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Y6 Senior Med COPY LaLz > 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
Q

what paraneoplastic hormone productions does SCLC cause

A

SIADH
ACTH
LEMS

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26
Q

what paraneoplastic hormone production does SCC cause

A

PTH
ectopic TSH

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27
Q

what is the difference between obstructive and restrictive lung disease

A

obstructive = difficult to exhale
restrictive = difficult to inhale (difficulty expanding the chest, due to stiffness of lung tissue)

28
Q

causes of obstructive lung disease

A

COPD
asthma
bronchiecasis

29
Q

causes of restrictive lung disease

A

interstitial lung disease
scoliiosis
obestiy
neuromusk

30
Q

what are the TWO requirements to diagnose asthma in an adult

A

FeNO test + spirometry with bronchodilator reversibility

31
Q

where is aspiration pneumonia most likely to occur

A

Right lung base

32
Q

why is aspiration pneumonia commonest in Right lung base

A

because the right bronchus is straightest

33
Q

RF for aspiration pneumonia

A

swallowing dysfunctiono
reduced consciousnesss
altered neuro status

34
Q

what is unusual about obs that should make you suspect an aspiration pneumonia

A

TEMPERATURE - they will be APYREXIC

35
Q

what do you need to give to a patient with IE COPD after discharge?

A

5 days pred

36
Q

what do you give when discharging asthma pt if no admission

A

QUADRUPLE inhaled ICS (instead if PO pred)

37
Q

most common causative organism of infecton in BRONCHIECTASIUS

A

Haemophilius influenza

38
Q

how do you differentiate mesothelioma from SCC lung cancer on CXR

A

Mesothelioma is PERIPHERAL
SCC more likely CENTRAL

39
Q

how does mesothelioma appear on CXR

A

pleural effusion, pleural thickening

peripheral pleural plaques and peripherla mass

40
Q

what is a restrictive pattern on sppirometry

A

FEV1/FVC >70 (increased)
TLCO (gas exchange) low

41
Q

which respsiratory condition presents with a restrictive picture

A

pulmonary fibrosis

42
Q

what makes an asthma attack near fatal

A

if pCO2 is RAISED

43
Q

2 requirements to diagnose asthma in 5-16 yo

A

spirometry with broncodilator reversibility +- FeNO testing (FeNO necessary if uncertainty)

44
Q

Requirements for asthma dx in adult

A

FeNO test > spirometri with broncodilator reversibility (may also use, PFV, BC, specialist inoput)

45
Q

what is Meig’s syndorme

A

OPA

Ovarian tumour
pleural effusion
ascites

46
Q

what is TLCO

A

Transfer factor of the
Lung for
Carbon
monOxide

47
Q

what does TLCO essentially indicate

A

the amount of carbon monoxide in the blood > reflects how much oxygen is taken up by RBC

48
Q

causes of raised TLCO

A

INCREASED PERFUSION OR DIFFUSION
e.g. exercise, polycythaemia, asthma

49
Q

how do you investigate a mesothelioma

A

CXR > CT chest
if pleural effusion: tap, drain (MCS, buochem, cytology)

50
Q

mx of mesothelioma

A

symptomatic tx
industrial compensation
chemotherapy or surgery where possible

POOR PROGNOSISS 12 months

51
Q

mx pulmonary fibrosis

A

conservative: educate, pulmonary rehab, smoking cessation

medical: LTOT, anti-tussives, pirferidone, immunosuppressants

surgical: lung transplant

52
Q

mx sarcoid:

A

NSAID
steroid
steroid sparing (methotrexate, hydroxychloroquine)

53
Q

mx bronchiectasis

A

correct underlying cause if possible e.g. ABPA = oral glucocorticoids

conservative: physio, pulm reab
smoking cessation
prophylactic rescue packs
broncodilators
immunisatin

54
Q

surgical options for COPD

A
  • bullectomy
  • lung reduction surgery
  • endobronchial valve placement
  • lung transplant
55
Q

what can you give for smoking cessation

A

nicotinic replacrement therapy (ok in pregnancy)
bupropion
varencycline

56
Q

when is bupropion contraindicated

A

in epileptics
because it may cause seizure

57
Q

why is intubation a RF for aspiration

A
  • 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
Q

why does a tension pneumothorax cause low BP

A

becuase it causes OUTFLOW OBSTRUCTION

59
Q

what is acute bronchitis

A

inflammation of trachea + major bronchi

60
Q

sx of bronchitis

A

cough
no sputum or sputum
sore throat, rhinorrhoea, wheeze

61
Q

what findings do you have on exam for bronchitis

A

may have NO FINDINGS on exam
incl on ascultation of lungs

62
Q

how do you manage bronchitis

A

fluids
analgesia
DOXYCYCLINE if:
- crp >100
consider if
- crp 20-100
- systemically unwell
- pre existing comorbidities

63
Q

what is the most common organism in infective exacerbations of COPD

A

H influenza

64
Q

typical atibiotic for atypiical pneumonia

A

clarythromycin or doxy

65
Q

mycoplasma pneumoiae pneumonia presentation

A

joint pain
cold aglutinin test
erythema multiforme
SJS AIHA

66
Q

legionella pnneumoniae presentation

A

air travel, air condiitionin, hhepatitis,
hyponatraemia, urinary angigen

Y6 Senior Med COPY LaLz (29 decks)

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