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medicine phase 2 a > resp > Flashcards

resp Flashcards

1
Q

What are the key presentations of asthma?

A

episodic symptoms
dry cough/wheeze
Hx of atopic conditions (eczema)
FH
bilateral widespread polyphonic wheeze

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2
Q

What are the first line investigations for asthma?

A

fractional exhaled nitric oxide
spirometry with bronchodilator reversibility

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3
Q

What are the second line investigations for asthma?

A

peak flow variability
direct bronchial challenge test

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4
Q

What is the 1st line treatment for asthma?

A

SABA

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5
Q

What is the 2nd line treatment for asthma?

A

SABA + ICS

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6
Q

What is the 3rd line treatment for asthma?

A

SABA + ICS + LTRA

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7
Q

What is the 4th line treatment for asthma?

A

SABA + ICS +LABA

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8
Q

Give an example of a SABA

A

salbutamol

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9
Q

Give and example of an ICS

A

beclometasone

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10
Q

Give an example of a LTRA

A

montelukast

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11
Q

give and example of a LABA

A

salmeterol

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12
Q

How do SABAs work?

A

stimulate beta2 receptors causing smooth muscle relaxation

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13
Q

How do ICSs work?

A

reduce inflammation/reactivity of airways

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14
Q

How do LTRAs work?

A

blocks leukotriene receptor and prevents inflammation/bronchoconstriction

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15
Q

How do LABAs work?

A

stimulate beta 2 receptors causing smooth muscle relaxation

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16
Q

Give two more example of medications that could be used for asthma

A

long acting muscarinic antagonists (LAMA)
theophylline

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17
Q

What are the typical presentations of COPD?

A

smoker
chronic: cough, SOB, sputum, wheeze, recurrent RTI

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18
Q

What would not usually be present in COPD to rule out differentials?

A

clubbing, haemoptysis, chest pain

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19
Q

What scale is used to measure severity of dyspnoea?

A

Medical research council (MRC) dyspnoea scale
5 point scale

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20
Q

How is COPD diagnosed?

A

clinical signs + spirometry

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21
Q

What test is used in spirometry for COPD?

A

FEV1:FVC <0.7
severity can be measured by percentage of FEV1 from predicted (4 stages)

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22
Q

What differentials would you want to rule out for suspected COPD?

A

cancer - X ray
anaemia - FBC
fibrosis - CT

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23
Q

What is the first line management for COPD?

A

smoking cessation
pneumococcal + influenza vacc
pulmonary rehab
treatment of comorbidities

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24
Q

What is the 1st line medical treatment for COPD?

A

SABA/SAMA

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25
Q

what is the 2nd line treatment for COPD in patients with steroid responsiveness (features of asthma?

A

LABA + ICS

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26
Q

What is the 2nd line treatment for COPD in patients with no steroid responsiveness?

A

LABA + LAMA

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27
Q

What is the third line treatment for COPD?

A

LAMA + LABA + ICS

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28
Q

Give an example of a SAMA

A

ipratropium

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29
Q

give an example of a LAMA

A

tiotropium

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30
Q

how does an exacerbation of COPD present?

A

acute worsening of symptoms

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31
Q

What is type 1 respiratory failure?

A

normal pCO2 and low/normal pO2

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32
Q

what is type 2 respiratory failure

A

raised pCO2 and low pO2

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33
Q

What investigations might you do in an exacerbation of COPD?

A

X-ray (pneumonia)
FBC/cultures (infection)

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34
Q

what oxygen saturation should a patient with COPD and CO2 retention aim for?

A

88-92%

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35
Q

what is treatment of exacerbations of COPD?

A

nebulised salbutamol
prednisolone
abx if infection
physio (to clear sputum)

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36
Q

What is the treatment of severe exacerbations of COPD?

A

IV aminophylline
NIV
ventilation/intubation (ICU)
doxapram (resp stimulant)

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37
Q

What are the causes of a pneumothorax?

A

spontaneous
trauma
iatrogenic
lung pathology

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38
Q

What is the typical presentation of a pneumothorax?

A

sudden SOB + pleuritic chest pain
(often young, tall, slim men)

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39
Q

what is the 1st investigation for a pneumothorax?

A

chest X ray

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40
Q

What other imaging tool can be used to more accurately assess a pneumothorax?

A

CT thorax

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41
Q

What is the management of a pneumothorax with no SOB and <2cm?

A

no treatment, 2-4 week follow up

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42
Q

What is the management of a pneumothorax with SOB and/or >2cm air gap?

A

aspiration

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43
Q

What intervention may be used if aspiration for a pneumothorax fails or if it is unstable/bilateral?

A

chest drain

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44
Q

What are the signs of a tension pneumothorax?

A

tracheal deviation away from pneumothorax
reduced air entry to affected side
increased resonant percussion
tachycardia
hypotension

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45
Q

What is the management of a tension pneumothorax?

A

insertion of a large bore catheter into the second intercostal space in the midclavicular line

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46
Q

Where is a chest drain performed?

A

triangle of safety
inferiorly b 5th intercostal space, anteriorly by anterior axillary line and posteriorly by mid axillary line

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47
Q

What bacteria causes TB

A

mycobacterium tuberculosis

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48
Q

How is TB stained?

A

Zeihl-Neelson stain - red
(acid-fastness)

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49
Q

what are the different stages of TB?

A

active
latent
secondary - after latent
miliary - disseminated, severe

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50
Q

Apart from the lungs, where else can TB effect?

A

lymph nodes, cutaneous, CNS, pericardium, bones, GU

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51
Q

Who is offered a BCG vaccine?

A

healthcare workers
people from TB hotspots or with relations with TB

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52
Q

What are the presentations of TB?

A

cough (haemoptysis)
lethargy
fever/night sweats
erythema nodosum

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53
Q

What test looks for past or present TB infection?

A

mantoux test

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54
Q

What further test can be done after a mantoux test?

A

interferon gamma release test

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55
Q

What would be seen on chest X ray in TB?

A

patchy consolidation, pleural effusions, millet seeds (miliary), ghon focus/complex

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56
Q

What are the other investigations for TB?

A

sputum/blood culture
NAAT

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57
Q

What is the management for acute pulmonary TB?

A

RIPE
Rifampicin
Isoniazide
pyrazinamide
ethambutol
(RIP are hepatotoxic)

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58
Q

What are the side effects of rifampicin?

A

red/orange discolouration of urine/tears
induced P450 so effects metabolisation of some drugs (oral contraceptive)

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59
Q

What are the side effects of Isoniazide?

A

peripheral neuropathy - treated with pyridoxine (vit B6)

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60
Q

What are the side effects of pyrazinamide?

A

hyperuricaemia - gout

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61
Q

What are the side effects of ethambutol?

A

colour blindness + reduced VA

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62
Q

what inheritance pattern is CF?

A

autosomal recessive
(chromosome 7)

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63
Q

what are the key consequences of CF?

A

thick pancreatic/biliary secretions
thick airway secretions
congenital bilateral absence of vas deferens

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64
Q

How would CF present in a newborn?

A

meconium ileus (first stool is stuck in the GI colon) causing vomiting/abdo distension

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65
Q

How would Cf present in a child?

A

recurrent LRTIs, failure to thrive, pancreatitis

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66
Q

What are some of the signs of CF?

A

nasal polyps
clubbing
crackles/wheeze on auscultation

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67
Q

What are the causes of nail clubbing in kid?

A

hereditary
cyanotic heart disease
infective endocarditis
CF, TB, IBD
cirrhosis

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68
Q

What tests can be done for CF?

A

newborn blood spot testing
sweat test (gold standard)
genetic testing

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69
Q

What infections are patients with CF at risk of?

A

staphylococcus aureus and psuedomonas (mainly)

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70
Q

What is the treatment for pseudonoma aeruginosa in CF patients?

A

long term nebulised tobramycin

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71
Q

What is the general management for CF?

A

chest physio
exercise
prophylactic flucloxacillin
bronchodilators
vaccines

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72
Q

what is bronchiectasis?

A

permanent dilation of the bronchi due to destruction of muscular/elastic components

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73
Q

what can cause bronchiectasis?

A

CF
primary ciliary dyskinesia
obstruction - tumour
post infection
chronic inflammation

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74
Q

Explain the pathophysiology of bronchiectasis

A

damage to cilia by immune cells
fibroblasts repair with collagen
loss of elasticity
arteriolar constriction
pulmonary hypertension

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75
Q

What are the presentations of bronchiectasis?

A

wheeze, productive cough, khaki sputum, SOB, chest pain, clubbing due to hypoxia

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76
Q

What would be seen on a CT scan in bronchiectasis?

A

dilated/thickened bronchi/oles

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77
Q

What other investigations might you do for bronchiectasis?

A

sputum culture
genetic testing (CF, PCD)
spirometry (obstructive picture)

78
Q

what are the therapeutic managements for bronchiectasis?

A

chest physio
postural drainage

79
Q

What medications might help in bronchiectasis?

A

prophylactic abx
bronchodilators
mucolytics
anti-inflammtory drugs

80
Q

Give and example of a mucolytic

A

acetylcysteine

81
Q

Give and example of an anti-inflammatory drug used to treat bronchiectasis

A

azithromycin

82
Q

What are the different classifications of pneumonia?

A

community acquired
hospital acquired
aspiration
atypical pneumonia
pneumonia in immunocompromised

83
Q

What are the typical symptoms of pneumonia?

A

SOB, productive cough, fever, pleuritic chest pain, delirium, haemoptysis

84
Q

What are the general signs of pneumonia

A

increased resp and HR
hypoxia/tension

85
Q

What are the chest signs of pneumonia?

A

bronchial breath sounds (harsh)
focal coarse crackles
dullness to percussion

86
Q

what score is used to determine severity of pneumonia?

A

CURB-65/CRB-65
Confusion
Urea >7 (only in hospital)
Resp rate >30
Blood pressure <90/60
65 age >65

87
Q

When should patients in the community be referred to the hospital with pneumonia?

A

CRB-65 >0

88
Q

What are the common pathogens to cause pneumonia?

A

streptococcus pneumoniae
haemophilus influenzae

89
Q

What pneumonia is common in immunocompromised patients?

A

moraxella catarrhalis
pneumocystis jiroveci (PCP)

90
Q

What are the 5 causes of atypical pneumonia?

A

legionella pneumophila
chlamydia psittacci
mycoplasma pneumoniae
chlamidophila pneumoniae
coxiella burnetti (Q fever)
(legions of psittaci MCQs)

91
Q

How are atypical pneumonias treated?

A

abx:
macrolides, fluoroquinolones, tetracyclines

92
Q

Give an example of a macrolide

A

clarithromycin, erythromycin, azithromycin

93
Q

Give an example of a fluoroquinolone

A

levofloxacin

94
Q

Give and example of a tetracycline

A

doxycycline

95
Q

How is fungal pneumonia (pneumocystis jiroveci) treated?

A

co-trimoxazole (trimethoprim/sulfamethoxazole)

96
Q

what investigations would be done for pneumonia?

A

chest x ray
bloods - WCC/CRP
U&Es

97
Q

What would be seen on chest x ray in penumonia?

A

consolidation

98
Q

What would bloods show in penumonia?

A

high WCC/CRP (WCC more quickly reactive to infection) - immuncompromised may not show raised WCC
raised urea

99
Q

What is the treatment for mild pneumonia?

A

amoxicillin or macrolide for 5 days

100
Q

What is the treatment for moderate pneumonia?

A

amoxicillin+macrolide for 7-10 days

101
Q

what are some of the complications of pneumonia?

A

sepsis, pleural effusion, empyema, death

102
Q

What are the most common causes of viral pharyngitis?

A

adenovirus, rhinovirus, EBV

103
Q

What are the most common causes of bacterial pharyngitis?

A

streptococcus pyogenes (strep A), H. influenzae

104
Q

What scores can be used to assess the likelihood of bacterial infection in tonsillitis?

A

Centor clinical prediction score
Fever pain score

105
Q

What are the criteria of the fever pain score?

A

fever in last 24hrs
purulence
attended within 3 days of onset
inflamed tonsils
no cough or coryza

106
Q

What investigation can you do for suspected bacterial tonsillitis?

A

rapid group A streptococcal (GAS) antigen test

107
Q

What are some of the differential diagnoses for tonsillitis?

A

glandular fever, epiglottitis

108
Q

What is the 1st line treatment for probable bacterial tonsillitis?

A

phenoxymethylpenicillin

109
Q

What is used in tonsillitis in patients with a penicillin allergy?

A

clarithromycin

110
Q

What are the 4 sets of paranasal sinuses?

A

frontal, maxillary, ethmoidal, sphenoid

111
Q

What are the presentations of sinusitis?

A

nasal congestion/discharge
facial pain/pressure/swelling
loss of smell

112
Q

What investigations may be done for sinusitis?

A

nasal endoscopy
CT scan

113
Q

When should sinusitis be treated with medication?

A

if there is no improvement within 10 days

114
Q

What is the first line treatment for sinusitis?

A

steroid nasal spray (mometasone)
delayed phenoxymethylpenicillin if not improving after 7 days

115
Q

What are the most common types of non-small cell lung cancer?

A

adenocarcinoma (non-smokers)
squamous cell (smokers)
large cell

116
Q

what are the symptoms of local lung cancer?

A

cough
SOB
haemoptysis
clubbing
weight loss
recurrent pneumonia

117
Q

what is the first line investigation for lung cancer?

A

chest X-ray

118
Q

What would be seen on a chest X ray in lung cancer?

A

hilar enlargement
peripheral opacity
pleural effusion
collapse

119
Q

How can you take a biopsy of lung cancer?

A

bronchoscopy or through the skin

120
Q

What imaging methods can be used to stage lung cancer?

A

staging Ct
PET-CT

121
Q

What is the first line treatment for non-small cell lung cancer?

A

surgery- lobectomy/segmentectomy

122
Q

How is small cell lung cancer treated?

A

chemo/radiotherapy

123
Q

What procedure may be done in palliative care for lung cancer?

A

endobronchial treatment - stent/debulking to relieve symptoms

124
Q

What are some of the extrapulmonary manifestations of lung cancer?

A

phrenic/recurrent laryngeal nerve palsy
SVC obstruction
Horners syndrome
SIADH
Cushings
hypercalcaemia
limbic encephalitis
lambert-eaton myasthenic syndrome

125
Q

What is the presentation of a recurrent laryngeal nerve palsy?

A

hoarse voice

126
Q

What does phrenic nerve palsy lead to?

A

SOB

127
Q

How does SVC obstruction show?

A

facial swelling, distended veins
Pemberton’s sign

128
Q

How does Horners syndrome present?

A

Tumour presses on the sympathetic ganglion causing ptosis, anhidrosis and miosis

129
Q

How does SIADH present?

A

hyponatraemia

130
Q

How does limbic encephalitis present?

A

short term memory loss, hallucinations, confusions (anti-Hu antibodies against limbic system)

131
Q

What is mesothelioma strongly linked to?

A

asbestos - large latent period (45 yrs)

132
Q

what is the protein content of an exudative pleural effusion?

A

> 3g/L

133
Q

What is the protein content of a transudative pleural effusion?

A

<3g/L

134
Q

What are the causes of an exudative pleural effusion?

A

inflammation causing protein leakage
- lung cancer
- pneumonia
- RA
- TB

135
Q

What are the causes of a transudative pleural effusion?

A

congestive HF
hypoalbuminaemia
hypothyroid
Meig’s syndrome

136
Q

What are the typical presentations of a pleural effusion?

A

SOB, dullness to percussion, reduced breath sounds, tracheal deviation

137
Q

What are the finding in chest X-ray of a pleural effusion?

A

blunting of costophrenic angle
fluid in fissures
meiscus in larger effusions
tracheal/mediastinal deviation

138
Q

What is the main treatment for pleural effusions?

A

conservative management (small effusions may resolve on their own)
pleural aspiration
chest drain

139
Q

What is empyema?

A

infection of a pleural effusion

140
Q

what characteristics would the pleural fluid have in empyema?

A

pus
pH<7.2
low glucose
high lactate dehydrogenase

141
Q

What is the usual cause of a PE?

A

a DVT that travels to the pulmonary arteries

142
Q

What are the risk factors for VTE?

A

immobility, long haul flights, surgery, pregnancy, HRT with oestrogen, SLE, malignancy

143
Q

What is the presentations of a PE?

A

SOB, cough, pleuritic chest pain, hypoxia, tachycardia/pnoea, low grad fever

144
Q

What score is used to determine the chance of a VTE in a symptomatic patient?

A

Wells score

145
Q

What should be done if theres a Wells score of more than 4 points (PE likely)

A

CT pulmonary angiogram
interim coag if not immediate

146
Q

What should be done in Wells score less than 4?

A

D-dimer - if positive, arrange CTPA

147
Q

Why might a CTPA be contraindicated?

A

renal impairment, contrast allergy

148
Q

What alternative investigation can be done for PE?

A

ventilation/perfusion (VQ) scan

149
Q

How might a PE effect blood pH?

A

alkalosis + low pO2

150
Q

what is the first line management of a PE?

A

DOAC

151
Q

What is the second line management of a PE or if DOAC contraindicated?

A

LMWH - if pregnant/antiphospholipid syndrome

152
Q

What is the ideal INR range for warfarin?

A

2-3s

153
Q

How long should VTE prophylaxis be continued if the cause of PE is unclear?

A

beyond 3 months (6)

154
Q

What treatment is used for massive PEs?

A

thrombolysis

155
Q

What medications can be used for thrombolysis?

A

streptokinase, alteplase, teneclepase

156
Q

How should thrombolysis drugs be administered?

A

IV - peripheral cannula
catheter directed

157
Q

what is the criteria for a moderate acute exacerbation of asthma?

A

PEFR 50-75% predicted

158
Q

what is the criteria for a severe acute exacerbation of asthma?

A

PEFR 33-50%
RR >25
HR >110
unable to complete sentenced

159
Q

what is the criteria for life threatening acute exacerbation of asthma?

A

PEFR <33%
sats <92%
getting tired
no wheeze
shock

160
Q

What is the treatment for a moderate exacerbation of asthma?

A

nebulised salbutamol
nebulised ipratropium bromide
oral prednisolone/IV hydrocortisone
abx

161
Q

What is the treatment for a severe exacerbation of asthma?

A

oxygen
aminophylline
consider IV salbutamol

162
Q

What is the treatment for a life threatening exacerbation of asthma?

A

IV magnesium sulphate
ICU admission
intubation

163
Q

What is interstitial lung disease?

A

umbrella term to describe conditions causing inflammation and fibrosis of the lung parenchyma

164
Q

How are interstitial lung diseases diagnosed?

A

high resolution CT - ground glass appearance
biopsy when unertain

165
Q

How does idiopathic pulmonary fibrosis present?

A

bibasal fine crackles and clubbing

166
Q

What two medications can slow the progression of idiopathic pulmonary fibrosis?

A

pirfenidone (antifibrotic/inflammatory)
nintedanib (monoclonal antibody targeting tyrosine kinase)

167
Q

What drugs can cause pulmonary fibrosis?

A

amiodarone
cyclophosphamide
methotrexate
nitrofurantoin

168
Q

what conditions can cause secondary pulmonary fibrosis?

A

alpha-1-antitripsin deficiency
RA
SLE
systemic sclerosis

169
Q

what type of hypersensitivity is hypersensitivity pneumotitis?

A

type 3

170
Q

How does cryptogenic organising pneumonia present?

A

similar to pneumonia: SOB, cough, fever

171
Q

How is cryptogenic organising pneumonia treated?

A

corticosteroids

172
Q

What are the properties of asbestos?

A

fibrogenic + oncogenic

173
Q

What are the group 1 causes of pulmonary hypertension (PH)

A

primary PH and connective tissue disorders such as SLE

174
Q

What are the group 2 causes of pulmonary hypertension?

A

left sided heart failure due to MI or hypertension

175
Q

What are the group 3 causes of PH?

A

chronic lung disease like COPD

176
Q

What are the group 4 causes of PH?

A

pulmonary vascular disease e.g. PE

177
Q

What are the group 5 causes of PH?

A

misc
sarcoidosis, glycogen storage disease, haem disorders

178
Q

What are the main symptoms of pulmonary hypertension?

A

SOB
syncope
tachycardia
raised jVP
hepatomegaly
oedema

179
Q

What would en ECG show in pulmonary hypertension?

A

RV hypertrophy - large R waves (V1-3)
large S waves on left sided leads (V4-6)
right axis deviation
RBBB

180
Q

What would be seen on chest X-ray in pulmonary hypertension?

A

dilated pulmonary arteries
RV hypertrophy

181
Q

What other tests might be abnormal in pulmonary hypertension?

A

raised NT-proBNP
raised pulmonary artery pressure in echo

182
Q

what are the medical treatments for primary pulmonary hypertension?

A

IV prostanoids (epoprostanol)
endothelin receptor antagonists (macitentan)
phosphodiesterase-5 inhibitors (sildenafil)

183
Q

What is sarcoidosis?

A

granulomatous inflammatory condition

184
Q

What is the typical presentation of a patient with sarcoidosis?

A

black woman 20-40yrs old with SOB and cough and erythema nodosum

185
Q

What is the triad of symptoms associated with Lofgrens syndrome?

A

erythema nodosum
bilateral hilar lymphadenopathy
polyarthralgia

186
Q

What would blood tests show in sarcoidosis?

A

raised ACE, calcium, soluble interleukin-2 inhibitor, CRP and immunoglobulins

187
Q

What would be seen on CT or X ray in sarcoidosis?

A

hilar lymphadenopathy

188
Q

What is the gold standard test for sarcoidosis?

A

bronchoscopy + biopsy
non-caseating granulomas with epithelioid cells

189
Q

What is the first line treatment for sarcoidosis?

A

steroids 6-24m) + bisphosphonates

190
Q

What can severe cases of sleep apnoea cause or increase the risk of?

A

cause hypertension/heart failure
increase risk of MI/stroke

191
Q

What scale can be used to assess symptoms of apnoea?

A

Epworth sleepiness scale

192
Q

What is the management of obstructive sleep apnoea?

A

lifestyle mods
continuous positive airway pressure (CPAP)
surgery

medicine phase 2 a (10 decks)

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