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Y6 Senior Med > Resp 2 > Flashcards

Resp 2 Flashcards

1
Q

define COPD

A

chronic inflammatory airway disease characterised by FIXED AIRWAY OBSTRCTION

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2
Q

Classical COPD hx

A

SOB, wheeze
decreased exercise tolerance
chronic cough wiht clear phlegm
smoking +++

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3
Q

classing COPD findings on O/E

A

inspection: barrel chest, tar stained fingers, cyanosis, pursed lips
ascultation: wheeze, ronchi

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4
Q

summary of COPD mx

A
  1. conservative: smoking cessation (with nicotine replpacement), pulmonary rehab, vaccines (annual flu vaccine, one-off pneumococcal
  2. medical: bronchodilator therapy, mucolytuic, rescue pack, prophylactic abs, LTOT
  3. surgical
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5
Q

what mucolytic do you give in COPD

A

carbocysteine

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6
Q

whyddo you give a rescue pak in COPD

A

in case they become unwell, so they can start tx at home

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7
Q

what does a COPD rescue pack contain

A

antibiotics + steroid

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8
Q

what surgical mx of COPD

A

bullectomy
lung reduction surgery
lung transplant (if they stopped smoking, FEV1 <20% predicted, cor pulmonale, pulmonary HTTN)

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9
Q

what criteria do you use for COPD prognosis

A 
BODE critera 
Body mass high (obese) 
Obstruction (low FEV1) 
Dyspnoea a
Exercise capacity low (test on 6min walk)
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10
Q

what does FEV1/FVC need to be to dx COPD

A

<0.7

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11
Q

FEV1 % criteria for COPD category

A

FEV1 >80 = mild
FEV1 50-79% = moderate
FEV1 30-49% = severe
<30% = very severe

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12
Q

sx of asthma

A

dry cough
wheeze (worse at night / morning9
triggers

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13
Q

findings of asthma on inspection

A

findings of atopy e.g. eczema, nnasal polyp

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14
Q

ascultation of asthma

A

audible polyphonic wheeze (due to different diameters)

clear chest if well

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15
Q

asthma ix

A

spirometry with bronchodilator reversiibility
peak flow
FeNO (marker of airway inflammation, >40)
allergy testing (total IgE, specific IgE RAST, skin prick, eosinophil count)

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16
Q

holistic asthma management

A

conservative:

  • teach / check inhaler technique
    • avoid triggers (teach to identify and avoid
  • monitor peak flow
  • educate
  • give personalised asthma action plan
  • flu vaccines

medical:
- bronchodilator therapy
if very allergic > antihistamine

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17
Q

what is atelectasis

A

A POST OP COMPLICATION

BASAL alveolar collapse, causing respiratory difficulty (as the airway becomes obstructed by bronchial secretions)

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18
Q

how do you manage atelectasis

A

chest physio + deep breathing

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19
Q

what is ABPA

A

T1 hypesensisivity to aspergillys

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20
Q

O/E ABPA

A

wheeze

coarse creps

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21
Q

Ix ABPA

A

raised eosinophils, total IgE, aspergillus +ve

CXR, HR-CT (bronchiectasis)

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22
Q

how do you manage ABPA

A

chest physio
oral glucocorticoids
consdier itraconazole

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23
Q

what channel type does CFTR mutation in CF affect? explain what this causes

A

Chlorride channel - which usually excretes chloride into secretions, pulling water with it > loosening the secretions

when chloride channel is mutated > no chloride movement > limited water movement > secretions are all thick

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24
Q

which and when do pneumonia pts need a follow up CXR

A

6-12 weeks later

to ensure resolution and exclude underlying pathology

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25
what paraneoplastic hormone productions does SCLC cause
SIADH ACTH LEMS
26
what paraneoplastic hormone production does SCC cause
PTH | ectopic TSH
27
what is the difference between obstructive and restrictive lung disease
``` obstructive = difficult to exhale restrictive = difficult to inhale (difficulty expanding the chest, due to stiffness of lung tissue) ```
28
causes of obstructive lung disease
COPD asthma bronchiecasis
29
causes of restrictive lung disease
interstitial lung disease scoliiosis obestiy neuromusk
30
what are the TWO requirements to diagnose asthma in an adult
FeNO test + spirometry with bronchodilator reversibility
31
where is aspiration pneumonia most likely to occur
Right lung base
32
why is aspiration pneumonia commonest in Right lung base
because the right bronchus is straightest
33
RF for aspiration pneumonia
swallowing dysfunctiono reduced consciousnesss altered neuro status
34
what is unusual about obs that should make you suspect an aspiration pneumonia
TEMPERATURE - they will be APYREXIC
35
what do you need to give to a patient with IE COPD after discharge?
5 days pred
36
what do you give when discharging asthma pt if no admission
QUADRUPLE inhaled ICS (instead if PO pred)
37
most common causative organism of infecton in BRONCHIECTASIUS
Haemophilius influenza
38
how do you differentiate mesothelioma from SCC lung cancer on CXR
Mesothelioma is PERIPHERAL | SCC more likely CENTRAL
39
how does mesothelioma appear on CXR
pleural effusion, pleural thickening peripheral pleural plaques and peripherla mass
40
what is a restrictive pattern on sppirometry
FEV1/FVC >70 (increased) | TLCO (gas exchange) low
41
which respsiratory condition presents with a restrictive picture
pulmonary fibrosis
42
what makes an asthma attack near fatal
if pCO2 is RAISED
43
2 requirements to diagnose asthma in 5-16 yo
spirometry with broncodilator reversibility +- FeNO testing (FeNO necessary if uncertainty)
44
Requirements for asthma dx in adult
FeNO test > spirometri with broncodilator reversibility (may also use, PFV, BC, specialist inoput)
45
what is Meig's syndorme
OPA Ovarian tumour pleural effusion ascites
46
what is TLCO
Transfer factor of the Lung for Carbon monOxide
47
what does TLCO essentially indicate
the amount of carbon monoxide in the blood > reflects how much oxygen is taken up by RBC
48
causes of raised TLCO
INCREASED PERFUSION OR DIFFUSION | e.g. exercise, polycythaemia, asthma
49
how do you investigate a mesothelioma
CXR > CT chest | if pleural effusion: tap, drain (MCS, buochem, cytology)
50
mx of mesothelioma
symptomatic tx industrial compensation chemotherapy or surgery where possible POOR PROGNOSISS 12 months
51
mx pulmonary fibrosis
conservative: educate, pulmonary rehab, smoking cessation medical: LTOT, anti-tussives, pirferidone, immunosuppressants surgical: lung transplant
52
mx sarcoid:
NSAID steroid steroid sparing (methotrexate, hydroxychloroquine)
53
mx bronchiectasis
correct underlying cause if possible e.g. ABPA = oral glucocorticoids ``` conservative: physio, pulm reab smoking cessation prophylactic rescue packs broncodilators immunisatin ```
54
surgical options for COPD
- bullectomy - lung reduction surgery - endobronchial valve placement - lung transplant
55
what can you give for smoking cessation
nicotinic replacrement therapy (ok in pregnancy) bupropion varencycline
56
when is bupropion contraindicated
in epileptics | because it may cause seizure
57
why is intubation a RF for aspiration
- Use of neuromuscular agents may lead to an impaired swallow - Intubation itself can cause regurgitation - Intubation may cause damage to the trachea/airway that can inadvertently increase the risk of gastric contents aspirating into the lung
58
why does a tension pneumothorax cause low BP
becuase it causes OUTFLOW OBSTRUCTION
59
what is acute bronchitis
inflammation of trachea + major bronchi
60
sx of bronchitis
cough no sputum or sputum sore throat, rhinorrhoea, wheeze
61
what findings do you have on exam for bronchitis
may have NO FINDINGS on exam | incl on ascultation of lungs
62
how do you manage bronchitis
``` fluids analgesia DOXYCYCLINE if: - crp >100 consider if - crp 20-100 - systemically unwell - pre existing comorbidities ```
63
what is the most common organism in infective exacerbations of COPD
H influenza
64
typical atibiotic for atypiical pneumonia
clarythromycin or doxy
65
mycoplasma pneumoiae pneumonia presentation
joint pain cold aglutinin test erythema multiforme SJS AIHA
66
legionella pnneumoniae presentation
air travel, air condiitionin, hhepatitis, | hyponatraemia, urinary angigen

Y6 Senior Med (29 decks)

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