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Resp Flashcards

1
Q

Rx of ABPA

A

Oral presnisolone tapering off over 12 months

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2
Q

inhaler technique

A

take off cap and shake
sit up straight with chin tilted up
press button and breathe in for at least 10 seconds.
Hold breath for 10 seconds before exhaling

if using a steroid inhaler, wash mouth afterwards due to oral candidiasis risk

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3
Q

using a spacer and advice

A

seal and then breathe in and out deeply
clean with detergent once a month and air dry. don’t wipe as can causes static which causes med to stick

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4
Q

COPD rx - non pharm and pharm

A

offer pneumococcal and influenza vaccines
stop smoking support
give SABA or SAMA

If not improving and asthmatic features or steroid responsiveness - give LABA and ICS.

If not improving and no asthmatic features or steroid responsiveness - give LABA and LAMA

offer all if not working after this

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5
Q

what is COPD

A

emphysema (dilated alveoli) and chronic bronchitis

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6
Q

MRC dyspnoea scale

A

1 breathlessness on strenuous exercise
2 breathlessness when walking up a hill
3 breathlessness when walking on a flat
4 breathlessness <100m
5 can’t leave the house

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7
Q

FEV1:FVC ratio in copd

A

<0.7 (70%)

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8
Q

what is an example of a LABA, LAMA and ICS combined inhaler

A

Trimbow

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9
Q

when is LTOT offered in COPD

how long do you have to use it

A

Offer LTOT to patients with a pO2 of < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following:
secondary polycythaemia
peripheral oedema
pulmonary hypertension (cor pulmonale)

Only to pts who are NON SMOKERS and do not retain CO2

16hrs per day for survival benefit

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10
Q

rx of acute exacerbation of copd

A

a-e
o2 - 88-92
salbutamol and ipatropium nebs
oral pred 30mg
NIV if type 2 response failure
abx if ?infective

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11
Q

signs of IECOPD

A

change in sputum volume
change insputum colour
fever

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12
Q

what is the most common cause of cor pulmonale

A

copd

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13
Q

what is cor pulmonale

A

respiratory failures leading to right ventricular failure due to pulmonary htn

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14
Q

likely ABG on COPD exacerbation

A

type 2 rest failure with a respiratory acidosis

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15
Q

ix on acute exacerbation of copd and why

A

FBC - infective
ECG - arrythmias
CXR - infection
Sputum culture
Blood culture

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16
Q

o2 targets in copd

A

88-92 if a co2 retainer
if not retaining CO2, then 94-98

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17
Q

practical tips for stopping smoking

A

use e cigarettes or nicotine patches
nicotine gum

smoke free helpline
nhs website has a smoking support locator

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18
Q

differentials of a monophonic localised wheeze

A

foreign body, tumour o thick sticky mucus plug

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19
Q

asthma triggers

A

cold
exercise
infection
animals
allergies

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20
Q

what wheeze is heard in asthma

A

widespread polyphonic expiratory wheeze

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21
Q

drugs that can worsen asthma

A

beta blockers
NSAIDs

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22
Q

ix for Asthma

A

spirometry and reversibility testing
Fractional exhaled Nitric Oxide

if still not sure:
PEFR variation - more than 20%

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23
Q

BTS stepwise approach for Asthma in children

A

1 SABA
2 SABA and very low dose ICS
3 SABA and very low dose ICS and LTRA or LABA
4 increase to low dose ICS or add other of LTRA or LABA
5 specialist care required

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24
Q

additional rx of asthma

A

Individual written asthma self-management plan
Yearly flu jab
Yearly asthma review when stable inc inhaler technique
Regular exercise
Avoid smoking (including passive smoke)
Avoiding triggers where appropriate

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25
Q

signs of resp distress in a child

A

accessory muscles
cyanosis
tracheal tug and intercostal muscles

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26
Q

initial ABG on acute exacerbation of asthma
what would be concerning

A

respiratory alkalosis due to tachypnoea
a normal CO2 is a concerning sign as is respiratory acidosis

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27
Q

features of mild, moderate, severe, life threatening and near fatal asthma

A

Mild:
* No features of severe asthma
* PEFR >75%

Moderate:
* No features of severe asthma
* PEFR 50-75%

Severe (if any one of the following):
* PEFR 33 – 50% of best or predicted
* Cannot complete sentences in 1 breath
* Respiratory Rate > 25/min
* Heart Rate >110/min

Life threatening (if any one of the following):
* PEFR < 33% of best or predicted
* Sats <92% or ABG pO2 < 8kPa
* Cyanosis, poor respiratory effort, near or fully silent
chest
* Exhaustion, confusion, hypotension or arrhythmias
* Normal pCO2

Near Fatal:
* Raised pCO2

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28
Q

rx of acute asthma

A

NEB salbutamol 5mg
Oral prednisolone 40 mg stat

Neb ipatropium bromide 500 micrograms
Back to back salbutamol

If life threatening or near fatal:
IV aminophylline or IV salbutamol
ITU or anaesthetic assessment

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29
Q

Criteria for safe asthma discharge after exacerbation

A

PEFR >75%
inhaler technique review
Provide PEFR meter and written asthma action plan
* At least 5 days oral prednisolone
* GP follow up within 2 working days
* Respiratory Clinic follow up within 4 weeks
Stop regular nebulisers for 24 hours prior to
discharge

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30
Q

Characteristic examination signs in pneumonia

A

dull percussion
coarse crackles
bronchial breath sounds

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31
Q

CURB 65 score and what total means

A

confusion
Urea >7
RR >30
BP <90
age >65

0/1 - treat at home
>2 - admit
>3 consider ITU

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32
Q

top 2 bacterial causes of pneumonia
+ others

A

strep pneumoniae
haemophilus influenzae

moraxella caterhalis in immunocompromised pts
MSRA
pseudomonas aureginosis in CF and bronchiectasis

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33
Q

patient has recently had a cheap hotel holiday and presents with pneumonia symptoms and hyponatraemia. What is dx and why are they hyponatraemia

A

legionaries disease
can cause SIADH

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34
Q

pneumonia with target lesions. What is the offending organism

A

mycoplasma pneumonia. Can cause erythema multiform

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35
Q

rx of atypical pneumonia

A

macrolides, fluroquinilones or tetracyclines

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36
Q

Pneumonia complications

A

lung abscess
emphysema
sepsis
ARDS
pleural effusion
death

37
Q

exudative vs transudative causes of pleural effusions

A

exudative - pneumonia, tb, malignancy, rheumatoid
transudative - hf, liver cirrhosis, renal failure

38
Q

Lights criteria and when is it used

A

If pleural fluid protein level between 25 and 35 g/L (i.e. borderline) use Light’s criteria
– exudate if one or more of the following:
– Pleural fluid/Serum protein >0.5
– Pleural fluid/Serum LDH >0.6
– Pleural fluidLDH>2/3 of the upper limit of normal

39
Q

pleural effusion examination findings

A

dull percussion
Reduced breath sounds
Tracheal deviation away from the effusion in very large effusions

40
Q

CXR pleural effusion

A

blunting of costaphrenic angles with a meniscus
may have fluid in the fissures

41
Q

rx of pleural effusion

A

US guided pleural aspiration
Chest drain

42
Q

When to suspect empyema
Pleural aspiration results
Rx

A

a pt with pneumonia gets better but then develops a new onset of fever.
Pleural aspiration shows pus, low pH, low glucose and high LDH. Empyema is treated with a chest drain and antibiotics.

43
Q

Pulmonary oedema presentation

A

SOB
Pink frothy sputum
Tachypnoea
Raised JVP
Decreased O2 sats

44
Q

Examination of pulmonary oedema

A

reduced breath sounds
coarse crackles

45
Q

CXR pulmonary oedema

A

Bilateral peri-hilar shadowing - bat wing sign
Blunting of the costophrenic angles
Fluid in the fissures (e.g. right horizontal fissure)
Kerley B lines

46
Q

rx of pulmonary oedema

A

A-E
IV furosemide

47
Q

causes of bronchiectasis

A

pneumonia
TB
CF
Alpha 1 antitrypsin
Whooping cough

48
Q

presentation of bronchiectasis

A

chronic productive cough and SOB
recurrent chest infections

49
Q

signs of bronchiectasis on examination

A

Weight loss (cachexia)
Finger clubbing
Signs of cor pulmonale (e.g., raised JVP and peripheral oedema)
Scattered crackles throughout the chest that change or clear with coughing
Scattered wheezes and squeaks

50
Q

Gold standard for bronchiectasis

A

high resolution CT - signet ring sign

51
Q

CXR findings in bronchiectasis

A

tram track sign
ring shadows

52
Q

general rx of bronchiectasis

A

Vaccines (e.g., pneumococcal and influenza)
Respiratory physiotherapy to help clear sputum
Pulmonary rehabilitation
Long-term antibiotics (e.g., azithromycin) for frequent exacerbations (e.g., 3 or more per year)
Inhaled colistin for Pseudomonas aeruginosa colonisation
Long-acting bronchodilators may be considered for breathlessness
Long-term oxygen therapy in patients with reduced oxygen saturation
Surgical lung resection may be considered for specific areas of disease
Lung transplant

53
Q

rx of bronchiectasis exacerbations

A

sputum culture and abx - most often ciprofloxacin
abx for 7-14 days

54
Q

key features to remember for bronchiectasis

A

The key features to remember with bronchiectasis are finger clubbing, diagnosis by HRCT, Pseudomonas colonisation and extended courses of 7-14 days of antibiotics for exacerbations.

55
Q

rf for pneumothorax

A

young thin tall male
cannabis
COPD, asthma, pneumonia
Iatrogenic - lung biopsy, mechanical ventilation or central line insertion

56
Q

RX of simple pneumothorax and landmarks

A

chest drain in the safety triangle (5th intercostal space mid axillary line and
Anterior axillary line)
insert above rib to avoid neuromuscular bundle

57
Q

how to know if chest drain is successful in pneumothorax

A

swinging - water in drain rises and fall as pt breathes
repeat cxr shows reduction in size

58
Q

2 key complications of chest drains

A

surgical emphysema
air leaks

59
Q

rx of pneumothorax that is resistant to treatment

A

abrasive or chemical pleurodesis

60
Q

rx of tension pneumothorax

A

Insert a large bore cannula into the second intercostal space in the midclavicular line.

Then chest drain

61
Q

examination findings of ILD

A

fine inspiratory crackles
clubbing

62
Q

most common type of ILD

A

idiopathic

63
Q

drug causes of ILD

A

amiodarone
bleomycin
nitrofurantoin
penicillamine
methotrexate

64
Q

spirometry result in ILD

A

restrictive - >0.7 (70%)

65
Q

general rx of ILD

A

Remove or treat the underlying cause
Home oxygen where there is hypoxia
Stop smoking
Physiotherapy and pulmonary rehabilitation
Pneumococcal and flu vaccine
Advanced care planning and palliative care where appropriate

66
Q

inflammatory causes of ILD

A

Alpha-1 antitrypsin deficiency
Rheumatoid arthritis
Systemic lupus erythematosus (SLE)
Systemic sclerosis
Sarcoidosis

67
Q

presentation of TB

A

chronic cough, night sweats, haemoptysis
lymphadenopathy
erythema nodosum

68
Q

RF for TB

A

Close contact with active tuberculosis (e.g., a household member)
Immigrants from areas with high tuberculosis prevalence
People with relatives or close contacts from countries with a high rate of TB
Immunocompromised (e.g., HIV or immunosuppressant medications)
Malnutrition, homelessness, drug users, smokers and alcoholics

69
Q

TB CXR findings - primary, reactivated and disseminated military

A

Primary tuberculosis may show patchy consolidation, pleural effusions and hilar lymphadenopathy.

Reactivated tuberculosis may show patchy or nodular consolidation with cavitation (gas-filled spaces), typically in the upper zones.

Disseminated miliary tuberculosis gives an appearance of millet seeds uniformly distributed across the lung fields.

70
Q

IX for TB

A

sputum cultures
blood cultures
CXR
Mantoux

71
Q

Rx of TB

A

RIPE for 2 months then RI + pyridoxine for 4 months

Testing for other infectious diseases (e.g., HIV, hepatitis B and hepatitis C)
Testing contacts for tuberculosis
Notifying UK Health Security Agency (UKHSA) of suspected cases
Negative pressure side room, Isolating patients with active tuberculosis to prevent spread (usually for at least 2 weeks of treatment)

72
Q

Side effects of TB drugs

A

Rifampicin - hepatitis, red/orange urine
Isoniazid - hepatitis, peripheral neuropathy
Pyrazinamide - hyperuricaemia (gout and kidney stones), hepatitis
Ethambutol - retrobulbular neuritis. Check visual acuity before treatment

73
Q

ABG in Pe

A

resp alkalosis

74
Q

PE rx if stable

A

apixaban or rivaroxaban
if CrCl <15 give LMWH

75
Q

PE rx if unstable eg massive PE

A

Consultant decision
- continuous infusion of unfractionated heparin and systemic thrombolysis

76
Q

first line long term anti coat option for pts with anti phospholipid syndrome who have had PE

A

warfarin

77
Q

First line long term preventative anti coag in pregnant lady who has had a PE

A

LMWH

78
Q

Causes of a raised D dimer

A

PE
pregnancy
HF
malignancy
surgery

79
Q

Wells score

A

Clinical signs and symptoms of DVT (minimum of leg swelling and pain with palpation of the deep veins) 3
An alternative diagnosis is less likely than PE 3
Heart rate more than 100 beats per minute 1.5
Immobilisation for more than 3 days or surgery in previous 4 weeks 1.5
Previous DVT/PE 1.5
Haemoptysis 1
Malignancy (on treatment, treated in the last 6 months, or palliative)

80
Q
A
81
Q

diagnostic test for osa

A

polysomnography

82
Q

complications of osa

A

htn
compensated resp acidosis
daytime somnolence

83
Q

rx of osa

A

weight loss
CPAP
DVLA if execcisive daytime sleepiness

84
Q

how does salbutamol work

A

stimulates B2 receptors in the lungs which causes relaxation of smooth muscle leading to bronchodilation

85
Q

ddx of asthma in children (think chronic cough)

A

viral induced wheeze
bronchiolitis
foreign body
CF
airway abnormalities

86
Q

insert chest drain above or below the rib?

A

above (5th intercostal space, mid axillary line)

87
Q

presentation of sarcoidosis acronym

A

General - fever, malaise, lymphadenopathy
Respiratory - 90% have dry cough, dyspnoea, chest pain, reduced lung function
Arthralgia
Neurological - Bells palsy, meningitis, SOL
Urinary - increased calcium - renal stones
Low hormones - pituitary - amenorrhoea
Opthalmological - uveitis, sjrogens
Myocardial - restrictive cardiomyopathy secondary to granulomas, pericardial effusion
Abdominal - splenomegaly and hepatomegaly

88
Q

ddx to consider for pneumothorax in a cold pt

A

large emphysematous bullae

89
Q
A

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