resp Flashcards
1
Q
name 5 signs of a tension pneumothorax
A
SOB
tachy
hypotensive
tracheal deviation away from the pneumothorax
reduced air entry
increased resonance to percussion on affected side
2
Q
management of a tension pneumothorax
A
dont wait for chest x ray before treating if suspected
insert large bore cannula into 2nd intercostal space, midclavicular line to create connection between air and lung
definitive management is chest drain insertion
other: supportive, high flow oxygen
3
Q
management of spontaneous pneumothorax
A
if less than 2 cm or asymptomatic = conservative as it will spontaneously reduce and follow up in 2-4 weeks
if over 2cm on x ray or SOB do aspiration, if aspiration fails twice then insert chest drain
if bilateral or patient unstable insert chest drain straight away
4
Q
management of COPD
A
- SABA or SAMA
- if no asthmatic features introduce LABA + LAMA
- if asthmatic features go for ICS - if no asthma = LABA + ICS
5
Q
what is the most common organism causing a cap
A
strep pneumoniae
6
Q
what is the most common organism causing a HAP
A
staph aureus / mycoplasma / h.influenzae
7
Q
definition of a HAP
A
pneumonia within 48 hours of hospital admission
8
Q
most common organism causing pneumonia in HIV
A
penumocystitis jivercoi
9
Q
most common cause of atypical pneumonia
A
mycoplasma
10
Q
how does an atypical pneumonia present
A
fever
11
Q
how does an atypical pneumonia present
A
fever, flu like symptoms eg arthralgia, myalgia, dry cough
12
Q
how does mycoplasma pneumonia present
A
flu like symptoms arthralgia, myalgia, dry cough, headache
13
Q
how does klebsiella pneumonia present
A
red currant sputum
14
Q
which organism is most likely to cause pneumonia in patients with bronchiectasis
A
h.influenzae
15
Q
patient with small cell lung cancer presents with weakness in arms and legs that is worse in his legs, that gets better with movement
A
lambert eaton syndrome
16
Q
which type of occupational lung exposure causes upper zone fibrosis
A
coal dust
17
Q
name 4 causes of erythema nodosum
A
idiopathic TB chlamydia strep infection sarcoidosis crohns UC
18
Q
name 6 causes of bronchiectasis
A
congenital: youngs syndrome, primary cilliary dyskinesia
post infection: pneumonia
post-obstructive: foreign body, hilar lymphadenopathy
other disease: UC, rheumatoid arthritis
19
Q
name 4 complications of bronchiectasis
A
recurrent infection haemoptysis pneumothorax resp failure cor pulmonale
20
Q
name the 2 diagnostic tests for a PE
A
- CTPA
2. V/Q scanning
21
Q
chest x ray findings in pulmonary fibrosis
A
- honey comb lung
- reduced lung volumes
- reticulonodular shadowing
22
Q
sites for lung mets
A
bone brain liver adrenals
23
Q
what survey is used in obstructive sleep apnea
A
epworth sleepiness scale
24
Q
name 5 causes of pulmonary fibrosis
A
idiopathic
Autoimmune: rheumatoid arthritis, sjorens, systemic sclerosis
drugs: amiodarone, nitrofurantoin, methotrexate
neurofibromatosis
25
name 3 risk factors for OSA
```
enlarged tonsils
enlarged adenoids
nasal polyps
obesity
alcohol
```
26
name a complication of OSA
right heart failure secondary to chronic pulmonary hypertension
27
name 2 signs of right heart failure on chest x ray
enlarged pulmonary arteries
| enlarged right ventricle
28
name 3 causes of a bilateral hilar lymphadenipathy
```
TB
bronchial carcinoma
lymphoma
sarcoidosis
EEA
```
29
what is seen on histological biopsy of sarcoidosis
non caseating granulomas
30
name a symptom of sarcoid for different body systems
skin: erythema nodosum
lungs: fibrosis, hilar lymphadenopathy
eyes: uveitis
msk: arthralgia, bone pain
CNS; neuropathy, cranial nerve palsies
cardio: cardiomyopathy
other: HYPERCALCAEMIA
liver: hepatosplenomegaly
31
what advice should be given to patients starting long term steroids
there is a risk of adrenal crisis as your body becomes dependent on the steroid tablets so you should never just suddenly stop taking them, you should taper them down and also double the dose when you are ill.
32
what tests should you do in the aspirate of a patient with a unilateral pleural effusion
1. culture, microscopy and sensitivity
2. look at protein, LDH, ph and gluose
3. cytology
4. ziehl neelsen staining for acid fast bacilli
33
how do you manage recurrant pleural effusions
pleurodiesis - involved putting an irritant such as talc into the pleural space to cause inflammation of the pleura meaning it adheres/sticks/fuses with the chest wall to prevent recurring effusion
34
what is an abscess
a collection of infected fluid contained within a cavity
35
name 2 complications of klebsiella pneumonia
more likely to get lung abscess
empyema
pleural adhesions
36
which group of patients are more at risk of klebsiella pneumonia
elderly
immunocompromised
alcoholics
diabetes
37
what is a complication of mycoplasma pneumonia and why does it occur
autoimmune haemolytic anaemia because of cold agglutins
38
what is a complication of mycoplasma pneumonia and why does it occur
autoimmune haemolytic anaemia because of cold agglutins
steven johnsons and erythema multiforme
GBS
meningoencephalitis
39
what cd4 count does pneumocystitis jiroveci usually occur at
< 200
40
what type of organism is pneumocystitis jiroveci
a fungus
41
describe curb 65
```
confusion - AMT -1
Urea >7 - U+E - 1
RR > 30
BP < 90 systolic
age over 65 -75, 76+ (1, 2)
```
```
1 = manage at home, 2 = consider hospital but could be outpatient
3 = deffo hospital
```
42
what antibiotics do you use for legionella pneumonia
ciprofloxacin or azithromycin
43
what antibiotic do you use for hap
co amox
if pen allerg use clari + doxy
44
what antibiotics do you use for cap
amox
if pen allerg use clari
45
what antibiotics are good for mycoplasma pneumonia
doxy
46
what antibiotic is used to treat pneumocystitis jiroveci
co-tramoxazole
47
specific test for legionella pneumonia
legionella urinary antigen test
48
which organism that causes a pneumonia causes an SIADH so HYPONATRAEMIA
legionella
| typically resents with pneumonia with derranged LFT's and a low sodium = legionella
49
antibiotic for legionella pneumonia
clarithromycin or erythromycin
50
antibiotic for mycoplasma pneumonia
doxy / clarithromycin
51
name 3 causes of a lung abscess
aspiraion pneumonia
pneumonia eg klebsiella increases risk
lung cancer
52
symptoms of a lung abscess
```
fever
productive cough
foul smelling sputum
sob
night sweats
weight loss
```
53
investigations for a lun abscess
1. diagnosis on CXR / CT thorax
2. CRP to monitor infection
3. sputum culture for organism
4. bronchoscopy with aspiration for culture, drainage
54
management of a lung abscess
1. abcde
2. o2
3. chest physio
4. iv abx for 3 weeks followed by orals for 3 months
5. if really bad and patient fit for surgery can do CT guided percutaneous drainage of abscess or pulmonary resection of affected area
55
define fev1
the volume of air forcibly exhaled in the first second after deep inspiration
56
define fvc
the total volume of air maximally exhaled after a deep inspiration in one breath
57
describe a restrictive spirometery chart
starts off well and following the trajectory of the normal line and then sharply plateaus as a straight line
58
describe an obstructive spirometery chart
starts off really crap (cos obstructive fev1 is reduced and the start is the 1st second) then sort of plateus more softly and continues upwards
59
how much is the MAP increased by in pulmonary hypertension
15mmhg
60
name 4 signs of pulmonary hypertension on examination
1. raised jvp
2. parasternal heave
3. pansystolic murmur from tricuspid regurg
4. end diastolic murmur from pulmonary regurg
61
name 5 causes of pulmonary hypertension
```
copd
pulmonary fibrosis
bronchiectasis
cystic fibrosis
vasculitis
PE
portal HTN
OSA
kyphosis
mnd
myasthenia gravis
```
62
how do you diangose pulmonary hypertension
right heart catheterisation to measure the MAP >25mmhg
63
how do you manage pulmonary hypertension
1. treat underlying cause
2. reduce pulmonary vascular resistance using LTOT / nifedipine, slidenifil, or prostacycline analogues
3. definitive management is heart and lung transplant
64
how does a PE present
```
pleuritic CP
haemoptysis
acute sob
acute collapse
tachycardia
tachypnoea
low bp
```
65
what does the chest sound like in a patient with a pe
clear
66
what score is used for PE/DVT
wells score
67
what is in wells score for pe
```
pe most likely diagnosis
HR > 100
clinical signs of DVt
immobilisation for 3 days or surgery in past 4 weeks
previous pe/dvt
haemoptysis
malignancy in past 6 months
```
68
what are the 8 rule out criteria for PE
```
must not have any of...
age over 50
oestrogen use
previous pe / dvt
haemoptysis
recent surgery
sats <95% oa
HR > 100
unilateral leg swelling
```
69
signs of a PE on ecg
large S wave in lead 1
inverted T wave in lead 3
large Q wave in lead 3
RAD + RBBB
70
how long is anticoagulation for unprovoked pe
6 months
71
how long is anticoagulation for provoked pe
3 months
72
how long is anticoagulation for recurrent PE
life long
73
first line management of PE
DOAC
74
surgical option for recurrent DVT's and not suitable for warfarin
inferior vena cava filter
75
haemodynamically unstable patient with pe management
thrombolysis if no contraindications
| if contraindications can consider emblectomy
76
what is the cause of a type 1 resp failure
v/q mismatch so the blood is there to carry the oxygen but the oxygen isn't getting in properly
77
what is the cause of a t2 resp failure
alveolar hypoventilation so lungs aren't blowing off the co2 so getting low o2 cos not breathing as much and high co2 cos not blowing off
78
name 3 causes of type 1 resp failure
```
asthma
ccf
pe
pneumonia
pneumothorax
```
79
name 3 causes of type 2 resp failure
```
copd
fibrosis
neuromuscular things so nmd, myasthenia
thoracic wall fractures
opiates - resp depression
```
80
which organism most common causes infective exacerbation of copd
h. influenzae
81
which organism causes whooping cough
bordetella pertussis
82
how long does whooping cough last
at least 14 days and up to 10-14 weeks
83
which organism causes epiglottitis
h.infuenzae type B
84
which organism causes croup
parainfluenza virus most common
| can also be caused by RSV and h.influenza
85
which organism causes bronchiolitis
RSV
86
at what age do kids get croup
6 months to 2 years
87
what is the difference in findings on x ray between croup and epiglottitis
croup: steeple sign - sub glottis oedema
epiglottitis: thumb sign - oedema of glottis
88
clinical differences between croup and epiglottitis
both have stridor
croup has low grade fever, epiglottitis high fever
drooling in epiglottitis, no drooling in croup
less resp distress and wob in croup
no sore throat in croup
muffled voice in epiglottitis, hoarse voice in croup
not really a cough in epiglottitis
usually unvaccinated with epiglottitis
89
differential diagnosis of stridor in a child
croup
epiglottitis
inhaled foreign body
90
what sign is seen on x ray in croup
steeple sign - sub glottis oedema
91
what sign is seen on x ray in epiglottitis
thumb sign - swollen epiglottis
92
management of croup
supportive
admit everyone under the age of 6 months
admit those with moderate to severe presentation
PO dexamethasone 0.15mg/kg stat to all kids
if severe can give high flow o2 and nebulised adrenaline
93
management of epiglottitis
contact seniors
dont distress child
call anaesthetist ready for intubation if needed
dexamethasone, and IV ceftriaxone
94
management of whooping cough
po clarithromycin / erythromycin /azithromycin within 14 days of onset
notify PHE
exclude from school for 21 days of symptom onset if no abx, if treated with abx exclude from school for 48 hours from abx start
treat contacts
95
how do you diagnose whooping cough
nasal swab for PCR and serology
| anti pertussis immunoglobulin G
96
how do you diagnose croup
clinical diagnosis
97
how do you diagnose epiglotittis
lateral x ray of neck
98
name 4 complications of whooping cough
```
subconjuntival haemorrhage from coughing
apneas
pneumothorax
syncope from coughing fits
vomiting from coughing fits
```
99
8 month old child presents with coughing for 1 week, severe episodes followed by vomiting and apneas and a loud sound after coughing fits
whooping cough
100
1 year old presents with very high fever, drooling, use of accessory muscles and looks very septic
epiglottitis
101
1 year old presents with coughing for 1 week, started off as just a cold and now has a cough and looks like they are struggling to breathe with sternal recessions and a barking cough that is worse at night
croup
102
4 signs of copd on examination
```
hyperinflation
wheeze
cyanosis
reduced chest expansion
hyperresonant
```
103
what scale is used to assess severity of breathlessness in copd
MRC dyspnoea scale
104
what finding can you see on FBC in copd patient
polycythemia - raised RCC
105
what does spirometery show in copd patient
obstructive - ratio <70%
106
how is severity of copd scored
```
based on FEV1
mild is >80% expected
mod is 50-79%
severe is 30-19%
v.severe is <30%
```
107
3 findings on chest x ray in copd patient
hyperinflation
bulla
flat hemi diaphragm
reduced vascular markings
108
management of stable copd
1. stop smoking - nrt
2. chest physio / rehab
3. saba, if asthma then LABA + ics if no asthma then laba + LAMA, after that then triple therapy
4. po azithromycin + pred rescue pack
5. can consider po theophylline if triple therapy not working
6. LTOT
109
which organism most likely to cause infective exacerbation of copd
h.influenza
110
management of IECOPD
1. abcde
2. o2 if hypoxic T 88-92
3. po amoxicillin 1st line if pen allerg doxy or clari
4. po pred for minimum 5 days
5. salbutamol nebs
111
criteria for LTOT
2 abg's 3 weeks apart that show..
ph <7.3
or between 7.3-8 but has other signs eg cor pulmonale or polycythaemia
112
which type of lung cancer is most common
squamous cell
113
which type of lung cancer secretes ADH
small cell
114
which type of lung cancer seceretes ACTH
small cell
115
which type of lung cancer is most common amongst non smokers
adenocarcinoma
116
where in the lung is an adenocarcinoma likely to be seen
peripheral lung
117
where in the lung is a SCC likely to be seen
central lung
118
where in the lung is a large cell cancer likely to be seen
peripheral
119
which type of lung cancer has the poorest prognosis
large cel
120
what does a large cell lung cancer secrete
b hcg
121
where is lung cancer most likely to metastesise to
brain bone liver adrenals
122
patient with small cell lung cancer presents with increasing muscle weakness that gets better with exercise - what is the cause
lambert eaton syndrome
123
management of small cell lung cancer
chemo and radiotherapy
| can do surgery if caught early
124
management of non small cell lung cancer
lobectomy is definitive management
do mediastinoscopy to look for node involvement prior to surgery
poor response to chemo so use radiotherapy
125
describe the 2WW criteria for suspected lung cancer
any chest x ray suspicious of cancer
anyone over 40 who smokes with unexplained haemoptysis
or
anyone over 40, non smoker with unexplained cough, SOB, chest pain, weight loss or appetite loss (must have 2)
126
name 3 investigations to rule out lung cancer
CXR
Ct thorax
bronchoscopy and biopsy of lesions
127
which type of lung cancer is most likely to cause hypercalcaemia
squamous cell carcinoma - secretes PTH
128
which type of lung cancer is most likely to cause hyperthyroidism
squamous cell carcinoma - secretes TSH
129
which type of lung cancer is most likely to cause hyponatraemia
small cell lung cancer - seceretes ADH - siadh - hyponatraemia
130
which type of lung cancer is most likely to cause cushings
small cell lung cancer - secretes acth - do dex suppression test so exclude cushings disease
131
```
acute sob
face, arm and neck swelling
pulseless JVP distension
visual disturbance
headache worse in mornings
periorbital oedema
```
SVC obstruction
132
management of SVC obstruction
1. dex
2. chemo and radio to reduce tumour size
3. endovascular stenting to reduce symptoms
133
name 3 causes of SVC obstruction
goitre
lung cancer
lymphoma
134
management of primary pneumothorax less than 2cm and no sob
discharge
135
management of primary pneumothorax over 2cm
aspiration and if that doesn't work then chest drain
| o2 if hypoxic
136
management of secondary pneumothorax
chest drain
137
what 2 activities should you avoid following a pneumothorax
scuba diving
| flying for 2 weeks
138
management of secondary pneumothorax
large bore cannula in 2nd intercostal space mid clavicular line
139
2 complications of tension pneumothorax
midline shift
cardiac arrest
cardiac tamponade
140
what test is used to test for TB immunity / past infection / current infection
mantoux test
141
what test is used to diagnose current TB infection
3 x sputum culture grown on lowestein jenson media and stained with ziehl neelson staining
can do a NAAT which is faster
142
how does a positive mantoux test show up
a 5mm induration after 72 hours
143
which test is used in people with a positive mantoux test to demonstrate a more accurate immune response
interferon gamma assay
144
how do you treat people with latent TB with no risk factors for reactivation
no treatment
145
how do you treat people with latent TB with risk factors for reactivation
rifampicin 3 months plus isoniazid for 6 month
146
how do you treat people with active TB and how long for
rifampicin - 6 months
isoniazid - 6 months
pyramidazole - 3 months
ethambutol - 3 months
147
what stain is used for TB culture
ziehl neelson stain
148
what other diseases should you test people with TB for
HIV hep b and hep c
149
what would you see on the chest x ray of a patient with TB
upper zone cavitations
patchy consolidation
hilar lymphadenopathy
if milliary TB - millet seeds throughout whole lung
150
how is TB spread
air borne droplets
151
pathophysiology of primary TB infection compared to secondary infection
primary: macrophages respond to mycobacterium and encapsulate it forming a ghon complex
152
pathophysiology of millary TB
body fails to encapsulate the mycobacterium so it spreads throughout the body and causes infection
153
presentation of TB
```
SOB
night sweats
chronic cough
haemoptysis
weight loss
lymphadenopathy
erythema nodosum
lethargy
back pain if spinal TB (potts disease)
```
154
what type of vaccine is the BCG (TB) vaccine
live attenuated
155
who is the TB vaccine (BCG) offered to
neonates whos were born in or whose parents were born in a high TB prevalence country, close contacts of TB patients and healthcare workers
156
name 5 causes of brochiectasis
```
post infection
primary cilliary dyskinesia
hypogammaglobulinaemia
idiopathic
blocked bronchioles eg tumour or foreign body
```
157
presentation of bronchiectasis
```
recurrent chest infections
chronic productive cough
haemoptysis
clubbing
wheeze
coarse creps
```
158
what is the gold standard investigation for diagnosing bronchiectasis
high resolution CT thorax
159
name 4 investigations you would do in a patient with suspected bronchiectasis
```
CXR
spirometery
CT thorax
sputum cultures
bronchoscopy
```
160
what 3 investigations would you do to identify a cause of bronchiectasis
CF sweat test
rheumatoid factor
ANA
serum immunoglobulins
161
management of bronchiectasis:
1. conservative
2. medical
3. surgical
```
chest physio
carbocistene - mucolytic
SABA
long term abx
steroids
excision of localised areas of disease or lung transplant if severe
```
162
which gene is mutated in cystic fibrosis and which chromosome is it on
cystic fibrosis transmembrane conductance regulatory gene on chromosome 7
163
presentation of cystic fibrosis (systemic)
chest: recurrent infections, resp failure, sob, chornic cough, bronchiectasis
pancreas: diabetes, reduced digestive enzymes so coaelic, malabsorption, pancreatitis, steatorrhoea, bloating
reduced bile salts so itch
meconium ileus
absence of vas deferens so infertile
failure to thrive
164
gold standard diagnosis of cystic fibrosis
CF sweat test - chloride levels over 60
165
investigations to order in suspected cystic fibrosis
```
cf sweat test
CXR
sputum culture
fecal elastase
OGTT
genetic testing for CFTCR gene
newborn heel prick testing at day 5-7 post partum
```
166
management of an infective exacerbation of cystic fibrosis
antibiotics - acute course
long term po fluclox
nebulised mucolytics - dornase alpha
bronchodilators
167
management of pancreatic symptoms of cystic fibrosis
vitamins ADEK
creon
insulin
high calorie diet
168
management of respiratory symptoms of cystic fibrosis
```
bronchodilators
mucolytics
LTOT
NIV
diuretics if cor pulmonale
```
169
how do you get rid of pseudomonas colonisation in cystic fibrosis
nebulised tobramycin
170
symptoms of obstructive sleep apnea
daytime sleepiness
apneas
snoring
irritability
171
investigations to diagnose osa
polysomnography - sleep studies
172
management of osa
weight loss
stop smoking
avoid alcohol in evening
CPAP over night
173
causes of a normal or raised total gas transfer with a raised transfer coefficient
asthma
because it is an obstructive condition where the problem isn't with the alveoli, its with the bronchioles consticting so the alveoli try and compensate by more blood flowing past them to increase the amount of oxygen taken up
174
describe the presentation of primary cilliary dyskinesia
bronchiectasis
recurrent sinusitis
dextrocardia
subfertility
