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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
Definitive diagnosis of a pulmonary embolism
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
26
Management of PE
``` 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
27
Someone treated for a PE with LMWH is being put onto long term warfarin how should this be done?
Continue warfarin for 5 days or until INR 2-3 for 24 hours (whichever is longer)
28
Causes of exudate pleural effusions and what does exudate mean
Protein concentration >35g/L Think inflammation - pneumonia - cancer - RA - TB
29
Causes of transudate pleural effusions and what this means
Protein concentration <25 g/L Think fluid movement - heart failure - hypoalbuminaemia- liver disease - hypothyroidism - meigs syndrome
30
Signs of pleural effusions
``` Dull percussion note Reduced breath sounds Bronchial breathing above effusion Reduced chest expansion Large - tracheal deviation away ```
31
CXR signs of pleural effusions
Reduced lung field Meniscus Fluid in lung fissures
32
Management of pleural effusion
Conservative - small and treatment of cause Aspiration Chest drainage Pleurodesis
33
Does the trachea deviate away or towards a tension pneumothorax
Away
34
Management of a pneumothorax
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
Young Black woman with dry cough and SOB and nodules on shins, exclude what?
Sarcoidosis
36
Features of sarcoidosis
``` SOB, dry cough Extra pulmonary involvement - erythema nordosum , uveitis, mediastinal lymphadenopathy, arthralgia, arthritis HYPERCALCAEMIA Fever Weight loss Fatigue ```
37
Hypercalaemia associated with which lung condition?
Sarcoidosis
38
CXR of sarcoidosis will show what?
Bilhilar lymphadenopathy
39
Investigation for Sarcoidosis
Bloods - hypercalcaemia, Raised ACE, CRP, test for other organ involvement CXR - bihilar lymphadenopathy Histology - bronchoscopy
40
Treatment of sarcoidosis
No treatment if asymptomatic or mild symptoms Steroids for at least 6 months Second line - methotrexate, azathioprine Lung transplant
41
Theophylline moA
Competitively inhibits phosphodiesterase The enzyme responsible for breaking down cyclic AMP, in smooth muscle cells Results in bronchodilation
42
When should someone be referred for lung cancer pathway
Over 40 with unexplained haemoptysis
43
Epistaxis, sinusitis, nasal crusting, dyspnoea, haemostasis CXR - multiple cavitation lesions Diagnosis? Investigation?
Granulomatosis with polyangiitis ANCA antibodies
44
Management of exacerbation of COPD
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
CXR findings of HF
``` Kerly B lines Cardiomegaly Pleural effusions Alveolar oedema - bats wings Dilated prominent upper lobe vessels ```
46
What would be an indication that a severe asthma attack may need intubation?
pH <7.35 - hypercapnia in a tired patient
47
Dyspnoea and hypoxaemia in a patient that underwent surgery less than 72 hours ago should indicate what?
Atelectasis
48
Criteria for discharge post-asthma attack
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
Cavorting lung lesion differentials
``` Abscess Squamous lung cancer TB Wegrners glomerulomatosis PE RA ```
50
Shipbuilding may expose someone to what?
Asbestosis
51
Oxygen target sats in COPD
No blood gases or CO2 raised - 88-92% | If CO2 normal on ABG - 94-98%
52
Features of acute respiratory distress syndrome
``` Acute onset tachypnoea, tachycardia On a background of cause - e.g. pneumonia Hypoxia Bilateral pulmonary oedema - crsckles Cyanosis ```
53
Managrment of acute respiratory distress syndrome
``` ITU Supportive therapy, treat cause CPAP Invasive haemodynamic monitoring Fluids Oxygen and ventilation General organ support ```
54
Asbestosis will lead to what finding on spirometry
Restrictive | Think fibrosis
55
Causes of obstructive lung disease
Asthma COPD Bronchiectasis
56
Causes of restrictive lung disease
``` IPF Asbestosis Sacroidosis Acute respiratory distress syndrome Kyphoscoliosis Neuromuscular disorders Severe obesity ```
57
What scale is used for obstructive sleep apnoes
Epworth sleepiness scale
58
Managemeng of obstructive sleep apnoea
``` 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
Macrolides (clarithromycin, azithromycin) what investigation should be done prior to starting?
ECG - they prolong QT
60
ABG - high pCO2, acidotic bicarb 44, indicates what?
Acute on chronic respiratory distress - high CO2 indicates respiratory acidosis - metabolic correction takes time so a very high bicarb. Suggests chronic respiratory acidosis
61
Indications for steroids in sarcoidosis
Parenchyma lung disease Uveitis Hypercalcaemia Neurological or cardiac involvement
62
Formoterol is what type of medication?
LABA
63
What medication is usually combined with ICS in an inhaler?
LABA
64
Tiotropium is an example of what medication?
LAMA
65
What abx is used in COPD prophylaxis
Azithromycin
66
Cannonball mets are associated with what cancer?
Renal cell most commonly Also prostate Do CT abdomen
67
Causes of white lung lesions on CXR
``` Consolidation Pleural effusions Collapse Pneumonectomy Tumpurs Fluid - pulmonary oedema ```
68
White out of a hemithorax differentials
Penumonectomy Complete lung collapse Large pleural effusions
69
Trachea pulled towards a total white out of a lung
Pneumonectomy Complete lung collapse - trachea moves towards to side of least pressure
70
Trachea pushed away from a white-out
Pleural effusions Diaphragmatic hernia Large mass - deviates towards lower pressure
71
Raised CO2, raised O2, severely acidotic, raised bicarb Cause
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
Raised platelets may be seen in what?
Lung cancer
73
Extra-pulmonary manifestations of lung cancer
``` siADH Hypercalcaemia - hyperparathyroidism Lambert eaton Cushings syndrome Horners syndrome Recurrent laryngeal nerve palsy ```
74
Lambert Eaton vs myasthenia gravis
Lambert Eaton improves with exercise, myasthenia gets worse

Medicine (25 decks)

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