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Easter revision 2018 > Resp > Flashcards

Resp Flashcards

1
Q

How do diarrhoea and vomiting affect acid base balance?

A

Diarrhoea –> lose HCO3 –> metabolic acidosis

Vomiting –> lose H –> metabolic alkalosis

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2
Q

Causes of resp acidosis and alkalosis

A

Resp acidosis: type 2 resp failure (COPD, severe asthma)

Resp alkalosis: type 1 resp failure (pneumonia, panic attacks)

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3
Q

Causes of metabolic acidosis and alkalosis

A

Metabolic acidosis: excess acid production e.g. diabetic ketoacidosis or exercise induced lactic acidosis, or diarrhoea so lose HCO3
Metabolic alkalosis: vom so lose H+, or diuretics

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4
Q

What is the treatment in acute severe asthma?

A

Oral prednisolone, nebulised salbutamol.
Then IV ipratropium bromide
THen IV magnesium
Call ICU

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5
Q

Define acute severe asthma

A

RR >25
HR>110
PEF 33-50%
Can’t complete sentences

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6
Q

Define life threatening asthma

A

SpO2 <92%
PEF <33%
Altered conscious level

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7
Q

Define near-fatal asthma

A

High CO2.

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8
Q

What is wheeze?

A

High pitched muscial whistling sound caused by narrowing of bronchial tubes

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9
Q

Why is wheeze more pronounced in expiration?

A

Because airways are narrower in expiration

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10
Q

Difference between specific and non-specific triggers of asthma?

A

Specific are allergens e.g. pollen, house dust mite

Non-specific are irritants e.g. cold weather, exercise

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11
Q

Most wheeze is ___piratory but wheeze in ____ is __piratory

A

Most wheeze expiratory, wheeze in stridor is inspiratory (because upper airway issue)

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12
Q

What can cause pink tinged frothy sputum?

A

LVF

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13
Q

What can cause clubbing?

A

Lung cancer, bronchiectasis, CF, pulmonary fibrosis

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14
Q

Why does pursed lip breathing help?

A

We don’t want to release too much air and make alveoli too small because then its harder to inflate them

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15
Q

What lung problems will cause mediastinal shift away from the problem?

A

Tension pneumothorax and pleural effusion

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16
Q

What lung problems will cause mediastinal shift towards the problem?

A

Lobar collapse, pulmonary fibrosis

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17
Q

What is hearing bronchial breath sounds in a vesicular location a sign of?

A

Pneumonia

18
Q

Name continous and discontinuous lung sounds

A

Continuous: wheezes and stridors
Discontinuous: pleural friction rubs and crackles

19
Q

What do fine and coarse crackles sound like?

A

Fine: high and soft
Coarse: loud and low

20
Q

When do fine crackles, coarse cracles, and pleural friction rubs occur?

A

Fine: pneumonia
Coarse: COPD, bronchiectasis
Pleural friction rubs: pleurisy, PE

21
Q

Do you know where to find the carina, aortic knuckle, hilar points, aorto-pulmonary window

A

good

22
Q

Identify a CXR pleural effusion

A

Uniformly white area with concave surface (meniscus sign), costophrenic angles and heart border not visible

23
Q

Identify a CXR tension pneumothorax

A

Air trapped between lung and chest wall, lung outline visible, air is hyperlucent, in tension there is mediastinal shift away

24
Q

Name 4 TB drugs

A

Rifampicin, Isoniazide, Pyrazinamide, Ethambutol

25
Q

Describe TB pathology

A

Caseating granuloma with Langhans giant cells, in pulmonary TB the granuloma calcifies to form a Ghon focus. Consolidation

26
Q

Name a cause of CAP and HAP and treatments

A

CAP strep pneu treat with amoxicillin (+)

HAP staph aureus treat with co-amoxiclav (+ and -)

27
Q

Describe a COPD CXR

A

Flattened hemidiaphragms, wider chest diameter, pulmonary arterial HTN, increased retrosternal space

28
Q

How to differentiate latent and active TB?

A

Latent TB + for IFNy and TST but - for sputum culture

29
Q

Where do TB lesions normally form

A

Apex of lungs because they’re aerobic

30
Q

Difference between miliary and extrapulmonary TB

A

Miliary (disseminated) TB spreads via blood to anywhere

Extrapulmonary TB can occur in the LNs, GI, peritoneum, bones and joints

31
Q

What should you treat pneumonia from atypical organism with?

A

Deoxycycline

32
Q

What are the three types of breath sounds and where should you listen for them

A

Tracheal (neck midline), bronchial (manubrium), vesicular (peripheral lung)

33
Q

What do the three types of breath sounds sound like

A

Tracheal - even inspiration and expiration, loud, harsh
Bronchial - short inspir and long expir, loud, less harsh
Vesicular - long inspir short expir, softer

34
Q

A pleural effusion sounds…

A

Stony dull

35
Q

Name causes of transudate and exudate in pleural effusion

A

Transudate: change in pressures e.g. HF, hypoalbuminemia.
Exudate: infections e.g. pneumonia, TB, bronchial carcinoma

36
Q

Name causes of pneumothorax

A

Trauma (rib fracture or sharp), spontaneous primary from subpleural bulla (thin young males), secondary spontaneous from COPD, asthma, TB, bronchiectasis, lung cancer

37
Q

What sign do you get from listening to consolidation

A

Bronchial breath sounds in vesicular location because consolidation solid transmits sounds better than normal air

38
Q

What’s a bovine cough and how does it compare to normal

A

Normal cough involves big inspiration, closing glottis, increasing intrapulmonary pressure and sudden opening of glottis
In bovine cough its a non-explosive cough because you can’t close glottis

39
Q

Name paraneoplastic syndromes due to lung cancer

A

SIADH, Cushing’s, finger clubbing, Eaton-Lambert syndrome (NMJ autoimmune), Horner’s syndrome

40
Q

Which lung cancer is the most common in never smokers

A

Adenocarcinoma (type of non-small cell)

41
Q

How does treatment differ in small cell and non-small cell lung cancer?

A

Non-small cell advances slower so if you catch in time surgery, chemo if late but only for symptom control. Small cell advances quicker so no surgery option, chemo or radio only

42
Q

How does staging affect lung cancer treatment

A

Stages I/II given radical treatment, stage III is inoperable, stage IV is palliative. Beyond N1 is inoperable

Easter revision 2018 (11 decks)

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