Resp Flashcards
1
Q
ABG - normal pH
A
7.35 - 7.45
2
Q
ABG - normal pCO2
A
4.5 - 6.0 kPa
3
Q
ABG - normal pO2
A
10 - 14 kPa
4
Q
Indications for NIV - in COPD
A
COPD with respiratory acidosis pH 7.25 - 7.35 (after starting nebs + steroids)
5
Q
Initial settings for BiPAP in COPD - EPAP
A
4 - 5 cm H2O
6
Q
Initial settings for BiPAP in COPD - IPAP
A
10 cm H2O
7
Q
Initial settings for BiPAP in COPD - back up rate
A
15 breaths/min
8
Q
Initial settings for BiPAP in COPD - back up insp:expiration ratio
A
1:3
9
Q
Primary pneumothorax - rim < 2cm - not short of breath
A
Consider discharge
10
Q
Primary pneumothorax - rim > 2cm or short of breath
A
Aspiration
11
Q
Primary pneumothorax - rim still >2cm or still short of breath after attempting aspiration
A
Insert chest drain
12
Q
Secondary pneumothorax - rim > 2cm and/or > 50 years old
A
Insert chest drain
Admit for 24+ hours
13
Q
Secondary pneumothorax - patient < 50 years old, rim 1 - 2 cm
A
Attempt aspiration
Admit for 24+ hours
14
Q
Secondary pneumothorax - rim still > 1 cm after attempting aspiration
A
Insert chest drain
Admit for 24+ hours
15
Q
Secondary pneumothorax - patient < 50 years old, rim < 1 cm
A
Give oxygen
Admit for 24+ hours
16
Q
Diving after secondary pneumothorax
A
Avoid permanently, unless had bilateral pleurectomy + normal lung Fx + CT post-operatively
17
Q
Features of Lefgren’s syndrome (acute form of sarcoidosis)
A
BHL
Erythema nodosum
Fever
Polyarthralgia
18
Q
Paraneoplastic ADH associated with which lung cancer
A
Small cell
19
Q
Paraneoplastic ACTH associated with which lung cancer
A
Small cell
20
Q
Lamber-Eaton paraneoplastic syndrome associated with which lung cancer
A
Small cell
21
Q
Paraneoplastic PTH-rp associated with which lung cancer
A
Squamous cell
22
Q
Paraneoplastic HPOA associated with which lung cancer
A
Squamous cell,
Adenocarcinoma
23
Q
Paraneoplastic TSH associated with which lung cancer
A
Squamous cell
24
Q
Paraneoplastic syndromes - Clubbing is associated with which lung cancer
A
Squamous cell
25
Paraneoplastic syndromes - Gynaecomastia is associated with which lung cancer
Adenocarcinoma
26
Causes of bronchiectasis
```
Post-infective
Bronchial obstruction
Cystic fibrosis, ciliary dyskinesias
Immune deficiency
ABPA
Yellow nail syndrome
```
27
Post-infective causes of bronchiectasis
TB
Measles
Pertussis
Pneumonia
28
Immune deficiency causes of bronchiectasis
Selective IgA deficiency
| Hypogammaglobulinaemia
29
Medication licensed for idiopathic pulmonary fibrosis
Pirfenidone,
| Nintedanib
30
Pirfenidone MOA
Anti-fibrotic agent
31
Features of ABPA
Bronchoconstriction
Bronchiectasis
Eosinophilia
32
Life threatening asthma - PEFR
PEFR <33% best or predicted
33
Life threatening asthma - Oxygen sats
sats < 92%
34
Life threatening asthma - pCO2
'Normal' pCO2 (4.6 - 6.0 kPa)
35
Life threatening asthma - Examination
Silent chest,
Cyanosis,
Poor respiratory effort
Exhaustion, confusion, coma
36
Severe asthma - PEFR
PEFR 33 - 50% best or predicted
37
Severe asthma - Examination
Can't complete sentences
38
Severe asthma - RR
RR >25/min
39
Severe asthma - HR
HR > 110 bpm
40
Life threatening asthma - Obs
Bradycardia
Dysrhythmia
Hypotension
41
Moderate asthma - PEFR
PEFR 50 - 75% best or predicted
42
Moderate asthma - Examination
Speech normal
43
Moderate asthma - RR
RR < 25/min
44
Moderate asthma - HR
HR < 110 bpm
45
COPD exaverbation - NIV unavailable/inappropriate
Doxapram
46
Doxapram MOA
Respiratory stimulant
47
COPD - still breathless on SABA/SAMA and LABA + ICS
Add LAMA
48
COPD - 1st line
SABA/SAMA prn
49
COPD - Still breathless on SABA/SAMA without asthmatic features/steroid responsiveness
SABA prn
LABA + LAMA regular
50
COPD - Still breathless on SABA/SAMA + asthmatic features/steroid responsiveness
SABA/SAMA prn
LABA + ICS regular
51
COPD -
SABA prn
LABA + LAMA regular
Still breathless
SABA prn
LABA + LAMA + ICS regular
52
COPD
SABA/SAMA prn
LABA + ICS regular
Still breathless
SABA prn
LABA + LAMA + ICS regular
53
Features of EGPA (Churg-Strauss)
```
Lung disease (late onset/worsening 'asthma')
Renal disease (AKI)
Eosinophilia
pANCA
Mononeuritis multiplex
NO SINUSITIS (in exams)
```
54
Pulmonary hypertension group 1
I - Pulmonary arterial hypertension (PAH)
55
Pulmonary hypertension group 2
II - Pulmonary hypertension secondary to left heart disease
56
Pulmonary hypertension group 3
III - Pulmonary hypertension secondary to lung disease
57
Pulmonary hypertension group 4
IV - Pulmonary hypertension secondary to chronic thromboembolic disease
58
Pulmonary hypertension group 5
V - Pulmonary hypertension with unclear cause
59
Sarcoidosis - indications for steroids
Stage 2 or 3 disease + symptomatic
Hypercalcaemia
Eye/heart/neuro involvement
60
Restrictive spirometry - FEV1/FVC ratio
FEV1/FVC > 0.7
61
Obstructive spirometry - FEV1/FVC ratio
FEV1/FVC < 0.7
62
Cavitating upper lobe pneumonia in diabetic/alcoholic
Klebsiella
63
Lung fibrosis in aerospace worker
Berylliosis
64
Management of acute eosinophilic pneumonia
Oral steroids
65
COPD not controlled on triple inhaled therapy
Roflumilast
66
Roflumilast MOA
Long-acting phosphodiesterase inhibitor
67
NSCLC stage I or II - management
Surgical resection
68
Contraindications to surgical resection in NSCLC
```
Stage IIIb/IV
FEV <1.5
Malignant effusion
Tumour near hilum
Vocal cord paralysis
SVC obstruction
```
69
Features of Hypersensitivity Pneumonitis / Extrinsic allergic alveolitis
```
Episodic SOB and cough
Environmental trigger
Acute: fever
Chronic: weight loss
No eosinophilia
```
70
Silicosis - fibrosis affects which zone
Upper zone fibrosis
71
Coal worker's pneumoconiosis - fibrosis affects which zone
Upper zone fibrosis
72
Histoplasmosis (fungus Histoplasma capsulatum) - typical features
Recent travel
URTI and retrosternal pain
Nodular shadowing
73
Pathogen commonly associated with bronchiectasis
Pseudomonas
74
Features of microscopic polyangiitis
```
Glomerulonephritis
Systemic features
Palpable purpura
Cough, dyspnoea, haemoptysis
Mononeuritis multiplex
ANCA +ve
```
75
Features of GPA (Wegeners)
```
Lung disease
SINUS DISEASE
Renal disease
No eosinophilia
ANCA positive (usually c, but may be p)
```
76
Adult with asthma - not controlled on SABA alone
SABA + low-dose ICS
77
Adult with new diagnosis of asthma with symptoms <3/week and no night-time awakening
SABA
78
Adult with new diagnosis of asthma with symptoms >3/week or night-time awakening
SABA + low-dose ICS
79
Adult with asthma - not controlled on SABA + low-dose ICS
SABA + low-dose ICS + LTRA
80
Adult with asthma - not controlled on SABA + low-dose ICS + LTRA
SABA + low-dose ICS + LABA
| +/- continure LTRA
81
Adult with asthma - not controlled on SABA + low-dose ICS + LABA
SABA + MART (LABA + low-dose ICS)
| +/- LTRA
82
Features of theophylline poisoning
Hypokalamia
Hyperglycaemia
Tachycardia + increased myocardial contractility
83
DLCO/TLCO
Diffusion capacity of lung for CO
84
KCO
Transfer coefficient
| =DLCO corrected for lung volume/transfer per 'bit' of lung
85
Causes of a low DLCO (low transfer co-efficient)
- Pulmonary fibrosis
- Pneumonia
- PE
- Pulmonary oedema
- Emphysema
- Anaemia
- Low cardiac output
86
Causes of a raised DLCO
```
Asthma
Pulmonary haemorrhage
Left-to-right heart shunt
Polycythaemia
Hyperkinetic state
Male, exercise
```
87
CURB-65 score - C
Confusion (AMTS <=8/10)
88
CURB-65 score - R
RR >= 30
89
CURB-65 score - U
Urea > 7
90
CURB-65 score - B
Systolic <= 90 ,or,
| Diastolic <= 60
91
CURB score of >=3
Consider ITU
92
Stable COPD - ABG shows pO2 <7.3
Offer LTOT
93
Stable COPD - ABG shows pO2 7.3 - 8
Offer LTOT if any of:
- secondary polycythaemia
- peripheral oedema
- pulmonary hypertension
94
LTOT assessment - patient develops respiratory acidosis
Medical optimisation + re-assess 4 weeks
95
LTOT assessment - PaCO2 rise of >1 kPa
Medical optimisation + re-assess 4 weeks
96
Two difficult to control organisms in CF
Pseudomonas aeruginosa
| Burkholderia
97
Caplan syndrome
Patient with RA + occupational dust exposure - > severe pneumoconiosis
98
Solitary lung nodule <5mm
Can be discharged
99
Solitary lung nodule >= 8 mm + high risk features
CT-PET, and biopsy if high uptake
100
Solitary lung nodule > 6 mm + low risk
CT surveillance (3 months)
101
Solitary lung nodule 5 -6 mm
CT surveillance (12 months)
102
ARDS diagnostic criteria
Acute onset
Oedema on CXR
Non-cardiogenic
pO2/FiO2 < 40kPa (200 mmHg)
103
CRB-65 score 0 - risk of death
< 1%
104
CRB-65 score 1 or 2 - risk of death
1 - 10%
105
CRB-65 score 3 or 4 - risk of death
> 10%
106
Small cell lung cancer with extensive disease
Consider chemotherapy
107
Treatment for MAC (mycobacterium avium complex)
Rifampicin + clarithromycin + ethambutol
108
Treatment for M.kansii NTM (Mycobacterium kansasii)
Rifampicin, isoniazid + ethambutol
109
Prognostic test in IPF
Carbon monoxide transfer factor
110
Hypersensitivity pneumonitis/EEA - bronchoalveolar lavage findings
Lymphocytosis
111
Hypersensitivity pneumonitis (Extrinsic allergic alveolitis) - CXR/CT findings
Upper/mid-zone fibrosis
112
Hypersensitivity pneumonitis (Extrinsic allergic alveolitis)- blood investigations
NO eosinophilia
| Serology for specific IgG antibodies (precipitins for bird/fungus)
113
Hypersensitivity pneumonitis/EEA - examples
Bird fancier's lung
Farmer's lung
Malt worker's lung
Mushroom worker's lung
114
Psuedomonas eradication in CF
2 weeks IV anti-pseudomonal antibiotic + inhaled aminoglycaside
or
6 weeks PO ciprofloxacin
115
Management of theophyllin poisoning
Gastric lavage if <1hr
Activated charcoal
Charcoal haemoperfusion
116
Features of sarcoidosis
Lung fibrosis/BHL
Renal failure
Non-caseating granulomas
117
Sarcoidosis CXR features
BHL
| Apical fibrosis
118
Sarcoidosis - blood findings
```
Lymphocytosis
Increased CD4:CD8 ratio
Raised ESR
ACE (in 70%)
Hypercalcaemia (10%)
```
119
Sarcoidosis - CXR stage 0
Normal
120
Sarcoidosis - CXR stage 1
Bilateral hilar lymphadenopathy
121
Sarcoidosis - CXR stage 2
BHL + interstitial infiltrates
122
Sarcoidosis - CXR stage 3
Diffuse interstitial infiltrates only
123
Sarcoidosis - CXR stage 4
Diffuse fibrosis
124
Commonest lung cancer in adolescents
Bronchial carcinoid
125
1st line management of psuedomonas in bronchiectasis
PO ciprofloxacin 14 days
126
2nd line management of psuedomonas in bronchiectasis
IV tazocin, ceftazidime, aztreonam or meropenem
127
Small cell lung cancer - Limited disease (T1-4, N0-3, M0)
Consider surgery
or
4 cycles cisplatin-based chemotherapy +/- radiotherapy
128
Small cell lung cancer - Early stage (T1-2a, N0, M0)
Consider surgery
Or chemo + radiotherapy
129
Small cell lung cancer - Extensive disease (T1-4, N0-3, M1a/b)
6 cycles cisplatin-based chemotherapy + radiotherapy if good response
130
1st line management of moderate/severe disease in granulomatosis with polyangiitis
Cyclophosphamide and corticosteroids
131
COPD patient develops respiratory acidosis/>1kPa rise in PaCO2 during LTOT on two repeated occasions (and apparently clinically stable)
Offer domiciliary oxygen only in conjunction with nocturnal ventilator support
132
MPO antibodies
pANCA
133
PR3 antibodies
cANCA
134
Causes of mononeuritis multiplex
```
Vasculitis
Diabetes
AIDS
Amyloidosis
RA
```
135
Microscopic polyangiitis - ANCA findings
pANCA in 50-70%
cANCA in 40%
136
Pulmonary causes of eosinophilia
- Asthma
- ABPA
- EGPA
- Eosinophilic pneumonia
- Hypereosinophilic syndrome
- Loffler's syndrome
- Tropical pulmonary eosinophilia
137
Treatment of ABPA
Oral steroids +/- itraconazole
138
Treatment of aspergilloma
Oral itraconazole +/- surgical resection
139
Delta-F508 mutation seen in
Cystic fibrosis
140
ESR in anti-GBM disease
Normal
141
Adult asthma step 1
SABA
142
Adult asthma step 2
| not controlled on 1 or new diagnosis with symptoms >3/week or nocturnal
SABA + low-dose ICS
143
Adult asthma step 3
SABA + low-dose ICS + LTRA
144
Adult asthma step 4
SABA + low-dose ICS + LABA
+/- LTRA depending on response before
145
Adult asthma step 5
Switch to MART:
-SABA
-MART (LABA + low-dose ICS)
+/- LTRA
146
Adult asthma step 6
- SABA
-MART (LABA + medium-dose ICS)
+/- LTRA
147
Adult asthma step 7
-SABA
-High dose ICS
- LABA
+/- LTRA
- trial LAMA/theophylline
-expert help
148
How to distinguish transudate vs exudate
Protein level <30g/L = Transudate
Protein level >30g/L = Exudate
If protein level 25-35g/L use Light's criteria
149
Light's criteria
Exudate likely if at least one of:
Fluid protein/serum protein >0.5
Fluid LDH/serum LDH >0.6
Fluid LDH more than 2/3 upper limits normal serum LDH
150
PEFR demonstrating severe acute asthma
33-50% of best/predicted
151
PEFR demonstrating life-threatening acute asthma
<33% best/predicted
152
Acute asthma - RR demonstrating severe
RR >25
153
Acute asthma - Pulse rate demonstrating severe (or life-threatening)
HR > 110
154
Acute asthma - signs demonstrating severe
Can't complete sentences
155
Acute asthma - signs demonstrating life-threatening
```
Silent chest
Cyanosis
Poor respiratory effort
Confusion
Exhaustion, coma
```
156
Acute asthma - Obs demonstrating life-threatening
Oxygen sats <92%
Bradycardia
Hypotension
Dysrhythmia
157
In which patients is Hypertrophic Pulmonary Osteoarthropathy seen?
Patients with Bronchial Carcinoma
158
What is the characteristic of Hypertrophic Pulmonary Osteoarthropathy?
Finger clubbing and long bone pain
159
What is the most sensitive Ix for Hypertrophic Pulmonary Osteoarthropathy?
Isotope Bone Scan
| Findings: uptake in long bones, around periarticular surfaces and sometimes also the mandible and scapulae
160
Treatment of Burkholderia Cepacia
IV regimes with two or more Abx:
- Ceftazidime + aminoglycoside
- Ceftazidime + Chloramphenicol
- Chloramphenicol + Minocyclne
161
Sensitive way to diagnose active TB?
Pleural Biopsy:
| Obtain sample so PCR for TB can be carried out rapidly
162
How severe is airflow obstruction in COPD if FEV1 30-49%
Severe
163
How severe is airflow obstruction in COPD if FEV1 50-79%
Moderate
164
How severe is airflow obstruction in COPD if FEV1 > 80%
Mild
165
How severe is airflow obstruction in COPD if FEV1 <30%
Very severe
166
What is the threshold for ventilatory support in patients with GBS?
20ml/kg
167
What criteria makes a patient with emphysema unsuitable for lung volume reduction surgery?
1) Non-upper lobe emphysema with high exercise capacity
2) FEV1 < 20%
3) Carbon Monoxide diffusing capacity <20%
168
The presence of what physical feature is associated with reaction to NSAIDs in asthmatics?
Nasal Polyps
169
Causes of Lower Zone Fibrosis?
MAID:
Most connective tissue disease (Rheumatoid)
Asbestosis
Idiopathic Pulmonary Fibrosis, Infection
Drugs (Amiodarone, Methotrexate, Bleomycin)
170
Nintednib MoA?
Small tyrosine kinase inhibitor including: PDGF, FGFR, VEGFR
171
Features of Psittacosis?
Fever, Low WCC, Splenomegaly, epistaxis
172
What is thunderstorm asthma?
Pressure changes in a thunderstorm causes release of pollen and spores which trigger asthma exacerbation
173
Time frame for development of pleural plaques, asbestosis and mesothelioma following exposure of asbestos?
>10 years: pleural plaques
> 20 years: asbestosis
>30 years: mesothelioma
