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finals > resp > Flashcards

resp Flashcards

1
Q

criteria for severe asthma

A

PEFR 33-50% best or predicted
cannot complete sentences
RR >25
HR >110

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2
Q

criteria for life-threatening asthma

A

PEFR <33%
SpO2 <92%
silent chest, cyanosis or feeble respiratory effort
dysrhythmia or hypotension
exhaustion, confusion or coma
normal pCO2, if borderline low might need ventilation

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3
Q

asthma not controlled by SABA + ICS

A

add LTRA (NICE guidance)

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4
Q

asthma not controlled by SABA + ICS + LTRA

A

add LABA

can cont LTRA depending on response

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5
Q

infective exacerbation of COPD ABX

A

amoxicillin or clarithromycin or doxycycline
avoid amoxicillin if penicillin allergic
avoid clarithromycin in long QT

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6
Q

differentiating between transudate and exudate pleural effusion

A

exudate: protein >30 and LDH >200, pleural effusion fluid protein:serum protein is >0.5
transudate: protein <30

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7
Q

causes of transudate pleural effusion

A

heart failure (most common)
hypoalbuminaemia (which can be due to nephrotic syndrome)
hypothyroidism

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8
Q

causes of exudate pleural effusion

A

pneumonia (most common)
connective tissue disease: RA, SLE
neoplasia
PE

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9
Q

causative organism of atypical pneumonia in bird owners

A

Chlamydia psittaci (psittacosis)

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10
Q

smoking cessation treatment for pregnant women

A

nicotine replacement therapy

bupropion is CI

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11
Q

restrictive spirometry

A

FEV1:FVC >70%
decreased FVC
normal/decreased FEV1

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12
Q

inhaler technique

A
  1. remove cap and shake
  2. breath out
  3. put mouthpiece in mouth, breath in slowly, press canister down and continue to inhale slowly and deeply
  4. hold breath for 10s
  5. for second dose wait 30s
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13
Q

causes of upper lobe fibrosis

CHARTS

A 
Coal workers pneumoniconiosis
Hypersensitivity pneumonitis (aka extrinsic allergic alveolitis)
Ankylosing spondylitis
Radiation
TB
Sarcoidosis
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14
Q

causes of lower lobe fibrosis

RASIO

A 
Rheumatoid
Asbestos
Scleroderma
Idiopathic pulmonary fibrosis - most common
Other - AMIODARONE
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15
Q

COPD not controlled by SABA, no asthmatic features/features suggesting steroid responsiveness

A 
add LABA (Formoterol) + LAMA (Tiotropium)
if already taking SAMA (e.g. Ipratropium) stop this and switch to SABA
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16
Q

when do you aspirate a pneumothorax

A

if primary and >2cm rim of air or SoB

if secondary and 1-2cm rim of air

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17
Q

when do you insert a chest drain for pneumothorax

A

if primary and aspiration fails

if secondary, >50 years and rim of air >2cm or if aspiration fails

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18
Q

COPD still breathless despite SABA/SAMA + LABA + ICS

A

add LAMA

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19
Q

when should non-invasive ventilation be used in COPD

A

respiratory acidosis (pH 7.25-7.35 and pCO2 >6kPa) that persists despite best medical mx

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20
Q

mx of acute asthma

A

O SHIT ME!

  1. Oxygen
  2. Salbutamol nebulisers
  3. Hydrocortisone IV or Prednisolone PO
  4. Ipratropium bromide nebulisers
  5. Theophylline
  6. Magnesium sulfate IV
  7. ESCALATE
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21
Q

obstructive spirometry

A

decreased FEV1:FVC
decreased FVC
significantly decreased FEV1

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22
Q

mx of allergic bronchopulmonary aspergillosis

A

prednisolone

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23
Q

ix for suspected lung cancer

A
  1. CXR
  2. contrast-enhanced CT
  3. ultrasound guided biopsy
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24
Q

mx for alpha1-antitrypsin deficiency

A

no smoking
supportive: bronchodilators, physio
IV alpha1-antitrypsin protein concentrates
surgery: lung volume reduction surgery

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25
Q

ix for mesothelioma

A

thoracoscopy and histology

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26
Q

CURB-65 score

A 
Confusion
Urea >7 mmol/l
RR >=30/min
BP: SBP <=90; DBP <=60
65 years or older
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27
Q

idiopathic pulmonary fibrosis pulmonary function test results

A

increased FEV/FVC1

decreased TLCO

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28
Q

ix for sleep apnoea

A

sleep studies - polysomnography

29
Q

paraneoplastic syndrome associated with squamous cell lung cancer

A

increased parathyroid hormone-related hormone
hypercalcaemia
‘squamous squishes your bones’

30
Q

paraneoplastic syndrome associated with small cell lung cancer

A 
SCLC:
SIADH
Cushing's (increased ACTH and ADH)
Lambert-Eaton myasthenic syndrome (proximal muscle weakness)
Cerebellar syndrome
31
Q

COPD still breathness despite SABA/SAMA and asthma/steroid responsive features

A

LABA + ICS

32
Q

how to diagnose occupational asthma

A

PEFR at work and away

33
Q

CI to lung cancer surgery

A

SVC obstruction
FEV <1.5
malignant pleural effusion
vocal cord paralysis

34
Q

respiratory causes of finger clubbing

A-F

A 
Abscess
Bronchiectasis
Cancer
DO NOT SAY COPD
Empyema
Fibrosis
35
Q

causes of bilateral hilar lymphadenopathy

A

sarcoid

TB

36
Q

ix for idiopathic pulmonary fibrosis

A

high-res CT

37
Q

empyema aspirate findings

A

turbid effusion
pH <7.2
low glucose
high LDH

38
Q

diagnostic criteria for ARDS

A

acute onset
pulmonary oedema
non-cardiogenic (if pulmonary capillary wedge pressure >15 mmHg consider cardiac pulmonary oedema)
pO2/FiO2 <40 kpa (200 mmHg)

39
Q

indications for starting corticosteroids in sarcoidosis

PUNCH

A 
Parenchymal lung disease
Uveitis
Neuro involvement
Cardiac involvement
Hypercalcaemia
40
Q

paraneoplastic syndrome associated with adenocarcinoma of the lung

A

gynaecomastia

41
Q

causes of lung white out on CXR - trachea pulled towards

A

pneumonectomy
complete lung collapse
pulmonary hypoplasia

42
Q

causes of lung white out on CXR - trachea central

A

consolidation
pulmonary oedema
mesothelioma

43
Q

causes of lung white out on CXR - trachea pushed away

A

pleural effusion
diaphragmatic hernia
large thoracic mass

44
Q

what tests must be done prior to starting Azithromycin

A

ECG (to exclude QT prolongation)

LFTs

45
Q

when can long-term oxygen therapy be offered in COPD

A

pO2 <7.3 kPa OR
pO2 7.3-8 and one of:
secondary polycythaemia, peripheral oedema, pulmonary hypertension

46
Q

mx for massive PE + hypotension

A

thrombolyse with Alteplase

embolectomy is last resort if thrombolysis fails/is CI

47
Q

Ipratropium

A

SAMA

48
Q

Formoterol

A

LABA

49
Q

Salmeterol

A

LABA

50
Q

Tiotropium

A

LAMA

51
Q

sleep apnoea can cause which deranged observation

A

hypertension

52
Q

which non-invasive ventilation is used in an acute exacerbation of COPD resistant to best medical mx

A

BiPAP

53
Q

risk factors for invasive aspergillosis

A

immunocompromised patients - HIV, leukaemia

following broad-spectrum ABX

54
Q

borders of safe triangle for chest drain insertion

A

lat dorsi
pec major
line superior to nipple
apex of axilla

55
Q

what does a very high bicarbonate on ABG suggest

A

chronic respiratory acidosis

56
Q

vaccinations received in COPD

A

annual influenza

once-off pneumococcal

57
Q

features of Addisonian crisis

A

hyponatraemia
hyperkalaemia
hypoglycaemia

58
Q

multiple nodules seen on CXR, most likely dx

A

metastatic cancer

59
Q

risk factors for pneumothorax

A

pre-existing lung disease: COPD, asthma, CF
Marfan’s, RA
non-invasive ventilation

60
Q

salbutamol

A

SABA (beta-2 agonist)

61
Q

extra-pulmonary features of cystic fibrosis

A

male infertility, female subfertility
diabetes mellitus
rectal prolapse
nasal polyps

62
Q

whiteout of a lung following aspiration (i.e. choking aspiration not aspiration for pneumothorax)

A

atelectasis secondary to bronchial obstruction

63
Q

most likely cause of unilateral pleural effusion

A

local problem such as bronchial carcinoma

64
Q

pleural plaques found on CXR mx

A

they are not malignant so reassurance with no follow up

65
Q

features of myasthenia crisis

A

acute respiratory failure characterised by FVC <1 litre
use of accessory muscles
weak cough

66
Q

risk factors for aspergilloma

A

existing lung cavities, e.g. secondary to TB, lung cancer or cystic fibrosis

67
Q

features of aspergilloma

A

may be asymptomatic

may present with non-productive cough, haemoptysis

68
Q

non-smoker - lung cancer

A

adenocarcinoma

69
Q

factors which improve survival in COPD

A

smoking cessation
long term oxygen therapy
lung volume reduction surgery

finals (25 decks)

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