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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
Q

Which pneumonia causing pathogen is a/w smoking and COPD?

A

Haemophilus influenzae & moraxella catarrhalis

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26
Q

Which pneumonia causing pathogen is a/w alcoholism, elderly, haemoptysis?

A

Klebsiella Pneumoniae

27
Q

G+ Diplococci

A

Strep Pneumoniae

28
Q

G+ Cocci

A

Staph Aureus

29
Q

G- Rods

A

Haemophilus Influenzae + Klebsiella Pneumoniae

30
Q

What should you do if the pt is getting worse despite abx and gram staining was unhelpful?

A

Ring the lab for sensitivities and change abx accordingly

31
Q

Tx of Chronic Asthma

A
  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
Q

Tx of Long-Term COPD

A
  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
Q

What are signs of a good steroid response?

A

Hx of atopy, high eosinophils, >20% change in FEV1 over time

34
Q

What are the top ddx for a chronic cough in a non-smoker?

A

Asthma, Post-Nasal Drip, GORD + ask about COVID testing

35
Q

What are the major criteria of ABPA? (5)

A

Hx of asthma, central bronchiectasis on CXR, immediate skin reactivity to aspergillus antigen, blood eosinophilia, inc serum IgE >1000IU/mL

36
Q

Mx of ABPA

A
  1. Glucocorticoids

2. Itraconazole

37
Q

What are the causes of bronchiectasis?

A

Idiopathic
Post-Infective
Immunodeficiency

Plus: CF, ABPA, foreign body, tumour, rheumatoid, IBD

38
Q

Ix for Bronchiectasis

A

Obstrc Spirometry
Sputum Cultures
HRCT

And identify cause: Ig, Sweat Test, Aspergillus Markers

39
Q

What would you see on HRCT in a pt w bronchiectasis?

A

Dilated thickened airways w evidence of mucus plugging

40
Q

Tx of Bronchiectasis

A

MDT, Smoking Cessation, Pulm Rehabilitation

Plus: physio, abx, correct underlying cause

41
Q

What are heart failure cells?

A

Iron Laden Macrophages

42
Q

What are the different types of lung cancer?

A

NSCLC: central squamous + peripheral adenocarcinoma

SCLC: ectopic ACTH + LEMS

43
Q

Which lung cancers are heavily linked to smoking?

A

Squamous + SCLC

44
Q

Which lung cancers metastasise early?

A

Adenocarcinoma + SCLC

45
Q

Ix for Lung Cancer

A

CXR
Volumetric CT
Biopsy

And identify mets: PET-CT w 18-FDG

46
Q

Tx of Lung Cancer

A

MDT, Chemo, Radio

And if NSCLC: consider lobectomy if localised

47
Q

Ix for COPD

A 
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
Q

What is the modified MRC dyspnoea scale to assess the functional impairment of COPD?

A
  1. Strenuous
  2. Hurrying
  3. Walking
  4. 100m
  5. Dressing
49
Q

Tx of COPD

A

MDT, Smoking Cessation, Pulm Rehabilitation

Plus: oxygen, bronchodilators, steroids, NIV for abnormal ABG, abx for exacerbation, monitor for lung cancer

50
Q

Ix for Pleural Effusion

A

CXR

Aspiration (MCS, TB, protein, glucose, pH exclude empyema, LDH, cytology)

51
Q

Tx for Pleural Effusion

A

MDT
US guided Drain
Tx underlying cause

52
Q

What are the causes of ILD?

A

Idiopathic
Autoimmune
Hypersensitivity

Plus: sarcoidosis + drugs

53
Q

Which drugs classically cause ILD?

A

Methotrexate
Amiodarone
Nitrofurantoin

54
Q

Ix for ILD

A 
Drug Hx
Complement
Autoantibodies
Precipitins
CXR
HRCT
PFTs
BAL
Echo
55
Q

Tx of ILD

A

MDT, Smoking Cessation, Pulm Rehabilitation

Plus: ambulatory O2, LTOT, antifibrotics for IPF, immunosuppressives for CTD/sarcoid related, transplant workup

56
Q

What would you see on HRCT in a pt w established ILD?

A

Honeycombing - IPF

Ground Glass - NSIP

57
Q

Asthma vs COPD

A

Spirometry w reversibility

58
Q

What are the four stages of pneumonia?

A

Congestion
Red Hepatization
Grey Hepatization
Resolution

59
Q

What are the criteria for discharge following acute asthma?

A

Stable on discharge meds for >12hrs, PEF >75%, inhaler technique checked and recorded

60
Q

Tx of HAP

A

Piperacillin-Tazobactam

61
Q

What must you do before starting a pt on NIV?

A

CXR: any focal consolidation + a pneumothorax are CIs

62
Q

What are the top three indications for NIV?

A

Nasals - Sleep Apnoea - prevents soft palate from closing

CPAP - Pulmonary Oedema - reduces LVEDP and afterload

BiPAP - COPD - improve both ventilation and tidal volume

63
Q

How does NIV work?

A

It improves the ventilation perfusion mismatch by improving recruitment of collapse alveoli and thus reduces work of breathing

64
Q

What is the best predictor for impending need of resp support?

A

RR >25/min

Year 5/6 (20 decks)

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