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Resp Flashcards

1
Q

Management of primary and secondary pneumothorax

A

(a) <2cm and no SOB - aspirate
(b) >50 years old and >2cm or SOB - chest drain
(c) <1cm - give oxygen, admit for 24hrs, likely discharge

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2
Q

Management of persistent/recurrent pneumothorax

A

Video-assisted thoracoscopic surgery (VATS) for mechanical/chemical pleurodesis +/- bullectomy

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3
Q

Discharge advice re: pneumothorax:

A
  1. Stop smoking
  2. Flying - absolute contraindication. CAA suggest can travel 2 weeks after successful drainage if no residual air. BTS state can travel 1-week post - CXR
  3. Avoid scuba diving unless bilateral surgical pleurectomy, normal lung function and CT chest
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4
Q

Causes of pleural effusion
(a) transudate
(b) exudate

A

(a) transudate - ALL THE FAILURES - heart failure, liver failure (cirrhosis), renal failure i.e. nephrotic syndrome, pulmonary embolism
(b) exudate - CANCER AND INFECTION - pneumonia, cancer, TB, viral infection, pulmonary embolism, autoimmune

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5
Q

Light’s crtieria for pleural effusion:
(a) pleural serum protein
(b) pleural serum LDH
(c) pleural fluid LDH

A

(a) pleural serum protein - exudate >0.5m transudate <0.5
(b) pleural serum LDH - exudate >0.6, transudate <0.6
(c) pleural fluid LDH - exudate >2/3 ULN, transudate <2/3 ULN

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6
Q

Lyme disease is caused by what pathogen

A

Borrelia burgdorferi

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7
Q

What rash is seen with Lyme disease

A

erythema migrans

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8
Q

What is the first-line test for Lyme disease?

A

ELISA antibodies to Borrelia burgdorferi

  • if negative and Lyne disease is still suspected in people tested within 4 weeks from symptoms onset, repeat the ELISA 4-6 weeks after the first ELISA test
  • if STILL suspected in people who have had symptoms for 12 weeks or more, or the ELISA test is positive, then an immunoblot test should be done
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9
Q

What is the management of Lyme disease

A
  1. Doxycycline
    - amoxicillin if pregnant
  2. Ceftriaxone if disseminated disease
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10
Q

What is Jarisch-Herxheimer reaction

A

Sometimes seen after initiating antibiotic therapy for Lyme disease: fever, rash, tachycardia after first dose of antibiotic (more commonly seen in syphilis, another spirochaetal disease)

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11
Q

COPD - still breathless despite using SABA/SAMA and asthma/steroid responsive features, what do you add next

A

Add both LABA and ICS

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12
Q

Treatment of Legionella

A

Erythromycin/clarithromycin

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13
Q

Drugs in syringe driver NaCl (not water for injection)

A

Grani(setron)
Ketamine
Ocreotide
Ketorolac
Ondansetron

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14
Q

Most common 3 bacterial pathogens causing COPD exacerbations

A
  1. Haemophilus influenzae - most common
  2. Strep pneumoniae
  3. Moraxella catarrhalis
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15
Q

NICE recommend giving antibiotics for COPD patients only if what

A

If sputum is purulent or there are clinical signs of pneumonia

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16
Q

NIV tends to be used for patients with COPD with T2RF. What pH is expected with them as they will have respiratory acidosis

A

pH 7.25-7.35

n.b. the more acidotic - likely will need HDU.

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17
Q

BiPAP settings initially for COPD
(a) Expiratory positive airway pressure - EPAP
(b) Inspiratory positive airway pressure - IPAP

A

(a) EPAP: 4-5cm H2O
(b) IPAP: 10-15 H2O

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18
Q

Smoking cessation 3 options are

A

Nicotine replacement therapy (NRT)
Vernicline
Bupropion

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19
Q

Varenicline is a nicotinic receptor partial agonist. It should be used in caution/ contraindicated in which patients

A

Depression/self-harm
Pregnancy
Breast feeding

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20
Q

Mechanism of action of bupropion for smoking cessation

A

Norepinephrine and DA reuptake inhibitor
Nicotinic antagonist

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21
Q

Bupropion is a norepinephrine and DA reuptake inhibitor and nicotinic antagonist. It is contraindicated in which patients?

A

Epilepsy
Pregnancy
Breast feeding

(+ eating disorder)

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22
Q

Mechanism of action of varenicline for smoking cessation

A

Nicotinic receptor partial agonist

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23
Q

Pregnant women who smoke - tested with carbon monoxide detectors, what is the level for referral

A

7ppm or above

Referral to NHS stop smoking

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24
Q

Management of smoking in pregnancy if CO reading >7ppm and referred to NHS stop smoking

A
  1. CBT
  2. Motivational interviewing
  3. Structured self-help
  4. Can consider NRT and remove patches before sleeping

VARENICLINE AND BUPROPION ARE CONTRAINDICATED

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25
Q

COPD patients receiving LTOT should breathe the extra oxygen for at least how many hours per day

A

15 HOURS

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26
Q

LTOT indications

A

Two readings of ABG pO2 of <7.3;

OR 7.3-8 and one of:
- secondary polycthaemia
- peripheral oedema
- pulmonary HTN

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27
Q

COPD management stepwise approach

A
  1. SABA/SAMA
  2. SABA + LABA + LAMA (if no asthma signs)
  3. Or SABA/SAMA + LABA + ICS (if asthma signs)
  4. SABA + LABA + LAMA + ICS
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28
Q

What are the vaccinations for COPD

A

Annual influenza vaccination
One-off pneumococcal vaccination

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29
Q

Who is pulmonary rehabilitation in COPD for

A

all people who view themselves as functionally disabled by COPD (usually Medical Research Council [MRC] grade 3 and above

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30
Q

Azithromycin can be used as prophylaxis in some COPD patients.
What tests need to be done for it

A

LFTs
ECG - can prolong QT interval

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31
Q

First line antibiotics for acute bronchitis (i.e. if systemically unwell, delayed Rx if CRP 20-100 or Rx now if CRP >100)

A

Doxycycline

(or amoxicillin for children and pregnant women)

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32
Q

Prednisolone dose for asthma vs COPD exacerbations

A

COPD = 30mg for 5 days
Asthma = 40mg for 5 days

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33
Q

Length of illness:
Acute otitis media

A

4 days

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34
Q

Length of illness:
Acute sore throat

A

1 week

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35
Q

Length of illness:
Common cold

A

1.5 weeks

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36
Q

Length of illness:
Acute rhinosinusitis

A

2.5 weeks

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37
Q

Length of illness:
Acute cough/bronchitis

A

3 weeks

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38
Q

What blood cell is raised in lung cancer

A

Raised platelets

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39
Q

What type of lung cancer is PET scan useful in

A

Non-small cell lung cancer

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40
Q

What type of lung condition has

FEV1/FVC <70%

A

Obstructive

e.g. COPD
CANNOT GET THE AIR OUT!

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41
Q

What type of lung condition has

FEV1/FVC >70%

A

Restrictive

e.g. GBS
CANNOT GET THE AIR IN

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42
Q

Obstructive lung disease i.e. COPD, asthma has FEV1/FVC <70%.

How much does this improve by at least (%) in reversibility asthma bronchodilator testing?

A

12% in FEV1

(and increase in 200ml or more volume)

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43
Q

Moderate asthma:
(a) PEFR
(b) Speech
(c) RR/sats
(d) HR

A

(a) PEFR >50% best
(b) Speech normal
(c) RR <25
(d) HR <110

this is treated with 10puffs salbutamol + prednisolone 40mg 5 days

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44
Q

Severe asthma:
(a) PEFR
(b) Speech
(c) RR/sats
(d) HR

A

(a) PEFR 33-50% best
(b) Speech - can’t complete sentences
(c) RR >25
(d) HR >110

45
Q

Life-threatening asthma:
(a) PEFR
(b) Speech
(c) RR/sats
(d) HR

A

(a) PEFR <33% best
(b) Exhaustion - none
(c) Sats <92%, silent chest
(d) Bradycardia

46
Q

Mid-diastolic murmur

What valve condition

A

Mitral stenosis

SOB
Atrial fibrillation
Malar flush

47
Q

Granulomatosis with polyangiitis (Wegner’s) cANA +ve affects which organs

A

ENT
Renal - glomerulonephritis

+ saddle shaped nose deformity

48
Q

Antibodies in Goodpastures disease

49
Q

patients who have frequent exacerbations of COPD should be given a home supply of …?

A

prednisolone and antibiotics

50
Q

Asthma inhaler stepwise guidelines

A
  1. SABA
  2. SABA + low dose ICS
  3. SABA + low dose ICS + LTRA
  4. SABA + low dose ICS + LABA
  5. SABA + LTRA + low dose MART
  6. SABA + LTRA + medium dose MART
  7. SABA + LTRA + high dose MART or theophylline /seek advice
51
Q

Maintenance and reliever therapy (MART) is inhaler of which two inhalers combined

A

ICS and LABA combined

52
Q

the median survival from the time of diagnosis of idiopathic pulmonary fibrosis

53
Q

COPD - reason for using inhaled corticosteroids

A

reduced frequency of exacerbations

54
Q

what medication can be used to prevent acute mountain sickness

A

Acetazolamide

causes primary metabolic acidosis, and compensatory respiratory alkalosis so increases resp rate + oxygenation!

55
Q

high altitude cerebral oedema management

A

dexamethasone

56
Q

high altitude pulmonary oedema management

A

nifedipine
dexamethasone
acetazolamide
phosphodiesterase type V inhibitors

+ oxygen

57
Q

respiratory causes of clubbing

A

lung cancer
tuberculosis
asbestosis
mesothelioma
fibrosing alveolitis
pyogenic causes: CF, abscess, bronchiectasis, empyema

58
Q

polycythaemia i.e. in COPD does what to the concentration of haemocrit

59
Q

What marker is most useful for monitoring the progression of patients with chronic obstructive pulmonary disease?

A

FEV1

% will reduce with severity

60
Q

what is the minimum number of salbutamol prescriptions in the past 12 months that should prompt an urgent review of a patient’s asthma control?

61
Q

what ABG result is seen with those who have obstructive sleep apnoea

A

compensated respiratory acidosis

62
Q

what is the most important management for long term symptom control in non-CF bronchiectasis

A

inspiratory muscle training + postural drainage

63
Q

Most common 4 organisms isolated from patients with bronchiectasis

A
  1. Haemophilus influenzae (most common)
  2. Pseudomonas
  3. Klebsiella
  4. Strep pneumoniae
64
Q

Following the 2014 National Review of Asthma Deaths, what number of courses of oral or intravenous steroids in the past 12 months should prompt referral to secondary care for optimisation of asthma treatment?

A

more than 2

65
Q

recommended doses for adrenaline for anaphylaxis for:
< 6months

A

100 - 150 micrograms (0.1 - 0.15 ml 1 in 1,000)

66
Q

recommended doses for adrenaline for anaphylaxis for:
6 months - 6 years

A

150 micrograms (0.15 ml 1 in 1,000)

67
Q

recommended doses for adrenaline for anaphylaxis for:
6-12 years

A

300 micrograms (0.3ml 1 in 1,000)

68
Q

recommended doses for adrenaline for anaphylaxis for:
Adult and child > 12 years

A

500 micrograms (0.5ml 1 in 1,000)

69
Q

how often can adrenaline for anaphylaxis be repeated

A

every 5 mins if needed

70
Q

best site for IM injection of adrenaline in anaphylaxis

A

anterolateral aspect of the middle third of the thigh

71
Q

what blood test can be done to assess if true episode of anaphylaxis happened

A

serum tryptase

elevated for 12 hours after

72
Q

patients with new diagnosis of anaphylaxis should be referred to a specialist allergy clinic. how many injectors should they be prescribed?

A

2 adrenaline auto-injectors

73
Q

Anaphylaxis patients can be discharged after 2 hours of symptom resolution i.e. fast track discharge if …

A
  • One dose of IM adrenaline
  • Given adrenaline auto-injector and trained
  • Supervision on discharge
74
Q

Anaphylaxis patients can be discharged after 6 hours if …

A
  • Two doses of IM adrenaline; OR
  • Previous biphasic reaction
75
Q

Anaphylaxis patients can only be discharged after 12 hours (i.e. not fast track 2 or 6 hour discharge) if…

A
  • MORE than 2 doses of IM adrenaline
  • Severe asthma
  • Ongoing reaction e.g. slow-release meds
  • Late at night/difficult to access A&E
76
Q

Oral allergy syndrome, also known as pollen-food allergy is what type of hypersensitivity reaction

A

IgE mediated

77
Q

The most common triggers for anaphylactic reactions in children is

78
Q

What is the most suitable first-line test to investigate possible food and pollen allergy?

A

Skin prick test

cheaper than RAST IgE

79
Q

People who’ve had a systemic reaction to an insect bite should be managed by…

A

refer to allergy specialist

80
Q

Skin prick testing can be read after

A

15-20 mins

81
Q

Skin patch testing can be read after

A

48 hours after patch removal

82
Q

Patients with COPD may have some asthmatic/steroid responsive features. What are 4 of these features?

A
  • previous diagnosis of asthma or atopy
  • high eosinophil count
  • variation in FEV1 (at least 400ml)
  • variation in diurnal PEFR (at least 20%)
83
Q

cor pulmonale 4 features

A

peripheral oedema
raised JVP
systolic parasternal heave
loud P2

84
Q

Cor pulmonale management

A

Loop diuretic for oedema
Consider LTOT
NICE does not recommend any ACE inhibitors, CCBs, a-blockers

85
Q

What diagnostic testing should be done for asthma in patients >17 years

A

Spirometry with bronchodilator (BDR) test
FeNO test
Consider occupational asthma referral if at workplace

86
Q

What diagnostic testing should be done for asthma in patients aged 5-16 years

A

Spirometry with BDR

FeNO test should then be requested if there is normal spirometry or obstructive spirometry with negative BDR test

87
Q

What diagnostic testing should be done for asthma in patients aged <5 years

A

Base on clinical judgement

88
Q

FEV1 is defined as..

A

expired volume of air in one second

as this is timed (in 1sec), it is lower than FVC! normally the ratio will be 80%

89
Q

Severity of COPD is categorised using FEV1 (% of predicted) levels. What are the threshold levels?

A

> 80% - stage 1, mild
50-80% - stage 2, moderate
30-50% - stage 3, severe
<30% - stage 4, very severe

90
Q

When should nicotine replacement patches be removed for pregnant women

A

at night-time before bed!

91
Q

4 risk factors for obstructive sleep apnoea

A
  1. obesity
  2. macroglossia - acromegaly, hypothyroid, amyloidosis
  3. large tonsils
  4. Marfan’s syndrome
92
Q

what two scores can be used for assessment of sleepiness symptoms in obstructive sleep apnoea

A
  1. epworth sleepiness scale
  2. Stop bang questionnaire

NOTE SLEEP STUDIES (POLYSOMNOGRAPHY) IS FOR DIAGNOSIS

93
Q

what is a diagnostic test for obstructive sleep apnoea

A

sleep studies - polysomnography

94
Q

management of obstructive sleep apnoea and who to inform

A
  1. weight loss
  2. CPAP
  3. intra-oral devices if CPAP not tolerated or mild OSA
  4. inform DVLA if excessive daytime sleepiness
95
Q

inhaler technique

A
  1. put inhaler in mouth
  2. as you breathe in press down
  3. hold breath for 10secs
  4. for a second dose, wait approx 30secs before repeating
96
Q

management of idiopathic pulmonary fibrosis

A
  1. pulmonary rehbailitation
  2. pirfenidone - antifibrotic agent
  3. LTOT
  4. lung transplant
97
Q

what 2 treatments are not recommended in COPD patients if they continue to smoke

A

azithromycin
LTOT

98
Q

CURB-65 score criteria

A

Confusion (AMTS <8/10)
Urea >7
RR >30
BP <90/60
Age >65

0 = treatment at home
1-2 = consider hospital
3-4 = urgent admission

99
Q

As well as CURB-65 score, NICE also recommend CRP testing. What are the levels and recommendations?

A

CRP <20 - do not offer Abx
20-100 - delayed Abx prescription
>100 - prescribe Abx

100
Q

First line for low-severity CAP

A

Amoxicillin
5 days

101
Q

Management for moderate and high-severity CAP

A

Amoxicillin AND macrolide dual therapy
7-10 day course

102
Q

all cases of pneumonia should have a repeat CXR when

103
Q

for stepping down asthma treatment, BTS guidelines advise reducing dose of inhaled steroids by how much each time

104
Q

oxygen therapy for COPD patients in hospital - targets and what masks to use

A

initially target 88-92%
28% Venturi mask at 4L/min

adjust range to 94-98% if pCO2 normal

105
Q

What can be offered as PRN use to patients with end-stage chronic obstructive pulmonary disease (COPD) that is unresponsive to other medical treatment?

A

Short acting oral morphine PRN

106
Q

What is the most appropriate way to supply oxygen (LTOT) for COPD patients?

A

Oxygen concentrator supplied via Home Oxygen Order Form

107
Q

cardiac causes of clubbing

A
  • cyanotic congenital heart disease (Fallot’s, TGA)
  • bacterial endocarditis
  • atrial myxoma
108
Q

What is an appropriate diagnostic investigation for occupational asthma?

A

Serial peak flow measurements at work and at home

Refer to respiratory occupational specialist

109
Q

Parallel line shadows (often called tram-lines) on x-ray is typically seen in what disease

A

Bronchiectasis

Large amounts of purulent sputum

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