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2a > Resp > Flashcards

Resp Flashcards

1
Q

Asthma investigations

A

Fev1 reduced
Fvc normal
Fev1/fvc <0.7
FeNO3 over 40ppb adults, over 35 child

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2
Q

Risk factors asthma

A

Atopy, low birth weight, not breast fed, exposure to allergens

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3
Q

Long term asthma management

A

1) SABA
2) SABA + ICS
3) SABA + ICS + LTRA
4) SABA + ICS + LTRA + LABA (stop LTRA in kids)

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4
Q

Saba inhaler example

A

Salbutamol

Only use when having an episode

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5
Q

ICS example

A

Beclametosone

Budesonide

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6
Q

LTRA

A

Leukotrine receptor agonist

Montelukast

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7
Q

LABA example

A

Salmeterol

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8
Q

Acute asthma management

A

1) oxygen, 2) salbutamol nebuliser 3) ipratropium bromide nebuliser (LABA). 4) hydrocortisone IV or oral prednisolone. 5) IV magnesium sulphate. 6) aminophylline/IV salbutamol

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9
Q

What is bronchitis

A

Inflammation of bronchioles

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10
Q

Emphysema

A

Loss of elasticity of alveoli

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11
Q

COPD Investigations

A

FEV1/FVC under.7
CXR hyperinflation, bullae (burst alveoli), flat hemidiaphragm, exclude malignancy
FBC to exclude secondary polycythaemia

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12
Q

Genetic component that can be present in COPD

A

Alpha 1 antitrypsin deficiency

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13
Q

Long term COPD management

A

SABA OR SAMA; if featured of asthma/ steroid responsiveness add LABA and ICS. If no asthma features just SABA +LABA + LAMA

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14
Q

Acute exacerbation of COPD management

A

1) bronchodilators and oxygen
2) oral prednisolone
3) CPAP before intubation and ventilation

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15
Q

TB management

A

RIPE for 2 months
RI for 4 months
Rifamycin isoniazid pyrazinamide ethambutol

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16
Q

Latent TB management

A

RI for 6 months

I for further 3 months

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17
Q

Where is the cavitation for TB

A

Upper lobe

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18
Q

Bronchiectasis

A

Permanent dilation of airway
Result of post infection, cf, lung cancer
H. Influenza most common
Get oedema so kerley b lines

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19
Q

CAP pneumonia

A

Strep pneumoniae

Haemophilus influenza

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20
Q

HAP pneumonia

A

Pseudomonas aeruginosa
E coli
Klebsiella - often alcohol dependent pts
Staph aureus - cf pts

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21
Q

Pneumonia in immunocompromised

A

Pneumocystis jiroveci - fungal - more subtle presentation

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22
Q

Atypical pneumonia

A

Legionella pneumophilia
Mycoplasma
Etc

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23
Q

Aspiration pneumonia

A

Inhalation of fluids etc

Those with swallowing difficulties etc

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24
Q

CURB65

A

Assesses severity of pneumonia
Confusion Urea >7, Resp rate >30 BP <95 systolic+/ <60 diastolic. Age >65
0-1 outpatient treatment
2 hospital admission or close outpatient management
3 consider intensive care

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25
Q

Course crackles

A

Pneumonia

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26
Q

Fine crackles

A

Fibrosis

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27
Q

Curb score 1 management

A

Oral amoxicillin for 5d (or macrolide)

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28
Q

Curb 2 management

A

Dual therapy with amoxicillin and macrolide for 7-10 days

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29
Q

Curb score over 3

A

IV coamoxiclav and macrolide

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30
Q

Most common pharyngitis organism

A

VIRAL (rhinovirus etc) or Group A beta haemolytic strep/ strep pyogenes

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31
Q

Symptoms of bacterial pharyngitis

A

Fever, pharyngeal exudate, cervical lymphadenopathy, absence of cough and runny nose

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32
Q

Symptoms of viral pharyngitis

A

Runny nose blocked nose sneezing cough

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33
Q

How to establish whether cause is bacterial

A

Rapid antigen detection test

If negative but still suspicious- throat culture

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34
Q

Sinusitis common causes

A

Strep pneumoniae
Haemophilus influenza
Rhino viruses
Can get secondary bacterial

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35
Q

Risk factors sinusitis

A

Nasal pathology (septal deviation, nasal polyps)
Recent local infection
Swimming/diving
Smoking

36
Q

Bacterial sinusitis signs

A

Longer lasting symptoms (over 10 days), purulent nasal discharge, nasal obstruction, dental/facial pain, headache

37
Q

Treatment sinusitis

A

Rarely give antibiotic. Usually analgesia, intranasal decongestants

38
Q

Subtypes of non small cell lung cancer

A

Adenocarcinoma
Squamous cell carcinoma
Large cell and differentiated carcinoma
Carcinoid tumours

39
Q

Most common lung cancer

A

Adenocarcinoma

40
Q

Which lung cancer is most strongly associated with cigarette smoking

A

Squamous cell carcinoma

Typically in central bronchus

41
Q

Which lung cancers cause paraneoplastic syndromes

A

Carcinoid tumours and small cell lung cancers

42
Q

Metastasise to lung

A

Breast bowel bladder kidney prostate

43
Q

Common sites of lung cancer metastasis

A

Liver bone adrenal glands brain

44
Q

Common paraneoplastic changed

A

PTH, ADH, ACTH

A&A - small cell lung cancers

45
Q

Extra pulmonary manifestations of lung cancer

A 
Pressing on recurrent laryngeal nerve - hoarse voice
SVC obstruction - pembertons sign (facial swelling, distended veins in neck & chest)
Horners syndrome (ptosis, miosis, anhidrosis)
46
Q

What is miosis

A

Constriction of pupil

47
Q

Lung cancer diagnostic

A

Percutaneous or bronchoscopic biopsy and histology

48
Q

Pleural effusion exudate causes

A

Inflammation: lung cancer, pneumonia, RA, TB

Local causes

49
Q

Pleural effusion transudatige causes

A

Fluid shifting - increased pressure or low protein count
Congestive HF, fluid overload, hypoalbuminsemia (cirrhosis, nephrotic syndrome)
Systemic causes

50
Q

High protein count

A

Over 3g/l

51
Q

CXR signs of pleural effusion

A

Blunting of costophrenic angle
Fluid in lung fissures
Meniscus
Tracheal and mediastinal deviation if large

52
Q

What is WELLs score

A

Likely hood of PE

Wells score under 4: PE unlikely, do ddimer

53
Q

PE management

A

Apixaban or rivaroxaban first line
Or LMWH for 5d then dabigatran
3 months for provoked, longer for unprovoked
IVC filter

54
Q

Haemodynamic instability with PE treatment

A

Thrombolysis (alteplase)

Surgical option: embolectomy

55
Q

Pneumothorax breath sounds

A

Absent or reduced

56
Q

Haemothorax brewth sounds

A

Hyperresonant

57
Q

Rifampicin SE

A

Red urine, hepatitis, drug interactions

58
Q

Isoniazid SE

A

Hepatitis

Neuropathy

59
Q

Pyrazinamide SE

A

Hepatitis
Arthralgia (joint stiffness)
Rash
Gout

60
Q

Ethambutol SE

A

(Bacteriostatic)

Optic neuritis

61
Q

Auscultation pneumonia

A

Increased vocal resonance

Increased tactile fremitus

62
Q

Anterior mediastinal mass

A

4Ts

Teratoma, Thymoma, Terrible lymphoma, Thyroid

63
Q

Sign of lower lobe left collapse

A

Sail sign

64
Q

Causes of fibrosis

A 
MTX, amiodarone, bleomycin
Autoimmune (RA,SLE, scleroderma)
Interstitial pneumonitis
Asbestosis, pneumoconiosis, silicosis
Sarcoid
65
Q

CF treatment

A

Chest physio, exercise, high calorie, CREON tablets for pancreatic insufficiency, prophylactic flucloxaxillin, bronchodilators, nebulised DNase, nebulised hypertonic saline, vaccinations

66
Q

GPA signs

A

Saddle shaped nose
Haemoptysis, cough, wheeze
Nose bleeds, hearing loss, sinusitis

67
Q

GPA treatment

A

Cyclophosphamide injections to get under control. Then mtx & sterlids

68
Q

Community acquired pleural infection

A

S. Milleri. S. Pneumonia. Staph aureus. Anaerobes

69
Q

Hospital acquired pleural infection

A

Mrsa
Staph aureus
Enterococcus

70
Q

Eosinophilic asthma

A

TH2

71
Q

Interstitial lung disease CT

A

Honeycomb appareanve of fibrosis. Traction bronchiectasis

72
Q

Idiopathic pulmonary fibrosis treatment

A

Pirfenidone - inhibits fibroblasts generating ECM. SE: photosensitive rash, GI
Nintedanib - inhibits tyrosine kinase receptors. SE diarrhoea

73
Q

Connective tissue disease CT

A

Ground glass changes

74
Q

Drugs that induce ILD

A

Nitrofurantoin. MTX. Amiodarone. Bleomycin

75
Q

Epiglossitis signs

A

Odynophagia, inspiratory stridor. Neck XR: thumb sign

Aetiology: HiB

76
Q

Bordatella pertussis treatment

A

Clarithromycin & vaccination

77
Q

Croup cause and presentation

A

Parainfluenza

Barking cough, inspiratory stridor, febrile, prominent intercostal recessions

78
Q

Example of a restrictive respiratory disease

A 
Sarcoidosis
Interstitial lung disease
Scoliosis
NMD
Marked obesity
79
Q

Obstructive disorders

A

COPD
Asthma
Bronchiectasis

80
Q

Small vs large pneumothorax

A

Small <2cm

81
Q

LAMA example

A

Tiotropium bromide

82
Q

Needle thoracostomy location

A

2nd intercostal space midclavicular line

83
Q

Influenza incubation period

A

1-4 days

84
Q

COPD XR signs

A

Hyperinflation
Bullae
Flat hemidiaphragm

85
Q

Which lung cancer rarely metastasez to distant sites

A

Mesothelioma

86
Q

Extra pulmonary TB signs

A

Persistent swollen glands. Abdominal pain. Dysuria . Jaematuria. Pain & loss of movement in bone/joint. Confusion. Headache. Seizures

2a (10 decks)

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