Brainscape's Knowledge GenomeTM

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


See full index

ICM Revision > RESP > Flashcards

RESP Flashcards

1
Q

D-dimer uses? When is it indicated?

A

Used to diagnose or exclude thrombotic clots

Indicated in CVT, PE, DIC (disseminated intravascular coagulation)

  • can also be used to monitor the effectiveness of DIC tx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What can cause a false D-dimer?

A

If someone is on anticoagulant therapy

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

When would a D-Dimer be requested as a first line investigation?

A

DVT Wells Score less than 1

PE Wells Score less than 4

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

What are the 2 types of respiratory failure? How is it detected?

A

Type 1 RF = Hypoxic
Type 2 RF = Hypoxic and Hypercapnic

Blood gases are used to asses these levels of oxygen in the blood

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

When are capillary blood used?

A

Heel-pricks in babies

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

Indications for and ABG?

A

Drop in sats below 90% during sleep in a normal pt

deteriorating sats

increased breathlessness in a ot with stable hypoxaemia i.e. COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Indications for CXR?

A 
Infection 
Major Trauma 
Acute chest pain 
Asthma/Bronchiolitis
Acute/Chronic dyspnoea 
Haemoptysis 
Suspected mass, metastasis or lymphadenopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Indications for CT?

A

Evaulation of an abnormality detected on CXR

Evaulation of aortic disease (aneurysm/dissection or trauma)

Malignant disease - staging, detecting lymphadenopathy, assess suitability for biopsy

Evaluation of pleural disease (CTPA - suspected PE)

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

Respiratory Ix offered in Primary care?

A

PEFR, Spirometry, CXR, Blood tests

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Main respiratory Ix in ED/2° care?

A

PEFR, Blood gases, D-Dimer, CXR, CTPAm VQ scan, viral swabs

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

What is spirometry and what is used for?

A

method allowing the assessment of lung function via the amount of air expelled after maximal inspiration

can help to differentiate between Obstructive and Restrictive Conditions

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

Normal Spirometry interpretation?

A

FEV 1 = >80%
FVC = >80%
FEV/FVC ratio >70%

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

Obstructive picture of spirometry?

A

Reduced FEV1 (<80% of predicted normal)

Reduced FVC (less than the FEV1 drop)

FEV1/FVC ratio <0.7

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

Restrictive picture of Spirometry?

A 
Reduced FEV1 (<80%)
Reduced FVC (<80%)
Normal FEV1/FVC (>70%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is Bronchodilator reversibility and when is it used?

A

Patients asked to stop bronchodilator prior to therapy and then during the test the effect of the bronchodilator is observed

Baseline spirometry without use of inhaler - 400mcg of salbutamol administered and spirometry is repeated after 15mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Interpretation of Bronchodilator reversibility?

A

Presence of reversibility - suggestive of asthma

Absence of reversibility - COPD

Partial reversibility - suggestive of coexisting conditions of asthma and COPD

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

What is Peak Flow?

A

mainly used in the diagnosis of asthma
- reduced PEFR in asthma

can also be used for the monitoring of asthma

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

What Ix are involved in TB?

A
  • CXR (/CT)
  • sputum smear - acid fast bacilli
  • GOLD STD = Sputum culture
  • NAATs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does TB CXR usually show?

A

upper lobe focal infiltrates/caviating lesions

enlarged hilar lymphadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does Acid-fast Bacilli tests involve?

A
  • Pulmonary TB - 3 sputum samples of TB microscopy and culture (AAFB) - 8-24hr intervals
  • microscopy of AFB
  • stain used to visualise is the Ziehl-Nelson stain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the limitations of Acid fast bacilli test?

A

cannot distinguish between viable and dead bacterium - only used upon dx not monitoring of tx

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

Interpretation of sputum culture?

A

microscopy = granulomatous inflammation - characteristic caesating necrosis

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

what Ix are used in malaria?

A

giesma-stained blood film - microscopy of thick and thin smears

RDT - detect malaria parasite antigens - provides a qualitative result

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

What Ix is used in whooping cough?

A

PCR of Nasopharyngeal swab/aspirate

Anti-pertussis toxin IgG detected in serum or oral fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Screening involved in Cystic Fibrosis?

A

new-born screening test

meconium ileus (~2wks), failure to thrive, resp symptoms (14 wks)

Blood spot immunoreactive trypsinogen (IRT) conc
CFTR gene analysis

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

Other Ix in Cystic Fibrosis?

A

Sweat test

  • pilocarpine soaked pad is placed onto arm - current passed through 5x for 5 mins
  • skin washed & dried - then sweat collector is placed over stimualted area for 30mins

sweat chloride of >60mmol/L supports diagnosis of CH
>40 makes CF unlikely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What Ix are done in Alpha-1-antitrypsin deficiency?

How is A1AT diagnosed?

A

CXR
- findings include bullae at lung bases and emphysemtaous changes

DX

  • serum a1-antitrypsin <18mmol/L
  • Spirometry , BDR - obstructive picture
  • imaging to determine extent of disease Pma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

When can viral throat swabs be done?

A

used to identify cuasative organism in patients with a acute hx of …\

  • fever
  • headache
  • cough
  • sore throat
  • myalgia
  • corysal symptoms

Panel include = influenza, parainfluenza, adeno/corona/rhine/entero.metapneumovirus
mycoplasma pneumonia and RSV

29
Q

Ix in Covid?

A

URT samples

  • single throat swab
  • throat and nose combined swab
  • Nasopharyngeal aspirate

LRT

  • sputum sample
  • CXR?
30
Q

What is asthma defined as?

A
  • hx of wheeze, SOB, chest tightness, cough - vary with time & intensity
  • variable expiratory air flow limitation
31
Q

What Ix are done in Asthma

A
  1. Spriometry
  2. BDR
  3. FeNO
  4. Peak flow
32
Q

Asthma Spirometry Interpretation

Error?

A

3 relaxed and 3 forced blows

Look for evidence of Obstruction - FEV, FVC, ratio all reduced

Errors include - early termination, slow start and extra breath

33
Q

Asthma BDR test Interpretation?

A

evidence of obstruction
reversible in asthma
- improvement of >12% or 200mls

34
Q

Asthma FeNO testing Interpretation?

A

consider asthma diagnosis in
adults >40ppb
children >35ppb

35
Q

FeNO levels altered when…

A

may be higher in

  • allergic rhinitis
  • rhinovirus
  • tall ppl & increased dietary nitrates

may be lower in

  • children
  • cigarette smokers
  • administration oral/inhaled steroids
36
Q

Peak Flow Asthma Interpretation?

A

BD for 2/52 - morning & evening - narrow at 4am and wide at 4pm

diurnal variability of >20% difference - 3 days in week for 2weeks

37
Q

What is a bronchoscopy? When is it indicated?

A

bronchoscopy - test used to visualise the lungs/airways if seen on CT

suspected mass - allows diagnosis
treatment - can take a biopsy which allows histological evidence

38
Q

What are sputum cultures used for? How are they taken?

A

To detect and identify the cause ofbacterialrespiratory tract infections;
to monitor the effectiveness of treatment

Excpectorated/induced samples coughed up
bronchoscopy - lavage
transtracheal/transoesophageal aspirates

39
Q

Indications of sputum culture ?

A

abnormal CXR,
productive cough,
chest signs suggestive of LRTI e.g cough, fevers/rigors, SOB, myalgia, chest pain and confusion

40
Q

Appearance if sputum?

A

Blood -?TB
Rusty - ?Pneumococcal
Purulent - ?green/yellow or milky opaque white
foamy - obstructive conditions or oedema

41
Q

2WWR in Respiratory conditions

A

abnormal CXR findings, 40yrs+, unexplained haemotoptysis

CT confirm whether scan is needed -

42
Q

Investigation in suspected aspiration pneumonia?

A

Bloods - FBC, CRP, U&Es, blood culture and gases

sputum culture

CXR - lung infiltrates or consolidation - usually in mid or lower lobes

if mechanical obstruction os present then bronchoscopy is used to remove it

43
Q

Investigation in suspected Pneumonia?

A

CXR - classically consolidation is present (lower lobes)

Bloods - FBC, U&Es and CRP

ABG - if oxygen saturations are low or the patient gas a pre-exisiting respiratory disease

44
Q

Scoring system used to Decipher whether Pneumonia is to be treated in community or hospital?

A 
CURB65
Confusion of <8/10 on MMTS
ureas above 7mmol/L
resp rate above 30/min 
BP - sys <90 and dias <60
aged 65+

0 - community
1- assess sats and arrange CXR
2+ - hospital

45
Q

Investigation in suspected acute bronchitis?

A

Usually a clinical diagnosis

CXRs are often normal

46
Q

Investigation in suspected complicated Influenza?

A

Diagnosis confirmed by laboratory testing

- rapid testing done in all pts with complicated influenza

47
Q

Investigation in suspected Croup?

A

vast majority are diagnosed clinically

CXR (PA) will show a steeple sign i.e. subglottic narrowing

48
Q

Investigation in suspected RSV/bronchiolitis?

A

Immunofluorescence of nasopharyngeal secretuons

- may show RSV

49
Q

Investigation in suspected Acute epiglottitis?

A

Diagnosis usually clinical. and often given by senior airway trained staff

XR may be done to rule out any FB once airway stable

CXR = ‘thumb sign’ on lateral view/plane

50
Q

Investigation in suspected Pertusis/whooping cough?

A

nasal swab culture - PCR and serology

51
Q

Investigation in suspected Emphyema?

A

Sputum culture
Blood test esp WCC and CRP
XR - collections of fluid around the lungs

52
Q

Investigation in suspected Tuberculosis?

A

CXR - upper lobe caviations, pleural effusions, mediastinal or bilateral hilar lymphadenopathy

Sputum Culture = GOLD STANDARD
- NAATs

Sputum smear - 3 positive Acid fast bacilli positive specimens needed

53
Q

what does screening for Tuberculosis involve?

A

Mantoux test

  • intradermal injection
  • results read 2-3days laters
  • diameter of induration 6-15mm suggests a tuberculin protein sensitivity
54
Q

Investigation in suspected Pulmonary fibrosis?

A

Spirometry
FEV1 = increased/normal
FEV1/FVC = increased

Reduced transfer factor/TLCO

Imaging CXR - bilateral interstitial shadowing
- ground glass appearance/honeycombing

high res CT = investigation of choice

55
Q

Investigation in suspected in Sarcoidosis?

A

CXR
- earlier stages = bilateral hilar lymphadenopathy which can then lead to interstitial infiltrates

  • very later stages = diffuse fibrosis
56
Q

Investigation in suspected pneumoconiosis?

A

CXR = fibrosis o=in upper zones of lungs

Spirometry = restrictive picture

57
Q

Investigation in suspected COPD?

A

spirometry - FEV/FVC <0.7

cosider alpha-1-antitrypsin deficiency

CXR

FBC - ?anaemia/polycythaemia

58
Q

Investigation in suspected Asthma?

A

Spirometry

  • FEV significantly reduced
  • FVC normal,
  • FEV1/FVC <70%

FeNO testing → 40ppb in 17yrs and older, 5-16yrs 35ppb

BDR → FEV1 improvement of 12% or more/ 200mL with SABA/ICS = positive

if imporvement is 4000mL = strongly suggestive of asthma

Peak flow → more than 20% varibalility - moniroting BD for 2-4weeks

59
Q

Investigations in suspected Obstructive sleep Apneoa?

A

sleep studies (polysomnography) done at sleep clinic

→ monitoring of oximetry, EEG, resp airflow, snoring, throaco-abdo movement

60
Q

Investigations in suspected Bronchiectasis?

A

clinical diagnosis mostly
Ix usually done to rule out other ddx - sputum culture, CXR, spirometry, O2 sats, FBC (wcc)

High-resolution CT - establishes the diagnosis of bronchiectasis

61
Q

Investigations in suspected Cystic Fibrosis?

A

sweat test → CF abnormally high sweat chloride >60mEq

62
Q

Investigations in suspected Pulmonary Hypertension?

A

ECHO - RV function assessment and estimate PAP
Right-heart catherization

CXR - exclude other lung diseases
ECG - RV hypertrophy and strain patterns

63
Q

Investigations in suspected Pulmonary Embolism?

A

PE wells Scoring assessed
4+ = admit and urgent CTPA
<4 = D-dimer test - if raised to urgent CTPA

All patient have CXR - wedge shaped opacification
ECG changes = RBBB, S1Q3T3,

Leg USS = if initial CTPA is negative, if patient is pregnant

VQ scan = renal impairment

64
Q

Investigations in suspected pleural effusions?

A

PA CXR should be done on all pts

US (pleural aspiration)

contrast CT - can help to investigate underlying cause

pleural fluid findings → low glucose, raised amylase and heavy blood staining

65
Q

Investigations in suspected Pneumothorax?

A

CXR - darker areas chest X-ray indicating gas/no tissue

ABG - check extent of hypoxia

66
Q

Investigation in suspected Pleurisy?

A

CXR - typically normal

67
Q

Investigation in suspected Lung Cancer?

A

CXR ⇒ check for masses, areas of opacification
CT ⇒ investigation of choice
bronchoscopy ⇒ allows biopsy and thus histological diagnosis
Bloods ⇒ FBC → raised platelets

68
Q

Investigations for suspected Mesothelioma?

A

CXR = pleural effusions or pleural thickening
Pleural CT
MC&S of any pleural effusion fluid
thoracoscopy

ICM Revision (19 decks)

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