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Medicine > Repiratory > Flashcards

Repiratory Flashcards

1
Q

Signs and symptoms of pneumonia

A 
Cough 
Sputum 
Wheeze
Systemic signs - fever 
Rigors 
Signs - cyanosis 
Crackles on auscultation 
Increased RE and HR 
Dull percussion 
Confusion
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2
Q

Common infection in COPD

A

Haemophilus influenza

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3
Q

Common lung infection in diabetics and alcoholics and its antibiotic

A

Klebsiella

Cefotaxime

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4
Q

Water associated pneumonia pathogen and its antibiotic

A

Legionella
Hyponatraemia common
Fluoroquinolone (ciprofloxacin) or clarithromyin

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5
Q

Mycoplasma infection findings and antibiotics

A

Dry cough, atypical CXR findings

Clarithromycin

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6
Q

Scoring system in pneumonia

A

CURB-65

Confusion 
Urea - > 7 
RR > 30 
BP <90 systolic, < 60 diastolic  
Age > 65
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7
Q

Empirical treatment for pneumonia

A

Amoxicillin
If curb > 2 = amoxicillin and clarithromycin
If curb > 3 = co-amoxiclav

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8
Q

First step in asthma management

A

Inhaled SABA as required

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9
Q

Someone’s asthma isn’t controlled on SABA

A

Add an inhaled corricosteroid (low dose)

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10
Q

Someomes asthma isn’t controlled on a SABA and ICS

A

Add a LeuKotriene reception antagonist

Montelukast

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11
Q

Someones asthma isn’t controlled on SABA, ICS and LTRA

A

Add a long acting B2 agonist (LABA)

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12
Q

Someone asthma isn’t controlled with SABA, ICS, LTRA, LABA

A

Increase doe of ICS or try another drug - theophylline

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13
Q

Signs of a severe asthma attack

A

Pefr 33-50 % of best
Cant complete ful sentences
RR > 25/MIN

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14
Q

Signs of a life-threarenjg asthma attack

A

PEFR < 33%
Oxygen sats < 92%
Silent chest
Cyanosis

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15
Q

Tests in COPD

A

Diagnosis based on clinical findings + spirometry
Spirometry will show obstructive pattern

ECG + echo for heart function
Peak flow
FBC - FBC - polycythaemia and anaemia
Alpha 1 antitrypsin - deficiency causes more severe disease
CXR - bronchial wall thickening, air space enlargement and rule out differentials
ABG - decreased oxygen with/out hypercapnia
Spirometry - obstructive pattern
Sputum cultures

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16
Q

Example of a SAMA

A

Ipratropium bromide

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17
Q

Example of SABA

A

Salbutamol,

Terbutaline

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18
Q

Step one in COPD management

A

SABA or SAMA

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19
Q

Someone’s COPD is not controlled by SABA, they do not have asthma and no response to steroids. What is next step?

A

LABA+LAMA (+SABA) as required

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20
Q

Someone’s COPD is not controlled by SABA, they do have asthma and show response to steroids. What is next step?

A

LABA+ICS (+SABA)

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21
Q

Someones COPD is not controlled by SABA, LAMA and LABA. Next step?

A

LAMA+LABA+ICS (+SABA)

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22
Q

Indications for long term oxygen therapy in COPD

A

Patients with paO2 < 7.3 kPa

Or those who have 7.3-8 and one of

  • secondary polycythaemia
  • peripheral oedema
  • pulmonary HTN
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23
Q

Risk factors for PEs

A 
Long haul flight 
Immobility 
Cancer 
Surgery 
Thrombophilia - antiphospholipid syndrome 
Leg fracture
Previous PE
COCP
Pregnancy
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24
Q

Investigations for PE

A

Obs
ECG - sinus tachycardia
Bloods - FBC, U+E, ABG - decreased O2 and CO2

Wells score
D-DIMER
CT pulmonary angiogram

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25
Q

Definitive diagnosis of a pulmonary embolism

A

Wells score
<4 = D dimer, if positive then do CT pulmonary angio
If >4 = treat or CT pulmonary angio

Alternative = ventilation, perfusion scan - will be ventilated but not perfused

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26
Q

Management of PE

A 
Oxygen if hypoxic 
Morphine and anti-emetic
IV access
Fluid if drop in BP 
Consider ITU

Haemodynamically unstable - thrombolysis
If not - apixaban or rivaroxiban, LMWH as an alternative

Long term coagulation - 3 months if provoked, 6 months if unprovoked, lifelong if active cancer

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27
Q

Someone treated for a PE with LMWH is being put onto long term warfarin how should this be done?

A

Continue warfarin for 5 days or until INR 2-3 for 24 hours (whichever is longer)

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28
Q

Causes of exudate pleural effusions and what does exudate mean

A

Protein concentration >35g/L

Think inflammation

  • pneumonia
  • cancer
  • RA
  • TB
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29
Q

Causes of transudate pleural effusions and what this means

A

Protein concentration <25 g/L

Think fluid movement

  • heart failure
  • hypoalbuminaemia- liver disease
  • hypothyroidism
  • meigs syndrome
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30
Q

Signs of pleural effusions

A 
Dull percussion note
Reduced breath sounds 
Bronchial breathing above effusion
Reduced chest expansion 
Large - tracheal deviation away
31
Q

CXR signs of pleural effusions

A

Reduced lung field
Meniscus
Fluid in lung fissures

32
Q

Management of pleural effusion

A

Conservative - small and treatment of cause
Aspiration
Chest drainage
Pleurodesis

33
Q

Does the trachea deviate away or towards a tension pneumothorax

34
Q

Management of a pneumothorax

A

Spontaneous, asymptomatic and <2cm of air = Conservative, will follow up CXR

Spontaneous SOB or >2cm of air = aspirate, if not successful then chest drain

Secondary

  • SOB and/or rim of air >2cm - chest drain
  • 1-2 cm - aspirate
  • otherwise admit for 24 hours obs
35
Q

Young Black woman with dry cough and SOB and nodules on shins, exclude what?

A

Sarcoidosis

36
Q

Features of sarcoidosis

A 
SOB, dry cough 
Extra pulmonary involvement - erythema nordosum , uveitis, mediastinal lymphadenopathy, arthralgia, arthritis 
HYPERCALCAEMIA 
Fever
Weight loss
Fatigue
37
Q

Hypercalaemia associated with which lung condition?

A

Sarcoidosis

38
Q

CXR of sarcoidosis will show what?

A

Bilhilar lymphadenopathy

39
Q

Investigation for Sarcoidosis

A

Bloods - hypercalcaemia, Raised ACE, CRP, test for other organ involvement
CXR - bihilar lymphadenopathy
Histology - bronchoscopy

40
Q

Treatment of sarcoidosis

A

No treatment if asymptomatic or mild symptoms
Steroids for at least 6 months
Second line - methotrexate, azathioprine
Lung transplant

41
Q

Theophylline moA

A

Competitively inhibits phosphodiesterase
The enzyme responsible for breaking down cyclic AMP, in smooth muscle cells

Results in bronchodilation

42
Q

When should someone be referred for lung cancer pathway

A

Over 40 with unexplained haemoptysis

43
Q

Epistaxis, sinusitis, nasal crusting, dyspnoea, haemostasis

CXR - multiple cavitation lesions

Diagnosis?

Investigation?

A

Granulomatosis with polyangiitis

ANCA antibodies

44
Q

Management of exacerbation of COPD

A

Home - prednisolone for 7-14 days
Regulat inhalers or home nebs
Abx if infection

Hospital - nebulised bronchodilators - salbutamol and ipratropium
Steroids - hydrocortisone
Abx if infection
Physiotherapy

Severe - IV aminophylline
Non-invasive ventilation

45
Q

CXR findings of HF

A 
Kerly B lines
Cardiomegaly 
Pleural effusions 
Alveolar oedema - bats wings 
Dilated prominent upper lobe vessels
46
Q

What would be an indication that a severe asthma attack may need intubation?

A

pH <7.35 - hypercapnia in a tired patient

47
Q

Dyspnoea and hypoxaemia in a patient that underwent surgery less than 72 hours ago should indicate what?

A

Atelectasis

48
Q

Criteria for discharge post-asthma attack

A

Been stable on their discharge medication (I.e. no nebuliser or oxygen) for 12-24 hours
Inhaler technique checked and recorded
PEF > 75% of best or predicted

49
Q

Cavorting lung lesion differentials

A 
Abscess
Squamous lung cancer 
TB
Wegrners glomerulomatosis
PE
RA
50
Q

Shipbuilding may expose someone to what?

A

Asbestosis

51
Q

Oxygen target sats in COPD

A

No blood gases or CO2 raised - 88-92%

If CO2 normal on ABG - 94-98%

52
Q

Features of acute respiratory distress syndrome

A 
Acute onset tachypnoea, tachycardia 
On a background of cause - e.g. pneumonia 
Hypoxia 
Bilateral pulmonary oedema - crsckles 
Cyanosis
53
Q

Managrment of acute respiratory distress syndrome

A 
ITU 
Supportive therapy, treat cause 
CPAP
Invasive haemodynamic monitoring 
Fluids
Oxygen and ventilation 
General organ support
54
Q

Asbestosis will lead to what finding on spirometry

A

Restrictive

Think fibrosis

55
Q

Causes of obstructive lung disease

A

Asthma
COPD
Bronchiectasis

56
Q

Causes of restrictive lung disease

A 
IPF
Asbestosis 
Sacroidosis
Acute respiratory distress syndrome 
Kyphoscoliosis 
Neuromuscular disorders
Severe obesity
57
Q

What scale is used for obstructive sleep apnoes

A

Epworth sleepiness scale

58
Q

Managemeng of obstructive sleep apnoea

A 
Refer to ENT or sleep clinic 
They can monitor obs during sleep 
First-step - correct lifestyle factors - weight, smoking, alcohol etc.
Second step - CPAP
Surgery
59
Q

Macrolides (clarithromycin, azithromycin) what investigation should be done prior to starting?

A

ECG - they prolong QT

60
Q

ABG - high pCO2, acidotic bicarb 44, indicates what?

A

Acute on chronic respiratory distress

  • high CO2 indicates respiratory acidosis
  • metabolic correction takes time so a very high bicarb. Suggests chronic respiratory acidosis
61
Q

Indications for steroids in sarcoidosis

A

Parenchyma lung disease
Uveitis
Hypercalcaemia
Neurological or cardiac involvement

62
Q

Formoterol is what type of medication?

63
Q

What medication is usually combined with ICS in an inhaler?

64
Q

Tiotropium is an example of what medication?

65
Q

What abx is used in COPD prophylaxis

A

Azithromycin

66
Q

Cannonball mets are associated with what cancer?

A

Renal cell most commonly

Also prostate

Do CT abdomen

67
Q

Causes of white lung lesions on CXR

A 
Consolidation 
Pleural effusions 
Collapse
Pneumonectomy
Tumpurs
Fluid - pulmonary oedema
68
Q

White out of a hemithorax differentials

A

Penumonectomy
Complete lung collapse
Large pleural effusions

69
Q

Trachea pulled towards a total white out of a lung

A

Pneumonectomy
Complete lung collapse

  • trachea moves towards to side of least pressure
70
Q

Trachea pushed away from a white-out

A

Pleural effusions
Diaphragmatic hernia
Large mass

  • deviates towards lower pressure
71
Q

Raised CO2, raised O2, severely acidotic, raised bicarb

Cause

A

Shows acidotic picture

Overadministration of O2 in a COPD patient
Raised bicarb, indicates chronic resp acidosis

Patient has lost hypoxic drive therefore retain CO2
And subsequently hypoventilate leading to respiratory arrest

If bicarb was normal - acute respiratory acidosis

72
Q

Raised platelets may be seen in what?

A

Lung cancer

73
Q

Extra-pulmonary manifestations of lung cancer

A 
siADH
Hypercalcaemia - hyperparathyroidism
Lambert eaton
Cushings syndrome 
Horners syndrome
Recurrent laryngeal nerve palsy
74
Q

Lambert Eaton vs myasthenia gravis

A

Lambert Eaton improves with exercise, myasthenia gets worse

Medicine (25 decks)

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