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Medecine - As PACES > Resp > Flashcards

Resp Flashcards

1
Q

Classification of airflow limitation

A
  1. Mild: FEV1 >80% - but FEV/FVC 0.7 and syptomatic
  2. Mod: FEV1 50-79%
  3. Severe : 30-49%
  4. Very severe: Fev1
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2
Q

BODE index

A

Define: multidimensional tool to predict mortality in COPD

BMI
Obstruction: FEV1
Dyspnoea: MRC score
Exercise capacity - 6 minute walk

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3
Q

Light’s criteria

A

Used to diagnose of an exudative effusion

Effusion: serum protein ratio > 0.5
Effusion: serum LDH ratio > 0.6
Effusion LDH IS 0.6 time the limit of normal

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4
Q

Cause of pleural effusion.

A

Transudate - less than 25gL

  • CCF
  • renal failure
  • low albumin: nephrotic syndrome, liver failure, enteropathy
  • meig syndrome: right sided pleural effusion, ascites and ovarian fibroma

Exudate - protein > 35g/l

  • infection: pneumonia, TB
  • neoplasm: primary or secondary
  • inflammation: RA, SLE
  • infarction: PE
  • trauma
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5
Q

Stages of clubbing

A
  1. Bogginess/increased fluctuate of nail bed
  2. Loss of concave nail fold angles
  3. Increased longitudinal and transverse curvature
  4. Soft tissue expansion of distal phalanx
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6
Q

Features of life threatening Asthma

A 
CHEST 
Cyanosis 
Hypotension 
Exhaustion, confusion 
Silent chest, poor resp effort 
Tachyarrhythmia or bradyarrhytmias

PEFR4.6kpa, PaO2

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7
Q

Features of severe asthma

A

PEFR : 33-50%
Can’t complete sentences in one breath
RR>25
HR>110

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8
Q

Cause of pulmonary fibrosis

A

Environmental: asbestosis and silicosis
Drugs: bleomycin, amiodarone, nitrofuratonin, sulfasalazine, methotrexate
Hypersentivity: EAA
Infection: TB, viral,funghi
Associated systemic disease: sarcoid, RA, SLE, Systemic sclerosis, UC, anksponk, sjogrens

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9
Q

Kartageners syndrome

A

Situs inversus
Chronic sinusitis
Bronchiectasis

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10
Q

Young syndrome

A

Bronchiectasis
Rhinosinusitis
Azoospermia

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11
Q

mMRC Dyspnoea score

A
  1. SOB only on vigorous exercise
  2. SOB only on hurrying or walking up stairs
  3. Walks slowly or has to stop for breath
  4. Stops for breath after
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12
Q

CURB - 65

A

Confusion - AMTS less than on equal to 8
Urea - 7mM
Resp rate > 30/min
BP = 90/60

0-1 - home
2 - hospital
3 consider ITU

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13
Q

SIRS

A

Inflammatory response to a variety of insults manifest by >=2 of

  1. Temp >38 or 90
  2. RR> 20
  3. WCC >12x10^9 or less than 4
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14
Q

Sepsis

A

SIRS caused by localised infection

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15
Q

Severe sepsis

A

Sepsis with at least 1 organ dysfunction or hypoperfusion

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16
Q

Septic shock

A

Severe sepsis with refractory hypotension

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17
Q

MODS

A

Impairment of >=2 organ system

Homeostasis can not be maintained without therepeutic intervention

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18
Q

Complications of pneumonia

A

Septic Shock and multi organ failure
Para-pneumonic effusions/empyema
Abscess: S. Aureus, klebsiella, anerobes
Resp failure

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19
Q

Side effects of TB medication

A

Rifampacin: hepatitis, orange secretions, enzyme induction
Isoniazid: peripheral sensory neuropathy
Pyrazinamide: hepatitis, arthralgia
Ethambutol - optic neuritis - loss of colour vision first

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20
Q

Indication for long term oxygen therapy

A

Stable non-smokers with Pa02

21
Q

Aim of long term oxygen therapy in COPD

A

PaO2 8>= for greater than or equal to 15 hours a day

Increase survival by 50%

22
Q

Chronic medial management of Asthma

A
  1. Inhaled short acting B2 agonist prn
  2. Inhaled corticosteroids- 200-800 micro gram a day
  3. Add long acting b2 agonist and asses response. If inadequate or no response increase steroids to 800mg and consider addition of a leukotrine receptor antagonist
  4. Trial of steroids - 2000ug/day - consider addition of other drugs
  5. Continuous use of frequent oral steroids
23
Q

CURB - 65

A

Confusion - AMTS 7mM
Resp rate > 30/min
BP = 3 consider ITU

24
Q

SIRS

A

Inflammatory response to a variety of insults manifest by >=2 of

  1. Temp >38 or 90
  2. RR> 20
  3. WCC >12x10^9 or less than 4
25
Q

Sepsis

A

SIRS caused by localised infection

26
Q

Severe sepsis

A

Sepsis with at least 1 organ dysfunction or hypoperfusion

27
Q

Septic shock

A

Severe sepsis with refractory hypotension

28
Q

MODS

A

Impairment of >=2 organ system

Homeostasis can not be maintained without therepeutic intervention

29
Q

Complications of pneumonia

A

Septic Shock and multi organ failure
Para-pneumonic effusions/empyema
Abscess: S. Aureus, klebsiella, anerobes
Resp failure

30
Q

Side effects of TB medication

A

Rifampacin: hepatitis, orange secretions, enzyme induction
Isoniazid: peripheral sensory neuropathy
Pyrazinamide: hepatitis, arthralgia
Ethambutol - optic neuritis - loss of colour vision first

31
Q

Indication for long term oxygen therapy

A

Stable non-smokers

Oxygen less than 7.3
Oxygen 7.3 - 8 and evidence of any of the following: secondary polycythemia, nocturnal hypoxemia, peripherals odema and pulmonary HTN

32
Q

Aim of long term oxygen therapy in COPD

A

PaO2 8>= for greater than or equal to 15 hours a day

Increase survival by 50%

33
Q

Definition of chronic bronchitis

A

Cough and sputum production on most days for 3 months of 2 successive year

34
Q

Definition of emphysema

A

Histopathalogical diagnosis of enlarged air spaces distal to terminal bronchioles with destruction of alveolar walls

35
Q

Wells score

A

Clinical signs and symptoms of a DVT - 3
Alternative diagnois is less likely than a PE - 3
HR>100 bpm -1.5
Immobilisation or surgery in previous 4 weeks - 1.5
Previous DVT/PE - 1.5
Heamoptysis - 1
Malignancy - 1

36
Q

Complications of COPD

A 
Acute/infective excaerbations 
Pulmonary HTN 
pneumothorax 
Polycythemia 
Lung cancer
37
Q

Parameters used in the gold classification

A

mMRC dyspnoea score
Airflow limitation
Numbers of excaerbations a year

38
Q

Complication of pneumonia

A 
Resp failure 
Hypotension 
AF 
Pleural effusion - exudative 
Empyema 
Lung abcess 
Sepsis 
Jaundice - can be due to sepsis, drugs or bacteria specific
39
Q

Detention of asthma

A

Episodic, reversible airway obstruction due to bronchial hyper-reactivity to a variety of stimuli

40
Q

Complication of lung cancer

A 
Local 
- bronchial obstruction: collapse of distal airway and increased infection risk 
- invasion of local structures: SVC, oseophagus( dysphagia) nerves - recurrent laryngeal, sympathetic( Horners) phrenic 
- AF 
-lymphatic carcinomoatosis 
Parenoplastic 
- SIADH 
- cushings
- serotonin 
- PTHrp 
- dermtomyositis 
- cerebellar degeneration 
Metastatic 
- pathological fracture 
- hepatic failure 
- confusion fits, focal Neuro 
- Addisons
41
Q

Assessment of risk in lung cancer surgery

A

Thoroscore - based on cardiorepsitiory function and co- morbidities

42
Q

Definition of pulmonary hypertension

A

Pulmonary aterial pressure >25mmHg

43
Q

Cause of pulmonary hypertension

A

Left heart disease e.g. MS, MR
lung parenchymal disease e.g. COPD, interstitial lung disease
Pulmonary vascular disease e.g. Idopathic pulmonary HTN, PE
Hypoventillation: OSA, thoracic cage abnormality, neuromuscular

44
Q

Gold standard for diagnosis of pulmonary HTN

A

Right heart catheterisation

45
Q

Complication of pulmonary HTN

A

Cor pulmoanle

Supraventricular tachyarrhythmia

46
Q

Definition of cor pulmonale

A

RHF due to chronic pulmonary hypertension

47
Q

Signs of cor pulmonale

A 
Increased JVP with prominent a waves 
Left parasternal heave 
Loud P2 and S3 
Graham steel 
Tricuspid regurgitation
48
Q

Cause of apical fibrosis

A 
Aspergillosis 
ABPA 
Pneumoconiosis - coal and silica 
Extrinsic allergic alveoltitis 
Ankylosis spondylitis 
TB

Medecine - As PACES (6 decks)

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