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Clinical Years / Progress Test > Resp > Flashcards

Resp Flashcards

1
Q

What causes upper lobe fibrosis?

A

Coal workers pneumonitis
Hypersensitivity
Ankylosing spondylitis
Radiation
Tuberculosis
Sarcoidosis

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2
Q

management of acute COPD exacerbation

A
  • increase bronchodilator use; can give via nebs
  • corticosteroid for 30 days
  • oral antibiotics ‘if sputum is purulent or there are clinical signs of pneumonia’; clarithromycin, doxycycline or amoxicillin
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3
Q

most likely cause of pneumonia if recent influenza

A

staphlycoccus aureus

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4
Q

treatment for sinusitis

A

intranasal corticosteroids

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5
Q

Stepwise asthma treatment

A

SABA
ICS
LTRA
LABA and review LTRA
MART therapy
Increase to high dose ICS or try additional drug

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6
Q

Spirometry of COPD

A

Obstructive non reversible picture

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7
Q

GOLD stages COPD

A

I FEV1>80%
II 50-80%
III 30-50%
IV <30%

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8
Q

Criteria for assessment for oxygen therapy in COPD

A

FEV1 <30% predicted
Cyanosis
Polycythaemia
Peripheral oedema
Raise JVP
Oxygen sats <92 on air

Must not smoke

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9
Q

Offer LTOT to patients with…

A

PO2 <7.3kpa
Or PO2 7.3-8kpa and one of secondary polycythaemia, peripheral oedema, pulmonary hypertension

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10
Q

pharamcological COPD treatment

A
  1. SABA(salbutamol) or SAMA (ipratropium)
  2. no asthmatic features; add LABA or LAMA (stop SAMA if starting LAMA)
  3. with asthmatic features; add LABA and ICS.
    if still breathless add LAMA
  4. oral theophylline under specialist
  5. consider prophylactic azithromycin if lots of exacerbations
  6. can try mucolytics if lots of mucus e.g. carbocisteine
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11
Q

non-pharmacological COPD treatment

A

smoking cessation
annual flu vaccine
one off pneumococcal
pulmonary rehabilitation

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12
Q

What cause of pneumonia is associated with erythema multiforms

A

Mycoplasma pneumonia

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13
Q

active TB treatment

A

pyrazinamide + ethambutol for first 2 months
isoniazid + rifampicin for the whole 6 months

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14
Q

important side effects of TB drugs

A

rifampicin - orange bodily fluids, toxicity and interactions
isoniazid - neuropathy, hepatitis
pyrazinamide - hepatotoxicty, arthralgia, sideroblastic anaemia
ehtambutol - optic neuritis

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15
Q

where does lung cancer tend to metastasise to

A

Bones
Liver
Adrenals
Brain

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16
Q

treatment/prognosis of SCLC

A

treatment not curative
classified as limitied or extensive
worse prognosis than NSCLC

responsible for the paraneoplastic syndromes

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17
Q

treatment/prognosis of NSCLC

A

based on TNM staging
stage 1 operable
2 & 3 mixed
stage 4 chemo only

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18
Q

types of NSCLCs

A

adenocarcinoma (most common 40%)
sqamous carcinoma (20%)
large cell (10%)
others (10%)

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19
Q

Non metastatic manifestations of lung cancer

A

Lambert Eaton syndrome
Myasthenia graves
(Both related to Ach in the synapse)

SIADH

hypertrophic osteoarthropathy (more common is nsclc)

Cushing syndrome

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20
Q

What is pancoast syndrome

A

Malignant neoplasm in the thoracic inlet disrupting the brachial plexus and cervical sympathetic nerves

causes Horner’s syndrome; ptosis, anhidrosis and miosis

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21
Q

what is the treatment for small cell lung cancer

A

combination of chemotherapy and radiotherapy

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22
Q

treatment of Non Small Cell LCas

A

mainstay is surgery + radiotherapy

later chemotherapy can be added

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23
Q

characteristic chest signs of pneumonia

A

bronchial breath sounds

focal course crackles

dullness to percussion

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24
Q

CURB-65

A

Confusion
Urea >7
Resp rate 30+
Blood pressure <90 systolic or <60 diastolic
>65 years

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25
Q

hospital investigations pneumonia

A

CXR
FBC
U+Es
CRP

+/- sputum and blood cultures depending on severity

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26
Q

pneumonia complications

A

acutely; reps failure, hypotension, AF

empyema
pleural effusion
sepsis
lung abscess
kidney or liver failure

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27
Q

mild CAP treatment

A

5-7 days antibiotics
can usually be managed in the community

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28
Q

moderate to severe CAP treatment

A

7-10 days of dual antibiotics
will need admission

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29
Q

what key drugs can induce pulmonary fibrosis

A

methotrexate
nitrofurantoin
amiodarone
cyclophosphamide

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30
Q

classical signs idiopathic pulmonary fibrosis

A

bibasal fine end inspiratory crackles
finger clubbing
progressive symptoms

31
Q

what conditions can cause secondary pulmonary fibrosis

A

SLE
rheumatoid arthritis
systemic sclerosis
a1-antitrypsin deficiency

32
Q

what is sarcoidosis

epidemiology

A

a granulomatous inflammatory condition

two age spikes - 20s and 60s
more common in women
more common in black people

33
Q

main symptoms and systems affected in sarcoidosis

A

chest symptoms but also has multiple extra-pulmonary manifestations such as erythema nodosum and lymphadenopathy

lungs; fibrosis, nodules, mediastinal lymphadenopathy

systemic; fever, fatigue, weight loss

liver; nodules, cirrhosis, cholestasis

eyes; uveitis, conjunctivitis, optic neuritis

skin; erythema nodosum, granulomas in scar tissue

each of heart, kidneys and nervous system can also be affected in about 1 in 20

34
Q

sarcoidosis investigations

A

serum ACE; diagnostics and screening
calcium in often raised
CRP can be raised
raised serum IL-2 receptor

histology is gold standard for confirming diagnosis

35
Q

sarcoidosis treatment

A

can often conservatively manage initially

when treatment required start oral steroids for 6 to 24 months

second line are azathioprine and methotrexate

36
Q

what is pulmonary hypertension

A

increased resistance and pressure of blood in the pulmonary arteries which causes strain on the right side of the heart and eventually back pressure into the venous system

37
Q

causes of pulmonary hypertension

A

primary pulmonary hypertension
CTDs such as lupus
chronic lung disease such as COPD
pulmonary vascular disease e.g. PE
others; haematological, sarcoidosis

38
Q

action if PE Well’s score
- likely (4+)
- unlikely

A

likely; immediate CTPA and anticoagulant

unlikely; interim anticoagulate, D-dimer and if positive CTPA, if negative PE very unlikely

39
Q

exudative pleural effusion

A

fluid has:
high protein
high LDH
high cholesterol

causes are related to inflammation; cancer, pneumonia, rheumatoid arthritis, TB

40
Q

transudative pleural effusion

A

fluid has:
low protein
low LDH
low cholesterol

caused by fluid shifts e.g from heart failure, hypoalbuminaemia, hypothyroidism, Meig’s (R sided due to Ovarian Ca)

41
Q

what is an empyema?

A

infected plural effusion

suspect in improving pneumonia but new or ongoing fever.

Pleural aspiration shows pus, acidic pH (pH < 7.2), low glucose and high LDH

42
Q

types of non-invasive ventilation

A

BiPAP - used in type 2 RF

CPAP - used in obstructive sleep apnoea, congestive cardiac failure, acute pulmonary oedema

43
Q

what is the diagnostic investigation in obstructive sleep apnoea

A

Polysomnography

44
Q

features of obstructive sleep apnoea

A

daytime sleepiness

compensated respiratory acidosis

hypertension

45
Q

assessment of sleepiness

A

Epworth Sleepiness Scale - completed by pt +/- partner

Multiple Sleep Latency Test (MSLT) - measures time to fall asleep using EEG

46
Q

management obstructive sleep apnoea

A

weight loss

CPAP

DVLA informed if excessive sleepiness

47
Q

most common cause of COPD exacerbation pneumonia

A

Haemophilus influenzae.

Other bacterial causes include Streptococcus pneumoniae and Moraxella catarrhalis.

Respiratory viruses account for around 30% of exacerbations

48
Q

most common pneumonia seen in alcoholics

A

Klebsiella pneumoniae

49
Q

COPD exacerbation management

A

increased freq bronchodilator use and consider nebulisers

5 days oral prednisolone 30mg

antibiotics is sputum purulent or clinical signs of pneumonia - amoxicillin, clarithromycin or doxycycline

50
Q

what antibiotic is used for prophylaxis in COPD patients who meet the criteria

A

azithromycin 250mg 3 times a week

> 3 exacerbations requiring steroid therapy and at least one exacerbation requiring hospital admission in the previous year

non smoker

trial for minimum of 6-12 months

51
Q

what type of fibrosis tends to affect the lower zones

A

idiopathic pulmonary fibrosis

CTDs

drug induced

asbestosis

52
Q

indications for surgery in bronchiectasis

A

uncontrolled haemoptysis

localised disease

53
Q

management of atelectasis

A

chest physiotherapy with mobilisation and breathing exercises

54
Q

Acute Respiratory Distress Syndrome

A

1) acute onset dyspnoea, increased RR, bilateral lung crackles, desaturating
2) signs of non-cardiogenic pulmonary oedema
3) reduced PaO2/FiO2 of <300 mmHg (or <40 kPa)

mortality around 40%

55
Q

are pleural plaques malignant

A

no benign and do not undergo malignant change

56
Q

life threatening asthma features

A

PEFR <33%
sats <92%
normocapnic
exhaustion

57
Q

severe asthma features

A

PEFR 33-50%
HR >110 bpm
RR >25
can’t complete sentences

58
Q

discharge criteria asthma exacerbation

A

stable on discharge medication for 12-24 hrs

PEF>75% best or predicted

inhaler technique checked and recorded

59
Q

trachea pulled toward a whiteout CXR

A

pneumonectomy

complete lung collapse

pulmonary hypoplasia

60
Q

trachea central complete white out CXR

A

consolidation

pulmonary oedema

mesothelioma

61
Q

trachea pushed away from whiteout CXR

A

pleural effusion

large thoracic mass

diaphragmatic hernia

62
Q

features of allergic bronchopulmonary aspergillosis

management

A

bronchiectasis + symptoms of bronchoconstriction

eosinophilia

managed with oral steroids sometimes with itraconazole

63
Q

smoking cessation help in pregnancy women

A

nicotine replacement therapy

bupropion and varenicline are contraindicated!

64
Q

what do lung abscesses usually occur secondary to

management

A

aspiration pneumonia
are typically polymicrobial due to this

needs IV antibiotics

65
Q

what paraneoplastic syndromes squamous cell lung ca

A

hypercalcemia secondary to PTH
clubbing
hypertrophic pulmonary osteoarthropathy
hyperthyroidism

66
Q

what paraneoplastic syndromes small cell lung cancer

A

hyponatramia secondary to SIADH
ACTH –> cushings
Lambert Eaton

67
Q

what drug class is montelukast an example of

A

Leukotrine Receptor Antagonists

68
Q

what blood gas abnormality does a neuromuscular disease usually cause

A

a respiratory acidosis

69
Q

primary pneumothorax management

A

if <2cm and no SoB discharge and follow up

if >2cm or SoB needle aspiration
chest drain if not resolved

70
Q

secondary pneumothorax management

A

if >50 yrs old or rim >2cm then chest drain should be inserted
if 1-2cm aspirate
all patients even if <1cm should be admitted with oxygen for 24 hrs

71
Q

pleural plaques

A

large plaques seen on X-ray
appear 2-40 yrs after asbestos exposure benign and do not undergo malignant transformation

72
Q

asbestosis

A

related to length of exposure
causes lower lobe fibrosis with symptoms of dyspnoea and reduced exercise tolerance, clubbing, end inspiratory crackles, restrictive lung function tests

73
Q

mesothelioma

A

malignancy of the pleura presenting with progressive SoB, chest pain and pleural effusion
poor prognosis

Clinical Years / Progress Test (24 decks)

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