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Y3 > Resp > Flashcards

Resp Flashcards

1
Q

Pneumonia symptoms

A

Productive cough(green)
Fever
Rigours
SOB(dyspnoea)
Pleuritic chest pain
Confusion(elderly)

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2
Q

Pneumonia examination signs

A

Increased RR
Cyanosis
Reduced/asymmetrical chest expansion
Dull percussion over affected area
Basal creps (coarse)
Bronchial breathing
Increased vocal resonance

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3
Q

Pneumonia investigations

A

Sputum MC&S
Bloods: FBC, LFT, CRP, ESR, ABG, culture
CXR: alveolar consolidation, air bronchograms, consolidation

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4
Q

pneumonia management

A

CURB65
0-1: outpatient
2: consider admission
3 or more: consider ICU

Community acquired:
Amoxicillin 500mg TDS 5/7
Or
Clarithromycin 500mg BD 5/7
Doxycycline 200mg 1/7, 100mg 4/7

Hospital acquired:
Co-amoxiclav 500mg TDS 5/7
Vancomycin(MRSA)
IV tazocin + metronidazole(pseudomonas)

S. Aureus: flucloxacillin 1g QDS 7/7

PCP: co-trimoxazole 960mg BD 5/7

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5
Q

Bronchiectasis signs and symptoms

A

Chronic daily productive cough(>8w)
Large amount of mucopurulent sputum, foul smelling, green/yellow/white
Haemoptysis
SOB
Fever
Weight loss
Non-pleuritic chest pain
Clubbing
Coarse crackles

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6
Q

Bronchiectasis investigations

A

Sputum MC&S:
Bloods: FBC, CRP, ESR, LFT, ABG
CXR
High resolution CT(gold standard): signet ring sign

Caused by cystic fibrosis(developed), TB(developing)

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7
Q

Bronchiectasis management

A

Conservative:
Diet, exercise
Smoking cessation
Vaccinations
Airway clearance->chest physio

Medical:
Steroids/bronchodilators
IV antibiotics if acute exacerbation
Pseudomonas: ciprofloxacin

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8
Q

TB signs and symptoms

A

Productive cough
Haemoptysis
Dyspnoea/SOB
Fever, weight loss
Erythema nodosum

Immunosuppressed
Recent travel

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9
Q

TB investigations

A

Sputum MC&S: Ziehl-Nielsen stain
Bloods: FBC, CRP, ABG
CXR: bi-hilar lymphadenopathy
Mantoux test
Interferon gamma release assay

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10
Q

TB management

A

Rifampicin(6m)
Isoniazid(6m)
Pyrazinamide(2m)
Ethambutol(2m)

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11
Q

Lung cancer symptoms

A

Haemoptysis
Cough
Dyspnoea
FLAWS

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12
Q

Lung cancer examination signs

A

Clubbing
Tar stains
Lymphadenopathy
Dull percussion
Creps
Increased vocal resonance

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13
Q

Lung cancer associations

A

Small cell:
Cushing’s syndrome
SIADH
Lambert-Eaton myasthenia syndrome

Squamous cell:
PTHrp

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14
Q

Lung cancer pancoast tumour(apical) signs and symptoms

A

Horner’s syndrome
Brachial plexus lesion
Recurrent laryngeal nerve lesion

Superior vena cava syndrome: SVC obstruction, facial oedema&flushing

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15
Q

Lung cancer investigations

A

Sputum cytology
FBC: Ca(bone met), ALP(bone met), LFT(liver met)
CXR
CT
PET(staging)
Lung biopsy: bronchoscopy/CT guided biopsy

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16
Q

Mesothelioma signs and symptoms

A

Asbestos exposure
Dry cough
FLAWS
Pleural friction rub

17
Q

Mesothelioma investigations

A

Sputum cytology
Bloods: FBC, Ca, ALP, LFT
CXR: pleural thickening, plaques
CT
PET(staging)
Thoracentesis: pleural fluid cytology
Thoracoscopy+biopsy: pleural lining

18
Q

Asthma signs and symptoms

A

SOB
Dry cough
Chest tightness
Polyphonic wheeze
Pets/dust

19
Q

Asthma investigations

A

Spirometry: FEV1 reduced, FEV1/FVC<0.7, BDR>12%

FeNO>40(adult)/35(child) ppb

Peak flow variability > 20%

spO2 is expected to be low in acute attack

20
Q

Asthma management

A

NSAIDs WORSEN asthma

1st: SABA
2nd: low dose ICS
3rd: ICS + LABA
4th: ICS + LABA + LTRA

21
Q

COPD signs and symptoms

A

SOB, worse on exertion
Chronic productive cough
Recurrent LRTIs
Smoking history

Chest hyperinflation
Cachexia
Cyanosis
Wheeze/crackles

22
Q

COPD investigations

A

Spirometry: reduced FEV1, FEV1/FVC<0.7
CXR

FBC
Sputum MC&S
ECG
CT
Alpha 1 antitrypsin

23
Q

COPD management

A

Smoking cessation
Pulmonary rehab
One off pneumococcal vaccine + annual flu jab
Consider azithromycin prophylaxis

1st Line:
Salbutamol + ipratropium

No asthma, no steroid response:
Salmeterol(LABA) + tiotropium(LAMA)

Asthma, steroid response:
Salmeterol + ICS

24
Q

COPD exacerbation management

A

Hospital admission if:
Cyanosis
Confusion
Arrhythmia
SpO2 < 90%

Medical:
30mg oral pred OD 5/7
Increase frequency of salbutamol
Consider amoxicillin, doxycycline, clarithromycin
Rescue pack

25
Q

Pulmonary fibrosis signs and symptoms

A

Worsening Dyspnoea, worse on exertion
Dry cough
Keeps pigeons
Asbestos exposure
Connective tissue disorder

26
Q

Pulmonary fibrosis investigations

A

CXR: interstitial fibrosis
CT
lung function tests: restrictive pattern
Biopsy

27
Q

Pulmonary fibrosis management

A

Underlying cause: stop drug/exposure
Exercise, physio
Oral steroid therapy
Prompt treatment of infections

28
Q

Pneumothorax signs and symptoms

A

Acute onset SOB
Chest pain

29
Q

Pneumothorax investigations

A

CXR
Rule out PE

30
Q

Pneumothorax management

A

Analgesia, O2 mask

Primary:
<2m -> repeat CXR
>2cm/SOB -> aspirate (chest drain if fail)

Secondary:
<2cm -> aspirate
>2cm -> chest drain

31
Q

Sarcoidosis signs and symptoms

A

Flu like symptoms
Pyrexia
Hypercalcaemia
Erythema nodosum

32
Q

Sarcoidosis investigations

A

CXR: bihilar lymphadenopathy
Lymph node biopsy
serum ACE
Serum calcium

33
Q

Sarcoidosis management

A

Bed rest
Oral prednisolone 40mg daily

Oral ibuprofen 30mg TDS

34
Q

PE signs and symptoms

A

Acute SOB
Raised JVP
shock
Chest pain

35
Q

PE investigations

A

CTPA (gold standard)
ECG, CXR to rule out other pathology
ABG
D dimer (non specific)
Troponin

36
Q

PE management

A

PE+hypotension:
Thrombolysis (streptokinase)

No comorbidity:
Apixaban/rivaroxaban 3/12

Anti phospholipid syndrome:
LMWH + warfarin 5 days til INR>2 then stop LMWH

Provoked: 3 months
Unprovoked: 6 months

37
Q

Acute cough management

A

Systematically well:
Honey
Herbal medicine

Systematically unwell/risk factors:
Adult -> doxycycline 200mg 1/7, 100mg 4/7
Child -> amoxicillin maximum 500mg TDS 5/7

38
Q

Anaphylaxis management

A

ABCDE
Adrenaline 500mg IM
Hydrocortisone IV
Chlorphenamine IV

Y3 (9 decks)

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