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Cardioresp > Resp > Flashcards

Resp Flashcards

1
Q

What results after exposure to antigen in sensitised individual during anaphylactic shock

A

Histamine release ~> capillary leak, oedema, wheeze, cyanosis

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2
Q

List the steps in treating a patient with anaphylaxis

A
  • remove trigger
  • maintain airway and intimate if necessary
  • 100% O2
  • IM adrenaline 0.5mg
  • IV hydrocortisone 200mg
  • IV chlorpheniramine 10mg
  • fluid resusc if hypotension
  • NEB salbutamol
  • NEB adrenaline
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3
Q

List the drugs given IM or IV in anaphylactic shock, and their doses

A
  • IM adrenaline
  • IV hydrocortisone
  • IV chlorpheniramine
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4
Q

What NEBs would you give in anaphylaxis

A

Salbutamol

Adrenaline

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5
Q

Define mild asthma

A

Pefr > 75%

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6
Q

Define moderate asthma

A

Pefr 50-75%

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7
Q

Define severe asthma

A
  • Pefr 33-50% of best or predicted
  • cannot complete sentences
  • resp rate > 25/min
  • hr > 110/min
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8
Q

Define life threatening asthma

A
  • Pefr less than 33%
  • sats less than 92% or po2 less than 8kpa
  • silent chest
  • exhaustion, confusion
  • normal pco2
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9
Q

Define near fatal asthma

A

Raised paco2 (co2 retention)

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10
Q

What are the steps for managing acute asthma exacerbation

A
  • ABCDE
  • O2 as needed
  • nebulised salbutamol 5mg
  • oral prednisolone 40mg / IV hydrocortisone if po not possible
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11
Q

How do you manage sever asthma

A

Nebulised ipratropium bromide 500mcg

Salbutamol back to back may be needed

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12
Q

How do you manage life threatening or near fatal asthma

A
  • urgent itu/anaesthetist assessment
  • urgent portable CXR
  • IV aminophylline
  • IV salbutamol if nebulised is ineffective
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13
Q

What is the mechanism of action of ipratropium bromide

A

Anticholinergic - blocks M3 receptors

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14
Q

What so2 would you aim for in a patient with COPD

A

88-92%

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15
Q

How do you manage COPD exacerbations

A 
Oxygen via Venturi mask
NEBs - salbutamol, ipratropium 
Prednisolone 30mg od 7/7
Abx if infection indicated
CXR
Consider niv/itu
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16
Q

When would you consider niv in a patient with exacerbation of COPD

A

Type 2 resp failure and ph 7.25-7.35

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17
Q

When would you consider itu referral in a patient with COPD exacerbation

A

Ph less than 7.25

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18
Q

What are the features on investigation and CXR that would indicate pneumonia

A
  • consolidation on CXR
  • fever
  • purulent sputum
  • raised wcc
  • raised CRP
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19
Q

Define anaphylaxis

A

A type 1 ige-mediated hypersensitivity reaction

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20
Q

What are the parts that make up the CURB65 score

A

C - confusion, mmt 2 or more points worse
U - urea >7.0
R - Resp rate > and including 30/min
B - BP less than 90 systolic or 60 diastolic
65 yo or older

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21
Q

What does the CURB65 score predict

A

Mortality in community acquired pneumonia

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22
Q

How should a patient with a curb65 of 0-1 be treated

A

As outpatient

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23
Q

How should patient with curb65 of 2 be treated

A

Consider short hospital stay

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24
Q

How should a patient with curb65 of 3-5 be treated

A

Hospitalisation + consider if they need itu

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25
Q

What are the two ways to define a massive haemoptysis

A
  • > 240mls in 24 hours

- >100mls/day over consecutive days

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26
Q

How is massive haemoptysis managed

A

ABCDE

  • lie patient on side of suspected lesion
  • oral tranexamic acid
  • stop NSAIDs/aspirin/anticoagulants
  • abx if suspected RTI
  • consider vit k
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27
Q

How would you investigate someone with massive haemoptysis

A

Ct aortogram

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28
Q

How does tranexamic acid work?

A

Inhibits breakdown of fibrin by inhibiting plasminogen being converted to plasmin (plasmin acts to cause fibrin degradation)

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29
Q

What features would you see on an X-ray of a patient with tension pneumothorax

A
  • lung is blacker on side of tension pneumothorax
  • mediastinum shifted into contralateral hemithorax
  • trachea deviated away from side of pneumothorax
  • kinking and compressing of great veins
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30
Q

What may be found on examination of patient with tension pneumothorax

A
  • increased percussion note (hyper resonance)
  • reduced air entry
  • reduced breath sounds
    …on affected side
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31
Q

What is the management of tension pneumothorax

A
  • large bore iv cannula into 2nd intercostal space in mid clavicular line
  • chest drain into affected side
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32
Q

List some of the symptoms and signs of PE

A
  • sudden onset pleuritic chest pain
  • pleural rub
  • sob
  • haemoptysis
  • syncope
  • hypotension
  • tachypnoea
  • cyanosis
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33
Q

At what O2 sats would you perform abg

A

Less than92%

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34
Q

What are the major risk factors for PE

A
  • surgery
  • obstetric causes
  • lower limb #
  • varicose veins
  • malignancy
  • reduced mobility
  • previous proven vte
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35
Q

Give a couple of surgical procedures that are major risk factors of PE

A

Abdo/ pelvic

Knee or hip replacement

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36
Q

Give the steps for managing PE

A

ABCDE

  • O2
  • fluids
  • thrombolysis if massive PE confirmed
  • full anticoagulation
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37
Q

What would you thrombolyse with in massive PE

A

Iv alteplase

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38
Q

What defines massive PE

A

Hypotension/imminent cardiac arrest

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39
Q

List some of the relative factors which act to contraindicate thrombolysis

A

Warfarin
Pregnancy
Advanced liver disease
Infective endocarditis

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40
Q

What may an ecg show with PE

A

Sinus tachycardia
Right axis deviation
Rbbb
Af

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41
Q

What may be seen on CXR with a PE

A
  • Small pleural effusion

- Wedge shaped area of infarction

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42
Q

What may ABGs show in a patient with PE

A

Pao2 reduced
Paco2 reduced
Often acidosis
(Hypervenitaltion and decreased gas exchange)

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43
Q

What is a d diner blood test helpful in diagnosing

A

PE

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44
Q

What towns investigations apart from ecg and CXR may you perform in a patient with suspected PE

A

CT pulmonary angiogram

V/Q scan

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45
Q

Give some of the preventative measures for PE

A
  • TED stockings
  • LMWH
  • avoid contraceptive pill
  • anticoagulation
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46
Q

At what blood pressure would you start to consider massive PE

A

Less than 90mmhg systolic

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47
Q

What conditions is asthma often associated with in patients

A
  • eczema
  • hay fever
  • allergies
  • (significant portion also have acid reflux)
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48
Q

Give some of the signs of asthma on inspection

A
  • tachypnoea
  • audible wheeze
  • hyper inflated chest
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49
Q

What may you find when examining the chest of a patient with asthma

A
  • hyper resonant percussion
  • diminished air entry
  • widespread
  • polyphonic wheeze
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50
Q

What is asthma

A

A chronic inflammatory disease of the airways, where obstruction is reversible

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51
Q

Describe the diurnal variation of asthma

A

Marked morning dipping of peak flow can predispose to attack

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52
Q

Give the two main differentials for wheeze

A

Acute asthma exacerbation

Bronchitis (inc COPD)

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53
Q

What is churg Strauss syndrome

A

autoimmune condition causing vasculitis, occurs in patients with a history of airway hypersensitivity

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54
Q

What is wegeners granulomatosis

A

Form of vasculitis that can cause damage to the lung and kidneys

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55
Q

What is the pathophysiology of asthma

A
  • airway epithelial damage
  • inflammatory reaction - mast cells, eosinophils, T cells
  • increased numbers of goblet cells
  • cytokines amplify inflamm
  • mucus plugging if severe
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56
Q

What are the features of airway epithelial damage in asthma

A
  • BM thickening

- Sub epithelial fibrosis

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57
Q

What are some of the inflammatory mediators involved in asthma pathophysiology

A
  • histamine
  • leukotrienes
  • prostaglandins
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58
Q

What is the criteria that make a patient suitable for discharge following exacerbation of asthma

A
  • pefr >75%

- not needed nebulised inhalers for at least 24hours

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59
Q

What steps would be take to manage a patient after discharge following presentation with acute asthma exacerbation

A
  • 5 days oral prednisolone
  • provide pefr meter
  • written asthma action plan
  • gp follow up 2 working days
  • Resp clinic follow up within 4 weeks
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60
Q

What is eosinophilia

A

Increased eosinophil count in response to allergens, drugs etc

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61
Q

List the trigger factors for asthma

A
  • smoking
  • urti
  • allergens
  • exercise/cold air
  • occupational irritants
  • drugs
  • foods/drinks
  • stress
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62
Q

How may aminophylline/theophylline be useful in treating asthma

A

Given as prophylaxis at night to prevent morning dip

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63
Q

What are some of the side effects of b2 agonists

A
  • tachy
  • reduced K+
  • tremor
  • anxiety
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64
Q

Why may LABAs be useful in treating asthma

A

Can help nocturnal symptoms and reduce morning dips

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65
Q

Why should a patient rinse their mouth after using inhaled steroids

A

Prevent oral candidiasis

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66
Q

How may you distinguish whether there is an occupational explore which brings on asthma attacks

A

Ask patient if they get less/no symptoms over the weekend or during holidays; ask them to measure their peak flow during work and home

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67
Q

What is step 1 of the BTS guidelines for asthma management

A

Inhaled short acting B2 agonist

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68
Q

What is step 2 of the BTS guidelines for asthma management

A

Add inhaled steroid (appropriate to severity of disease)

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69
Q

What is step 3 of the BTS guidelines for asthma management

A

Add LABA +/- theophylline +/- B2 agonist tablet

  • if only some response, increase steroid dose
  • if no response, stop LABA and increase steroids
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70
Q

What is step 4 of the BTS guidelines for asthma management

A

Add leukotriene receptor antagonist eg montelukast

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71
Q

What is step 5 of the BTS asthma management plan

A

Daily steroid tablet

Refer for specialist care

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72
Q

On a ct scan, if one were to see dark round areas, what do they indicate

A

Air retention causing bullae

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73
Q

When is anti IgE monoclonal antibody treatment indicated in a patient with asthma e.g. Omalizumab

A

Selected patients with persistent allergic asthma

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74
Q

What is the definition of COPD

A

A condition characterised by irreversible airway obstruction which is usually progressive and predominantly caused by smoking

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75
Q

What two conditions is COPD an umbrella term for

A

Emphysema and bronchitis

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76
Q

Define emphysema

A

Enlarged air spaces distal to terminal bronchioles, with destruction of alveolar walls

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77
Q

Define bronchitis

A

Inflammation of airways with cough, sputum production for most days for 3 months of 2 successive years

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78
Q

What is the difference between diagnosis of emphysema and bronchitis

A

Emphysema is defined histologically, bronchitis is defined clinically

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79
Q

What are the pathophysiological features of COPD

A
  • mucous gland hyperplasia
  • loss of filial function
  • emphysema
  • chronic inflammation (macrophages and neutrophils)
  • fibrosis of small airways
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80
Q

List the causes of COPD

A

Smoking
a1-antitrypsin deficiency
Industrial exposure

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81
Q

What fev1 ranges indicate mild, moderate and severe COPD

A 
Mild = 50-80%
Mod = 30-49%
Severe = less than 30%
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82
Q

How are patient sight COPD managed

A
  • SMOKING CESSATION
  • pulmonary rehab
  • bronchodilators
  • antimuscaricins
  • steroids
  • mucolytics
  • Ltot if appropriate
  • lung volume reduction if appropriate
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83
Q

What are the indications for lung vol surgery in patient with COPD

A

Recurrent pneumothorax

Bullous disease

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84
Q

How would you treat mild COPD

A

Antimuscarinic

Or B2 agonist PRN

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85
Q

How is moderate COPD managed pharmacologically

A

Regular antimuscarinic
Or LABA
+ inhaled corticosteroid e.g. Beclamethasone

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86
Q

How is severe COPD treated

A

LABA
+ inhaled steroid
+ anticholinergic

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87
Q

What may ecg and CXR show in a patient with COPD

A

Ecg : ra and rv hypertrophy

CXR: hyperinflation, flat hemidiaphragm, large central pulmonary arteries, bullae

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88
Q

How do you know that a lung is hyper inflated on CXR

A

More than 6 ribs in the MCL above the diaphragm

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89
Q

What are the medical features of pink puffers in COPD

A

Increased alveolar ventilation
Near normal pao2 with normal or slightly low paco2
Breathless

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90
Q

What are the medical features of blue bloaters in COPD

A

Decreased alveolar ventilation
Pao2 is decreased and paco2 is increased
Cyanosed but not breathless
Rely on hypoxia drive

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91
Q

Why do blue bloaters rely on hypoxic drive

A

Their respiratory centres have a decreased sensitivity to co2

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92
Q

What can blue bloaters go on to have

A

Cor pulmonale

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93
Q

What can pink puffers go on to have

A

Type 1 resp failure

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94
Q

Why may Ltot be given in a patient with severe COPD

A

To prevent renal and cardiac damage from prolonged hypoxia

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95
Q

How is Ltot (long term O2 therapy) given

A

Continuous oxygen therapy for most of the day - at least 16 hours/day for a survival benefit

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96
Q

At which po2 levels is Ltot offered in COPD patients

A

Po2 consistently below 7.3 kpa or below 8kpa with cor pulmonale

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97
Q

What are some of the drawbacks of Ltot

A

Reduced mobility and independence

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98
Q

Describe the cycle which pulmonary rehabilitation tries to break in patient with COPD

A

You feel breathless > avoid activity > do less > muscles weaken > get more breathless > feel depressed > you feel breathless

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99
Q

What adverse social effects can the vicious cycle of COPD lead to

A

Increasing isolation and inactivity, which leads to worsening of symptoms

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100
Q

What are some of the complications of COPD

A 
Acute exacerbation
Infections
Polycythaemia
Resp failure
For pulmonale
Cancer
Bullae rupture leading to pneumothorax
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101
Q

What are the symptoms of COPD

A

Cough
Sputum
Wheeze
Dyspnoea

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102
Q

What are the signs of COPD

A 
Tachypnoea
Use of accessory muscles
Hyperinflation of chest
Reduced expansion
Increased percussion note
Cyanosis 
Quiet breath sounds
Wheeze
Cor pulmonale
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103
Q

What types of organism tend to cause hospital acquired pneumonia

A
  • gram negative enterobacteria
  • s aureus
  • pseudomonas
  • klebsiella
  • bacteroides
  • clostridia
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104
Q

Give some conditions that may predispose to aspiration pneumonia

A 
Stroke
Myasthenia gravis
Bulbar palsies
Decreased consciousness
Oesophageal disease eg GORD
Poor dental hygiene
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105
Q

List some organisms causing pneumonia in immune improvised patients

A
  • pneumocystis jirovecii/P. Carinii
  • fungi
  • M. Catarrhalis
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106
Q

What are the common organisms causing community acquired pneumonia

A
  • strep pneumoniae
  • h influenzae
  • mycoplasma pneumoniae
  • viruses and flu also
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107
Q

What will be seen on CXR of patient with pneumonia

A

Consolidation
Lobar or multi lobar infiltrates
Cavitation
Pleural effusion

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108
Q

What are the differentials for consolidation on CXR

A
  • pneumonia
  • TB
  • lung ca
  • lobar collapse (blockage of bronchi)
  • haemorrhage
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109
Q

What does a curb 65 score act as a guide for

A

Risk of mortality for patients with pneumonia

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110
Q

What other features, except for a high scoring curb 65 can increase risk of death in a patient with pneumonia

A
  • coexisting disease
  • bilateral involvement
  • multi lobar involvement
  • pao2
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111
Q

What investigation should you perform in a febrile patient with pneumonia

A

Blood cultures

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112
Q

In severe cases/high curb 65 score, what investigations would you do

A

Investigations for atypical causes e.g. Serology and urine legionella antigen test

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113
Q

On examination of a patient with pneumonia, what signs may you pick up?

A

signs of consolidation e.g.

  • decreased percussion note
  • diminished expansion
  • bronchial breathing
  • increased Fremitus
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114
Q

Give some of the steps of pneumonia follow up

A
  • HIV test
  • immunoglobulins
  • pneumococcal IgG serotypes
  • H influenzae B IgG
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115
Q

When would you do a follow up appointment and CXR in a patient with pneumonia

A

In 6 weeks

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116
Q

What factors may cause a non-resolving pneumonia (CHAOS)

A 
Complications
Host immunocompromised
Antibiotic inadequate
Organism resistant
Second diagnosis - not pneumonia
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117
Q

List some of the complications of pneumonia

A 
Empyema
Lung abscess
Resp failure
Septicaemia 
Pericarditis, myocarditis
Pleural effusion 
AF
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118
Q

What is the management of pneumonia usually

A

Amoxicillin + clarithromycin/doxycycline (look at hospital guidelines)

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119
Q

What is the treatment for aspiration pneumonia

A

Cefuroxime + metronidazole

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120
Q

What is the treatment for atypical pneumonia

A

Coamoxiclav or cefuroxime/other cephalosporin
+ clarithromycin
+ flucloxacillin (if S. aureus is indicated)

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121
Q

When treating a patient with pneumonia, what are your targets for pao2 and sats

A

Pao2 > 8kpa

Sats >94%

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122
Q

If a patient with penumonai becomes septic, who do you refer them to

A

ITU

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123
Q

What can precipitate hypotension in a patient with pneumonia

A

Dehydration and sepsis

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124
Q

Give a skin feature of TB

A

Erythema nodosum

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125
Q

Give non-chest manifestations of TB

A

Erythema nodosum, lymphadenopathy, meningitis, frequency, dysuria, pericardial effusion

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126
Q

By which route is TB spread to become milliary

A

Haematogenous

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127
Q

What is the characteristic CXR feature of TB

A

Reticulonodular shadowing, usually in upper zone

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128
Q

What is the tuberculin test

A

TB antigen is injected intradermally,
If it is positive, it indicates immunity
If it is strong positive, it indicates active infection

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129
Q

What may cause positive tuberculin test in a patient

A

Immunity - either previous exposure or BCG vaccination

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130
Q

What are some of the infective differential causes of haemoptysis

A
  • pneumonia
  • TB
  • bronchiactesis
  • CF
  • cavitation lung lesion (e.g. Fungal)
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131
Q

What are some of the haemorrhagic differential causes for haemoptysis

A
  • bronchial artery erosion
  • PE
  • vasculitis
  • coagulopathy
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132
Q

List the differential diagnoses for haemoptysis

A
  • infections (TB, pneumonia etc.)
  • malignancy
  • haemorrhagic
  • PE
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133
Q

If there is a CXR suggestive of TB, what investigation would you do next

A

Sputum sample

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134
Q

If a patient has active non respiratory TB, which investigations would you choose to cover as much as possible

A
  • sputum sample
  • CXR
  • pleural fluid
  • urine sample
  • pus
  • csf
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135
Q

List some risk factors for TB

A
  • past history of TB
  • known history of TB contact
  • born in country with high TB incidence
  • travel to country with high TB incidence
  • immunosuppression
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136
Q

What is the histological hallmark of TB

A

Caseating granuloma

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137
Q

How would you test for TB bacterium

A

Ziel Neelsen testing for acid fast bacilli

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138
Q

What are the CXR signs for a patient with TB

A
  • consolidation
  • cavitation
  • fibrosis
  • calcification
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139
Q

Should you wait for cultures results if histology and clinical picture is consistent with TB

A

No

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140
Q

If a patient with TB has a productive cough, what samples should you collect

A

Three sputum cultures for acid fast bacilli and TB culture

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141
Q

If you have a patient with suspected TB which has atypical features on examination and CXR, what investigation would you then do

A

Ct

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142
Q

If you are unsure between diagnosis of TB or p euro ka, how would you manage that patient

A

Which treatment as per pneumonia, while investigation possibility of TB

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143
Q

What is the standard therapy for TB

A
  • 4 antibiotics for the first 2 months: Rifampicin, Isoniazid, Pyrazinamide, Ethambutol
  • then followed by two antibiotics for the next 4 months: Rifampicin and isoniazid
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144
Q

Why is weight Important when treating a patient with TB

A

Dose of anti TB antibiotics depends on weight

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145
Q

Why do you need to check visual acuity before giving ethambutol

A

He drug causes ocular toxicity, so you need to test colour vision and acuity before commencing treatment

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146
Q

What is DOT

A

Directly observed therapy - observing patient staking anti TB meds to help with compliance

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147
Q

What drug can you give in conjunction with isoniazid to act as prophylaxis for peripheral neuropathy

A

Pyridoxine

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148
Q

What are the two major side effects of Rifampicin

A

Hepatitis

Orange /red secretions

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149
Q

What is the major side effects of isoniazid

A

Peripheral neuropathy

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150
Q

What is the major side effect of Pyrazinamide

A

Arthralgia

151
Q

What is the main Side effect of ethambutol

A

Optic neuritis/retro bulbar neuritis

152
Q

What is the pathophysiology of bronchiactesis

A

Chronic/recurrent infections of the bronchi + bronchioles leading to permanent dilatation of the airways

153
Q

What is the gold standard diagnostic test for bronchiactesis

A

High res ct

154
Q

What are some of the infective causes for bronchiactesis

A

Whooping cough, TB, pneumonia, measles

155
Q

What immune deficiency disorder is associated with bronchiactesis

A

Hypogammaglobulinaemia

156
Q

List some mucus/clearance disorders that are associated with bronchiactesis

A

Cf
Primary ciliary dyskinesia
Youngs syndrome
Kartagener syndrome

157
Q

What is the triad of youngs syndrome

A

Bronchiactesis, sinusitis and reduced fertitility

158
Q

What is the triad of Kartagener syndrome

A

Bronchiactesis, sinusitis and situs inversus

159
Q

What does youngs syndrome cause

A

Abnormally viscous mucus –> bronchiactesis

160
Q

What does kartageners syndrome cause

A

Defect in action of cilia –> bronchiactesis

161
Q

What are some of the obstructive causes of bronchiactesis

A

Foreign body, tumour, extrinsic lymph node

162
Q

List some of the common organisms of bronchiactesis

A 
H influenzae
Pseudomonas aeuroginosa
Mortadella catarrhalis
Strep pneumoniae
S aureus 
Aspergillus
163
Q

How is bronchiactesis managed

A

Treat underlying cause
Physiotherapy
Bronchodilators are supportive
Pulmonary rehab

164
Q

What are the symptoms of bronchiactesis

A

Persistent cough
Copious purulent sputum
Intermittent haemoptysis

165
Q

What are the signs o/e of patients with bronchiactesis

A

Finger clubbing
Coarse insp crepts
Wheeze

166
Q

How would you treat latent TB

A

3 month prophylaxis of Rifampicin and isoniazid (shorter course can improve compliance)

167
Q

How may you treat a patient with renal impairment differently from other patients if they have TB

A

Give triple rather than quadruple therapy, omitting either Pyrazinamide or ethambutol, as these are renally excreted

168
Q

What is cystic fibrosis

A

An autosomal recessive disease leading to mutations in the cftr channel, leading to multisystemic disease characterised by thickened mucus

169
Q

What chromosome is the cftr gene found on

A

17

170
Q

What are some of the feature in neonates that may alert you that they child has cf

A

Failure to thrive, meconeum ileus, rectal prolapse

171
Q

How is CF diagnosed

A

characteristic phenotypic features OR history of sibling CF OR +ve newborn screening test
AND +ve sweat test, genotype +ve, demonstration of abnormal nasal epithelial transport

172
Q

What is a positive sweat test for CF

A

> 60mmol/L Cl-

173
Q

What is the screening for pancreatic exocrine dysfunction I. Patients with cf

A

Faecal elastase

174
Q

What are the presentations for cf

A

1) meconeum ileus
2) intestinal malabsorption
3) recurrent chest infections
4) newborn screening

175
Q

What is meconeum ileus

A

The bowel is blocked by sticky secretions, causing signs of intestinal obstruction

176
Q

What are the symptoms and signs of meconeum ileus

A

Bilious vomiting, abdo distension, delay in passing meconeum

177
Q

What signs may be seen in a patient’s hands if they have cf

A

Finger clubbing

Cyanosis

178
Q

What features in the urt may a patient with cf have

A

Chronic sinusitis

Nasal polyps

179
Q

What lrt signs may a patient with cf have

A 
Repeated lrti's
Bronchiactesis
Cough, wheeze,
Pneumothorax
Haemoptysis
Resp failure
Cor pulmonale
180
Q

What GI symptoms may a patient with cf have

A
  • liver disease
  • portal hypertension
  • gallstones
  • pancreatic insufficiency, diabetes
  • distal instensti obstruction syndrome
  • steatorrhoea
181
Q

What MSK symptoms may be associated with cf

A

Osteoporosis
Hpoa
Arthritis
Arthropathy

182
Q

What reproductive problems may be found in patients with cf

A

Male infertility

183
Q

What is the role of the cftr usually and what happens in cf

A

Usually transports chloride ions outside the cell and into the mucus, and water follows to thin the mucus. In cf this doesn’t function normally so the mucus remains thick

184
Q

List some complications of cf

A
  • resp infections
  • low body weight
  • distal intestinal obstruction syndrome
185
Q

How are resp infections in cf managed

A

Chest Physio and abx,

Abx may be needed prophylactically to maintain health

186
Q

How may pancreatic insufficiency be managed in cf

A

Pancreatic enzyme replacement therapy
High calorie intake
Extra supplements
May need NG or PEG feeding

187
Q

How does Distal Intestinal Obstruction Syndrome in CF present usually

A

Rif mass

188
Q

Why does Distal Intestinal Obstruction Syndrome occur in cf

A

Intestinal contents in distal ileum and proximal colon are thick and dehydrated, causing obstruction. This is due to insuffiencient pancreatic enzymes

189
Q

Where does faecal obstruction occur in cf patients with Distal Intestinal Obstruction Syndrome

A

Ileoceacum (unlike constipation, which is whole bowel)

190
Q

What does AXR show in cf patients with DIOS show

A

Faecal loading at junction of small and large bowel

191
Q

What is some of the lifestyle advice that should be given to patient with cf

A
  • no smoking
  • avoid others with infections
  • avoid jacuzzis
  • clean and dry nebulisers thoroughly
  • avoid stables etc
  • annual influenza immunisation
  • nacl tablets in hot weather
192
Q

List some of the non-lifestyle management techniques for cf

A
  • treat DM if present
  • abx
  • chest physio
  • mucolytics
  • bronchodilators
  • pancreatic enzyme replacement
  • fat soluble vitamin supplements
  • urodeoxycholic acid
193
Q

What are the fat soluble supplements

A

A/d/e/k

194
Q

What bloods would you do on a patient with cf

A 
FBC
U+E
LFT
clotting
Vit a/d/e/k
Annual glucose tolerance test
195
Q

What bacteriological investigations should be carried out in a patient with cf

A

Cough swab

Sputum culture

196
Q

What may CXR show in a patient with cf when not infected

A

Hyperinflation

Bronchiactesis

197
Q

What may be the findings on abdo ultrasound in a patient with cf

A

Fatty liver
Cirrhosis
Chronic pancreatitis

198
Q

What pattern would spirometry show in cf

A

Obstructive pattern

199
Q

How do you manage advanced cf

A
  • O2
  • niv
  • lung+/- heart transplant
  • diuretics for cor pulmonale
200
Q

What is the pleural cavity

A

Potential space between the pleural surfaces of the visceral and partietal pleural layers, containing fluid

201
Q

What is the parietal pleura attached to

A

Chest wall

202
Q

What are pleural plaques

A

Discrete fibrous areas in the pleura

203
Q

List the types of pneumothorax

A
  • spontaneous - either primary or secondary
  • traumatic
  • TENSION
  • iatrogenic e.g. Post central line insertion
204
Q

What are the risk factors for pneumothorax

A
  • pre existing lung disease
  • height
  • smoking/cannabis
  • diving
  • trauma/chest procedure
  • Marfans and other connective tissue disorders
205
Q

How is primary pneumothorax over 2cm treated

A

If symptomatic, give o2 and aspirate

206
Q

What advice would you give to a patient with pneumothorax

A

No flying or diving until resolved within certain period

207
Q

List the causes of translate effusions

A

1) hf
2) cirrhosis
3) hypoalbuminaemia
4) PE

208
Q

What is meigs syndrome

A

Triad of ascites, pleural effusion and benign ovarian tumour

209
Q

How do you treat persistent transudate pleural effusion despite treatment

A

Aspiration/drainage

210
Q

What defines a pleural effusion as being exudate or transudate

A

If >30g/l pleural protein, then it’s an exudate

211
Q

List the causes of exudate effusion

A

1) malignancy
2) infections
3) ra and other inflammatory conditions

212
Q

What is lights criteria for pleural effusion used

A

If the pleural fluid protein is between 25 and 35 g/l, use lights criteria to determine if transudate or exudate

213
Q

What 3 extra factors are used in lights criteria to indicate an exudate rather than transudate

A
  • pleural fluid/serum protein >0.5
  • pleural fluid/serum LDH >0.6
  • pleural fluid LDH>2/3 of upper limit of normal
214
Q

What is malignant mesothelioma

A

Tumour of mesothelioma cells, usually in Pleura and associated with asbestos exposure

215
Q

What are the signs and symptoms of mesothelioma

A 
Chest pain
Dyspnoea
Weight loss
Finger clubbing
Recurrent pleural effusion
216
Q

What are the symptoms of spread of mesothelioma

A

Lymphadenopathy
Hepatomegaly
Bone pain/tenderness
Abdo pain

217
Q

What tests do you perform in a patient with mesothelioma

A

CXR
Ct
Showing pleural thickening/effusion
Bloody pleural fluid

218
Q

How is mesothelioma treated

A

Chemo

219
Q

What are the symptoms of pleural effusion

A

Asymptomatic or dyspnoea, pleuritic chest pain

220
Q

What are the signs on examination of a patient with pleural effusion

A
  • decreased expansion
  • stony dull percussion note
  • diminished breath sounds
  • tactile vocal Fremitus and resonance are decreased
  • bronchial breath sounds above effusion
221
Q

What is pluerodesis

A

Where the pleural space is artificially obliterated with drugs etc

222
Q

What is the definition for ILD

A

Umbrella term for conditions that affect the lung parenchyma in a diffuse manner

223
Q

What are the pathological features of ild

A

Fibrosis and remodelling of the interstitium

Hyperplasia of type 2 pneumocytes

224
Q

Which blood investigations should you obtain with ild patients

A
  • ANA
  • ENA
  • ANCA
  • RhF
  • anti gbm
  • IgG to serum precipitins
  • ACE
225
Q

What do positive serum precipitins indicate in ild

A

Exposure only

226
Q

What is the commonest type of ild

A

UIP - usual interstitial pneumonia

227
Q

What are the classical findings on examination with a patient with ild

A

Clubbing, reduced chest expansion, fine inspiratory crepts (Velcro) best heard basally

228
Q

What are some of the signs and symptoms that are shared in conditions that fall under the category of ild

A

Dyspnoea on exertion
Progressive sob
Non productive dry paroxysmal cough
Abnormal breath sounds

229
Q

What does tlco show in patients with ild

A

Reduced

230
Q

What imaging investigations would you use for ild

A

CXR

High res ct

231
Q

In idiopathic pulmonary fibrosis, what is the pathophysiology

A

Idiopathic interstitial pneumonia, with inflammatory cell infiltrate and pulmonary fibrosis of unknown cause

232
Q

What investigation may be needed for IPF diagnosis

A

Lung biopsy

233
Q

What are the symptoms of Idiopathic Pulmonary Fibrosis

A
  • dry cough
  • exertional dyspnoea
  • malaise
  • weight loss
  • Arthralgia
234
Q

What signs may a patient with IPF have

A

Cyanosis
Finger clubbing
Fine end inspiratory crepts

235
Q

What are two complications of IPF

A

Resp failure

Increased chance of lung ca

236
Q

What is the management of IPF (poor prognosis)

A

Pulmonary rehab
O2
Opiates
Lung transplant

237
Q

Do you give steroids to IPF patients

A

No

238
Q

Give three respiratory causes of clubbing

A
  • ILD
  • lung ca
  • bronchiactesis
239
Q

Give some examples of occupations associated with extrinsic allergic alveolitis

A

1) those in contact with birds
2) farmers
3) mushroom workers
4) sugar workers
5) malt workers
6) coal workers
7) industrial - asbestosis, silicosis

240
Q

What causes extrinsic allergic alveolitis

A

Inhalation of organic antigen e.g. Fungal spore, to which the individual has been sensitised

241
Q

What are the pahtophysiological changes that occur in patients with extrinsic allergic alveolitis

A
  • alveoli are infiltrated by inflammatory cells
242
Q

What are the pathophysiological changes that occur in chronic phase of extrinsic allergic alveolitis

A

Granuloma formation and obliterative bronc holistic

243
Q

What is the histological hallmark for sarcoidosis

A

Non Caseating granulomas

244
Q

What does chest X Ray in a patient with sarcoidosis show

A

Lots of small nodules

245
Q

What can coal workers pneumoconiosis progress to

A

Massive fibrosis and eventually cor pulmonale

246
Q

What is ca plans syndrome

A

Ra
Pneumoconiosis
Pulmonary rheumatic nodules

247
Q

How is ild managed

A
  • remove exposure
  • stop smoking
  • review drugs that are associated with ild
  • transplant
  • O2
  • palliative
248
Q

What are the three classes of ild

A
  • known cause e.g occupational
  • idiopathic
  • associated with systemic disorders
249
Q

What are some of the known causes of ild

A

1) occupational/environmental exposure
2) drugs
3) hypersensitivity reactions

250
Q

What are some of the systemic disorders associated with ild

A

1) sarcoidosis
2) ra
3) sle, systemic sclerosis, mixed connective tissue disease, sjogrens
4) UC, renal tubular disease, autoimmune thyroid disease

251
Q

List some drugs associated with ild

A

nitrofuratoin
Bleomycin
Amiodarone
Sulfasalazine

252
Q

List the three idiopathic conditions of ild

A

1) IPF
2) cryptogenic organising pneumonia
3) lymphocytic interstitial pneumonia

253
Q

What is the definition of obstructive sleep apnoea

A

Intermittent closure/collapse of the pharyngeal airway, causing aponeic episodes during sleep. Terminated by partial arousal

254
Q

Describe a typical patient with obstructive sleep apnoea

A

Male, upper body obesity, undersized mandible

255
Q

What is the process that causes obstructive sleep apnoea

A

EITHER already small pharyngeal size undergoes normal muscle relaxation during sleep and closes airway
OR there is excessive narrowing occurring with relaxation during sleep

256
Q

Give some causes of small pharyngeal size

A
  • fatty infiltration or pharyngeal tissues
  • large tonsils
  • craniofacial abnormalities
  • extra submucosal tissue e.g. Myxeodema
257
Q

Give some physiological causes of excessive narrowing of the airway during sleep (sleep apnoea)

A
  • obesity
  • neuromuscular disease
  • muscles relaxants e.g. Alcohol, sedatives
  • age
258
Q

Why do patients wake up during airway collapse in obstructive sleep apnoea

A

Arousal deactivates the pahryngeal dilators

259
Q

What are the signs and symptoms of obstructive sleep apnoea

A 
Recurrent arousals during sleep
Poor sleep quality 
Daytime somnolence
Sob 
Daytime rise in BP 
Morning headache
260
Q

What is the name of the scale used to assess daytime sleepiness in patients with obstructve sleep apnoea

A

Epworth sleepiness scale

261
Q

Give some examples of activities that are assessed when using the epworth sleepiness scale

A

Reading, watching TV, sitting and talking, resting etc.

262
Q

How are the scores for sleepiness during activities rated in patients with obstructive sleep apnoea

A

0- would never doze
1- slight chance of dozing
2- moderate chance
3- high chance

263
Q

What are the sleep study options for investigating patients with obstructive sleep apnoea

A
  • overnight oximetry to pick up fluctuations
  • limited sleep study
  • full polysomnography
264
Q

What does a limited sleep study investigate for patients with sleep apnoea

A
  • overnight oximetry
  • snoring
  • body movement
  • heart rate
  • oronasal flow
265
Q

What is full polysomnography

A

Limited sleep study + eeg and emg

266
Q

Give some of the lifestyle changes a patient with obstructive sleep apnoea can make

A
  • weight loss
  • sleep in decubitus position
  • avoid evening alcohol
267
Q

How do you treat significant obstructive sleep apnoea

A

CPAP +/- niv prior to CPAP if acidotic

268
Q

How does CPAP help with obstructive sleep apnoea

A

Opens collapsed alveoli, prevents airway collapse and improves v/q matching

269
Q

What is fio2

A

Fraction of inspired oxygen

270
Q

What is the difference between CPAP and BIPAP

A

CPAP provides constant positive pressure during inspiration and expiration
BIPAP applies two pressures - IPAP during inspiration and EPAP during expiration

271
Q

List the different histological types of lung cancer

A
  • squamous cell
  • Adenocarcinoma
  • small (oat) cell
  • large cell
272
Q

What sign may you see in the eyes of a patient with lung cancer

A

Horner syndrome

273
Q

Patients with lung cancer may have svc obstruction, what are the characteristic signs in a patient with svc obstruction

A

Oedema of the face and arms, swollen chest veins

274
Q

List some areas of the body where lung cancer may spread

A 
Pleura
Liver
Adrenals
Brain
Bone
275
Q

List risk factors for lung cancer

A
  • large number of years smoking
  • airflow obstruction
  • increasing age
  • family history of lung cancer
  • exposure to carcinogens e.g. Asbestos
276
Q

What is 0 on the WHO scale for performance status

A

Normal - fully active without restriction

277
Q

What is 1 on the WHO scale of performance status

A

Restricted in physically strenuous activity but ambulatory and able to carry out light work e.g. Housework

278
Q

What is stage 2 on the WHO performance scale

A

Ambulatory and capable of all self care but unable to carry out work activities

279
Q

What is grade 3 on the WHO scale for performance status

A

Capable of limited self care, confined to bed or chair more than half of waking hours

280
Q

What is grade 4 on the WHO performance scale

A

Completely disabled, cannot self care and totally co fed to bed/chair

281
Q

What is stage 5 on the WHO performance status

A

Dead

282
Q

How do you investigate possible lung cancer spread to the lymph nodes

A

Aspiration

283
Q

What bloods would you do to investigate lung cancer

A

FBC, u+e, calcium, LFTs, INR

284
Q

What signs do you look for on CXR

A
  • mass
  • lung collapse
  • pleural effusion
  • consolidation
  • hilar enlargement
285
Q

Where on a CXR would you look for bone secondaries

A

Ribs

286
Q

What would you use a ct scan for in patients with lung cancer

A

Staging, Tnm

287
Q

What cytology would you perform on a patient with lung cancer

A

Sputum and pleural fluid

288
Q

What are some of the local nerve complications of lung cancer

A
  • recurrent laryngeal nerve palsy
  • phrenic nerve palsy
  • Horner’s syndrome
289
Q

What type of tumour can cause Horner’s syndrome

A

Pancoasts tumour

290
Q

What are some of the heart-related complications of lung cancer

A

Pericarditis

AF

291
Q

If lung cancer has spread to the bone, what findings may there be

A

Raised calcium

Anaemia

292
Q

How do you treat stage I/II non small cell lung cancer

A

Curative surgery,

or curative radiotherapy if Resp reserve is poor

293
Q

How do you treat stage III non small cell lung cancer

A

Surgery and adjuvant chemo if patient is fit

294
Q

How do you treat patients with stage III/IV non small cell lung cancer

A

Chemotherapy

295
Q

How is small cell lung cancer treated

A

As it has a rapid growth rate, it is almost always too extensive for surgery at the time of diagnosis. Mainstay treatment is chemo, palliative therapy.

296
Q

List some of the supportive treatments given to lung cancer patients

A 
Analgesia
Steroids
Antiemetics
Antitussive
Bronchodilator
297
Q

What is the definition of type 1 respiratory failure

A

Hypoxia (pao2 less than 8kpa), with normal or low paco2. Caused primarily by ventilation perfusion mismatch

298
Q

List some conditions that can lead to type 1 respiratory failure

A

1) pneumonia
2) pulmonary oedema
3) ARDS
4) PE
5) fibrosing alveolitis
6) emphysema
7) asthma

299
Q

Define type 2 respiratory failure

A

Hypoxia (pao2 less than 8kpa) with hypercapnia (paco2 >6kpa), caused by alveolar hypoventilation +/- vq mismatch

300
Q

What are some pulmonary diseases that can lead to type 2 Resp failure

A 
Asthma
COPD
Obstructive sleep aponea
Pneumonia
Pulmonary fibrosis
301
Q

List some of the causes of decreased respiratory drive that can cause type 2 respiratory failure

A

Sedative drugs
CNS tumour
Trauma

302
Q

List some of the neuromuscular diseases that can cause type 2 respiratory failure

A 
Cervical cord lesion
Diaphragmatic paralysis 
Poliomyelitis
Myasthenia gravis
Guillain barre syndrome
303
Q

Give some thoracic wall diseases that can cause type 2 respiratory failure

A

Kyphosis
Scoliosis
Flail chest

304
Q

What is guillain barre syndrome

A

Rapid onset muscle weakness due to damage to peripheral nervous system

305
Q

In respiratory failure, list some of the signs and symptoms associated with the hypoxic effects of the condition

A
  • dyspnoea
  • restlessness
  • agitation
  • confusion
  • central cyanosis
306
Q

In respiratory failure, what are some of the sequelae to long term hypoxia

A
  • polycythaemia
  • pulmonary hypotension
  • cor pulmonale
307
Q

In respiratory failure, list some of the features of hypercapnia

A
  • headache
  • peripheral vasodilatation
  • tachycardia
  • bounding pulse
  • tremor/flap
  • papilloedema
  • confusion, drowsiness
  • coma
308
Q

Which investigations would you perform on a patient with respiratory failure

A 
FBC, u+e, CRP
ABG
CXR
Sputum and blood cultures if febrile
Spirometry
309
Q

How do you treat type 1 respiratory failure

A

Venturi mask delivering 35-60% oxygen via face mask

Assisted ventilation if pao2

310
Q

How do you manage type 2 respiratory failure

A

Treat underlying cause
Controlled O2 therapy starting at 24% via Venturi mask
Recheck abg after 20mins
If paco2 is steady or lower, then increase O2 to 28%

311
Q

What measures are taken to control type 2 respiratory failure if giving lower flows of oxygen via a Venturi mask isnt reaching the desired effects

A

Consider respiratory stimulant or assisted ventilation if still hypoxic and paco2 has risen over 1.5 kpa
If all else fails, intubation and ventilation

312
Q

When would you consider doing an ABG

A

1) unexpected deterioration in the ill patient
2) acute exacerbation of chronic chest infection
3) impaired consciousness
4) impaired respiratory effort
5) signs of co2 retention
6) cyanosis, confusion, visual hallucinations
7) validation of pulse oximetry

313
Q

What is the management of COPD patients with breathlessness and exercise limitation

A

Short acting beta agonists

Short acting muscarinic antagonists

314
Q

What is the treatment for COPD patients with occasional exacerbations or persistent breathlessness

A

If fev >50 then LABA + LAMA instead of SAMA

If fev

315
Q

How do you treat COPD patients with persistent exacerbations of COPD and breathlessness

A

LABA + ICS if fev1 >50

LAMA + LABA + ICS if fev1

316
Q

What is Ltot

A

Long term oxygen therapy - where continuous home oxygen therapy is given to patients with chronic hypoxaemia of

317
Q

List some of the indications for Ltot

A 
COPD
ILD
CF
Bronchiactesis
Chronic HF
318
Q

If you’re not sure as to whether a patient has pneumonia or TB, how do you go on to treat them

A

Treat as if pneumonia as per curb65 while investigation for pneumonia

319
Q

TB cultures can take weeks to come back, so how do you treat a patient with highly suspected TB in the meanwhile

A

Start anti TB therapy and send off sputum cultures at the same time (looking for acid fast bacilli etc)

320
Q

List absolute contraindications for thrombolysis

A
  • haemorrhagic/ischaemic stroke
321
Q

How does aminophylline work

A

Inhibits phosphodiesterase, increasing camp levels and causing bronchodilation. Inhibits TNF alpha and leukotriene synthesis

322
Q

Levels of which intracellular molecule do b2 agonists increase

A

Camp

323
Q

List tow drug classes that can worsen asthma

A

Beta blockers, NSAIDs

324
Q

What is tryptase a marker of, hence should be measured in which emergency lung condition

A

Mast cell activation - measure serum tryptase in anaphylaxis

325
Q

What is LTOT used for

A

Preventing organ damage caused by prolonged hypoxia, for survival benefit

326
Q

How many hours a day is LTOT used for

A

Most of the day - at least 16 hours or more

327
Q

What are the criteria for LTOT treatment

A

Po2 consistently below 7.3 kpa or below 8kpa with cor pulmonale
Must be non smokers and not retain high levels of co2

328
Q

Describe the cycle that COPD patients go through, that Pulmonary Rehabilitation tires to break

A

Feel breathless -> avoid activities that make you breathless -> do less -> muscles weaken -> get more breathless -> feel depressed -> avoid activities that make you feel breathless

329
Q

How many weeks does the MDT pulmonary rehabilitation programme last

A

6-12 weeks

330
Q

What does the pulmonary rehabilitation programme involve

A

Supervised exercise, unsupervised home exercise, nutritional advice, disease education

331
Q

What are the gold criteria for COPD severity classification

A

Mild - fev higher or equal to 80%
Mod - fev 50-80%
Sev - fev

332
Q

List the bacteria most commonly responsible for atypical pneumonia

A

Mycoplasma pneumoniae,
Chlamydia pneumoniae
Legionella pneumophilia

333
Q

List the viruses most common in community acquired and atypical pneumonia

A

Influenza virus, RSV, adenovirus

334
Q

What are the four main antibiotics used to treat pneumonia empirically

A

1) doxycycline
2) clarithromycin or azithromycin
3) levofloxacin

335
Q

What are some of the vaccines which may be given to certain individuals to prevent community acquired pneumonia

A

Pneumococcal vaccine, flu vaccine

336
Q

If a pneumonia patient has a high curb 65 score, which extra tests should you do on them

A

Atypical pneumonia screen, serology and urine legionella test

337
Q

What is sarcoidosis

A

Multisystemic granulomatous disorder of unknown cause, usually affecting afrocarribbeans and Northern Europeans

338
Q

How does acute sarcoidosis tend to present

A

Erythema nodosum +/- polyarthralgia

339
Q

How does pulmonary disease sarcoidosis present on CXR

A

Bilateral hilar lymphadenopathy +/- pulmonary infiltrates or fibrosis

340
Q

What does tissue biopsy in sarcoidosis show

A

Non Caseating granuloma

341
Q

How is acute sarcoidosis managed

A

As it’ll usually recover spontaneously, NSAIDs and best rest are recommended

342
Q

When are steroids indicated in sarcoidosis

A

If it is causing parenchymal lung disease or affecting other systems e,g, causing uveitis or hypercalcaemia

343
Q

What is allergic bronchopulmonary aspergillosis

A

Hypersensitivity reactions to aspergillus fumigatus causing brocnhoconstriction when early and bronchiactesis if chronic

344
Q

How is allergic boncropulmonary aspergillosis treated

A

Prednisolone

345
Q

What is an aspergilloma

A

A fungus collection inside a cavity

346
Q

How is aspergilloma treated

A

Surgical excision

347
Q

What is cor pulmonale

A

Right heart failure due to chronic pulmonary arterial hypertension

348
Q

How do you manage cor pulmonale

A
  • treat underlying cause e.g. COPD
  • treat resp failure
  • assess for LTOT
  • treat hf with diuretics etc
  • consider venesection if haemorrhoids is >55%
349
Q

What is he a-a gradient in the lungs

A

Alveolar:arterial gradient

This is the measure of difference between alveolar O2 conc and arterial O2 conc

350
Q

What does A-a gradient determine

A

Is the problem in oxygenation is intra- or extra pulmonary

351
Q

What is the healthy A-a gradient in young people

A

Less than 2 kpa difference

352
Q

What is the healthy A-a gradient in older people

A

Less than 4kpa gradient

353
Q

What does an A-a gradient of >4 kpa indicate

A

Lung pathology is present

354
Q

How is the aveolar partial pressure of oxygen measured, in order to then work out the A-a gradient

A

Alveolar partial pressure of oxygen = (room air oxygen partial pressure (usually 20kpa)) - (paco2 in blood/0.8)
Then this PA02 value - pao2 in blood gives you the A-a gradient

355
Q

What is the typical apprance on blood film of a patient infected with CMV

A

Owls eye cells

356
Q

What is chlorpheniramine

A

Antihistamine

357
Q

What CXR signs may be seen in a patient with PE

A

Small pleural effusion,

Wedge shaped infarct (much later)

358
Q

What are the nice guidelines for PE and ctpa management

A

If wells score over 4, PE is likely so assess for ctpa.
If ctpa/(v/q) unavailable/unsuitable then immediately thrombolyse
Ctpa diagnoses PE, which can then be treated appropriately according to guidelines. If ctpa doesn’t diagnose PE then assess for DVT likeliness
If avail ale

359
Q

How long do patients who have had a PE have to wait before they can fly

A

At least one week following normalisation of CXR before they’re allowed to fly

360
Q

What is the most common cause of monophonic wheeze

A

Bronchial carcinoma

361
Q

When a patient who has had an asthma exacerbation is discharged, what steps are taken

A
  • asthma nurse review - inhaler technique, adherence
  • asthma action plan
  • pefr over 75%
  • stop NEBs 1 day prior to discharge
  • provide pefr
  • at least 5 days of oral pred
  • gp follow up in 2 working days
  • Resp clinic follow up in 4 weeks
  • consider psychosocial
362
Q

Describe the pulmonary rehabilitation programme

A

Aims to break the cycle of breathlessness and I activity patients with COPD undergo, with a 6-12 week MDT approach, where a patient is encouraged to do supervised exercise, home exercises and nutritional and disease education is given

363
Q

What does giving Ltot avoid in patients

A

Hypoxaemic damage to kidneys or heart

364
Q

Which condition can give coarse end inspiratory crepts on auscultation

A

Bronchiactesis

365
Q

What is kussmauls breathing

A

Deep and laboured breathe , often associated with ps every metabolic acidosis

366
Q

List the different symptoms related to para neoplastic syndrome in lung tumours

A

Clubbing, hypercalcaemia, anaemia, SIADH, cushings, thromboembolic disease

367
Q

How do you treat mild community acquired pneumonia

A

Amoxicillin or Doxycycline or clarithromycin

368
Q

How do you treat moderate community acquired pneumonia

A

Amoxicillin and either clarithromycin or doxycycline

369
Q

How do you treat severe community acquired pneumonia

A

Coamoxiclav or cefuroxime + clarithromycin.
Add flucloxacillin if staph aureus suspected
Or add vancomycin if mrsa suspected

370
Q

What antibiotic do you consider adding in patients with pneumonia in whom you suspect legionella infection

A

Rifampicin

371
Q

Which antibiotic do you add in patients with pneumonia in whom you suspect chlamydia as a cause

A

Tetracycline

372
Q

Which antibiotic do you consider adding in a patient with pneumonia in whom you suspect pneumocystis jirovecii

A

Cotrimoxazole

373
Q

How do you treat hospital acquired pneumonia

A

Aminoglycoside + antipseudomonal penicillin/cephalosporin

Cardioresp (2 decks)

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