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[EDITED] ICSM Year 6 + edits > Passmed: Resp > Flashcards

Passmed: Resp Flashcards

1
Q

Moderate asthma

A

PEFR 50-75
Speech normal
RR <25
Pulse < 110

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2
Q

Severe Asthma

A

PEFR 33-50
Can’t complete sentences
RR >25
Pulse >110

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3
Q

Life-threatening Asthma

A

PEFR < 33
O2 < 92
Normal pC02
Silent chest, cyanosis, low resp effort, bradycardia, dysrhythmia, hypotension
exhaustion, confusion or coma

near fatal = raised C02 or mechanical ventilation

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4
Q

ABG indication in acute asthma

A

O2 < 92

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5
Q

CXR indications in Asthma

A

life-threatening
Pneumothorax
failure to respond to treatment

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6
Q

Who should be admitted with acute asthma

A

Life threatening
severe - if not respond to intital treatment
previous near fatal
pregnancy
attack despite using oral CS that night

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7
Q

Acute asthma patients that need oxygen

A

Hypoxaemic
acutely unwell - 15L - 94/98

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8
Q

How should SABA be delivered in LT A asthma

A

neb

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9
Q

What is given post A asthma

A

40-50mg pred PO - 5 days
continue normal meds as well

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10
Q

Treatment options in ITU for A asthma and indications

A

failure to respond to treatments - give senior critical care support

intubation and ventilation + ECMO

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11
Q

Criteria for A asthma discharge

A

stable (no additional meds) - 12/24 hrs
inhaler technique checked
PEF > 75%

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12
Q

Signs of acute bronchitis

A

cough
sore throat
rhinorrhoea
wheeze - only chest sign

clinical diagnosis - CRP testing

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13
Q

Mx of Acute bronchitis

A

analgesia
fluid
AB if:
- systemic
- - pre-existing co morbidities
- CRP 20/100 delay - above 100 give AB

AB = doxycycline, give amoxicillin in children / pregnant women

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14
Q

Post A COPD treatment

A

increase BD use + neb
pred 30mg 5 days
purulent sputum / pneumonia - ABS
- amox / clari / doxy

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15
Q

A COPD admission criteria

A

breathlessness
confusion
cyanosis
90> sats
social reasons
comorbidity

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16
Q

Initial oxygen therapy COPD

A

28% venturi mask 4 litres - no history resp acidosis

if co2 normal adjust target range

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17
Q

T2Rf in A COPD

A

NIV
- 7.25-7.35

then use BiPaP

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18
Q

What is ARDS

A

increased permeability of alveoli = fluid accumulation
- non cardiogenic PO

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19
Q

Causes of ARDS

A

infection
blood transfusion
trauma
smoke
acute pancreatitis
covid-19
cardio-pulmonary bypass

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20
Q

Features of ARDS and Ix

A

dyspnoea
resp rate raised
bilateral lung crackles
low oxygen sats

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21
Q

Specific features of ARDS

A

acute onset - within 1 week of factor
PO
non cardiogenic -check wedge pressure
pO2/fio2 < 40 /300

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22
Q

Mx of ARDS

A

ITU
treat hypoxaemia
organ support e.g vasopressors
underlying cause
prone and muscle relaxation

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23
Q

Where is bronchiectasis in ABPA

A

proximal

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24
Q

Ix for ABPA

A

eosinophilia
CXR
+ve RAST test
raised IgE

glucocorticoids

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25
Q

How to interpret a blood gas

A

hypoxaemic
acidaemic or alklaemic
PaCO2
Metabolic component (base excess high or low)

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26
Q

Treatment of pleural plaques

A

benign and no malignant change

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27
Q

Features of asbestos exposure

A

pleural thickening
plaques
asbestosis - lower zone fibrosis, reduced exercise tolerance

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28
Q

Features of mesothelioma

A

progressive sob
chest pain
pleural effusion
palliative chemo

lung cancer more common with asbestos - smoking increase further

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29
Q

RF for aspiration pneumonia

A

poor dental hygiene
swallowing
prlonged hospitalisation
impaired consciousness
impaired mucociliary clearance

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30
Q

Most common site for aspiration pneumonia

A

right middle
right lower

larger and more vertical

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31
Q

Test for asthma over 17 and under

A

> 17 - ask about work for occupational, spirometry (less than 70) with BDR & FeNO

<17 - spirometry with BDR, FeNO only if normal (child 35 not 40)

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32
Q

BDR results

A

adults - FEV1 12% or 200ml
Child - 12% improvement

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33
Q

Occupational asthma causes and work up

A

Isocyanates - spray paint

serial measurements of peak expiratory flow - go to specialist

34
Q

Asthma step down

A

every 3 months
25-50% of inhaled steroids

35
Q

Atelectasis

A

basal alveolar collapse post operation

bronchial secretions leading to hypoxaemia and dyspnoea 72 hrs postoperatively

position upright and breathing exercises

36
Q

Causes of Bilateral hilar lymphadenopathy

A

Sarcoid and TB

lymphoma
pneumoconiosis
fungi

37
Q

Causes of bronchiectasis

A

permanent dilatation of airways in response to infection / inflammation

  • post infective
  • CF
  • obstruction
  • immune def
  • ABPA
  • Ciliary dyskinetic e.g kartageners
  • yellow nail syndrome

tramlines and signet ring

38
Q

Mx of Bronchiectasis

A

physio
postural drainage
ABs
bronchodilators
immunise

39
Q

Contraindications for chest drain

A

INR > 1.3
platelet count < 75
Pulmonary bullae
pleural adhesions

40
Q

Chest drain features

A

45 angle
5th intercostal space, MAL, lidocaine
seldinger technique - aspirate fluid, go up on inspiration

41
Q

Complications of chest drain

A

failure to insert
bleeding
infection
penetration
re-expansion pulomonary oedema - clamp and urgent CXR ( avoid rapid fluid output)

42
Q

Removal of chest drain

A

no output > 24 hrs
no longer bubbling
penetrating chest injury review by specialist

43
Q

Causes of lobar collapse

A

lung cancer - adults
asthma
foreign body

trachea towards, media towards, elevation of hemidiaphragm

44
Q

Cannonball mets from where

A

Renal cell carcinoma

45
Q

Causes of mediastinal widening

A

patient rotation

acute: AAA, lymphoma, goitre, teratoma, thymus tumour

46
Q

CXR pulmonary oedema

A

bat wing
upper lobe diversion
kerley b
pleural effusion
cardiomegaly - if cardiogenic

47
Q

Causes of white lung lesions

A

Trachea toward - pneumonectomy, lung collapse, hypoplasia
Central - consolidation, PO, mesothelioma
Away - effusion, diaphragmatic hernia, thoracic mass

48
Q

Features of pneumoconiosis

A

coal dust
immune response
simple - asymp, some opacities, normal lung marking and no lung markings
progressive massive fibrosis - mixed lung picture

upper zone fibrosis, avoid coal, chronic bronchitis treatment and get compensation

49
Q

Features of COPD

A

CXR - hyperinflation, bullae, flat hemidiaphragm
Bloods - secondary poly
staging - 80, 50-79, 30-49, 30 (very severe) - FEV1

50
Q

Asthmatic features of COPD

A

LABA + LAMA + ICS on triple
exclude lama if first time

swap sama to saba

theophylline if cannot inhale, reduce if macrolide co-prescribe

51
Q

What should be done before prescribing azithromycin

A

ecg - qt prolongation

52
Q

PDE-4 and COPD

A

reduce exacerbations e.g roflumilast
severe - less than 50%
2 or more exacerbations in previous 12 months despite triple therapy of LAMA< LABA and ICS

53
Q

Churg strauss syndrome

A

asthma
blood eosinophilia
paranasal sinusitis
mononeuritis
pANCA

Gran with P - renal failure + epistaxis + cANCA - steroids

54
Q

Aspergilloma and haemoptysis

A

past history of TB

55
Q

Inhaler technique

A

remove cap and shake
breathe out gently
put in mouthpiece as breath in slow and depp, inhale steadiliy
hold breath for 10 seconds
second dose wait 30 seconds - repeat
only use number of doses on label

56
Q

Features of kartageners

A

primary ciliary dyskinesia
dextrocardia
bronchiectasis
recurrent sinusitis
subfertility

57
Q

Klebsiella

A

gram neg
following aspiration and uti
alcoholic and diabetics
red current jelly
upper lobe
lung abcess and empyema

58
Q

Features of lung abscess

A

aspiration pneumonia
staph / kleb
subacute -slow symptoms and systemic features
CXR - fluid filled space
IV ABs then percutaneous drainage

59
Q

Features of each lung cancer

A

small cell - adh, acth, lambert eaton (weak on use)

scc - parathyroid, clubbing, hypertrophic pulmonary osteoarthropathy, hypert ectopic tsh

adeno - gynaecomastia, hpoa

60
Q

Ix for lung cancer

A

CXR - then ct
bronchoscopy for histology
raised platelets on blood

61
Q

Referral criteria for lung cancer

A

cxr of LC
aged 40 unexplained lung cancer - 2ww

urgent cxr in 2 weeks over 40 and 2 / smoked / 1 - cough, fatigue, etc

consider if 40 over with - recurrent chest infection, clubbing, chest signs, thrombocytosis

62
Q

Lung fibrosis zones

A

upper - hypersen pneumonitis, coal, silicosis, sarcoid, anklyosing, tbf, radiation induced

lower - ipf, connective tissue e.g. sle, drugs, asbestosis

63
Q

cytology negative exudative effusions

A

local anaesthetic thoracoscopy

chemo for meso

64
Q

Cons of OSA

A

daytime somnolence
resp acidosis
hypertension

65
Q

Oxygen therapy indications

A

critically ill - anaphylais, shock - 15litre

no for MI, stroke, obstetirc, anxiety

66
Q

Pleural effusion causes

A

trans - failures, heart most common
exudate (high protein above 30) - infection e.g. pneumonia, connecitve tissue, neoplasia, pancreaitis, pe, dressler

67
Q

Ix and Mx of Pleural Effusion

A

PA CXR
USS on aspiration
21G and 50ml syndrine

lights: exudate likely if one - pleural fluid protein > 0.5, LDH pleural / serum ldh > 0.6, pleural ldh 2/3 upper limit of normal serum ldh

68
Q

characterisitc pleural fluid

A

low glucose - RA and TB
raised amylase - pancreatitis and oesophageal perforation
heavy blood staining - mesothelioma, pe, tb

69
Q

No symptoms with pneumothorax

A

conservative care regardless of size

70
Q

high risk characteristics of pneumothorax

A

haemodynamic compromise (suggesting a tension pneumothorax)
significant hypoxia
bilateral pneumothorax
underlying lung disease
≥ 50 years of age with significant smoking history
haemothorax

always chest drain, Video (VATS) - persisent for pleurodesis

71
Q

Pneumothorax discharge advice

A

smoking - avoid
flying - 2 weeks after if no air
no scube diving - unless bilateral surgical pleurectomy and normal lung function and CT scane

72
Q

Causes of restrictive lung disease

A

PF
Asbestosis
sarcoidosis
ards
kyphoscoliosis
neuromuscular
severe obesity

73
Q

Causes of resp acidosis

A

copd
asthma
neuromuscular
obesity
sedative - benzo / opiate overdose

74
Q

Causes of resp alkalosis

A

anxiety
pe
salicylate poisoning
cns disorder: stroke
altitude
pregnancy

75
Q

Resp tract infection features

A

centor: exudate, lymphadeno, fever, absence of cough

76
Q

Sarcoidosis features

A

non-caseating
erythema nodosum, lupus pernio, uveitis

Indications for steroids: CXR staging (2 or 3 - BHL + interstitial infilitrates), hypercalcaemia, eye, heart or neuro involvement

fibrosis

77
Q

Poor prognosis with Sarcoid

A

insidious > 6 months
no erythema nodosum
extrapulmonary features - lupus pernio, spelnomegaly,
stage III or more on CXR
black african

78
Q

Silicosis

A

mining, slate,
silica inhalation - develop to TB

upper zone fibrosing lung disease, egg shell calcification

79
Q

Smoking cessation

A

nicotine replacement therapy - 2 weeks to stop date

not offer re prescription in next 6 months

varenicline - nicotinic rec partial agonist - 1 week before stop date - 12 weeks , no for depresion and pregancy / breast feeding

bupropion - nor and dop reuptake inhibitor - 1 before stop, seizures and epilepsy + breast

80
Q

Transfer factor

A

rate at which gas diffuse into blood

raised - asthma, pulmonary haemorrhage, polycythamia, hyperkinetic, male gender, exercise

lwoer - pf, pneumonia, pe, po, emphysema, anaemia, low cardiac output

[EDITED] ICSM Year 6 + edits (28 decks)

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