resp Flashcards
asthma management drug order?
reliever?
1st line
2nd line
SABA- reliever, ICS - 3x use of SABA
second line add on drug is Leukotriene receptor antagonist - ORAL
if a pt is on ICS and LRT what is the complication?
might not adhere as LTRA is oral and to be taken at night
might want to offer LABA
what to do if
If asthma is uncontrolled on a low dose of ICS and a LTRA?
offer a long acting beta 2 agonist
children asthma 5-16
what is added onto SABA ICS?
LTRA- review 4-8 weeks
what skin involvement - eryhtema nodosum has a resp condition associated?
investiagtion findings for this?
sarcoidosis
raised ESR and calcium
Hx of sarcoidosis
dry cough, skin involvement, dyspnoea
COPD management acute on chronic attack?
drug choices
amoxicillin
doxycycline
clarithromycin
gallstone investigation of choice?
ultrasound
what is the spirometry result findings for asthma
FEV1/FVC <70%
‘the FEV1 is normally normal in asthmatic patients’
True / false
false
what is FEV1
forced expiratory volume - volume that has been exhaled at the end of the first second of forced expiratio
what causes a resp alkalosis
PE
anxiety / hyperventilate
altitude
paracetamol poisoning
what causes a resp acidosis
copd asthma benzos opiates nmd
stable management of copd
smoke cessation
influenza vaccination
pneumococcal vaccination
saba/sama - first line
is there an oral prophylactic abx therapy that can be offered to copd sufferers with recuurent infective exarcebations?
what side effect can this drug bring?
yes
azithromycin
prolongation of QT interval
moderate asthma
RR
pulse
<25
<110
severe asthma features
pefr 33-50%
RR>25
pulse >110
life threateneing asthma features
silent chest / cyanosis
oxygen sats <92%
pefr 33%
what does curb 65 stand for
confusion
urea
resp rate
blood pressure
aged 65
this pneumonia presents with
Hyponatraemia and lymphopenia common
Classically seen secondary to infected air conditioning units
legionella pneumophillia
if you suspect pneumocystis jiroveci
how would the patient present
what test must you do?
dry cough , exercise induced , absence of wheeze / chest signs
test for HIV
lung fibrosis that affects upper zone?
hypersensitivity pneumonitis coal workers pneumoconiosis silicosis sarcoidosis ankylosing spondylitis tb
lower zone lung fibrosis
drug induced ; amiodarone , methrotrexate
asbestosis
sle
CHARTs - acronym for what resp condition?
coal worjers hisiocystosis ankylosing radiation tuberculosis silicosis
what is sarcoidosis characterised by ?
what xray findings?
non-caseating graulomas
bilateral lymphadenopathy
stereotypical ~HX
an 80-year-old man who used to work in ship building presents with progressive shortness-of-breath. A chest x-ray shows multiple pleural plaques and bilateral lower zone interstitial shadowing
asbestosis
what are pleural plaques in the lung caused by?
asbestosis related lung disease - 20/40 years later
mid zone fibrosis
dyspnoea
cough
fever
extrinsic allergic alveolitis
in a respiratory acidosis is the pCO2 high or low?
how is a resp acidosis compensated?
the pC)2 is high whihc is why there is a resp acidosis
the compensation would be a high hco3-
in aptient with copd
what does a really high bicarb show?
chronic resp acidosis
PaCO2 >_______ suggests a respiratory acidosis (or respiratory compensation for a metabolic alkalosis)
6.0kpa
ROME
abg
Resp = Opposite
ph is low and pCO2 is high
ph is high and pCO2 is low
metabolic= equal
low ph+ low base excess
high ph +high bicarb/ be
what skin rash do you get with sarcoidosis
painless/ not itchy raised purple plaque of induarted skin
predisposing factors for OSA?
what conditions
hypothyroidism
amyloidosis
marfans syndrome
assessment of OSA
epworth sleepiness scale
MSLT
management for osa >?
weigth loss
cpap
curb65
what is a normal u?
confused
urea
resp rate
blood pressure
65?
lenticular crescentic opacity is diagnostic of what?
empyema
where is aspiration pneumonia more likely to occur
RIGHT
TB
skin involvement?
lupus vulgaris
TB investigations
what stain?
CXR findings?
ziehl-neelson stain
upper lobe shadowing , streaky fibrosis , cavitation
hilar lymphadenopathy
what are the main complications of primary TB
post primary TB
lobar collapse
bronchiectasis
pleural effusion
empyema
pleural effusion
adenocarcinoma
protein/ serum protein ratio of 0.25 - pleural effusion aspirate
is this a transudate or an exudate?
transudate
congestive heart failure
what is the quadruple therapy for pulmonary tuberculosis ?
rifampicin
isoniazid
ethambutol
pyrizinamide
visual acuity needs to be tested as part of management of TB
what other tests need to be done?
why??
ethambutol causes loss in visual acquity
LFTs as the drugs used are hepatotoxic
latent tb treatment?
3 months of isoniazid w pyridoxine and rifampicin
isoniazid w pyridoxine for 6 months
HAP
staph aureus
pseudomonas aeruginosa
klebsiella pneumonia
cavitating lesions which pneumonia?
klebsiella
staph aureus
pneumonia
cavitating lesion
abscess
staph aureus
parrot fever, associated with birds pneumonia?
chlamydia psittaci
coxiella burnetti
causes q fever
farm animals
causes of a cavitating lung lesion?
cancer- squamous cell lung cancer
autoimmune :RA, granulomatosis with polyangitis
TB
staph
klebseilla
which pneumonia is +
strep pneumonia - cocci
staph aureus - clusters
bacillus? - pneumonia
haemophjillus
klebsiella
pseudomnas aeruginoas
pleurtic chest pain
pneumothorax
pulmonary embolism
pericarditis
pneumonia
pleural effusion
pneumonia examination sign
assymetry reduced chest expansion coarse crackles bronchial breathing increased vocal resonance decreased percussion note
