Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

A- Resp and cardio > Investigations - respiratory > Flashcards

Investigations - respiratory Flashcards

1
Q

What conditions are FEV1/FVC ratio impaired in?

A

Obstructive lung disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why is there normal FEV1/FVC ratio in restricitve lung disease?

A

Equal impairment of each

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is BNP

A

Brain Natiuretic peptide - hormone secreted by myocardium in response to wall stress eg pressure overload. Normally only small levels.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When do you test BNP

A

Testing for heart failure when patient presents with SOB, fatigue and pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is NIV

A

Non invasive ventilation eg CPAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does CPAP do

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

VENTURI mask

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does PERC do?

A

Rules out the possibility of a PE with no criteria prior and a chance of <15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Criteria for PERC

A

Age over 50
HR over 100
O2 less than 95% oRA
Unilateral leg swell
Haemoptysis
Recent surgery or trauma
Prior PE or DVT
Hormone use

If anyone of above is positive, cannot rule out PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is an sPESI?

A

simplified PE severtiy index
Groups patients into low or high rusk groups for mortality based on clinical parameters for PE within 30 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What sPESI score predicts high risk mortality?

A

1 or more = high risk adverse outcomes next 30 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does Wells score test?

A

Risk of developing DVT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is WELLS score used for?

A

Whether to have CTPA to investigate for PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Criteria for Wells

A

Active cancer, or cancer that’s been treated within last six months 1
Paralyzed leg 1
Recently bedridden for more than three days or had major surgery within last four weeks 1
Tenderness near a deep vein 1
Swollen leg 1
Swollen calf with diameter that’s more than 3 centimeters larger than the other calf’s 1
Pitting edema in one leg 1
Large veins in your legs that aren’t varicose veins 1
Previously diagnosed with DVT 1
Other diagnosis more likely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Criteria sPESI

A

Age, years >80
History of cancer
History of chronic cardiopulmonary disease
Heart rate, bpm ≥110
Systolic BP, mmHg <100
O₂ saturation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Gold/yellow top bloods

A

Kidney function - U+Es
HcG
Troponin
CRP
LFTs
Bone Profile
Thyroid function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

when is someone unsuitable for spirometry

A
  • Recent surgery eg opthalmology/abdominal/thoracic
  • Recent cardiac arrest
  • haemoptysis
  • Vomiting
  • TB
  • AAA - if aneurysm >6cm - relaxed VC if required for surgery
  • Pneumothroax
  • Caution with cough syncope
  • Confusion, dementia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What should be avoided pre spirometry

A

SABA - 4 hours
LABA - 12 hoours
SA anticholinergics - 6 hours
LA anticholinergics - 24 hours
Performing vigorous exercise 30 mins
Smoking 24 hours
Wear tight fit clothing
Alcohol - 4 hours
Eating substantial meal 2 hours
Relaxed as possible, seated 5-10 mins before

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are normal spirometry values?

A

FEV >80%
FVC >80%
FEV1/FVC - 70-80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Hallmarks of obstruction

A
  • Reduced FEV1/FVC ratio
  • Reduced FEV1
  • Increased exhalation time
  • ate or no plateu on volume time curve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Hallmarks of restrictions

A
  • Reduced FVC
  • Normal or elevated ratio
  • Reduced exhalation time
  • Early plateu on volume time curve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Extrapulmonary causes of restrvitive disease

A
  • Kyphoscoliosis
  • Ankylosing spndylitis
  • Lung volume reduction surgery
  • Muscle weakness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Intrapulmonary causes of restrictive lung disease

A
  • Pulomonary fibrosis
  • Sarcoidosis
  • Asbestosis
  • Fibrosing alveolitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is peak flow a measure of?

A
  • Measure of how FAST air out of lungs
  • Large AW claibre measure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What normal values depend on in peak flow?
- Age - Height - Weight Normally over 20%
26
What sort of conditions cause reduced PEFR?
OBSTRUCTIVE Asthma, COPD, tumour
27
What use spirometry measure?
- Registers AMOUNT of air exhaled or inhaled - RATE at which aire goes in and out lungs - Forceful and complete exhalation after maximal inhalation - FEV1/FVC/Ratio/trace itself
28
What does measuring FEV1/FVC pre and post bronchodilator measure?
(ideally held medication) - Estimates degree of reversibility - 10-15 mins after MDI SABA
29
What are the parameters for responsiveness to SABA on FEV1?
If FEV1 increases by 12% AD 200ml = responsive
30
What are the requirements for reproducibility of spirometry?
- Need the highest recording of 3 traces - 2 highest FVC recordings within 0.15L of each other - 2 highest FEV1 recordings within 0.15L of each other
31
What is FEV1 clinical use?
Determining severity of airflow obstruction of present and also in monitoring response to treatment/decline
32
What FVC clincial use?
- Indication lung volume - If reduced → full PFTs - If decreased + sus airflow obstruction → relaxed VC
33
What is the clinical use for FEV1/FVC ratio? Drawbacks?
- If Airflow obstruction is present Negatives - Not helpful for severity - Fixed thresholds can lead to misclasification (classically <0/7 = obstruction) - Normal can be normal OR restrictive disease
34
What is the FEV1/FVC in restrictive disease?
Normal
35
What is the normal decline in FEV1/FVC?
decline of 20-30ml/year
36
How to calculate relaxed vital capacity?
- FEV1/VC % - Largest FEV1 / largest VC x 100
37
What is relaxed vital capacity?
Max volume expried from full inspiration, done at a steady orrelaxed pace
38
Where go for escalation?
- ITU - HDU - Coronary care unit - CCU - Acute respiratory units - CPAP + BIPAP
39
Types of shock
- Distributive - warm and dry - Cardiogenic - cold and wet - Obstructive - cold and dry - Hypovolaemic - cold and dry
40
Indications for emergency dialysis
AEIOU - Acidosis <7.1 pH - Electrolytes - refractory hyperkalemia K<6.5 mEq/L - Intoxications - Overload fluid refractory to diuresis - Uremic pericarditis, uremic encephalopathy
41
Management for resp support
- Mechanical ventilatory support - CPAP, BIPAP - Intubation - Dialysis for oxygen - hypoxic despite ventilation
42
How to manage low BP in emergency
- Fluid bolus - Blood - Vasopressors - constrict vessels, increase BP
43
How to manage heart failure in emergency
- Balloon pumps - Stent - VD - Vasoactive drugs
44
Where treat each level for emergencies?
Level 1 = ward treatment Level 2 = deteriorated, need single organ support eg ARU, CCU, Level 3 = advanced resp support - intubation or ventialtion, 2 or more organs failing
45
What is adenophagia?
Pain on swallowing
46
Clinical trajectory ITU
1) Early death Dying on ITU - unconscious, can’t talk to relatives 2) Rapid recovery 3) Chronic critical illness - Organ dysfunction - Persistent Kidney Injury - Neurocognitive decline - Sepsis - induced myopahty - satellite cell dysfunction - Persistent inflammation - Immunosupression - Catabolism
47
Drugs that cause kidney damage
INH, Isopropyl alcohol Salicyclates Theophylline, Tenormin (atenolol) Uremia Methanol Barbituates Lithium Ethylene glycol Dabigatran, Depakote
48
When use CPAP?
TI resp failure
49
How ween off intubation if not appropriate to go straight to breathing?
Tracheotomy
50
What is critical illness polyneuropathy and what does it cause?
Shocked = little blood supply to muscles and nerves, vasopressin → peripheral constrictions, poor blood supply - Acquired channelopathies - Pro-inflammatory imbalance - Microvascular disruption - Metabolic derangements - Altered cellular bioenergy and mitochondrial function - Alteration of gene expression
51
Why don't escalate care?
Shocked = little blood supply to muscles and nerves, vasopressin → peripheral constrictions, poor blood supply - Acquired channelopathies - Pro-inflammatory imbalance - Microvascular disruption - Metabolic derangements - Altered cellular bioenergy and mitochondrial function - Alteration of gene expression
52
Medical futility at end of life - when?
- No clear attainable foal - not enhancing quality, rescuing or prolonging lige - Pointless, not reasonable - Burden > benefit - risks, actual harm, possible harm - size of benefit, likelihood of benefit - Has to be defined with regard to individual patient holistically
53
Options if not escalated to ITU?
- Ward based care - Limited escalation of care - CIPAP, BIPAPA, peripheral BP support - DNACPRs - Palliation - natural death is so important
54
When DNACPRs and what consider?
Legally binding, signed by F2 or above, consultant needs to sign too, but still valid without Friends and family discussion Every reasonable measure
55
How to make a dignified death?
- Human desire to help people - Worst outcome is bad death - Peacefuk and dignified - Unnecessary or invasice treatment and diagnostics in days/hours of life - Hurried/rushed conversations about end of life care in emotionally fraught circumsatnces, often without patient involvement - Short window of time to fulfill preferences - Hospital may become only viable location of deatg - Symptoms of dying not adressed until late in dying process
56
ACS emergency treatment
- Antiemetic-metacorpramide - nausea - Morphine - Oxygen - nitrates → vasodilation → increase perfusion to heart - SC heparin - STEMI ALWAYS → HOSPITAL - NSTEMI sometimes reperfuse, context based
57
NEWS score parameters
NEW SCORE NORMAL PARAMETERS RR = 12-2- HR = 60-100 BP = 120-140 systolic Temp = 36-7.5 Spo2 >94% on RA Level of consciousess = AVPU urine output = 5ml/kg/hr, 30-50 ml/hr
58
What confusion levels deserve escalation?
P on AVPU or GCS 8
59
What anaemia does alcohol cause?
Macrocytic
60
What type of anaemia does iron deficiency cause?
Microcytic
61
What is used for the bleeding score for patients on anticoagulants in AF?
ORBIT
62
What is TLCO
KCO + alveolar volume
63
Decreased KCO +TLCO
emphysema
64
Increased KCO +TLCO
- Pulmonary haemorrhage - RBC are alreayd there - Polycythaemia - Shunts (L→R)
65
What is KCO + TLCO
Normal to raised KCO decreased TLCO
66
What is KCO and TLCO a measure of
KCO = measure of blood per unit of lung Restrictive = more blood per unit of lung
67
Obesity causes breathlessness due to increased workload of the chest wall, particularly when distributed in the abdomen. What might you expect to see on lung function testing and blood gas analysis?
Spirometry may be restrictive, with reduced FVC>FEV1. KCO should be normal or high. Blood gases could show a raised pCO2 and bicarbonate indicating compensated hypercapnia. The restriction is likely to be highest during sleep (effect of gravity on the obese abdomen) so pCO2 is most likely to be elevated in the morning. An abnormally shaped chest wall e.g. due to kyphoscoliosis, limits chest wall expansion and therefore reduces ventilation
68
External pressure from air (pneumothorax) or fluid (pleural effusion) can cause breathlessness by reducing the lung’s ability to expand and increasing work for the diaphragm. What clinical findings might make you think of pleural disease?
[Pneumothorax and pleural effusion] A pneumothorax may present suddenly and be associated with chest pain; pleural effusion usually develops much more gradually. On examination both will be associated with reduced breath sounds, but signs associated with a pneumothorax include hyperresonance to percussion and subcutaneous emphysema whilst pleural effusion causes ‘stony dullness’ on percussion and may be associated with fluid overload elsewhere e.g. oedema and ascites. Radiology is your first line investigation!
69
Liver screen full
Coag screen Serum albumin Autoantibodies - ASMA, AMA, ANA, p-ANCA, LKA Immunoglobulins Anti-HBc - IgM, IgG hb SaB HB sAb PBC - IgM IAMA - IgG, A etc Antibodies and antigens for hepatitis Toxicology Copper transferrin saturation Platelets

A- Resp and cardio (58 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions