ≥7.26) persists despite immediate maximum standard medical treatment.
Maximum treatment consists of:
- O2 via venturi mask
- nebulised salbutamol
- nebulised ipratropium bromide
- broad spec Abx e.g. amoxicillin
Most common cause of pneumonia in bronchiectasis?
H. influenzae
Is it safe to breastfeed whilst taking prednisolone?
Yes
What are the top 3 causes of exudative pleural effusions?
1) malignancy: lung cancer or mesothelioma
2) infection: pneumonia or TB
3) RA
What 2 urine tests may be helpful in patients with pneumonia?
1) Legionella urinary antigen
2) Pneumococcal urinary antigen
What are 2 key examination findings in idiopathic pulmonary fibrosis?
1) Bibasal fine end-inspiratory crackles
2) Finger clubbing
What are the 3 criteria for using non-invasive ventilation to treat an exacerbation of COPD?
1) Persistent respiratory acidosis (pH <7.35 and PaCO2 >6) despite max medical treatment
2) Potential to recover
3) Acceptable to patient
What are the 2 most common infective organisms in bronchiectasis?
1) H. influenzae
2) Pseudomonas aeruginosa
What is Lofgren’s syndrome?
Lofgren syndrome is a specific acute clinical presentation of systemic sarcoidosis, consisting of a classic triad of fever, erythema nodosum, and bilateral hilar adenopathy.
What is the triad of features in Lofgren’s syndrome?
1) Erythema nodosum
2) Bilateral hilar lymphadenopathy
3) Polyarthralgia (joint pain in multiple joints)
What is the mechanism of tiotropium?
Long acting muscarinic antagonist (LAMA)
What is the mechanism of ipratropium?
Short acting muscarinic antagonist (SAMA)
What is the mechanism of montelukast?
Leukotriene receptor antagonist
What value defines pulmonary hypertension?
A mean pulmonary arterial pressure of >20 mmHg
What dose of steroids should be given in a mild asthma exacerbation?
Quadrupled dose of their ICS for up to 2 weeks
What type of atypical pneumonia is most associated with erythema multiforme?
Mycoplasma pnuemoniae
What common antibiotic can cause pulmonary fibrosis?
Nitrofurantoin
What are the four most prevalent types of cancer in the UK (in order)?
1) Breast
2) Prostate
3) Lung
4) Bowel
Other than spirometry, what other tests can be used to support a diagnosis of asthma?
1) FeNO
2) Spirometry with reversibility
3) Peak flow variability (diary)
What is found on chest auscultation in a patient with bronchiectasis? (3)
1) Scattered crackles throughout chest
2) Crackles clear or change after coughing
3) Scattered wheezes and squeaks
