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PACES > Resp > Flashcards

Resp Flashcards

1
Q

Causes of consolidation

A

Pneumonia
Pulmonary haemorrhage
Malignancy
Pulmonary oedema

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2
Q

Signs of COPD

A
  • CO2 retention tremor

- Hyperexpanded ‘Barrel’ chest

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3
Q

Signs of pneumothorax

A
  • Tracheal deviation (away from side)
  • Reduced chest expansion
  • Hyper-resonance on percussion
  • absent breath sounds
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4
Q

Signs of lobar collapse/lobectomy

A
  • Trachial deviation (towards side)
  • Reduced expansion
  • Absent breath sounds
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5
Q

Indications for lobectomy

A
  • Cancer
  • Trauma
  • Bronchiectasis (lung volume reduction)
  • TB
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6
Q

Signs of pleural effusion

A
  • Reduced expansion
  • Stony dull percussion
  • Reduced breath sounds
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7
Q

Signs of consolidation

A
  • Reduced expansion
  • Dull percussion
  • Bronchial breathing on auscultation
  • Coarse crackles
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8
Q

Causes of interstitial lung disease

A

Inhaled antigen (organic)

  • Bird fancier’s lung
  • Farmer’s lung

Inhaled irritant (inorganic)

  • Asbestosis
  • Pneumoconiosis e.g. Coal miner’s lung
  • Silicosis

Idiopathic

Associated with systemic disease

  • RA
  • SLE
  • Sarcoidosis

Iatrogenic

  • Methotrexate
  • Amiodarone (basal fibrosis)
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9
Q

Interstitial lung disease Mx

A

Conservative

  • Chest physiotherapy
  • Pneumococcal and flu vaccines
  • Stop smoking
  • Stop causative medications

Surgical
- Lung transplantation

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10
Q

Spirometry interpretation

A

Predicted FEV1/FVC ratio can be calculated based on age, height, sex, ethnicity

FEV1/FVC normal = 80%

FEV1/FVC ratio <0.7 = obstructive airway disease (both FEV1 and FVC reduced, FEV1 more drastically) - FEV1 determines severity

FEV1/FVC ratio >0.7 = restrictive airway disease (both reduced, FVC more than FEV1) - TLC determines severity

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11
Q

Causes of coarse crackles

A

Aspiration
Pneumonia
Pulmonary oedema

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12
Q

Causes of fine crepitations

A

Interstitial lung fibrosis

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13
Q

Additional airway sounds

A 
Pleural rub (rubbing sound heard on inspiration)
Wheeze (polyphonic or monophonic)
Fine crepitations (late inspiratory)
Coarse crepitations (early inspiratory)
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14
Q

Chronic asthma Mx

A

MDT

Conservative
Avoid triggers
Inhaler technique
Regular asthma review
No smoking
Flu vaccines 
Medical
SABA + ICS
SABA + ICS + LRTA
SABA + ICS + LABA (stop LRTA if ineffective)
SABA + (ICS + LABA) = (MART)
Increase ICS dose
Specialist referral
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15
Q

Causes of bronchiectasis

A 
A1 antitrypsin deficiency
Systemic disease e.g. RA
Severe respiratory infections e.g. TB
CF
PCD
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16
Q

COPD classification based on FEV1 percentage predicted

A

50-79%: Mild
30-49%: Moderate
Less than 30%: Severe

17
Q

Stable COPD Mx

A

Conservative

  • Pulmonary rehabilitation
  • Pneumococcal and flu vaccines
  • Stop smoking

Medical
- SABA or SAMA

  • SABA + LABA + ICS (if steroid responsive)
  • SABA + LABA + LAMA+ ICS
  • Specialist referral
  • SABA + LABA + LAMA (if not steroid responsive)
  • SABA + LABA + LAMA + ICS
  • Specialist referral
  • LTOT
  • Prophylactic antibiotics (azithromycin - if multiple exacerbations)
18
Q

LTOT criteria

A 
Have a PaO2 < 7.3 kPa 
Have a PaO2 7.3 - 8 kPa and one or more of the following:
					® Secondary polycythaemia 
					® Peripheral oedema 
					® Pulmonary hypertension
19
Q

Ix for interstitial lung disease

A

Bedside
PEFR
Spirometry

Bloods
FBC, U&Es
Antibody screen - Anti-CCP, RF, dsDNA

Imaging
High resolution CT chest
CXR

Lung biopsy (diagnostic, not normally done)

20
Q

Types of lung cancer and paraneoplastic syndromes

A

Small cell carcinoma (ACTH, SIADH, LEMS) - Associated with smoking

Non-small cell carcinoma

  • Large cell carcinoma
  • Lung adenocarcinoma (most common in non-smokers)
  • Squamous cell carcinoma (PTHrp) - associated with smoking, most common
21
Q

Lung cancer Ix

A

Bloods

Imaging
CXR
2ww CT PET

Interventional
EBUS- guided biopsy

22
Q

2ww criteria for lung cancer

A 
Presenting symptoms for CXR:
Cough 
SOB
Fatigue
Weight loss
Chest pain
Appetite loss

Refer if:
Over 40 + 2 symptoms
Smoker + 1 symptom

23
Q

Lung cancer Mx

A

Conservative
MDT (Macmillan, psych support)
Smoking cessation

Chemotherapy (especially for small cell carcinoma)
Radiotherapy

Lobectomy
Pneumonectomy

NSCLC: Surgery (20% suitable) or curative/palliative radiotherapy

SCLC: Surgery (early disease), Chemoradiotherapy (advanced disease)

24
Q

TB drug SEs

A

Rifampicin: Orange secretions
Isoniazid: Peripheral neuropathy, Liver injury
Pyrazinamide: Liver injury
Ethambutol: Visual disturbance

25
Q

Causes of upper lobe fibrosis (TAP)

A

TB
ABPA
Pneumoconiosis

26
Q

Contraindications to surgery for lung cancer

A 
Poor health
Vocal cord paralysis
SVCO
Malignant pleural effusions
FEV <1.5L (so have to do spirometry beforehand)
27
Q

Indications for draining a pleural effusion

A

Frankly purulent fluid
pH <7.1
Bacteria on gram stain and culture
Loculated effusions

28
Q

Variants of asthma

A 
Atopic
Seasonal 
Exercise induced
Occupational (adult onset, and improve on days off)
Cough variant
29
Q

Asthma diagnostic tests

A

1a. Spirometry + bronchodilator reversibility test:
FEV1/FVC ratio <0.7 + bronchodilator FEV1 reversibility >12% is suggestive of asthma

1b. FeNO test (use in primary care if possible)
>40 in steroid naive adult is suggestive of asthma

  1. Peak flow variability studies (BD PF monitoring)
    Do regardless of spirometry result if FeNO <40

Variability >20% over 2-4 weeks is suggestive of asthma

  1. Bronchial histamine challenge test
30
Q

Asthma diagnostic criteria adults

A

FeNO >40 PLUS one of:

  • Positive bronchodilator reversibility
  • Positive peak flow variability

OR

Positive bronchodilator reversibility AND
Positive peak flow variability

OR

FeNO 25-39 PLUS
Positive bronchial challenge test

31
Q

Causes of obstructive lung disease

A

Asthma
COPD
Bronchiectasis

32
Q

Causes of restrictive lung disease

A

Pulmonary fibrosis
Sarcoidosis
Neuromuscular disorders

33
Q

Causes of polyphonic wheeze

A

Asthma
COPD
Bronchiectasis

34
Q

Causes of monophonic wheeze

A

Airway obstruction

  • Tumour
  • Lymph nodes
  • Secretions
35
Q

What is bronchial breathing?

A

Sign of consolidation - inspiratory and expiratory phases sound equal in length and volume (normally inspiration is louder than expiration)

36
Q

Types of lung cancer

A

Small cell carcinoma (smoking, bronchial)

Non-small cell carcinoma
Adenocarcinoma (non-smokers, lobar, most common)
Squamous cell carcinoma (smokers, bronchial)
Large cell carcinoma

PACES (13 decks)

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