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Final Year - Passmed > Resp 2 > Flashcards

Resp 2 Flashcards

1
Q

when does Light’s criteria apply?

A

pleural fluid
25-35 g/L

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2
Q

Light’s criteria - pleural effusion

Exudative

A

Pleural fluid LDH > 2/3 of the upper limit of the serum LDH

pleural fluid LDH / serum LDH >0.6

Pleural protein / serum LDH >0.5

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3
Q

Ix pleural effusion?

A

PA CXR
USS
contrast CT

pleural aspiration
21G needle
50ml syringe

pH, protein, LDH, cytology and microbiology

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4
Q

Exudative causes of pleural effusion?

A

inflammation

> protein is leaking from tissues into pleura

Infection
Pneumonia / TB
Inflammatory
> RA

Malignancy
Mesothelioma
Lung cancer

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5
Q

Transudative causes of Pleural effusion?

A

congestive cardiac failure
HYPO albumin
hypothyroid
Meigs

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6
Q

Meigs?

A

Pleural effusion
Ascites
benign ovarian tumour

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7
Q

escalating life threatening asthma

A

Urgent intubation and ventilation

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8
Q

superior vena cava syndrome

A

intraluminal mass or compression

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9
Q

when to attempt chest drain compared to needle aspiration? in pneumothorax?

A

needle
> symptom relief
big enough rim

Chest drain
> high risk features
» haemodynamic instab
» hypoxia
» bilateral
» underlying lung disease
» 50 years of age

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10
Q

montelukast MOA?

A

leukotriene receptor antagonist
blocks action of leukotrienes

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11
Q

what doe leukotrienes do?

A

narrowing and swelling of the airways in the lungs
= wheezing
SOB
chest tightness
cough

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12
Q

fostair is?

A

formoterol and beclometasone

LABA and ICS

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13
Q

severity of COPD is classified by?

A

FEV1

<30% is very severe
<49% Severe
<79% Moderate
<80% Mild

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14
Q

sarcoidosis mx

A

NSAIDs

steroid treatment : oral prednisolone
> lung disease
> uveitis
> hypercalcaemia
> neuro / cardiac involvement

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15
Q

Sudden deterioration with ventilation suggests

A

tension pneumothorax

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16
Q

what is an empyema formation

A

pus in a cavity

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17
Q

klebsiella

A

gram - pneumonia

alcholics and diabetics
upper lobe

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18
Q

Obstructive sleep apnoea can cause

A

HTN
compensated resp acidosis

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19
Q

COPD second line
if on sama what to do
and no atopy

A

stop SAMA
> replace with SABA

start LABA
LAMA

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20
Q

how to manage a tension pneumothorax?

A

decompress immediately with needle

Perform needle thoracostomy

decompress the pleural space and restore normal respiratory function

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21
Q

commonest cause of anterior mediastinum mass?

A

teratoma
terrible lymphadenopathy
thymic mass

thyroid mass

22
Q

what is 1 pack year?

A

20 cigs per day for 1 year

23
Q

chest drain swinging

A

RISES in inspiration

falls in expiration

chest drain is into the pleural space of the patient
> connect to a bottle
responds to thoracic pressures

24
Q

safe triangle chest drain

A

> mid axillary line of 5th intercostal space
edge of latissimus dorsi
lateral border of pectoralis major
line superior to level of nipple

apex below the axilla

25
Q

example of a LAMA
sama?

A

tiotropium
> spiriva

Ipratropium bromide
atrovent

26
Q

sama and saba combo

A

combivent

27
Q

LTOT indications in COPD

A

cyanosis
polycythaemia
raised JVP

<30% FEV1

o2 sats of 92%
peripheral oedema

28
Q

when is oral theophylline used in COPD?

A

when all else fails

29
Q

aspiration pneumonia from HAP - how to differentiate?

A

classically RLL
> right main brainstem is LARGE and STRAIGHT

30
Q

what is lung volume reduction surgery?

A

removal of poorly ventilated but perfused areas of lung
so blood can be redistributed

30
Q
A
31
Q

Late stage alpha 1 antitrypsin deficency management?

A

lung volume reduction surgery

31
Q

Before starting Azithromycin why is it important to do an ECG?

A

rule out prolonged QT interval and baseline liver function tests

31
Q

diagnosis of mesothelioma?

A

histology and thoracoscopy

32
Q

indication for corticosteroid use in sarcoidosis?

A

hypercalcaemia
parenchymal lung disease
uveitis

neuro / cardio involvement

32
Q

Asthma adults diagnosis?

A

symptoms

spirometry

FENO

bronchodilator reversibility

33
Q

bronchodilator reversibilty?

A

> 12% FEV1 increase and 200ml

> 10% of predicted normal

34
Q

peak expiratory flow reversibility changes in asthma diagnostic

A

2 weeks

> 20%

35
Q

1st line in children asthma
5-16

A

FeNO
>35 ppb

36
Q

CRP and WCC in infection

A

acute phase reactant
CRP is more laggy

WC is more reflective

37
Q

Mx of atelectasis?

A

chest physiotherapy and mobilisation and breathing exercise

38
Q

what is atelectasis?

A

basal alveolar collapse
airway obstructed by bronchial secretions
>dyspnoea
>hypoxaemia 72 hours post op

39
Q

hypoventilation would lead to?

A

respiratory depression can cause hypoventilation

Resp acidosis
accumulation of CO2
decrease in blood pH

40
Q

Lung Cancer Mx
SCLC

A

chemo mainstay

adjuvant radiotherapy

41
Q

kartageneres syndrome

A

PCD

dextrocardia - complete situs invertus

chronic sinusitis
bronchiectasis

42
Q

cancers with raised platelets?

A

lung
endometrial
gastri

oesophageal
colorectal

il6 stimulate platelet

43
Q

what is the contraindication to chest drain insertion and bleeding?

A

INR >1.3

44
Q

cannonball mets on a CXR

A

CT abdomen
as it is most commonly caused by RCC

45
Q

acute asthma BTS guidelines for ABG use?

A

o2 sats <92%

46
Q

managing a Pleural effusion

A

Imaging
PA chest xray

USS> successful pleural aspiration

contrast CT ; underlying cause

47
Q

pleural fluid findings

low glucose
amylase
blood staining

A

low glucose: rheumatoid arthritis, tuberculosis

raised amylase: pancreatitis, oesophageal perforation

heavy blood staining: mesothelioma, pulmonary embolism, tuberculosis

48
Q

Lung cancer referral

A

CXR findings suggestive of lung cancer

> 40 and over w unexplained haemoptysis

Final Year - Passmed (9 decks)

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