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FINALS > RESP > Flashcards

RESP Flashcards

1
Q

What are the three types of pneumonia?

A

HAP
CAP
Aspiration

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2
Q

What is the definition of a HAP?

A

> 48 hours after admission

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3
Q

Name 5 signs of septic shock secondary to pneumonia.

A 
• Tachypnoea (raised respiratory rate)
• Tachycardia (raised heart rate)
• Hypoxia (low oxygen)
• Hypotension (shock)
• Fever
ConfusioN
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4
Q

Name 3 chest signs of pneumonia.

A
  1. Bronchial breath sounds - consolidation of surrounding lung tissue (inspiration and expiration)
  2. Focal coarse crackles - air passing through sputum (like a straw through a drink)
    Dullness to percussion - due to collapse or consolidation
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5
Q

Which bacteria most commonly cause CAP?

A

Streptococcus pneumoniae

Haemophilus influenzae

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6
Q

Which bacteria cause pneumonia in immunocompromised patients?

A

Moraxella catarrhalis

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7
Q

Which bacteria cause pneumonia in patients with cystic fibrosis?

A

Pseudomonas aeruginosa

Staphylococcus aureus

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8
Q

Which investigations should be ordered for pneumonia?

A

CXR
FBC (WCC)
U&Es (for urea)
CRP

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9
Q

When is a rise in CRP expected in pnuemonia?

A

Delayed response, 2-3 days after.
WCC is more accurate of current infection.
Patients who are immunocompromised may not see a rise in CRP.

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10
Q

What scoring system is used to assess the severity of pneumonia? What are each of the parameters?

A

• C – Confusion (new disorientation in person, place or time)
• U – Urea > 7
• R – Respiratory rate ≥ 30
• B – Blood pressure < 90 systolic or ≤ 60 diastolic.
65 – Age ≥ 65

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11
Q

How should you interpret the CURB65 score?

A

• Score 0/1: Consider treatment at home
• Score ≥ 2: Consider hospital admission
Score ≥ 3: Consider intensive care assessment

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12
Q

What are the complications of pneumonia?

A 
Sepsis
Pleural effusions
Empyema
Lung abscess
Death
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13
Q

What is the definition of an atypical pneumonia?

A

Cannot be cultured in the normal way OR detected using a gram stain.

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14
Q

How can you remember the 5 causes of atypical pneumonia?

A 
Legionella pneumophila
Psittaci
Mycoplasma pneumoniae
Chlamydia pneumoniae
Coxiella burnetii (Q fever)
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15
Q

What electrolyte imbalance is seen in legionnaires disease? How is it caused?

A

Hyponatraemia

SIADH

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16
Q

Which bacteria causes pneumonia and erythema multiforme?

A

Mycoplasma pneumoniae

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17
Q

Which bacteria is associated with farming/animals?

A

Coxiella burnetii (Q fever)

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18
Q

Which bacteria is associated with infected birds?

A

Chlamydia psittaci

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19
Q

Which organism causes fungal pneumonia? Which patients are most likely to be infected?

A

Pneumocystis jiroveci (causes PCP in patients with HIV)

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20
Q

What antibiotics can be used to treat atypical pneumonias?

A

macrolides (e.g. clarithromycin)
fluoroquinolones (e.g. levofloxacin)
tetracyclines (e.g. doxycycline)

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21
Q

Which antibiotic is used to treat PCP?

A

Septrin

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22
Q

Which organisms is more common in patients who have recently had influenza?

A

Staphylococcus aureus

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23
Q

What are the two types of lung disease that can be distinguished using lung function tests?

A

Obstructive

Restrictive

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24
Q

What is FEV1?

A

Forced expiratory volume in 1 second

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25
Q

What is FVC?

A

Forced vital capacity

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26
Q

What is a reversibility test?

A

Use a bronchodilator e.g. salbutamol and repeat the test.

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27
Q

Describe the pattern seen in obstructive disease? Name two causes.

A

FEV1:FVC ratio is <75%

FEV1 <80%.

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28
Q

Describe the pattern in restrictive disease? Name 4 causes.

A

FEV1:FVC ratio >75%

29
Q

How can you distinguish between COPD and asthma on spirometry?

A

Asthma is reversible (FEV1 improves after bronchodilator).

30
Q

What is peak flow? What is it used for?

A

Measure of the fastest expiratory flow (measures how much obstruction to air flow there is).

31
Q

How should you counsel a patient on doing a peak flow test?

A

Stand up
Take a deep breath in
Form a tight seal around the mouth piece
Blow as fast and hard as possible into the device
Take three attempts and record the best result

32
Q

How are the results of a peak flow interpreted?

A

Compared to predicted value (%) based on height, age, and sex.

33
Q

What is the biggest risk factor for lung cancer?

A

Smoking - 80% preventable if non-smoker

34
Q

What is the most common cancer in non-smokers?

A

Adenocarcinoma

35
Q

Which type of cancer is most common in smokers?

A

Squamous cell carcinomas

36
Q

What are the three main types of cancer?

A

NSCLC:

  1. Adenocarcinoma
  2. Squamous cell carcinoma

SCLC (neurosecretory)

37
Q

Which type of lung cancer carries a worse prognosis?

A

Small cell lung cancer

38
Q

How does lung cancer present? Name some red flag symptoms.

A
  • Shortness of breath
  • Cough
RED FLAGS
• Haemoptysis (coughing up blood)
• Finger clubbing
• Recurrent pneumonia
• Weight loss
Lymphadenopathy – often supraclavicular nodes are the first to be found on examination
39
Q

Which nodes are most commonly infiltrated by lung cancer?

A

Supraclavicular nodes

40
Q

Name 6 paraneoplastic syndromes.

A
  1. Nerve palsies - phrenic & laryngeal
  2. SVC obstruction - Pemberton’s sign (medical emergency)
  3. Exogenous hormone secretion - SIADH, Cushing’s & hyperparathyroidism
  4. Limbic encephalitis
  5. LEMS
  6. Horner’s syndrome
41
Q

Name two nerves that can be affected in paraneoplastic syndromes.

A

Recurrent laryngeal nerve palsy - hoarse voice

Phrenic nerve - diaphragm weakness (SOB)

42
Q

Which vessel might become obstructed by a lung tumour? How does this present?

A

SVC obstruction - facial swelling, distended veins in the neck and upper chest

43
Q

What is Pemberton’s sign?

A

Raising the hands about the head causes facial swelling and cyanosis - medical emergency

44
Q

Which two hormones can be exogenously excreted by SCLCs?

A

ADH –> SIADH

ATCH –> Cushing’s

45
Q

Which hormone is exogenously excreted by squamous cell carcinomas of the lung?

A

Parathyroid hormone - secreted by squamous cell

46
Q

What is limbic encephalitis?

A

Limbic encephalitis - SCLC causes immune system to make antibodies to the tissues in the brain.
Short-term memory loss
Hallucinations
Seizures

Anti-hu antibodies

47
Q

What is LEMS?

A

Lambert-Eaton myasthenic syndrome (LEMS): antibodies again SCLC cells.

Also target voltage gated calcium channels on the pre-synaptic terminals of motor neurones.

48
Q

What are the causes of post-operative pyrexia?

A 
Post operative pyrexia (5 W's) 
Day 1 - wind: Atelectasis 
Day 3 - water: UTI
Day 5 - Wound: site infection 
Day 7 - Walking: DVT/PE 
Anytime - Wonder drugs: Adverse drug reaction
49
Q

What are the causes of upper zone fibrosis?

A

CHARTS

Coal workers’ pneumoconiosis
Histiocytosis
Ankylosing spondylitis/Allergic bronchopulmonary aspergillosis
Radiation
Tuberculosis
Silicosis (progressive massive fibrosis), sarcoidosis

50
Q

Which bacteria commonly causes aspiration pneumonia?

A

Klebsiella pneumoniae

51
Q

Which bacteria can cause red-current jelly sputum?

A

Klebsiella pneumoniae

Common in alcoholics and T2DM

52
Q

What are the causes of a white out on CXR?

A 
consolidation
pleural effusion
collapse
pneumonectomy
specific lesions e.g. tumours
fluid e.g. pulmonary oedema
53
Q

What are the symptoms of COPD?

A

Chronic cough –> sputum
SOBOE
Wheeze
Recurrent RTIs (esp in winter)

54
Q

How is breathlessness graded?

A

MRC Dyspnoea Council:

Grade 1 = SOBOE (strenuous)
Grade 2 = SOB walking uphill
Grade 3 = SOB slows walking
Grade 4 = must stop to catch breath after 100m
Grade 5 = cannot leave the house
55
Q

How is COPD diagnosed?

A

Clinical presentation

Spirometry

56
Q

What investigations should be done in COPD?

A
  1. Spirometry (diagnose obstructive disease and assess severity)
  2. CXR. - RO Lung ca
  3. FBC - polycythaemia (secondary to chronic hypoxia)
  4. Sputum sample - RO pnuemonia
  5. Serum alpha-1 antitrypsin (esp if early onset)
  6. BMI baseline (weight loss = lung ca, weight gain = steroids)
  7. TLCO - reduced (raised in asthma)
57
Q

How is the severity of COPD measured?

A 
FEV1:
Stage 1 = <80%
Stage 2= 50-79%
Stage 3= 30-49%
Stage 4= <30%
58
Q

What is the single most important factor in the management of COPD?

A

STOP SMOKING

59
Q

What smoking cessation advice can be offered in COPD?

A

Nicotine therapy
Vareniciline
Bupropion

60
Q

What is the first-line medical management of COPD?

A

SABA (salbutamol) or SAMA (ipratiotropium)

61
Q

What are the steps in the medical management of COPD without asthmatic features?

A
  1. SABA or SAMA
  2. [SABA] + combined LABA & LAMA
  3. Oral theophylline (short courses)
  4. Oral azathioprine (prophylaxis in stable patients)
  5. Mucolytics
62
Q

What are the steps in the medical management of COPD in a patient with asthmatic features/response to steroids?

A
  1. SABA or SAMA
  2. [SABA] + combined [LABA + ICS]
  3. [SABA] + combined [LABA + LAMA + ICS]
  4. Oral theophylline
  5. Oral azithromycin
  6. Mucolytics
63
Q

What should be done before starting a patient on prophylactic azithromycin for COPD?

A
  1. CT thorax - RO bronchiectasis
  2. Sputum culture - RO TB or atypical pneumonia
  3. LFTs/ECG (azithromycin causes QT prolongation)
64
Q

What can improve survival in COPD patients?

A

Smoking cessation
LTOT
Lung volume reduction surgery

65
Q

Which vaccinations should COPD patients receive?

A

Annual influenza

One-off pneumococcal

66
Q

Name a cardiac complication of COPD. How is it managed?

A

Cor pulmonale - ^JVP, peripheral oedema, parasternal heave, loud P2

Loop diuretics (oedema)
LTOT
67
Q

How should you manage an acute exacerbation of COPD?

A

O SHIT:

  1. O2
  2. Salbutamol 2.5-5mg NEB B2B
  3. Hydrocortisone 100mg IV
  4. Ipratropium 500mg NEB
  5. Theophylline: aminophylline infusion

+Antibiotics
+Chest physio
+NIV –> intubation

68
Q

How do you assess a patient for LTOT therapy?

A

2xABG, 3 weeks apart:

pH <7.3 OR PaO2 7.3-8

+ polycythaemia, peripheral oedema, pulmonary hypertension

69
Q

When can patients not be offered LTOT?

A

Continued smoking

FINALS (26 decks)

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