Resp Flashcards

1
Q

What are the signs of pulmonary oedema?

A

A-E

alveolar oedema (bat wings)
Kelley B lines
Cardiomegaly
Diversion of blood to upper lobes (where the vessels in the upper zone are larger than in lower zone)
pleural Effusions

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2
Q

How to assess adequacy of a plain CXR?

A

RIPE

Rotation
Inspiration
Projection (AP or PA)
Exposure

OR

PRIM

Projection
Rotation
Inspiration
Markings

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3
Q

Assessment of a chest x ray

A

Airway
Breathing (lungs and pleura)
Cardiac (size and borders)
Diaphragm (incl. costophrenic angles)
Everything else (mediastinal contours, bones, soft tissues, tubes, valves, pacemakers and review areas)

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4
Q

CXR findgins of pectus excavatum

A

7-shaped ribs
missing right heart border
heart displaced to the left

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5
Q

What ix should patients with unexplained persistent cough have?

A

CXR

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6
Q

What can increase the reliability of the sweat test?

A

giving fludrocortisone before

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7
Q

Summarise the BTS asthma management ladder

A
  1. Inhaled SABA
  2. add ICS
  3. Add LABA
  4. consider increasing ICS dose and adding 4th drug (LTRA, SR theophylline, b2 agonist tablet)
  5. oral steroids and refer to specialist care
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8
Q

examination findings in PE

A

sinus tachycardia
tachypnoea
hypoxaemia
loud s2
elevated JVP
calf swelling/tenderness
haemoptysis

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9
Q

3 commonest causes of persistent cough with normal CXR

A

asthma (50%)
sinusitis with postnasal drip (25%)
GORD (20%)

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10
Q

Causes of hypoxaemia (PaO2 <8)

A
  1. hypoventilation
  2. V/Q mismatch (shunting vs deadspace)
  3. Diffusion impairment
  4. high altitude
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11
Q

genetic RF for PE

A

protein C & S deficiency
Factor V leiden
FH

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12
Q

Management of haemodinamically unstable with PE

A

LMWH
thrombolysis
thromectomyn
IV fluids
warfarin
NOAC

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13
Q

medication for thrombolysis

A

alteplase

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14
Q

Causes of pulmonary HTN

A

group 1: PAH (idiopathic, hereditary, drug/toxin, CTD)

group 2: PH secondary to LHF (raised capillary wedge pressure)

group 3: PH secondary to underlying lung disease and hypoxia

group 4: chronic thromboembolic pulmonary HTN

group 5: secondary to conditions with multifactorial mechanisms causing PH

(you don’t come across group 5 that much)

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15
Q

sx of pulmonary HTN

A

breathlessness on exertion
Lower leg swelling

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16
Q

signs on examination of pulm HTN

A

pan systolic murmur (tricuspid regurgitation)
central cyanosis
signs of connective tissue disease

17
Q

features of RHF

A

peripheral oedema
ascites
raised JVP

18
Q

Management of group 1 pulm HTN

A

pulmonary vasodilator therapy aimed at decreasing pulmonary vascular resistance

Calcium channel blockers: First-line pulmonary vasodilator therapy for patients with PAH and positive vasoreactivity testing

19
Q

Management of group 2 pulm HTN

A
20
Q

Management of group 3 pulm HTN

A
21
Q

Management of group 4 pulm HTN

A

anticoagulation

pulmonary endarterectomy

22
Q

Management of COPD and asthma exacerbation - where do you give more steroids?

A

asthma

due to very inflammatory nature

23
Q

what does inability to complete sentence indicate in asthma?

A

severe asthma attack

24
Q

Is NIV a treatment option for asthma exacerbations?

A

no

but it is for COPD

25
Q

Components of CURB 65

A

Confusion
Urea (>7 mmol/L urea)
RR > or = 30
BP (sys <90 or dia <or = 60)

> or = 65 age

26
Q

Management of CAP based on CURB65 and HAP

A

1: amoxicillin or tetracycline/macrolide if allergic

2: amoxicillin + macroldie

3 or more: beta lactase (Co-amox) + macrolide

HAP: abx covering pseudomonas e.g. tazosin

27
Q

which medications can cause pulmonary fibrosis?

A

methotrexate
chemotherapy
amiodarone
nitrofurantoin
biologics

28
Q

Initial management of infective exacerbation of COPD

A

oral prednisolone 30mg OD for 5/7
abx (co-amox/amoxicillin/clarithromycin)

29
Q

prevention of COPD exacerbation

A

stop smoking
flu and pneumococcal vaccines
mucolytic
pulm rehab
educatem safety net, rescue pack - steroids and abx
annual r/v (6 monthly if severe, <30% predicted)

review inhlaers and consider sustainability
-> discuss switching from MDI to DPI
correct disposal of inhalers, e.g. bring to pharmacy
recycle inhalers

30
Q

What is the acronym for causes of upper lobe fibrosis?

A

CHARTS

C - Coal worker’s pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis

31
Q

Does pneumonia predispose to a pneumothorax?

A

no

32
Q

Which of these conditions predispose to pneumothorax?
- lung fibrosis
- lung carcinoma
- liver biopsy
- pneumonia
- emphysema
- central line insertion
- asthma

A

all except pneumonia

33
Q

Features of moderate acute asthma

A
  • PEF >50-75% expected
  • worsening sx
  • no features of acute severe asthma
34
Q

Features of severe acute asthma

A
  • PEF 33-50% expected
  • RR 25 or above
  • HR 110 or above
  • unable to complete sentences in one breath
35
Q

Features of life-threatening acute asthma

A
  • PEF <33% expected
  • sats <92%
  • PaO2 < 8kPa
  • normal PaCO2 (4.6-6.0 kPa)
  • altered conscious state
  • exhaustion
  • arrythmia
  • hypotension
  • cyanosis
  • silent chest
  • poor respiratory effort
36
Q

Features of near fatal acute asthma

A

Raised PaCO2 and/or requiring mechanical ventilation with raised inflation pressures

37
Q
A