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RESP Flashcards

1
Q

2 points

Acute Asthma definition

2 parts

A
  • Worsening dyspnoea, wheeze and cough.
  • Not responding to salbutamol
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2
Q

4 points

Acute Asthma Moderate Criteria

A
  • PEFR 50-75%
  • RR < 25/min
  • HR < 110bpm
  • Speech Normal
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3
Q

Acute Asthma Severe Criteria

A
  • PEFR 30-50%
  • RR > 25/min
  • HR > 110bpm
  • Incomplete sentences
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4
Q

33 92 CHASE

Acute Asthma Life-threatening Criteria

A
  • PEFR < 33%
  • O2 < 92%
  • Silent chest, cyanosis, feeble resp effort
  • Bradycardia, dysrhythmia or hypotension
  • Exhaustion, confusion, coma

Normal pCO2 in asthma attack = EXHAUSTION = Life threatening

33 92 CHASE (Cyanosis, Hypotension, Arrthymia, Silent chest, Exhaustion)

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5
Q

In acute asthma when is an ABG and CXR recommended? (BTS)

A
  • ABG –> O2 sat < 92%
  • CXR –> life threat, suspected pneumothorax, failure to respond to tx
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6
Q

2 points

What is near fatal asthma?

A
  • Raised pCO2 and/or
  • Requiring mechanical ventilation with raised inflation pressures
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7
Q

Acute Asthma Admission Criteria

A
  • Life threatening,
  • Severe if failure to respond to inital tx
  • Pregnancy, previous near fatal, oral CCS user, px at night
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8
Q

O SHIT ME

6 steps of Acute asthma management

A
  1. Oxygen if hypoxic / NRB 15L if acutely unwell (94-98% target)
  2. Salbutamol Nebs (SABA)
  3. Hydrocortisone / CCS Prednisolone 40-50mg 5 days PO
  4. Ipatropium Bromide nebs (SAMA)
  5. Theophylline IV - senior
  6. MgSO4 - BTS mixed evidence base
  7. ECMO or Intubate + ventilation - in ITU
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9
Q

Where does Acute Bronchitis occur

A

Trachea and major bronchi

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10
Q

Typical px of Acute bronchitis

A
  • Cough +/- productive
  • Sore throat
  • Rhinorrhoea
  • +/- Low grade fever
  • CX EX normal +/- wheeze
  • Viral and Typically resolves in 3w but 25% ongoing cough
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11
Q

Ix and Mx Acute Bronchitis

A
  • Clinical dx
  • Analgesia, Fluids
  • +/- Abx Doxycyline if systemically unwell, co-morbidities, CRP > 100, CRP 20-100 delayed,
  • Amox in children and pregnant
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12
Q

C4-GAS

COPD Causes

A
  • Cadium
  • Coal
  • Cotton
  • Cement
  • Grains (cereal)
  • A1ATd
  • Smoking
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13
Q

What 4 Ix are done if COPD is suspected

A
  1. Post BD spirometry - FEV1:FVC < 70%
  2. CXR: Hyperinflation, bullae, flat hemodiaphragm, exclude lung ca
  3. FBC - exclude 2ndary polycythaemia
  4. BMI
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14
Q

Classification of COPD Severity

A
  1. Post BD FEV1/FVC < 0.7
  2. FEV1 of predicted…
    * >80% - mild sx for dx
    * 50-79% - moderate
    * 30-49% - severe
    * <30% - very severe
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15
Q

COPD Mx
Step up if ongoing SOB and exacerbations

A
  1. SABA or SAMA PRN
  2. NO ASTHMATIC FXTS (steroid responsive)
    SABA PRN - LABA + LAMA
  3. ASTHMATIC FXTS
    SABA or SAMA PRN - LABA + ICS
  4. SABA PRN - LABA + LAMA + ICS

NICE recommend combined inhalers

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16
Q

4 points

General COPD Mx

A
  1. Smoking cessation, NRT - Varenicline or buproprion
  2. Annual influenza
  3. One off pneumococcal
  4. Pulmonary rehab if functionally disabled by COPD
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17
Q

2 points

When is Oral Theophylline used in COPD Mx

A
  1. Intolerant to inhalers, have tried short and long acting BDs
  2. Reduce dose if macrolide or fluoroquinolone abx are co prescribed
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18
Q

4 points

What abx is prescribed prophylactically for select COPD pts

A
  • Azithromycin 250mg 3x pw
  • non smokers
  • optimized tx
  • ongoing exacerbations
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19
Q

4 points

What role to Phosphodiesterase-4 (PDE-4) inhibitors have in COPD mx and for which pts

A
  • Reduce exacerbation risk
  • Criteria -
    1. * severe copd,
    2. > 2 exacerbations in last 1yr,
    3. on triple therapy
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20
Q

What 4 criteria are classed as asthmatic features in COPD management pathway

A
  1. Previous asthma atopy dx
  2. Raised eosinophil count >= 300
  3. FEV1 Variation over time (< 400ml)
  4. Diurnal Variation in PEF (<20%)
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21
Q

GIVE AN EXAMPLE OF
1. SABA
2. LABA
3. SAMA
4. LAMA
5. LTRA

A
  1. Salbutamol - SABA
  2. Salmetarol - LABA
  3. Ipatropium - SAMA
  4. Tiotropium - LAMA
  5. Montelukast - LTRA
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22
Q

3 points

Improve survival in COPD

A
  1. Smoking cessation - TOP
  2. LTOT - if fit criteria
  3. Lung volume reduction surgery - select pts
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23
Q

3 points

Mx of cor pulmonale in COPD

including not recommended by NICE

A
  1. Loop diuretic for odema
  2. Consider long term O2 therapy
  3. ACEi CCB Alpha blockers are not recommended by NICE
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24
Q

3 points

Who and what at 2 organs does A1AT deficiency affect and how?

A

YOUNG NON SMOKERS
Lungs - panacinar emphysema esp lower lobes
Liver - cirrohsis , hepatocellular carcinoma - adults and cholestasis in children

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25
Q

5 points

What 5 lung diseases does Asbestos cause

A
  1. Pleural plaques - benign most common
  2. Pleural Thickening
  3. Asbestosis - severity = exposure length, lower lobe fibrosis
  4. Mesothelioma - malignant dz in pleura
  5. Lung cancer - most common, synergistic effect with smoking
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26
Q

6 points

Fxts of Asbestosis

include mx and latent period

A
  1. dyspnoea, reduced exercise tolerance
  2. clubbing
  3. B/L end inspiratory crackles
  4. LFTs restrictive pattern with reduced gas transfer
  5. Latent period 15-30yrs
  6. Conservative Mx
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27
Q

5 points

Pathogenesis of Mesothelioma

A
  1. Malignancy of mesothelial cells of pleura
  2. Mets to contralateral lung and peritoneum
  3. R lung > L lung
  4. Very limited exposure can cause dz
  5. Crocidolite (blue) asbestos most dangerous
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28
Q

6 points

Mesothelioma fxts

including latent period

A
  1. dyspnoea, weight loss, chest wall pain
  2. Clubbing
  3. Painless pleural effusion (30%)
  4. Pre - existing asbestosis in 20%
  5. Hx of asbestos exposure in 85-90%
  6. Latent period 30-40yrs
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29
Q

3 points

What sign on CXR would be suspicous for mesothelioma and what next Ix’s shoud be done

A
  1. Pleural effusion or Pleural thickening
  2. Do pleural CT
  3. Sample fluid if pleural effusion for MC&S, biochem, cytology
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30
Q

2 points

Criteria for suspected Lung cancer pathway referral 2ww

A
  1. CXR findings suggest Lung ca
  2. 40yrs + unexplained haemoptysis
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31
Q

2 points

When should a CXR (within 2w) to assess for lung ca be offered?

A

40yrs+ and 2 of (1 if smoker):
* Cough
* Fatigue
* SOB
* Chest pain
* Weight loss
* Appetite loss

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32
Q

2 points

When should a Urgent CXR (within 2w) be considered to assess for Lung cancer

A

40yrs+ and one of
* Persistent or recurrent chest infection
* Finger clubbing
* Supraclavicular LNA or persistent cervical LNA
* Thrombocytosis
* Chest signs consistent with lung cancer

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33
Q

8 points

Lung Cancer RFs

Bonus - what is not related

A
  1. Smoking x 10
  2. Asbestos x5
  3. Arsenic
  4. Radon
  5. Nicklel
  6. Chromate
  7. Aromatic Hydrocarbon
  8. Cryptogenic fibrosing alveolitis

Coal dust not related to lung cancer

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34
Q

Relationship between smoking and asbestos

A

Syngergistic - smoker with asbestps exposure has a 10 x 5 = 50 x increased risk of lung cancer

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35
Q

7 points

SCLC features

A
  1. Small cell lung cancer 15% cases
  2. Worse Prognosis
  3. Usually central
  4. Ectopic ADH –> Hyponatremia
  5. Ectopic ACTH –> Cushings syndrome, B/L adrenal hyperplasia,
  6. High cortisol –> hypokalemic acidosis
  7. LEMs –> abs to VGCCs
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36
Q

4 points

SCLC Mx

A
  1. Usually metastatic at dx
  2. If early stage consider surgery
  3. Combo CT and RT
  4. Palliative Chemo
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37
Q

5 points

Types of NSCLC

A
  1. Adenocarcinoma - most common - in non smokers too
  2. Squamous - cavitating lesions - few non smokers
  3. Large cell
  4. Aveolar cell carcinoma - no relation to smoking, ++ sputum
  5. Bronchial adenoma - mostly carcinoid
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38
Q

4 points

Squamous cell lung cancer Fxts

A
  1. PTH-rp secretion –> hypercalcaemia
  2. Clubbing
  3. Hypertrophic pulmonary osteoarthropathy - HPOA
  4. Hyperthyroidism due to ectopic TSH
39
Q

2 points

Adenocarcinoma lung cancer Fxts

A
  1. Gynaecomastia
  2. Hypertrophic pulmonary osteoarthropathy (HPOA)
40
Q

4 points

OSA predisposing factors

A
  1. Obesity
  2. Macroglossia - acromegaly, hypothyroid, amyloidosis
  3. Large tonsils
  4. Marfans
41
Q

4 points

OSA fxts

A
  1. Daytime somnolence
  2. Compensated resp acidosis
  3. Hypertension
  4. XS snoring, periods of apnoea
42
Q

Ax - 2 points | Dx - 1 point

How is OSA Ax and DX

A

Ix
1. Epworth sleepiness questionaire
2. Multiple Sleep Latency test
Dx
1. Polysomnography sleep studies

43
Q

3 points

OSA management

A
  1. Weight loss
  2. CPAP 1st L - mod/severe
  3. Inform DVLA if xs day sleepiness
44
Q

4 points

When is Non-Invasive Ventilation (NIV) indicated?

A
  1. COPD with respiratiry acidosis (pH: 7.25-7.35)
  2. T2RF secondary to chest wall deformity, NM dz, OSA
  3. Cardiogenc pulmonary oedema unresponsive to CPAP
  4. Weaning from tracheal intubation
45
Q

4 points

Most common pathogens causing bronchiectasis

A
  1. Haemophilus influenzae - most common
  2. Pseudomonas aeruginosa
  3. Klebsiella spp. - diabetic/ alchoholic
  4. Streptococcus pneumoniae
46
Q

6 points

Mangament of Bronchiectasis - after assessing for treatable causes e.g. immune deficiency

A
  1. physical training -inspiratory muscles if non cystic fibrosis
  2. Postural drainage
  3. Abx for exacerbations + long term if severe
  4. BDs in select
  5. Immunisations
  6. Surgery in select - localized disease
47
Q

CXR signs of Pulmonary Odema

A
  1. interstitial odema
  2. Bat wing appearance
  3. Upper lobe diversion - increased bf to superior parts of lung
  4. Kerley B lines
  5. Pleural effusion
  6. Cardiomegaly of cardiogenic cause
48
Q

3 points

Asthma dx in 17yrs +

A
  1. If sx better on non work days - occupational asthma need specialist ref
  2. Spirometry with BD reversibility test (BDR) - FEV1/FVC < 70% is considered obstructive
  3. FeNO test (fractional exhaled nitric oxide)
49
Q

When is a FeNO test positive in adults and children

A

Adults >= 40ppb
Children >= 35ppb

50
Q

How is Asthma diagnosed in children < 5yrs

A

Diagnosis on clinical judgement

51
Q

4 points

What occupations are at risk of Silicosis

A
  1. Mining
  2. Slate works
  3. Foundreis
  4. Potteries
52
Q

3 points

Pathogenesis of Silicosis

A
  1. Upper zone fibrotic lung disease from inhaling silica particles
  2. RF for developing tuberculosis
  3. Egg shell calcification of hilar LNs
53
Q

2 points

Typical patient with Sarcoidosis

A
  1. Young adults
  2. African descent
  3. Non caseating granuloma
54
Q

Sarcoidosis fxts

A
  1. Non caseating granuloma
    2.
55
Q

What bacteria commonly causes a cavitating pneumonia in the upper lobes, mainly in diabetics and alcoholics

A

Klebsiella pneumoniae

56
Q

Bacteria causing atypical pneumonia associated with extra-pulmonary symptoms such as haemolytic anaemia and erythema multiforme

A

Mycoplasma pneumoniae

57
Q

Bacteria most likely to cause pneumonia after infection with the influenza virus.

A

Staphylococcus aureus

58
Q

Bacteria causing an atypical pneumonia that commonly spreads via a contaminated water supply (e.g. air conditioner vents).

A

Legionella pneumophila

59
Q

3 points

PFTs Restrictive Lung Disease

A
    1. FEV1: reduced
    1. FVC: significantly reduced
    1. FEV1/FVC: high or normal

Restrictive Raises/Remains constant FeV1: FVC ratio

60
Q

3 points

PFTs Obstructive Lung Disease

A
    1. FEV1: significantly reduced
    1. FVC: reduced
    1. FEV1/FVC: reduced

Obstructive Obscures (decreases) Fev1: FVC ratio

61
Q

BREAST

Upper Zone Fibrosis Causes

A
  • Berilosis
  • Radiation
  • Extrinsic allergic allveolitis
  • Ank Spon, ABPA (Allergic bronchopulmonary aspergillosis)
  • Silicosis
  • TB
62
Q

ABCDE

Lower Zone Fibrosis Causes

A
  • A - Asbestosis, A1AT deficiency
  • B - Bronchiectasis
  • C - Connective tissue disease eg. RA, Systemic sclerosis
  • D - Drugs eg. Methotrexate, nitrofurantoin, amiodarone, bleomycin
  • E - eediopathic pulmonary fibrosis
63
Q

The silly egg sandwich I found is mine!

56 M - 1yr hx of progressive exertional dyspnoea with dry cough.
CXR: bilateral upper zone fibrosis and egg-shell calcification of the hilar nodes.

A

Silicosis

The silly (silicosis) egg (egg-shells appearance on CXR) sandwich I found (foundries workers) is mine (minors)!

64
Q

Target oxygen saturations for COPD with normal pCO2

A

94-98%

65
Q

Target oxygen saturations for hypercapnic risk/ COPD patients prior to ABG availability

A

88-92%

66
Q

2 points

Aspergilloma typically presents in what type of patient

A
  • Immunocompromised: hiv
  • Underlying cavitating lung disease: TB or Emphysema
67
Q

4 points

Aspergilloma: Presentation and CXR findings

A
  • haemoptysis
  • fever
  • cough
  • CXR: apical mass in the right lung lobe
68
Q

2 points

Aspergilloma Mx

A
  • itraconazole
  • steroids
69
Q

What Ix does NICE recommend for patients with known or suspected lung cancer

A

Contrast enhanced CT scan of chest, liver and adrenals

70
Q

What is an indication for surgery in brochiectasis

A

Localized disease ie one lobe

71
Q

What ABG picture will hyperventilation show

A

Respiratory Alkalosis
pH: high
pCO2: low
pO2: normal

72
Q

Lung abscess Mx

A
  • IV abx
  • CT guided percutaneous drainage
73
Q

Define Empyema

A

A collection purulent fluid in the pleural space - commonly caused by pneumonia

74
Q

Lung abscess Vs Empyema

A

A pus-filled cavity in the lung surrounded by inflamed tissue and caused by an infection

75
Q

Define Liquefactive necrosis

A

The dead tissue is converted into a cavity of viscous liquid containing:
* Inflammatory cells + debris
* Bacteria
* Frank pus

76
Q

Lung abscess pathophysiology

A

MO –> Infection –> liquefactive necrosis of lung tissue –> cavitation –> cavity
over weeks | Rt > Lt

77
Q

Lung abscess RFs

A
  • Smoker
  • Bad oral hygiene / dentition
  • Halitosis
  • Fever
  • Productive cough - frank pus +++
78
Q

TO FINISH

Lung abscess causes

A
  • Inhalation of oropharyngeal content / Aspiration
  • Infective endocarditis - esp R sided as pyemia (septic emboli) goes to lungs
  • Pre-existing cavities - TB or Bronchiectasis
  • Bacterial infection - a complication. Staph A. or Klebsiella pn.
  • Bronchial obstruction - malignancy
79
Q

Define Bronchiectasis

A

Permanent dilatation of the airways 2ndary to chronic inflammation or recurrent infection destroying cartilage and elastic tissue

80
Q

Bronchiectasis pathophysiology

A

recurrent infection and inflammation –> destruction of elastic tissue + cartilage –> irreversible dilatation and outpouching of bronchi + bronchioles –> segmental bronchi fill with mucus and pus (purulent sputum) –> fibrosis –> either local (surgey) or diffuse

81
Q

Bronchiectasis primary causes

A

Haemophilus influenza - most common
Adenovirus - conjunctivitis

82
Q

Bronchiectasis secondary causes

A
  • CF - Western
  • Infection - TB - world, eygpt
  • ABPA - persistent inflammation + mucus impaction
  • Focal bronchiol obstruction - malignancy - distal brochiectasis
  • Decreased mucociliary clearance - CF HIV Kartagener
  • Toxic inhalation - chemical fumes, aspiration, GERD
  • Esophageal immotility - CREST/ Scleroderma - aspiration risk
83
Q

What vaccine reduces the incidence of Bronchiectasis

A

Pertussis vaccine reduces the incidence of Brochiectasis

84
Q

Most common cause of Haemoptysis

A

Chronic bronchitis

85
Q

Bronchiectasis px

A
  • Hx of CF / TB / ABPA
  • cough productive - copius pus +++
  • +/- haemoptysis
  • clubbing (any supprative lung dz)
  • Auscultation - wheezes crackles
86
Q

Productive cough cupful of purulent mucus vs mucus

A

purulent mucus - bronchiectasis
mucus - chronci bronchitis

87
Q

Bronchiectasis Mx

A
  • Tx cause - abx if infection etc
  • Clear chest pus - postural drainage
  • Chest physio
  • Mucolytic / expectorant
  • If localized - surgical resection
  • If massive haemoptysis - intubate and vascular embolization
88
Q

Types of NIV

When is CPAP used over BiPAP

A
  • Bilevel Positive Airway Pressure is a type of NIV used in T2 RF. esp COPD exacerbation
  • CPAP used in T2 RF esp pulmonary odema
89
Q

What is Berylliosis

A
  • Chronic granulomatous lung disease from exposure to beryllium dust
  • Works in electronics + metal extraction industries
  • cough, fever, night sweats
90
Q

Sacoidosis 4 key features

A
  • PERSISTENT COUGH
  • PAINFUL RASH (erythema nodusum)
  • HYPERCALCAEMIA (renal pathology)
  • LYPHADENOPATHY
  • African
91
Q

F28 pregnant - beclometasone and salmeterol inhalers safe to continue?

A

**YES **
BNF ‘inhaled drugs, theophylline and prednisolone can be taken as normal during pregnancy and breast-feeding’.

92
Q

The commonest causes of an anterior mediastinum mass

A

THE 4 T’s
* Teratoma
* Terrible lymphadenopathy
* Thymic mass
* Thyroid mass

93
Q

Staphylococcus aureus is commonly seen in…

A
  • skin infections
  • can lead to infective endocarditis
  • associated with biofilms causing infection.
94
Q

What is the most common organism causing infective exacerbations of COPD

A

Haemophilus influenzae

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