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Yr 4 - ACC > Corrections - Respiratory > Flashcards

Corrections - Respiratory Flashcards

1
Q

What is the most common cause of an exudative pleural effusion?

A

Pneumonia

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2
Q

Give some causes of an exudative pleural effusion

A

1) infection:
- pneumonia
- TB
- subphrenic abscess

2) connective tissue disease:
- RA
- SLE

3) neoplasia:
- lung cancer
- mesothelioma
- metastases

4) pancreatitis

5) PE

6) Dressler’s syndrome

7) yellow nail syndrome

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3
Q

What is the most common cause of a transudative pleural effusion?

A

Heart failure

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4
Q

Give some causes of a transudative pleural effusion

A

1) HF

2) hypoalbuminaemia:
- liver disease
- nephrotic syndrome
- malabsorption

3) hypothyroidism

4) Meig’s syndrome

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5
Q

Can a PE cause a transudative or exudative pleural effusion?

A

Exudative

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6
Q

Can Meig’s syndrome cause a transudative or exudative pleural effusion?

A

Transudative

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7
Q

Transmission of which type of infection is most likely to occur following a platelet transfusion?

Why?

A

Bacterial

As platelet concentrates are generally stored at room temperature they provide a more favourable environment for bacterial contamination than other blood products.

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8
Q

Who is sarcoidosis more common in?

A

young adults and in people of African descent

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9
Q

What are the acute features of sarcoidosis?

A

1) erythema nodosum
2) bilateral hilar lymphadenopathy
3) swinging fever
4) polyarthralgia

I.e. Painful shin rash + cough –> think sarcoidosis

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10
Q

What triad of symptoms is seen in a fat embolism?

A

1) respiratory
2) neurological
3) petechial rash (tends to occur after the first 2 symptoms)

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11
Q

What is bronchiectasis?

A

a permanent dilatation of the airways secondary to chronic infection or inflammation.

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12
Q

Features of bronchiectasis?

A

1) persistent productive cough: large volumes of sputum

2) dyspnoea

3) haemoptysis

4) signs:
- coarse crackles
- wheeze

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13
Q

What treatment is indicated in a pneumonia with CURB 65 score of 0-1?

A

Consider outpatient treatment with single Abx.

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14
Q

What treatment is indicated in a pneumonia with CURB 65 score of 2?

A

Consider short inpatient treatment and dual Abx

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15
Q

What treatment is indicated in a pneumonia with CURB 65 score of 3?

A

Consider in patient treatment and IV dual Abx

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16
Q

What treatment is indicated in a pneumonia with CURB 65 score of 4-5?

A

Inpatient therapy in HDU/specialist care with IV dual Abx.

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17
Q

The CURB-65 score is often used to choose Abx therapy.

What Abx is indicated in patients with a CURB-65 score of 0-1?

A

Amoxicillin or doxycycline (oral)

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18
Q

What Abx is indicated in patients with a CURB-65 score of 2?

A

Amoxicillin and clarithromycin (oral or IV)

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19
Q

What Abx is indicated in patients with a CURB-65 score of 3?

A

IV co-amoxiclav and clarithromycin

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20
Q

What Abx is indicated in patients with a CURB-65 score of 4-5?

A

IV co-amoxiclav and clarithromycin

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21
Q

When is a PE classed as ‘provoked’?

A

If occurs WITHIN 3 months of transient risk factor e.g. surgery.

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22
Q

Who may a V/Q scan be used in instead of a CTPA in a PE?

A

Contrast allergy, pregnancy, young female, children.

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23
Q

Features of a ‘massive’ PE?

A

1) Hypotension
2) Cardiac arrest

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24
Q

Features of a ‘sub-massive’ PE?

A

1) hypoxia
2) cardiac ECHP or ECG features of right heart strain
3) positive cardiac biomarker e.g. troponin

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25
Q

What are 3 contraindications to DOACs in treatment of PE?

A

1) If patient is already on warfarin e.g. metallic heart valve

2) pregnancy/BF (use LMWH instead)

3) clots around metal work e.g. around stents/filters

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26
Q

What is d-dimer?

A

A fibrin degradation product (i.e. produced in clot breakdown).

27
Q

What Wells score indicates a high risk PE?

A

≥ 4

28
Q

Patients who receive long term oxygen therapy (LTOT) should breathe supplementary oxygen for how many hours a day?

A

At least 15 hours a day

29
Q

What features indicate that a patient should be ASSESSED for LTOT?

A

If any of the following features:

1) Very severe airflow obstruction (FEV1 < 30% predicted).

2) Cyanosis

3) 2ary polycythaemia

4) Peripheral oedmea

5) Raised JVP

6) O2 sats ≤92% on room air

30
Q

How is assessment for LTOT done?

A

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

31
Q

What features indicate that a patient should be OFFERED LTOT?

A

Offer to patients with a pO2 of <7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following:

1) 2ary polycythaemia

2) peripheral oedema

3) pulmonary HTN

32
Q

What is the rule with LTOT and smoking?

A

Do NOT offer LTOT to people who continue to smoke despite being offered smoking cessation advice and treatment, and referral to specialist stop smoking services.

33
Q

What risk assessment should be carried out before offering LTOT?

A

1) the risks of falls from tripping over the equipment

2) the risks of burns and fires, and the increased risk of these for people who live in homes where someone smokes (including e‑cigarettes)

34
Q

Define refractory anaphylaxis

A

Respiratory and/or cardiovascular problems persisting despite 2 doses of IM adrenaline.

35
Q

What can be considered in refractory anaphylaxis?

A

IV adrenaline infusion

36
Q

How often can IM adrenaline be repeated in anaphylaxis?

A

Every 5 minutes if necessary

37
Q

What are the ‘CRAB’ features of multiple myeloma?

A

C - hyperCalcaemia

R - Renal failure

A - Anaemia (and thrombocytopenia)

B - Bone fractures/lytic leasions

38
Q

What is hypogammaglobulinaemia?

A

Hypogammaglobulinemia is a disorder caused by low serum immunoglobulin or antibody levels –> presents with long-lasting or frequent infections.

39
Q

management of necrotising fasciitis?

A

Immediate surgical debridement and IV Abx

40
Q

What class of drug is tiotropium?

A

Long acting muscarinic antagonist (LAMA)

41
Q

Stepwise management of COPD?

A

1) SABA or SAMA as required

Are asthma features present?

2) If no asthma features present –> SABA as required, LABA + LAMA regularly

3) If asthma features present –> SABA or SAMA as required, LABA + ICS regularly

4) SABA, LABA + LAMA + ICS

42
Q

When is oral theophylline considered in COPD?

A

Only reserved for those who cannot tolerate inhaled therapy or have failed with optimum inhaled treatment.

43
Q

Where is emphysema most prominent in A1AT deficiency vs COPD?

A

A1AT: lower lobes

COPD: upper lobes

44
Q

Which patients have an acute exacerbation of COPD require Abx?

A

Those with purulent sputum or clinical signs of pneumonia

45
Q

What O2 therapy should any critically ill patient (including CO2 retainers) initially be treated with?

A

High flow oxygen 15L/min

46
Q

When managing patients with COPD, once the pCO2 is known to be normal, what are the target O2 sats?

A

94-98%

47
Q

Why is good analgesia required in rib fractures?

A

To ensure breathing is not affected by pain - inadequate ventilation may predispose to chest infections.

48
Q

What intervention is helpful in ventilated patients with ARDS?

A

Prone positioning

49
Q

What should be considered in all patients with an acute exacerbation of COPD in whom a respiratory acidosis persists despite immediate maximum standard medical treatment?

A

NIV e.g. BiPAP

50
Q

BiPAP vs CPAP in type 1 vs type 2 respiratory failure?

A

Type 1 –> CPAP

Type 2 –> BiPAP

51
Q

How long must malignancy be resolved for to no longer be considered a ‘provoked’ PE/DVT?

A

≥3 months

52
Q

What are the common signs of Pneumocystis jiroveci pneumonia (PCP)?

A
  • SOB (especially exercise induced desaturation)
  • dry cough
  • fever
  • very few chest signs
53
Q

What is a common complication of PCP?

A

Pneumothorax

54
Q

What is the most common opportunistic infection in AIDS?

A

Pneumocystis jiroveci pneumonia (PCP)

55
Q

Which AIDS patients should receive PCP prophylaxis?

A

all patients with a CD4 count < 200/mm³ should receive PCP prophylaxis

56
Q

1st line Abx for an infective exacerbation of COPD?

A

Amoxicillin, clarithromycin or doxycycline.

57
Q

What triad is seen in Kartagener’s syndrome?

A

1) situs inversus totalis (including dextrocardia)

2) chronic sinusitis

3) bronchiectasis

58
Q

What should patients with frequent exacerbations of COPD be given at home?

A

A home supply for prednisolone & Abx

59
Q

What is the Abx prophylaxis recommended in COPD patients (that meet criteria)?

A

Azithromycin

60
Q

Who should azithromycin as Abx prophylaxis be considered for in COPD patients?

A

> 3 exacerbations requiring steroid therapy AND at least 1 exacerbation requiring hospital admission in the previous year.

61
Q

What should ALL patients with pneumonia who have COPD be given?

A

Corticosteroids (even if no evidence of COPD being exacerbated)

62
Q

What are some asthmatic features/features suggesting steroid responsiveness in COPD?

A

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%)

63
Q
A

Yr 4 - ACC (73 decks)

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