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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

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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

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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

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4
Q

management of COPD

A
  1. SABA or SAMA
  2. if no asthmatic features introduce LABA + LAMA
    - if asthmatic features go for ICS
  3. if no asthma = LABA + ICS
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5
Q

what is the most common organism causing a cap

A

strep pneumoniae

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6
Q

what is the most common organism causing a HAP

A

staph aureus / mycoplasma / h.influenzae

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7
Q

definition of a HAP

A

pneumonia within 48 hours of hospital admission

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8
Q

most common organism causing pneumonia in HIV

A

penumocystitis jivercoi

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9
Q

most common cause of atypical pneumonia

A

mycoplasma

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10
Q

how does an atypical pneumonia present

A

fever

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11
Q

how does an atypical pneumonia present

A

fever, flu like symptoms eg arthralgia, myalgia, dry cough

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12
Q

how does mycoplasma pneumonia present

A

flu like symptoms arthralgia, myalgia, dry cough, headache

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13
Q

how does klebsiella pneumonia present

A

red currant sputum

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14
Q

which organism is most likely to cause pneumonia in patients with bronchiectasis

A

h.influenzae

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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

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16
Q

which type of occupational lung exposure causes upper zone fibrosis

A

coal dust

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17
Q

name 4 causes of erythema nodosum

A 
idiopathic
TB
chlamydia
strep infection
sarcoidosis
crohns
UC
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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

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19
Q

name 4 complications of bronchiectasis

A 
recurrent infection
haemoptysis
pneumothorax
resp failure
cor pulmonale
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20
Q

name the 2 diagnostic tests for a PE

A
  1. CTPA

2. V/Q scanning

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21
Q

chest x ray findings in pulmonary fibrosis

A
  1. honey comb lung
  2. reduced lung volumes
  3. reticulonodular shadowing
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22
Q

sites for lung mets

A

bone brain liver adrenals

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23
Q

what survey is used in obstructive sleep apnea

A

epworth sleepiness scale

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24
Q

name 5 causes of pulmonary fibrosis

A

idiopathic
Autoimmune: rheumatoid arthritis, sjorens, systemic sclerosis
drugs: amiodarone, nitrofurantoin, methotrexate
neurofibromatosis

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25
Q

name 3 risk factors for OSA

A 
enlarged tonsils
enlarged adenoids
nasal polyps
obesity
alcohol
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26
Q

name a complication of OSA

A

right heart failure secondary to chronic pulmonary hypertension

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27
Q

name 2 signs of right heart failure on chest x ray

A

enlarged pulmonary arteries

enlarged right ventricle

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28
Q

name 3 causes of a bilateral hilar lymphadenipathy

A 
TB
bronchial carcinoma
lymphoma
sarcoidosis
EEA
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29
Q

what is seen on histological biopsy of sarcoidosis

A

non caseating granulomas

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30
Q

name a symptom of sarcoid for different body systems

A

skin: erythema nodosum
lungs: fibrosis, hilar lymphadenopathy
eyes: uveitis
msk: arthralgia, bone pain
CNS; neuropathy, cranial nerve palsies
cardio: cardiomyopathy
other: HYPERCALCAEMIA
liver: hepatosplenomegaly

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31
Q

what advice should be given to patients starting long term steroids

A

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.

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32
Q

what tests should you do in the aspirate of a patient with a unilateral pleural effusion

A
  1. culture, microscopy and sensitivity
  2. look at protein, LDH, ph and gluose
  3. cytology
  4. ziehl neelsen staining for acid fast bacilli
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33
Q

how do you manage recurrant pleural effusions

A

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

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34
Q

what is an abscess

A

a collection of infected fluid contained within a cavity

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35
Q

name 2 complications of klebsiella pneumonia

A

more likely to get lung abscess
empyema
pleural adhesions

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36
Q

which group of patients are more at risk of klebsiella pneumonia

A

elderly
immunocompromised
alcoholics
diabetes

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37
Q

what is a complication of mycoplasma pneumonia and why does it occur

A

autoimmune haemolytic anaemia because of cold agglutins

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38
Q

what is a complication of mycoplasma pneumonia and why does it occur

A

autoimmune haemolytic anaemia because of cold agglutins

steven johnsons and erythema multiforme
GBS
meningoencephalitis

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39
Q

what cd4 count does pneumocystitis jiroveci usually occur at

A

< 200

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40
Q

what type of organism is pneumocystitis jiroveci

A

a fungus

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41
Q

describe curb 65

A 
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
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42
Q

what antibiotics do you use for legionella pneumonia

A

ciprofloxacin or azithromycin

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43
Q

what antibiotic do you use for hap

A

co amox

if pen allerg use clari + doxy

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44
Q

what antibiotics do you use for cap

A

amox

if pen allerg use clari

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45
Q

what antibiotics are good for mycoplasma pneumonia

A

doxy

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46
Q

what antibiotic is used to treat pneumocystitis jiroveci

A

co-tramoxazole

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47
Q

specific test for legionella pneumonia

A

legionella urinary antigen test

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48
Q

which organism that causes a pneumonia causes an SIADH so HYPONATRAEMIA

A

legionella

typically resents with pneumonia with derranged LFT’s and a low sodium = legionella

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49
Q

antibiotic for legionella pneumonia

A

clarithromycin or erythromycin

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50
Q

antibiotic for mycoplasma pneumonia

A

doxy / clarithromycin

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51
Q

name 3 causes of a lung abscess

A

aspiraion pneumonia
pneumonia eg klebsiella increases risk
lung cancer

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52
Q

symptoms of a lung abscess

A 
fever
productive cough
foul smelling sputum
sob
night sweats
weight loss
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53
Q

investigations for a lun abscess

A
  1. diagnosis on CXR / CT thorax
  2. CRP to monitor infection
  3. sputum culture for organism
  4. bronchoscopy with aspiration for culture, drainage
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54
Q

management of a lung abscess

A
  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
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55
Q

define fev1

A

the volume of air forcibly exhaled in the first second after deep inspiration

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56
Q

define fvc

A

the total volume of air maximally exhaled after a deep inspiration in one breath

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57
Q

describe a restrictive spirometery chart

A

starts off well and following the trajectory of the normal line and then sharply plateaus as a straight line

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58
Q

describe an obstructive spirometery chart

A

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

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59
Q

how much is the MAP increased by in pulmonary hypertension

A

15mmhg

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60
Q

name 4 signs of pulmonary hypertension on examination

A
  1. raised jvp
  2. parasternal heave
  3. pansystolic murmur from tricuspid regurg
  4. end diastolic murmur from pulmonary regurg
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61
Q

name 5 causes of pulmonary hypertension

A 
copd
pulmonary fibrosis
bronchiectasis
cystic fibrosis
vasculitis 
PE
portal HTN
OSA
kyphosis
mnd
myasthenia gravis
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62
Q

how do you diangose pulmonary hypertension

A

right heart catheterisation to measure the MAP >25mmhg

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63
Q

how do you manage pulmonary hypertension

A
  1. treat underlying cause
  2. reduce pulmonary vascular resistance using LTOT / nifedipine, slidenifil, or prostacycline analogues
  3. definitive management is heart and lung transplant
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64
Q

how does a PE present

A 
pleuritic CP
haemoptysis
acute sob 
acute collapse
tachycardia
tachypnoea
low bp
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65
Q

what does the chest sound like in a patient with a pe

A

clear

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66
Q

what score is used for PE/DVT

A

wells score

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67
Q

what is in wells score for pe

A 
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
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68
Q

what are the 8 rule out criteria for PE

A 
must not have any of...
age over 50
oestrogen use
previous pe / dvt
haemoptysis
recent surgery
sats <95% oa
HR > 100
unilateral leg swelling
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69
Q

signs of a PE on ecg

A

large S wave in lead 1
inverted T wave in lead 3
large Q wave in lead 3
RAD + RBBB

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70
Q

how long is anticoagulation for unprovoked pe

A

6 months

71
Q

how long is anticoagulation for provoked pe

A

3 months

72
Q

how long is anticoagulation for recurrent PE

A

life long

73
Q

first line management of PE

A

DOAC

74
Q

surgical option for recurrent DVT’s and not suitable for warfarin

A

inferior vena cava filter

75
Q

haemodynamically unstable patient with pe management

A

thrombolysis if no contraindications

if contraindications can consider emblectomy

76
Q

what is the cause of a type 1 resp failure

A

v/q mismatch so the blood is there to carry the oxygen but the oxygen isn’t getting in properly

77
Q

what is the cause of a t2 resp failure

A

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
Q

name 3 causes of type 1 resp failure

A 
asthma
ccf
pe
pneumonia
pneumothorax
79
Q

name 3 causes of type 2 resp failure

A 
copd
fibrosis
neuromuscular things so nmd, myasthenia
thoracic wall fractures
opiates - resp depression
80
Q

which organism most common causes infective exacerbation of copd

A

h. influenzae

81
Q

which organism causes whooping cough

A

bordetella pertussis

82
Q

how long does whooping cough last

A

at least 14 days and up to 10-14 weeks

83
Q

which organism causes epiglottitis

A

h.infuenzae type B

84
Q

which organism causes croup

A

parainfluenza virus most common

can also be caused by RSV and h.influenza

85
Q

which organism causes bronchiolitis

A

RSV

86
Q

at what age do kids get croup

A

6 months to 2 years

87
Q

what is the difference in findings on x ray between croup and epiglottitis

A

croup: steeple sign - sub glottis oedema
epiglottitis: thumb sign - oedema of glottis

88
Q

clinical differences between croup and epiglottitis

A

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
Q

differential diagnosis of stridor in a child

A

croup
epiglottitis
inhaled foreign body

90
Q

what sign is seen on x ray in croup

A

steeple sign - sub glottis oedema

91
Q

what sign is seen on x ray in epiglottitis

A

thumb sign - swollen epiglottis

92
Q

management of croup

A

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
Q

management of epiglottitis

A

contact seniors
dont distress child
call anaesthetist ready for intubation if needed
dexamethasone, and IV ceftriaxone

94
Q

management of whooping cough

A

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
Q

how do you diagnose whooping cough

A

nasal swab for PCR and serology

anti pertussis immunoglobulin G

96
Q

how do you diagnose croup

A

clinical diagnosis

97
Q

how do you diagnose epiglotittis

A

lateral x ray of neck

98
Q

name 4 complications of whooping cough

A 
subconjuntival haemorrhage from coughing 
apneas
pneumothorax
syncope from coughing fits
vomiting from coughing fits
99
Q

8 month old child presents with coughing for 1 week, severe episodes followed by vomiting and apneas and a loud sound after coughing fits

A

whooping cough

100
Q

1 year old presents with very high fever, drooling, use of accessory muscles and looks very septic

A

epiglottitis

101
Q

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

A

croup

102
Q

4 signs of copd on examination

A 
hyperinflation
wheeze
cyanosis
reduced chest expansion
hyperresonant
103
Q

what scale is used to assess severity of breathlessness in copd

A

MRC dyspnoea scale

104
Q

what finding can you see on FBC in copd patient

A

polycythemia - raised RCC

105
Q

what does spirometery show in copd patient

A

obstructive - ratio <70%

106
Q

how is severity of copd scored

A 
based on FEV1
mild is  >80% expected
mod is 50-79%
severe is 30-19%
v.severe is <30%
107
Q

3 findings on chest x ray in copd patient

A

hyperinflation
bulla
flat hemi diaphragm
reduced vascular markings

108
Q

management of stable copd

A
  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
Q

which organism most likely to cause infective exacerbation of copd

A

h.influenza

110
Q

management of IECOPD

A
  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
Q

criteria for LTOT

A

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
Q

which type of lung cancer is most common

A

squamous cell

113
Q

which type of lung cancer secretes ADH

A

small cell

114
Q

which type of lung cancer seceretes ACTH

A

small cell

115
Q

which type of lung cancer is most common amongst non smokers

A

adenocarcinoma

116
Q

where in the lung is an adenocarcinoma likely to be seen

A

peripheral lung

117
Q

where in the lung is a SCC likely to be seen

A

central lung

118
Q

where in the lung is a large cell cancer likely to be seen

A

peripheral

119
Q

which type of lung cancer has the poorest prognosis

A

large cel

120
Q

what does a large cell lung cancer secrete

A

b hcg

121
Q

where is lung cancer most likely to metastesise to

A

brain bone liver adrenals

122
Q

patient with small cell lung cancer presents with increasing muscle weakness that gets better with exercise - what is the cause

A

lambert eaton syndrome

123
Q

management of small cell lung cancer

A

chemo and radiotherapy

can do surgery if caught early

124
Q

management of non small cell lung cancer

A

lobectomy is definitive management
do mediastinoscopy to look for node involvement prior to surgery
poor response to chemo so use radiotherapy

125
Q

describe the 2WW criteria for suspected lung cancer

A

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
Q

name 3 investigations to rule out lung cancer

A

CXR
Ct thorax
bronchoscopy and biopsy of lesions

127
Q

which type of lung cancer is most likely to cause hypercalcaemia

A

squamous cell carcinoma - secretes PTH

128
Q

which type of lung cancer is most likely to cause hyperthyroidism

A

squamous cell carcinoma - secretes TSH

129
Q

which type of lung cancer is most likely to cause hyponatraemia

A

small cell lung cancer - seceretes ADH - siadh - hyponatraemia

130
Q

which type of lung cancer is most likely to cause cushings

A

small cell lung cancer - secretes acth - do dex suppression test so exclude cushings disease

131
Q 
acute sob
face, arm and neck swelling
pulseless JVP distension
visual disturbance
headache worse in mornings
periorbital oedema
A

SVC obstruction

132
Q

management of SVC obstruction

A
  1. dex
  2. chemo and radio to reduce tumour size
  3. endovascular stenting to reduce symptoms
133
Q

name 3 causes of SVC obstruction

A

goitre
lung cancer
lymphoma

134
Q

management of primary pneumothorax less than 2cm and no sob

A

discharge

135
Q

management of primary pneumothorax over 2cm

A

aspiration and if that doesn’t work then chest drain

o2 if hypoxic

136
Q

management of secondary pneumothorax

A

chest drain

137
Q

what 2 activities should you avoid following a pneumothorax

A

scuba diving

flying for 2 weeks

138
Q

management of secondary pneumothorax

A

large bore cannula in 2nd intercostal space mid clavicular line

139
Q

2 complications of tension pneumothorax

A

midline shift
cardiac arrest
cardiac tamponade

140
Q

what test is used to test for TB immunity / past infection / current infection

A

mantoux test

141
Q

what test is used to diagnose current TB infection

A

3 x sputum culture grown on lowestein jenson media and stained with ziehl neelson staining
can do a NAAT which is faster

142
Q

how does a positive mantoux test show up

A

a 5mm induration after 72 hours

143
Q

which test is used in people with a positive mantoux test to demonstrate a more accurate immune response

A

interferon gamma assay

144
Q

how do you treat people with latent TB with no risk factors for reactivation

A

no treatment

145
Q

how do you treat people with latent TB with risk factors for reactivation

A

rifampicin 3 months plus isoniazid for 6 month

146
Q

how do you treat people with active TB and how long for

A

rifampicin - 6 months
isoniazid - 6 months
pyramidazole - 3 months
ethambutol - 3 months

147
Q

what stain is used for TB culture

A

ziehl neelson stain

148
Q

what other diseases should you test people with TB for

A

HIV hep b and hep c

149
Q

what would you see on the chest x ray of a patient with TB

A

upper zone cavitations
patchy consolidation
hilar lymphadenopathy

if milliary TB - millet seeds throughout whole lung

150
Q

how is TB spread

A

air borne droplets

151
Q

pathophysiology of primary TB infection compared to secondary infection

A

primary: macrophages respond to mycobacterium and encapsulate it forming a ghon complex

152
Q

pathophysiology of millary TB

A

body fails to encapsulate the mycobacterium so it spreads throughout the body and causes infection

153
Q

presentation of TB

A 
SOB 
night sweats
chronic cough
haemoptysis
weight loss
lymphadenopathy
erythema nodosum
lethargy
back pain if spinal TB (potts disease)
154
Q

what type of vaccine is the BCG (TB) vaccine

A

live attenuated

155
Q

who is the TB vaccine (BCG) offered to

A

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
Q

name 5 causes of brochiectasis

A 
post infection 
primary cilliary dyskinesia
hypogammaglobulinaemia
idiopathic
blocked bronchioles eg tumour or foreign body
157
Q

presentation of bronchiectasis

A 
recurrent chest infections
chronic productive cough
haemoptysis
clubbing
wheeze
coarse creps
158
Q

what is the gold standard investigation for diagnosing bronchiectasis

A

high resolution CT thorax

159
Q

name 4 investigations you would do in a patient with suspected bronchiectasis

A 
CXR
spirometery
CT thorax
sputum cultures
bronchoscopy
160
Q

what 3 investigations would you do to identify a cause of bronchiectasis

A

CF sweat test
rheumatoid factor
ANA
serum immunoglobulins

161
Q

management of bronchiectasis:

  1. conservative
  2. medical
  3. surgical
A 
chest physio
carbocistene - mucolytic
SABA
long term abx
steroids
excision of localised areas of disease or lung transplant if severe
162
Q

which gene is mutated in cystic fibrosis and which chromosome is it on

A

cystic fibrosis transmembrane conductance regulatory gene on chromosome 7

163
Q

presentation of cystic fibrosis (systemic)

A

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
Q

gold standard diagnosis of cystic fibrosis

A

CF sweat test - chloride levels over 60

165
Q

investigations to order in suspected cystic fibrosis

A 
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
Q

management of an infective exacerbation of cystic fibrosis

A

antibiotics - acute course
long term po fluclox
nebulised mucolytics - dornase alpha
bronchodilators

167
Q

management of pancreatic symptoms of cystic fibrosis

A

vitamins ADEK
creon
insulin
high calorie diet

168
Q

management of respiratory symptoms of cystic fibrosis

A 
bronchodilators
mucolytics 
LTOT
NIV
diuretics if cor pulmonale
169
Q

how do you get rid of pseudomonas colonisation in cystic fibrosis

A

nebulised tobramycin

170
Q

symptoms of obstructive sleep apnea

A

daytime sleepiness
apneas
snoring
irritability

171
Q

investigations to diagnose osa

A

polysomnography - sleep studies

172
Q

management of osa

A

weight loss
stop smoking
avoid alcohol in evening
CPAP over night

173
Q

causes of a normal or raised total gas transfer with a raised transfer coefficient

A

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
Q

describe the presentation of primary cilliary dyskinesia

A

bronchiectasis
recurrent sinusitis
dextrocardia
subfertility

finals (18 decks)

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