Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 2a Revision > Resp > Flashcards

Resp Flashcards

1
Q

what are the different types of lung CA

A
  • Small Cell Lung CA
  • Non-small Cell Lung CA
  • Mesothelioma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the two types of Non-small Cell Lung CA

A
  • squamous cell carcinoma

- adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does small cell lung CA contain and what do they cause

A

neurosecretory granules that release neuroendocrine hormones = multiple PARA-NEOPLASTIC SYNDROMES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the common signs of lung CA

A
  • SOB
  • cough
  • haemoptysis
  • clubbing
  • weight loss
  • recurrent pneumonia
  • lymphadenopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the first line Ix for ?lung CA

A

CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what XR findings may indicate Lung Ca

A
  • hilar enlargement
  • peripheral opacity
  • pleural effusion (consolidation on XR)
  • collapsed lung
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What other Ix are used in the diagnosis of lung CA

A
  • staging CT
  • PET-CT
  • Bronchoscopy with endobronchial US (US guided biopsy)
  • Histology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What system in used to stage lung CA

A

TNM staging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Mx options for non-small cell lung Ca

A

MDT management

  • surgery first line (Lobectomy)
  • radiotherapy
  • chemotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Mx options for small cell lung Ca

A

MDT management

  • chemotherapy
  • radiotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which lung Ca has the worse prognosis

A

small cell lung cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What can be done in the palliative management of lung cancer

A
  • palliative chemotherapy

- endobronchial treatment (stents/debulking)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How else might a pt first present with lung Ca

A

extrapulmonary manifestation or paraneoplastic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

define paraneoplastic syndromes

A

a group of rare disorders that are triggered by an abnormal immune response to a neoplasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

which paraneoplastic syndromes are associated with small cell lung cancer

A
  • Syndrome of inappropriate ADH
  • Cushings syndrome
  • limbic encephalitis
  • Lambert-Eaton Myasthenic Syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how does SIADH present

A

hyponatraemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

which paraneoplastic syndrome is associated with squamous cell lung cancer

A

Hypercalcaemia of malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the extrapulmonary manifestations of lung CA

A
  • Recurrent laryngeal nerve palsy (HOARSE VOICE)
  • Phrenic nerve palsy (SOB-diaphragm weakness)
  • Superior vena cave obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How does Superior vena cave obstruction present

A
  • facial swelling
  • difficulty breathing
  • distended veins in the neck and upper chest
  • Pemberton’s sign
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is Pemberton’s sign

A

when raising the pts arms above their head causes facial congestion and cyanosis

= MEDICAL EMERGENCY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is the main cause of extrapulmonary manifestations?

A

compression from the tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is a Pancoast tumour

A

tumour in the pulmonary apex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what paraneoplastic syndrome does a pancoast tumour cause

A

Horner’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is the classic Horner’s triad

A
  • ptosis
  • anhidrosis
  • miosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is limbic encephalitis

A

when the CA causes the immune system to create antibodies against the limbic system = INFLAMMATION in these areas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How does limbic encephalitis present

A
  • short term memory impairment
  • hallucinations
  • confusion
  • seizures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

which antibody is limbic encephalitis associated with

A

anti-Hi antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is Lambert-Eaton Myasthenic Syndrome

A

when antibodies that target the small cell lung CA are target voltage-gated Ca channels on the presynaptic terminals in motor neurones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How does Lambert-Eaton Myasthenic Syndrome present

A
  • proximal muscle weakness which gets worse with prolonged use
  • diplopia
  • ptosis
  • slurred speech
  • dysphasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

which muscles are affected in Lambert-Eaton Myasthenic Syndrome to cause the eye symptoms

A
  • intraocular muscles (Diplopia)

- levator muscles (ptosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is mesothelioma

A

malignancy of the mesothelial cells of the pleura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what is mesothelioma associated with

A

asbestos inhalation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is the prognosis with mesothelioma

A

Poor - Mx mainly palliative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

define COPD

A

long-term non-reversible deterioration in air flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what lung diseases are found in COPD

A
  • emphysema

- chronic bronchitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

common differentials for COPD

A
  • heart failure
  • lung CA
  • fibrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what are the respiratory causes of clubbing

A
  • lung Ca
  • pulmonary fibrosis
  • CF
  • bronchiectasis
  • lung abscess
  • interstitial lung disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the grading scale of dyspnoea

A

Medical Research Council (MRC) scale

Grade 1: breathless of strenuous exercise
Grade 2: breathless on walking up hill
Grade 3: Breathlessness that slows walking on flat
Grade 4: Stop to catch breath after 100m on flat
Grade 5: unable to leave house due to breathlessness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How is COPD diagnosed

A

clinical presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what Ix can be used for COPD

A

spirometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What will spirometry show

A

obstructive picture with minimal/no reversibility with a beta-2-agonist

  • FEV1/FVC ratio < 0.7
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is FVC

A

Forced Vital Capacity

  • overall lung capacity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is FEV1

A

Forced Expiratory Volume in 1 second

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

how can the severity of COPD be assessed

A

using the FEV1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what are the different levels of severity for COPD

A

stage 1: FEV1 > 80% predicted
stage 2: FEV1 50-79%
stage 3: FEV1 30-49%
stage 4 FEV1 < 30% predicted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

what other Ix may be done for ?COPD

A
  • CXR (exclude Ca)
  • FBC (exclude polycythaemia/anaemia)
  • BMI (assess if any weight loss)
  • Sputum culture (exclude chronic infections)
  • ECG/ECHO
  • CT thorax (exclude Ca, fibrosis, bronchiectasis)
  • Serum alpha-1 antitrypsin (look for deficiency)
  • transfer factor for CO
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what does deficiency in Serum alpha-1 antitrypsin cause

A

early onset and increased severity of COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what can transfer factor for CO (TLCO) show

A

this is decreased in COPD and can be used to assess the severity of the disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

what lifestyle advice is given for COPD

A
  • smoking cessation
  • annual flu vaccinations
  • pneumococcal vaccine
  • nutritional support
  • pulmonary rehab/physio
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

what is the pharmacological Mx for COPD (long-term)

A
  1. beta-2 agonist (salbutamol) or short acting antimuscarinic (ipratropium bromide)
  2. LABA + LAMA (if not steroid responsive)/ ICS (if steroid responsive)
  3. LABA + LAMA + ICS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

give an example of a LABA+LAMA inhaler

A

anoro ellipta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

give an example of a LABA+ICS inhaler

A

symbicort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

give an example of a LABA+LAMA+ICS inhaler

A

Trimbo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Mx of sever COPD

A
  • nebulisers
  • oral theophylline
  • oral mucolytic therapy to break down sputum (carbocisteine)
  • long term prophylactic abx (azithromycin)
  • long term O2 therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

what is oral theophylline

A

a phosphodiesterase inhibitor - inhibitory effect of cAMP on immune cell function = ANTI-INFLAMMATORY EFFECT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What ABG result indicates T1RF

A
  • low O2

- low/normal CO2

57
Q

what ABG result indicates T2RF

A
  • low O2

- high CO2

58
Q

What SpO2 are you aiming for in T2RF

A

88-92%

59
Q

how may a pt present with acute exacerbation of COPD

A
  • acute increase SOB
  • cough
  • sputum production
  • wheeze
60
Q

what Ix are done for ?acute exacerbation of COPD

A
  • CXR
  • Sputum + blood cultures
  • ECG
  • FBC
  • U&E
61
Q

Mx of acute exacerbation in the community

A
  • prednisolone (30mg OD 7-14days)
  • regular inhalers/at home nebs
  • antibiotics (if evidence of infection)
62
Q

Mx of acute exacerbation in Hospital

A
  • nebulised bronchodilators (salbutamol)
  • steroids (200mg hydrocortisone)
  • abx
  • chest physio
63
Q

Mx of acute exacerbation if pt continues to deteriorate

A
  • IV aminophylline
  • Non-invasive ventilation
  • intubation
  • doxapram (respiratory stimulation where NIV/intubation not appropriate)
64
Q

define chronic bronchitis

A

hypertrophy and hyperplasia of the mucus glands in the bronchi

65
Q

define emphysema

A

enlargement of air spaces and destruction of alveolar walls

66
Q

what are the clinical signs of COPD

A
  • using accessory muscles to breath
  • tachypnoea
  • hyperinflation
  • reduced chest expansion
  • hyper-resonant percussion
  • decreased breath sounds
  • wheeze
  • cyanosis
  • cor pulmonale
67
Q

what signs may suggest COPD on a CXR

A
  • hyperinflation
  • bullae
  • decreased peripheral vascular markings
  • flattened hemidiaphragms
68
Q

what are the indications for long term oxygen therapy

A
  • PaO2 < 7.3 kPa on 2 reading more than 3wks apart
  • PaO2 7.3-8kPa plus (1 of)
    • nocturnal hypoxia
    • polycythaemia
    • peripheral oedema
    • pulmonary HTN

MUST BE NON-SMOKERS! FIRE HAZARD!!!

69
Q

indications for surgery with sever COPD

A
  • upper lobe predominant emphysema
  • FEV1 > 20%
  • PaCO2 < 7.3kPa
  • TLCO > 20%
70
Q

define asthma

A

chronic inflammatory condition of the lung that causes episodic exacerbations of bronchoconstriction

71
Q

what are the common triggers for asthma

A
  • infection
  • night time/early morning
  • cold/damp air
  • animals
  • exercise
  • dust
  • strong emotions
72
Q

how do asthmatic pts typically present

A
  • SOB
  • episodic symptoms
  • dry cough/wheeze
  • Hx of atopic conditions
  • FHx
  • bilateral widespread ‘polyphonic’ wheeze
73
Q

what is the atopic triad

A
  • asthma
  • eczema
  • hayfever
74
Q

what are the first line Ix for ?asthma

A
  • spirometry with bronchodilator reversibility

- fractional exhaled nitric oxide

75
Q

what other Ix can be used for ?athma

A
  • peak flow variability

- direct bronchial challenge test (histamine)

76
Q

Name a Short acting beta 2 adrenergic receptor agonist (SABA)

A

Salbutomol

77
Q

how do Short acting beta 2 adrenergic receptor agonist (SABA) work

A

promote the release of adrenalin that acts on the smooth muscles of the airway to cause relaxation

78
Q

how are Short acting beta 2 adrenergic receptor agonist (SABA) used

A

short term

  • “rescue” or “reliever”
79
Q

Name an Inhaled corticosteroid (ICS)

A

beclomethasone

80
Q

how do Inhaled corticosteroid (ICS) work

A

reduce the inflammation and reactivity of the airway

81
Q

how are Inhaled corticosteroid (ICS) used

A

“maintenance” or “preventer”

82
Q

name a long-acting beta 2 agonist (LABA)

A

salmeterol

83
Q

how do long-acting beta 2 agonist (LABA) work

A

promote the release of adrenalin that acts on the smooth muscles of the airway to cause relaxation, but has a much longer action

84
Q

Name a long-acting muscarinic antagonist (LAMA)

A

tiotropium

85
Q

How do long-acting muscarinic antagonist (LAMA) work

A

block the acetylcholine receptors causing bronchodilation

86
Q

Name a Leukotriene receptor antagonist

A

montelukast

87
Q

how do Leukotriene receptor antagonists work

A

by blocking the affects of leukotrienes

88
Q

what do leukotrienes cause

A

they are produced by the immune system and cause

  • inflammation
  • bronchoconstriction
  • mucus secretion
89
Q

how does theophylline work

A

relaxes the brachial smooth muscle and reduce inflammation

90
Q

what do you have to be careful of when using theophylline

A

its narrow therapeutic window

  • must monitor plasma theophylline levels in blood
91
Q

when is are plasma theophylline levels checked

A
  • 5 days after starting

- 3 days after every dose change

92
Q

what is maintenance and reliever therapy (MART)

A

a combination of ICS and LABA

93
Q

what is the pharmacological Mx of asthma

A
  1. SABA
    • ICS
    • low dose Leukotriene
    • LABA
  5. if still not controlled change ICS + LABA to MART
  6. increase ICS dose
  7. theothylline
  8. refer to specialist
94
Q

what is the non-pharmacological Mx of asthma

A
  • annual flu jab
  • annual asthma review
  • advise exercise and avoid smoking
95
Q

what characterises an acute asthma attack

A

rapid deterioration of symptoms

96
Q

how does an acute asthma attack present

A
  • progressively worsening SOB
  • use of accessory muscles
  • tachypnoeic
  • symmetrical expiratory wheeze
  • reduced air entry
97
Q

what are the different severitys of an acute asthma attack

A
  • moderate
  • severe
  • life-threatening
98
Q

what defines a moderate asthma attack

A
  • PERF 50-75% predicted
99
Q

what defines a severe asthma attack

A
  • PERF 33-50%
  • RR > 25
  • HR > 110
  • unable to complete sentences
100
Q

what defines a life-threatening asthma attack

A
  • PERF < 33%
  • Stats < 92%
  • silent chest
  • pt becoming tired (respiratory acidosis - normal/high pCO2)
  • haemodynamic instability (SHOCK)
101
Q

Mx of a moderate asthma attack

A
  • Nebulised SABA (salbutamol)
  • Nebulised ipratropium bromide
  • steriods
  • abx (if evidence of infection)
102
Q

Mx of a severe asthma attack

A
  • O2
  • aminophylline infusion
  • consider IV salbutamol
103
Q

Mx of a life-threatening asthma attack

A
  • IV Magnesium sulphate infusion
  • admission to HDU/ICU
  • intubation in worst case scenario
104
Q

Why is Magnesium sulphate infusion in acute asthma attacks

A

Mg competes with Ca at calcium-mediated smooth muscle binding sites resulting in bronchodilation

105
Q

what is used to monitor a pts response to Tx in an acute asthma attack

A
  • RR
  • Resp effort
  • Peak flow
  • SpO2
  • check auscultation
106
Q

what must you measure when prescribing salbutamol

A

serum K - can cause hypokalaemia

107
Q

What are the two types of Venous Thromboembolism (VTE)

A
  • PE

- DVT

108
Q

Risk factors for VTE disease

A
  • immobility
  • recent surgery
  • long haul flights
  • pregnancy
  • Oestrogen HRT
  • Malignancy
  • Polycythaemia
  • SLE
  • Thrombophilia
109
Q

presentation of a DVT

A
  • pain along the deep veins
  • unilateral swelling of the calf/thigh
  • pitting oedema
  • distention of superficial viens
  • raised skin temperature
  • skin discolouration
  • a palpabale cord (hard, thickened vein)
110
Q

what are the differentail diagnosis of a DVT

A
  • traume
  • post-thrombotic syndrome
  • venous/lymphatic obstruction
  • vasculitis
  • Ruptured Baker’s cyst (@popliteal fossa)
  • Cellulitis
  • Septic arthritis
  • Compartment syndrome
111
Q

first line Ix for DVT

A

d-dimer

112
Q

What is the diagnostic Ix for DVT

A
  • US
113
Q

What scoring system is used to assess the pts risk of DVT

A

Well’s Score

114
Q

how does a PE present (symptoms)

A
  • dyspnea
  • cough
  • haemoptysis
  • pleuritic chest pain
  • dizziness/syncope - Right HF signs in SEVERE cases

look out for Sx of DVT

115
Q

what are the types of VTE prohpylaxis

A
  • LMWH (enoxaparin)

- anti-embolic compression stockings

116
Q

what are the contra-indications for using LMWH prophylaxis

A
  • pt is already on a blood thinner
  • pt has active bleeding
  • pt has had a previous bad reaction
117
Q

what is the main contra-indication for compression stockings

A
  • peripheral arterial disease
118
Q

what scoring system is used to assess a pts risk of a PE

A

Well’s score

119
Q

what can the emboli in a PE be made up of

A
  • thrombosis
  • fat (following long bone fracture/orthopaedic surgery)
  • amniotic fluid
  • air (following neck vein cannulation or bronchial trauma)
120
Q

what are the signs of a PE

A
  • hypoxia
  • tachycardia
  • tachypnoea
  • pyrexia
  • elevated jugular venous pressure
  • pleural rub
  • haemodynamic instability causing hypotension
121
Q

what cardiac signs may be present with a PE

A
  • gallop heart rhythm
  • widely split second heart sound
  • tricuspid regurgitant murmur
122
Q

Differential diagnosis for PE

A
  • ACS
  • Aortic dissection
  • Cardiac tamponade
  • Pneumonia
  • Pneumothorax
  • Sepsis
123
Q

what Ix are performed for a PE

A

depends upon Well’s score

LIKELY - CT pulmonary angiogram

UNLIKELY - d-dimer and if that comes back positive CT pulmonary angiogram

124
Q

how is the d-dimer test used?

A

it has high sensitivity so if it is negative Drs can be pretty confident the pt has not had a PE/DVT.

If it is positive if is not necessarily indicative of a PE?DVT

125
Q

what can cause a raised d-dimer

A
  • pneumonia
  • malignancy
  • HF
  • surgery
  • pregnancy
126
Q

what other Ix can be used to establish a definitive diagnosis of PE

A

V/Q mismatch scan

127
Q

what result is found on an ABG with PE

A

respiratory alkalosis

128
Q

how is an unprovoked PE defined

A

PE in a person with no recent major clinical risk factor for PE, who is not taking the combined oral contraceptive pill or hormone replacement therapy

129
Q

what Ix are done for unprovoked PE

A

Ix for CA

  • CXR
  • FBC
  • U&E
  • serum Ca
  • PT & APTT
  • LFTSs
  • Urinalysis
130
Q

according to the well’s score what is a likely PE

A

> 4 points

131
Q

what Ix may be done for a PE

A
  • ECG
  • CXR
  • ABG
  • ECHO
  • Cardiac troponins
132
Q

Mx of PE

A
  • O2
  • IV access
  • Analgesia (morphine)
  • Monitoring
  • LMWH
133
Q

name two LMWH

A
  • enxoaparin

- dalteparin

134
Q

what long term anticoagulants can be used in VTE

A
  • Warfarin
  • LMWH
  • NOAC or DOACs
135
Q

how does Warfarin work

A

Vit K antagonist

136
Q

what is the target INR for warfarin

A

between 2 and 3

137
Q

name 3 NOAC/DOAC

A
  • apixaban
  • dabigatran
  • rivaroxiban
138
Q

when are LMWH first line for long-term management

A

pregnancy or CA

139
Q

how long should the pt stay on anti-coagulants for with VTE

A
  • 3 mths if obvious reversable cause
  • > 3mths if cause unclear
  • 6mths if active CA

Phase 2a Revision (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions