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1. 4th year > Resp > Flashcards

Resp Flashcards

1
Q

PEFR in obstructive disease

A

reduced

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2
Q

PEFR in restrictive disease

A

normal

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3
Q

restrictive or obstructive: asthma

A

obstructive

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4
Q

restrictive or obstructive: pulmonary fibrosis

A

restrictive

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5
Q

restrictive or obstructive: asbestosis, sarcoidosis

A

restrictive

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6
Q

restrictive or obstructive: COPD

A

obstructive

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7
Q

restrictive or obstructive: bronchiectasis

A

obstructive

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8
Q

what is measured in peak flow

A

peak expiratory flow rate, with variation depending on age height and sex (FVC)

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9
Q

what is measured in spirometry

A

forced vital capacity
forced expiratory volume in 1 second (FEV1)
Forced expiratory ratio (FER) - FEV1/FVC

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10
Q

FEV1/FVC in restrictive disease

A

normal

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11
Q

FEV1/FVC in obstructive disease

A

reduced

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12
Q

how can you distinguish between COPD and asthma in spirometry

A

FVC is normal in asthma but decreased in COPD

or do bronchial challenge/reversibility

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13
Q

results of bronchial challenge in COPD and asthma

A

asthma > 15% increase

COPD < 15% increase

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14
Q

TCLO in asthma

A

normal/raised

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15
Q

TCLO in emphysema

A

reduced

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16
Q

TCLO in restrictive disease

A

reduced

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17
Q

TCLO in Wegeners/good pastures

A

raised

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18
Q

TCLO in polycythaemia

A

raised

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19
Q

FVC: significantly reduced
FEV1: decreased
FER: > 75% i.e. normal
TCLO: reduced

A

restrictive pattern

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20
Q

restrictive spirometry pattern:

FVC, FEV1, FER, TCLO

A

FVC: significantly reduced
FEV1: decreased
FER: > 75% i.e. normal
TCLO - reduced

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21
Q

FVC - decreased
FEV1 decreased
FER decreased
TCLO decreased

A

COPD

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22
Q

spirometry of COPD

A

FVC - decreased
FEV1 decreased
FER decreased
TCLO decreased

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23
Q 
what disease
FVC - decreased
FEV1 decreased
FER decreased 
TCLO decreased
A

COPD

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24
Q

spirometry of asthma

A

FVC - normal
FEV1 significantly decreased
FER decreased
TCLO normal/raised

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25
Q

FVC - normal
FEV1 significantly decreased
FER decreased
TCLO normal/raised

A

asthma

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26
Q

chronic asthma > 17 YOs

step 1

A

SABA

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27
Q

chronic asthma > 17 YOs

step 2

A

SABA + ICS

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28
Q

chronic asthma > 17 YOs

step 3

A

NICE - SABA + ICS + LTRA

SIGN - SABA + ICS + LABA

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29
Q

chronic asthma > 17 YOs

step 4

A

SABA + ICS + LABA

continue LTRA if there was good response

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30
Q

chronic asthma > 17 YOs

step 5

A

SABA +/- LTRA + low dose ICS/LABA mart

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31
Q

chronic asthma > 17 YOs

step 6

A

SABA +/- LTRA + med dose ICS/LABA mart
or
moderate fixed dose ICS and separate laba

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32
Q

chronic asthma > 17 YOs

step 7

A

SABA +/- LRTA
+ high dose ICS fixed (not mart)
or trial of 4th drug e.g. LAMA or theophylline
seek advice

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33
Q

what is considered low dose ICS

A

< 400mcg

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34
Q

what is considered medium dose ICS

A

400-800mcg

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35
Q

what is considered high dose ICS

A

> 800 mcg

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36
Q

SIGN guidelines

patient on SABA, ICS, LABA poorly controlled asthma

A

increase ICS or trial another drug - LTRA, theophylline, LAMA

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37
Q

what is a common side effect of LTRA

A

night mares

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38
Q

when are LTRAs e.g. montelukast particularly good

A

allergic phenotypes or exercise induced

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39
Q

what drug is good in asthma with SOB without allergy or inflammation

A

tiotropium

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40
Q

why are theophyllines generally considered last line

A

make people feel sick

dont work in smokers

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41
Q

asthma in kids 5-15 step 1

A

SABA

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42
Q

asthma in kids 5-15 step 2

A

SABA + paed low dose ICS

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43
Q

asthma in kids 5-15 step 3

A

SABA + paed low dose ICS + LTRA

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44
Q

asthma in kids 5-15 step 4

A

SABA + paed low dose ICS + LABA

stop the LTRA

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45
Q

asthma in kids 5-15 step 5

A

SABA + PLD ICS Mart

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46
Q

asthma in kids 5-15 step 6

A

SABA + PMD ICS mart

or fixed dose moderate ICS + separate LABA

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47
Q

asthma in kids 5-15 step 7

A

SABA + one of

  • paediatric high dose fixed dose regime or MART
  • trial of theophylline
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48
Q

asthma kids < 5 step 1

A

SABA

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49
Q

asthma kids < 5 step 2

A

SABA + 8 week trial of paediatric moderate dose ICS - after 8 weeks stop the ICS and monitor - if symptoms did not resolve during the trial period review diagnosis
if symptoms resolved and reoccurred within 4w of stopping then restart ICS at a low dose
if over 4 weeks and symptoms reoccurred repeat the trial

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50
Q

asthma kids < 5 step 3

A

SABA + PLD ICS + LTRA

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51
Q

asthma kids < 5 step 4

A

stop the LTRA and refer to paediatric asthma specialist

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52
Q

acute asthma treatment

A
  • sit up and give high flow O2
  • salbutamol neb
  • prednisolone oral or hydrocortisone IV + normal ICS
  • ipratropium bromide (SAMA) via neb
  • IV theophylline
  • IV mag sulf
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53
Q

how long should prednisolone be continued after an asthma attack

A

5 days

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54
Q

acute asthma acronym

A 
O SHIT ME
oxygen
salbutamol
hydrocortisone/prednisolone
ipratropium
theophylline 
mag sulf 
escalate
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55
Q

most important intervention in COPD

A

smoking cessation

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56
Q

vaccinations in COPD

A

annual flu

once of pneumococcal

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57
Q

who should be considered for LTOT

A

PO2 < 7.3, or 7.3-8 with one of the following:
• Secondary polycythaemia
• Peripheral oedema
• Pulmonary hypertension

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58
Q

COPD treatment ladder step 1

A

SABA or SAMA prn

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59
Q

COPD treatment ladder step 2 if patient has no asthma features

A

SABA + LABA + LAMA

if pt was taking SAMA as first therapy then switch to SABA

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60
Q

COPD treatment ladder step 2 if asthma features

A

SABA or SAMA + LABA + ICS

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61
Q

COPD treatment ladder step 3

A

SABA + triple therapy of LABA LAMA and ICS

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62
Q

COPD treatment ladder step 4

A

oral theophylline

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63
Q

what antibiotic prophylaxis is used in COPD in certain patients

A

azithromycin

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64
Q

acute exac of COPD acronym

A 
iTOAPES
- ipratropium
- theophylline
oxygen
amoxicillin
prednisolone
escalate 
salbutamol
65
Q

acute exac of COPD

A
  • 0xygen
  • nebulised salbutamol and ipratropium
  • theophylline IV
  • oral prednisolone (5 days)
  • amoxicillin if infection suspected (doxy if pen al)
  • NIV
66
Q

what is the most common cause of acute exacerbations of COPD and bronchiectasis

A

H influenzae

67
Q

what 3 paraneoplastic syndromes do Small cell lung cancers cause

A

Lambert eaton
SIADH
cushings

68
Q

most common type of lung cancer

A

adenocarcinoma

69
Q

two lung cancers found centrally and associated with smoking

A

small cell and squamous cell

70
Q

where is adenocarcinoma typically found in lung

A

peripheries

71
Q

what is a sign that can happen in adenocarcinoma

A

gynaecomastia

72
Q

paraneoplastic syndrome caused by squamous cell carcinoma

A

PTHrp - hypercalcaemia

TSH - hyperthyroid

73
Q

1st line IX in lung cancer

A

CXR

74
Q

gold standard ix in suspected lung cancer

A

CT

75
Q

what ix is needed for diagnosis of lung cancer

A

bronchoscopy and biopsy

76
Q

most small cell tumours are _____sensitive

A

chemo

77
Q

most non-small cell tumours are ____sensitive

A

radio

78
Q

auscultation of idiopathic pulmonary fibrosis

A

bibasal fine end inspiratory crackles

79
Q

CT mesothelioma

A

pleural thickenings

80
Q

interstitial lung disease on XR

A

ground glass appearance

81
Q

lower zone fibrosis cause

A

idiopathic pulmonary fibrosis

asbestosis

82
Q

mid zone fibrosis cause

A

progressive massive fibrosis

83
Q

idiopathic pulmonary fibrosis gold standard ix and findings

A

high resolution CT scan

honeycomb lung and thickened interstitium

84
Q

idiopathic pulmonary fibrosis treatment

A

lung transplant
supportive
anti-fibrotic - perfenidone

85
Q

granuloma in sarcoidosis

A

non-caseating

86
Q

sarcoidosis treatment

A

oral or inhaled steroids +/- immunosuppression

87
Q

extrinsic allergic alveolitis

  • acute
  • chronic
A

acute - tapered dose of oral steroids

chronic - allergen avoidance and long term steroids

88
Q

egg shell calcification at hilar nodes

A

silicosis

89
Q

treatment of pleural plaques from asbestos exposure

A

nothing - benign

90
Q

croup cause

A

parainfluenza virus

91
Q

croup presentation

A

stridor
barking cough worse at night
fever
coryza

92
Q

croup xray

A

steeple sign

93
Q

treatment croup

A

dexamethasone

94
Q

acute epiglottitis cause

A

haemophilus influenza B

95
Q

acute epiglottitis presentation

A 
rapid onset
drooling 
fever
stridor 
tripod position
96
Q

acute epiglottitis CXR

A

thumb sign

97
Q

acute epiglottitis tx

A

ceftriaxone IV

98
Q

bronchiolitis cause

A

RSV

99
Q

tx acute bronchitis

A

doxycycline or amoxicillin

100
Q

cause of whooping cough

A

bordetella pertusis

101
Q

key signs of whooping cough

A

inspiratory whoop

coughing bouts often ending in vomiting/cyanosis

102
Q

diagnosis whooping cough

A

nasal swab culture

103
Q

school exclusion of whooping cough

A

notifiable disease and school exclusion for 48 hours from starting abx or 21 days from cough onset

104
Q

tx whooping cough

A

erythromycin

105
Q

infective exac of COPD treatment

A

amoxicillin
prenisolone for 5 days
increase bronchodilator frequency

106
Q

most common cause of CAP and HAP

A

strep pneumonia

107
Q

1st line for all children with pneumonia

A

amoxicillin

108
Q

pneumonia associated with cold sores

A

strep pneumonia

109
Q

pneumonia common in COPD

A

H influenza

110
Q

pneumonia secondary to viral influenza

A

S. Aureus

111
Q

pneumonia associated with painful vesicles on tympanic membrane

A

mycoplasma

112
Q

tx mycoplasma

A

doxycycline or clarithromycin

113
Q

ix mycoplasma

A

serology

positive cold agglutination test

114
Q

pneumonia seen in patients with pet birds

A

chlamydia psittaci

115
Q

tx chlamydia psittaci

A

doxycycline

erythromycin

116
Q

pneumonia from sheep

A

coxiella burnetti

117
Q

treatment of coxiella

A

clarithromycin

118
Q

treatment of legionella

A

levofloxacin or clarithromycin + rifampicin

119
Q

legionella ix

A

urine antigen
deranged LFT
hyponatraemia

120
Q

red current jelly sputum

A

klebsiella

121
Q

when is PCP seen

A

immunocompromised/HIV

when CD4 < 200

122
Q

ix of PCP

A

bronchoalveolar lavage

123
Q

tx of PCP

A

co-trim

can be given as prophylaxis

124
Q

when is pseudomonas pneumonia seen

A

CF / bronchiectasis

125
Q

what is the treatment of pseudomonas

A

ciprofloxacin

126
Q

CURB65 criteria

A

Confusion (>8/10 abbreviated mental test score), urea > 7, RR > 30, BP < 90 systolic, diastolic < 60, over 65

127
Q

tx mild/moderate CAP

A

amoxicillin

128
Q

tx mild/moderate CAP pen all

A

doxycycline

129
Q

tx mild/moderate CAP if NBM

A

IV clarithromycin

130
Q

tx severe CAP

A

co-amox IV + doxy

131
Q

tx severe CAP if pen all

A

levofloxacin

132
Q

tx severe CAP if in ITU

A

co amox + clarithromycin
or
levofloxacin + clarithromycin

133
Q

tx severe HAP

A

IV amox and met and gent

134
Q

tx severe HAP step down

A

co trim and met

135
Q

tx non-severe amox

A

oral amox and met

136
Q

tx pneumonia assocaited with influenza

A

co-amoxiclav

137
Q

granuloma in TB

A

caseating

138
Q

main test for latent TB

A

mantoux skin test

139
Q

gold standard for TB

A

sputum culture

140
Q

treatment of active TB

A

2 months RIPE

4 months RI

141
Q

latent TB treatment

A

3 months R + I (with pyridoxine) or 6 months of I (with pyridoxine)

142
Q

treatment meningeal tuberculosis

A

12 months RIPE + steroids

143
Q

effusion of < 30g protein is a

A

transudate

144
Q

effusion of > 30g protein or protein/serum ratio is > 0.5

A

exudate

145
Q

most common cause of transudate

A

heart failure

146
Q

1st line IX of effusion

A

PA CXR

147
Q

D sign on X ray

A

empyema

148
Q

CF inheritance

A

AR

149
Q

CF ix

A

sweat test chloride > 60mmol

150
Q

tx CF

A

supportive etc

orkambi

151
Q

ix sleep apnoea diagnostic

A

polysomnography

152
Q

tx sleep apnoea

A

CPAP

153
Q

treatment pneumothorax

primary with < 2cm air and no SOB

A

discharge

154
Q

treatment pneumothorax primary with > 2cm ring / SOB

A

aspiration

then chest drain if needed

155
Q

treatment pneumothorax secondary

patient > 50 and >2cm air or SOB

A

chest drain

156
Q

treatment pneumothorax
secondary
1-2cm air

A

aspirate

157
Q

treatment pneumothorax secondary < 1cm air

A

admit and give o2 for 24 hours

158
Q

how is aspiration done

A

Insert 16g cannula into mid clavicular line of 2nd intercostal space

159
Q

tension pneumothorax treatment

A 
1st aspirate (MCL, 2ICS)
then chest drain (5ICS MAL)

1. 4th year (23 decks)

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