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Year 5/6 > Medicine: Resp > Flashcards

Medicine: Resp Flashcards

1
Q

What clinical signs should you enquire more about?

A

Plasters and IV infusions

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2
Q

Examination findings of pneumothorax

A 
Trachea - deviated away
Expansion - reduced
Fremitus - decreased
Percussion - resonant
Auscultation - absent
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3
Q

How are pneumothoracies classified? (3)

A

Spontaneous: 1° w/o and 2° w underlying disease

Traumatic: blunt (closed), penetrating (open), iatrogenic

Tension: progressively inc pressure, cardioresp compromise, life threatening

Any type may lead to tension, clinical dx, medical emerg

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4
Q

Which drain do you use for pneumothoraces?

A

Just the underwater seal bottle

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5
Q

Describe bubbling and swinging wrt chest drains?

A

Bubbles - air is being expelled during expiration

Swinging - the fluid going up and down the tube during insp/exp

Swinging w/o bubbles shows all the air from the pneumothorax is out

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6
Q

If the drain doesn’t stop bubbling what does this suggest? And what should you do?

A

There’s a fistula -> requires specialist intervention

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7
Q

Examination findings of pleural effusion

A 
Trachea - deviated away
Expansion - reduced
Fremitus - decreased
Percussion - stoney dull
Auscultation - absent
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8
Q

What does dec tactile vocal fremitus suggest?

A

Pleural effusion - liquid - absorbs sound

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9
Q

What is the g/L for both exudative and transudative pleural effusion?

A

Exudative: >35

Transudative: <25

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10
Q

Outline Lights criteria for exudative vs transudative pleural effusion

A

Any one of is exudative vs if none transudative:

Pleural:Serum Protein >0.5

Pleural:Serum LDH >0.6

Pleural Fluid LDH >2/3 upper limit of normal

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11
Q

List four exudative causes of pleural effusion (high protein content)

A

Infection, malignancy, pulmonary embolism, AI disease

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12
Q

List four transudative causes of pleural effusion (low protein content)

A

Congestive HF, hepatic cirrhosis, nephrotic syndrome, CKD

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13
Q

Patho of exudative pleural effusion

A

Inc capillary permeability

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14
Q

Patho of transudative pleural effusion

A

Inc capillary hydrostatic pressure

Dec capillary oncotic pressure

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15
Q

Which causes of pleural effusion a/w low glucose? (4)

A

MEAT

Malignancy
Empyema
Arthritis
TB

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16
Q

Which drain do you use for pleural effusions?

A

Both a trap bottle and underwater seal bottle

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17
Q

Examination findings of pneumonia

A 
Trachea - central
Expansion - reduced
Fremitus - increased
Percussion - dull
Auscultation - bronchial
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18
Q

What does inc tactile vocal fremitus suggest?

A

Pneumonia - solid - conducts sound

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19
Q

Ix for suspected pneumonia

A
  1. Bloods: purple - FBC (raised WCC) and ESR & yellow - U+Es, LFTs, CRP (?sepsis)
  2. Imaging: CXR
  3. Sputum, blood cultures, MC&S -> start empirical abx
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20
Q

Alongside oxygen which abx are used to tx pneumonia?

A

CAP - Augmentin + Clarithromycin

HAP - Ciprofloxacin + Vancomycin

Adjust abx according to MC&S results ~2days after starting

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21
Q

Which abx does strep pneumoniae always respond to?

A

Penicillin

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22
Q

Which abx treats haemophilus influenzae?

A

Cefuroxime

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23
Q

Which drug commonly interacts w clarithromycin?

A

Warfarin

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24
Q

Which pneumonia causing pathogen is a/w recent viral infection?

A

Staph Aureus

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25
Which pneumonia causing pathogen is a/w smoking and COPD?
Haemophilus influenzae & moraxella catarrhalis
26
Which pneumonia causing pathogen is a/w alcoholism, elderly, haemoptysis?
Klebsiella Pneumoniae
27
G+ Diplococci
Strep Pneumoniae
28
G+ Cocci
Staph Aureus
29
G- Rods
Haemophilus Influenzae + Klebsiella Pneumoniae
30
What should you do if the pt is getting worse despite abx and gram staining was unhelpful?
Ring the lab for sensitivities and change abx accordingly
31
Tx of Chronic Asthma
1. SABA 2. SABA + Low ICS 3. SABA + Low ICS + LTRA 4. SABA + Low ICS + LABA +/- LTRA 5. SABA + Low MART +/- LTRA 6. SABA + Med MART +/- LTRA 7. Inc MART Dose or Add Aminophylline
32
Tx of Long-Term COPD
1. SABA + SAMA 2. If signs of asthma or good steroid response: no add LABA+LAMA OR yes add LABA+ICS 3. SABA + LABA + LAMA + ICS
33
What are signs of a good steroid response?
Hx of atopy, high eosinophils, >20% change in FEV1 over time
34
What are the top ddx for a chronic cough in a non-smoker?
Asthma, Post-Nasal Drip, GORD + ask about COVID testing
35
What are the major criteria of ABPA? (5)
Hx of asthma, central bronchiectasis on CXR, immediate skin reactivity to aspergillus antigen, blood eosinophilia, inc serum IgE >1000IU/mL
36
Mx of ABPA
1. Glucocorticoids | 2. Itraconazole
37
What are the causes of bronchiectasis?
Idiopathic Post-Infective Immunodeficiency Plus: CF, ABPA, foreign body, tumour, rheumatoid, IBD
38
Ix for Bronchiectasis
Obstrc Spirometry Sputum Cultures HRCT And identify cause: Ig, Sweat Test, Aspergillus Markers
39
What would you see on HRCT in a pt w bronchiectasis?
Dilated thickened airways w evidence of mucus plugging
40
Tx of Bronchiectasis
MDT, Smoking Cessation, Pulm Rehabilitation Plus: physio, abx, correct underlying cause
41
What are heart failure cells?
Iron Laden Macrophages
42
What are the different types of lung cancer?
NSCLC: central squamous + peripheral adenocarcinoma SCLC: ectopic ACTH + LEMS
43
Which lung cancers are heavily linked to smoking?
Squamous + SCLC
44
Which lung cancers metastasise early?
Adenocarcinoma + SCLC
45
Ix for Lung Cancer
CXR Volumetric CT Biopsy And identify mets: PET-CT w 18-FDG
46
Tx of Lung Cancer
MDT, Chemo, Radio And if NSCLC: consider lobectomy if localised
47
Ix for COPD
``` FBC BNP A1AT PFTs ABG - evaluate severity of resp failure CXR HRCT - looking for distribution of disease if considering pts for lung volume reduction surgery Echo - mMRC GOLD ```
48
What is the modified MRC dyspnoea scale to assess the functional impairment of COPD?
0. Strenuous 1. Hurrying 2. Walking 3. 100m 4. Dressing
49
Tx of COPD
MDT, Smoking Cessation, Pulm Rehabilitation Plus: oxygen, bronchodilators, steroids, NIV for abnormal ABG, abx for exacerbation, monitor for lung cancer
50
Ix for Pleural Effusion
CXR | Aspiration (MCS, TB, protein, glucose, pH exclude empyema, LDH, cytology)
51
Tx for Pleural Effusion
MDT US guided Drain Tx underlying cause
52
What are the causes of ILD?
Idiopathic Autoimmune Hypersensitivity Plus: sarcoidosis + drugs
53
Which drugs classically cause ILD?
Methotrexate Amiodarone Nitrofurantoin
54
Ix for ILD
``` Drug Hx Complement Autoantibodies Precipitins CXR HRCT PFTs BAL Echo ```
55
Tx of ILD
MDT, Smoking Cessation, Pulm Rehabilitation Plus: ambulatory O2, LTOT, antifibrotics for IPF, immunosuppressives for CTD/sarcoid related, transplant workup
56
What would you see on HRCT in a pt w established ILD?
Honeycombing - IPF Ground Glass - NSIP
57
Asthma vs COPD
Spirometry w reversibility
58
What are the four stages of pneumonia?
Congestion Red Hepatization Grey Hepatization Resolution
59
What are the criteria for discharge following acute asthma?
Stable on discharge meds for >12hrs, PEF >75%, inhaler technique checked and recorded
60
Tx of HAP
Piperacillin-Tazobactam
61
What must you do before starting a pt on NIV?
CXR: any focal consolidation + a pneumothorax are CIs
62
What are the top three indications for NIV?
Nasals - Sleep Apnoea - prevents soft palate from closing CPAP - Pulmonary Oedema - reduces LVEDP and afterload BiPAP - COPD - improve both ventilation and tidal volume
63
How does NIV work?
It improves the ventilation perfusion mismatch by improving recruitment of collapse alveoli and thus reduces work of breathing
64
What is the best predictor for impending need of resp support?
RR >25/min

Year 5/6 (20 decks)

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