Resp Flashcards
When stepping down asthma treatment what should you do?
Reduce the ICS by 25-50%
What are the common features of a lung abscess presentation?
Symptoms develop over weeks, systemic symptoms, productive cough with foul-smelling sputum, some haemoptysis, chest pain, dyspnoea
What are the X-Ray signs of a lung abscess?
fluid-filled space within an area of consolidation, air-fluid level
What is the management of a lung abscess?
IV Abx
percutaneous drainage if not resolving
What is FEV1?
The total volume of air someone is able to exhale in the first second of forced expiration
What is FVC?
The total volume of air that can be exhaled by the person in one breath
What is the FEV1/FVC ratio like in obstructive diseases?
Low (FEV1 is low but the total volume of air the lungs can hold is the same, they just have issues getting it out)
What is alpha-1-antitrypsin deficiency?
A genetic condition that classically causes emphysema
What are the causes of upper zone lung fibrosis?
CHARTS
- coal workers pneumoconiosis, hypersensitivity pneumonitis, ankylosing spondylitis, radiation, tuberculosis, silicosis/sarcoidosis
What is the most common type of lung cancer in non-smokers?
Adenocarcinoma
What are the most common types of lung cancer in smokers?
adenocarcinoma, small cell and squamous cell
Which type of lung cancer is associated with gynaecomastia?
Adenocarcinoma
Which type of lung cancer is most associated with finger clubbing?
squamous cell
What is a pancoast tumour?
A tumour at the apex of the lung
What are the features of a pancoast tumour?
Persistent hoarse voice, smoking history, malaise, weight loss
What score is used to decide if a PE can be managed in outpatients?
Pulmonary embolism severity index (PESI)
What is a common complication of steroid inhaler use?
Oral/oesophageal candidiasis (painful swallowing)
What is the management of extrinsic alveolitis?
e.g. farmers lung/pigeon fanciers lung
Avoid triggers,
oral glucocorticoids
What is the most common cause of resp infections in COPD patients?
Haem flu (most common), step pneumonia
What are the features of idiopathic pulmonary fibrosis?
- exertional dyspnoea
- bibasal fine end creps
- dry cough
- clubbing
- ground- glass
What X Ray finding is indicative of bronchiectasis?
tram-line - parallel line shadows
What is the PEFR gradings of asthma attacks?
<33% = life-threatening
33-50% = severe
50-70% = moderate
What does a pneumonectomy look like on an X-Ray?
White space where the lung is - fills with fluid after a while that is why it is white
What is the management of an acute exacerbation of COPD?
Oral prednisolone for 5 days
When do you give antibiotics in a COPD exacerbation?
When the sputum is purulent or there are clinical signs of pneumonia
What are the features of autoimmune hepatitis?
Jaundice, amenorrhoea, signs of chronic liver disease
What may be seen on bloods in autoimmune hepatitis?
Deranged lfts, raised WCC, raised IgG, ANA/SMA/LKMI antibodies
What is the management of autoimmune hepatitis?
Steroids, immunosuppressants - azathioprine, liver transplantation
What is good inhaler technique?
- shake
- breathe out gently
- breathe in slow and deep, press down and keep breathing in
- hold breath for 10 seconds
- wait 30 seconds before second dose
What is a common endocrine complication of small cell lung cancer?
SIADH
which conditions have a raised transfer coefficient?
asthma, pulmonary haemorrhage, left to right cardiac shunts, polycythaemia
Which conditions cause a lower transfer coefficient?
pulmonary fibrosis, pneumonia, pulmonary emboli, pulmonary oedema, emphysema, anaemia, low cardiac output
What are the features of a pneumothorax?
Sudden onset dyspnoea, chest pain, hyper-resonant on percussion, reduced
What is the criteria for discharging a patient following an acute asthma attack?
- stable on their discharge medication for 12-24hrs
- inhaler technique
- PEF > 75% of predicted
What is the most common organism in a COPD exacerbation?
haemophilus influenzae
What is the most common organism that causes a bronchiectasis exacerbation?
haemophilus influenzae
Which conditions cause upper zone fibrosis?
C - coal workers pneumoconiosis
H - hypersensitivity pneumonitis
A - ankylosing spondylitis
R - Radiation
T - tuberculosis
What is the fluid from if it is exudate? (fluid protein/serum protein ratio >0.5)
TB, lung cancer, meigs syndrome
What would cause a transudate pleural effusion?
non-resp causes like nephrotic syndrome, heart failure
What can you give in type 2 respiratory failure if medical interventions didn’t work?
BiPAP
Which chest signs on auscultation do you hear in pulmonary fibrosis?
fine end-inspiratory crepitations
What would you give in a viral COPD exacerbation?
5 day course of oral prednisolone
What condition has a ground glass appearance on CXR?
IPF
What type of lung cancer is associated with Cushing’s syndrome?
small cell lung cancer
What is the management of allergic aspergilliosis?
Oral prednisolone
What are the features of sarcoidosis?
erythema nodosum, bilateral hilar lymphadenopathy, fever, polyarthralgia, lupus pernio, cough, hypercalcaemia
What is the management of life-threatening asthma in those who do not respond to treatment?
intubation and ventilation
How do you calculate pack years?
1 pack year is 20 cigarettes per day for 1 year
Which anticoagulation is used for a PE?
apixaban or rivaroxaban
Which type of pneumonia is most associated with cold sores?
strep pneumoniae pneumonia (pneumococcus pneumoniae)
How do you diagnose legionella pneumonia?
urinary antigen
What is the definitive management to prevent recurrent pneumothoraxes?
video assisted thoracoscopy surgery pleurodesis
What are the features of Churg-Strauss syndrome (eosinophilic granulomatosis with polyangiitis)?
asthma, eosinophilia, sinusitis/nasal polyps, pANCA
When would you use a V/Q scan instead of a CTPA in a suspected PE?
If there is renal impairment - CTPA uses contrast
Which causative organism causes a pneumonia with cavitating lesions in the lower zone?
Staph aureus - also can be preceded by an influenza
Which causative organism is indicated in pneumonia in an alcoholic?
Klebsiella pneumonia
When adding a new type of inhaled drug do you add a new inhaler or start a combination?
Combi inhaler
What is the minimum size of a pneumothorax to insert a chest drain?
2cm
What is the first line management of COPD?
SABA or SAMA
What is the second line management of COPD?
not steroid responsive: add LAMA + LABA
steroid responsive: add LABA + ICS
What are the classic signs of pneumocystitis jiroveci?
HIV patients, dry cough, exercised-induced desaturation
What is the management of a tension pneumothorax?
Urgent decompression with a needle - can insert a chest drain later
What is the management of a PE?
Apixaban or rivaroxaban 1st line
If haemodynamically unstable: thrombolysis such as alteplase
LMWH if really severe renal failure
How is asthma diagnosed?
FEV1 increased more than 12% after bronchodilator or PEFR variability > 20%
What amount of protein in the pleural fluid if it is exudative?
> 30g/L - caused by cancers, infection, connective tissue disorders
What results would you see on spirometry for IPF?
FEV1:FVC > 70%, low FVC, reduced transfer coefficient
What is the first line investigation for adults with suspected asthma?
eosinophil count or fractional nitric oxide
What is the first line investigation for children with suspected asthma?
fractional nitric oxide
Which paraneoplastic features are associated with small cell lung cancer?
ADH, ACTH, Lambert Eaton
Which paraneoplastic features are common with squamous cell lung cancer?
PTH-related protein, hyperthyroid, osteoarthropathy
Which paraneoplastic features are common with adenocarcinoma?
Gynaecomastia, oestoarthropathy
Which lung conditions cause upper zone fibrosis?
CHARTS. Coal-workers pneumoconiosis, hypersensitivity pneumonitis, ankylosing spondylitis, radiation, TB, sarcoid/silicosis
What is the cause and management of pleural plaques?
Caused by asbestos exposure - are benign and do not require follow-up
What is the management of asbestosis?
conservative
What is the management of a mesothelioma?
Palliative chemotherapy
What is the difference in presentation between acute bronchitis and pneumonia?
Acute bronchitis - nothing on CXR, wheeze on auscultation
Pneumonia: focal chest signs (on auscultation)
What is the management of acute bronchitis?
If CRP < 20
CRP 20-100 - delayed abx
CRP > 100 - doxycycline (amox in pregnant women and kids)
What are the features of sarcoidosis?
erythema nodosum, hilar lymphadenopathy, swinging fever and polyarthralgia, hypercalcaemia, lupus pernio (rash over face)
In a COPD exacerbation what PhD would be considered for Invasive ventilation?
pH < 7.25 IV
pH 7.25-7.35 NIV
What are the chest X-Ray findings of silicosis?
upper zone fibrosis and egg shell calcification of hilar nodes
Which antibiotic can be given as prophylaxis for recurrent COPD exacerbations?
Azithromycin
How can you differentiate between a PE and fat-embolism syndrome?
Both have similar symptoms, fat embolism can cause confusion and neurological symptoms too. Often occurs 12-72hrs after traumatic fracture
What type of blood gas does hyperventilation show?
Respiratory alkalosis - blowing of CO2 makes it more alkaline. PaCO2 low, normal PaO2
What is the management of a primary or secondary pneumothorax with no alarming features?
Primary - Outpatient follow-up every 2-4 days
Secondary - conservative management with inpatient follow-up
What are the parts of a CURB-65 score?
Confusion (8)
Urea > 7
RR > 30
BP < 90/60
Age > 65
What is the management of asthma in adults?
1: ICS/formoterol combi reliever (AIR)
2. low dose MART (ICS/formoterol maintenance) - can start this first if bad symptoms like nocturnal awakening
3. medium dose MART
4. Add LAMA/LTRA
When do you offer long-term oxygen therapy in COPD?
If PaO2 is 7.3-8
AND has polycythaemia, oedema, or pulmonary hypertension
What pH level does it need to be to intubate in COPD?
< 7.26 - above that but below 7.35 give BiPAP
How do you diagnose sleep apnoea?
Polysomnography
What should the PaO2 of oxygen be?
10 less than the fraction of inspired oxygen
What is the difference in blood gases between type 2 acute and chronic resp failure?
Acute - bicarb usually normal as kidneys take hours or days to raise, and pH is low
Chronic - pH is normal due to metabolic compensation, Bicarb is high
Why do people with COPD get polycythaemia?
hypoxia increases EPO production which increases RBC production (raised haemoglobin and haematocrit)
In a pleural effusion which factors determine whether a chest drain should be placed?
cloudy fluid, pH < 7.2, organisms
How long after resolution of pneumonia should you have a CXR?
6 weeks
What are the specific features of a legionella infection?
bradycardia, confusion, lymphopaenia, hyponatraemia, deranged lfts
What type of NIV is used for sleep apnoea?
CPAP (BiPAP for COPD/asthma exacerbations)
What is the most common cause of CAP?
streptococcus pneumonia
Which vaccines should you get if you have COPD?
one off pneumococcal and yearly flu (if CKD or hyposplenism have pneumococcal every 5 years)
Which antibiotic can be given prophylactically in COPD?
azithromycin
What is Meig’s syndrome?
Benign ovarian tumour, ascites, pleural effusion
What is the diagnostic investigation in idiopathic pulmonary fibrosis?
Chest CT
What is the first line management of asthma in adults?
low dose ICS and formoterol (LABA) (as-needed AIR therapy) - and then second line change to maintenance
What is atelectasis?
Partial or complete collapse of a part of a lung due to fluid filling the alveolar space or deflation of the alveoli
Which drugs typically cause lung fibrosis?
Amiodarone and methotrexate
What is the first line antibiotic for a hospital acquired pneumonia?
Co-Amoxiclav
What is an exudative pleural effusions?
Excess fluid in the pleural space, due to capillary leakage. > 35g/L, usually due to infection or malignancy
What abx do you give in CAP?
0-1 = oral amoxicillin/clarith/doxy
2 = combi oral
3-5 = IV coamox and clarith
