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Finals > Resp > Flashcards

Resp Flashcards

1
Q

Acute severe asthma symptoms?

A

PEF 33-50

resp 25

HR 110

Cannot complete sentences

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2
Q

Life threatening asthma features?

A

PEF <33%

spo2 <92%

Normal PaC02

Silent chest

cyanosis

arrhythmia

hypotension

poor effort

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3
Q

Near fatal Asthma features

A

Raised PaC02 and or mechanical ventilation needed

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4
Q

Differentials for asthma?

A

Foreign body

Anaphylaxis

Pneumothorax

Bronchiolitis in children

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5
Q

Treatment of acute ashtma attack?

A

Salbutamol 5 mg nebulised with O2 (repeat 15-20 minute intervals)

Ipratropium bromide 500 mcg nebulised with O2 (4-6 hourly)

Hydrocortisone 100 mg IV or prednisolone 40 mg orally

Magnesium sulphate 2 g IV over 20 minutes

CXR for pneumonia/pneumothorax

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6
Q

Acute exacerbation COPD treatment?

A

Similar to asthma:

Controlled 02 88-92%

Arterial blood gas (decreased PaO2, raised PaCO2 and raised bicarbonate if chronic disease)

Chest X-ray (to exclude pneumothorax/infection)

ECG (might show evidence of cor pulmonale)

Salbutamol 5 mg nebuliser

Ipratropium bromide 500 mcg nebuliser

Hydrocortisone 100 mg intravenously or prednisolone 30 mg orally (7 days)

Antibiotics if evidence of infection

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7
Q

Steroid doses for asthma and for copd and length?

A

COPD 30mg 7-14days

Asthma 40-50mg 5 days

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8
Q

Infective exacerbation of COPD?

A

Increased volume, colour sputum or cough, no x rays signs

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9
Q

Acute bronchitis ABX dose if unwell?

A

Amox 500mg TDs, or Doxy 200mg then 100mg 5 days for both

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10
Q

When to sent for urgent Chest Xray?

A

in people aged 40 and over if they have two or more of the following unexplained symptoms

Cough

Fatigue

Shortness of breath

Chest pain

Weight loss

Appetite loss

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11
Q

Cough lasting how long for CXR?

A

>3 weeks

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12
Q

Wells score >4 suspected PE what to do?

A

CTPA

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13
Q

Suspected PE wells score 4 or less what to do?

A

D-dimer and if +ve CTPA

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14
Q

Consider what in patients with unprovoked PE?

A

Offer investigations to assess the possibility of an undiagnosed cancer

Consider arranging hereditary thrombophilia testing or antiphospholipid

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15
Q

VTE in pregnancy or Cancer what to use?

A

LMWH- 6 months minimum or until end of cancer treatment

or end of preggers

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16
Q

What chadsvasc score would make you not consider anticoagulation ?

A

Score of 0 in men and of 1 in women

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17
Q

When would you consider treatment of AF which chadsvasc scores?

A

>2 start in all people and consider if 1 in men

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18
Q

What does CHA2DS2VASc mean ?

A

C- CCF

H- Hypertension

A2- Age >75

D- Diabetes-

S2- Stroke

V- Vascular

A- Age 64-75

S- Sex female

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19
Q

Risk of falls, should we anticoagulate?

A

Yes, no evidence that falls induce bleeds

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20
Q

What classifies someone as having a secondary pneumothorax?

A

Age >50 significant smoking history

Evidence of underlying lung disease on history, exam or CXR

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21
Q

You have diagnosed a secondary pneumothorax which is >2cm what is your management?

A

Admit and insert a chest drain

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22
Q

You have diagnosed a secondary pneumothorax which is between 1-2cm what do you do?

A

Initially aspirate and if it is <1cm admit for observation and high flow 02, if not insert a chest drain

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23
Q

All secondary pneumothoraces require….?

A

Admission to hospital for a least 24hrs and usually high flow 02

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24
Q

Bilateral pneumothoraces management assume any size?

A

Proceed to chest drain, also consider if haemodynamic instability

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25
Q

Diagnose a primary pneumothorax of 2.5cm what is your initial management?

A

Aspirate 16-18g cannula (<2.5l)

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26
Q

You aspirate a 2.5cm primary pneumothorax how is it considered succesful? What will you do if it is or is not?

A

Considered a succes if <2cm and breathing improvement you can consider discharge and OPD 2-4 weeks, if no or limited success admit for chest drain.

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27
Q

Primary pneumothorax of 1cm management?

A

Consider discharge and safety netting.

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28
Q

Where is size of pneumothorax measured?

A

Interpleural distance at level of the hilum

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29
Q

Which way does the trache deviate in a Tension pneumothorax?

A

Away from affected side as pressure builds and pushes it away

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30
Q

What si the curb 65 score? what do the results mean?

A

Confusion or <8/10 amts

Urea >7

Resp >30

BP <90sys or <60 dia

65 years or more

Score out of 5 0-1 low 2 intermediate 3-5 high

0-1 home care, 2 hospital care higher consider intensive interventions

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31
Q

ABX therapy for curb score of 2?

A

Consider dual therapy and IV 7-14 days

Amoxicillin plus a macrolide

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32
Q

Pneumonia in alcoholics and which other group? classic sign? What seen on CXR?

A

Klebsiella, Diabetics red currant jelly

Often causes abscess and empyema in upper lobes

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33
Q

Exercise inducte desaturation, bilateral interstitial infiltrates?

Treatment?

A

PCP

Co-Trimoxazole

Steroids if hypoxic

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34
Q

PCP symptoms?

A

Dry cough, dyspnoea, fever, few chest signs

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35
Q

Flu like symptos preceeding a dry cough, bilateral consolidation- thrombocytopenia and erythema multiforme?

A

Mycoplasma pneumoniae

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36
Q

Legionella pneumonia signs?

A

Hyponatraemia, dry cough, recent travel, possible lft problems

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37
Q

Pneumonia screen?

A

Urinary antigen for legionella and pneumococcus

Sputum culture

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38
Q

Patient had flu a few weeks ago and presents with pneumonia, ?organism

A

Staph aureus

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39
Q

COPD exacerbation organism?

A

Haemophillus

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40
Q

Organism which likes to grow and cause pneumonia in bronchiectasis?

A

Pseudomonas

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41
Q

Bronchiectasis causes?

A

post-infective: tuberculosis, measles, pertussis, pneumonia

cystic fibrosis

bronchial obstruction e.g. lung cancer/foreign body

Kartageners

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42
Q

Bronchiectasis CT sign?

A

Signet ring

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43
Q

CXR signs bronchiectasis?

A

Tramlines

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44
Q

Most common cause of pneumonia?

A

Strep pneumoniae

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45
Q

Characteristic symptoms of strep pneumoniae?

A

Rapid onset

High fever

herpes labialis

pleuritc chest pain

46
Q

What to include in asthma history?

A

wheeze, cough or breathlessness, and any daily or seasonal variation in these symptoms

any triggers that make symptoms worse

a personal or family history of atopic disorders.

Occupational history

47
Q

Fraction of expired FENO to diagnose asthma and improvement of what on use of peak flow after bronchdilator?

A

>40ppb and 12% or greater improvement and >200ml volume

48
Q

% significant peak flow variability?

A

20%

49
Q

What should you measure first if suspecting asthma?

A

FENO and spirometry with bronchodilator reversability

50
Q

Initial and add on treatment for asthma?

A

SABA for everyone, but can start ICS immediately if symptoms >3 times a week at diagnosis.

51
Q

Asthma not contolled on SABA and low dose ICS?

A

Add LTRA

52
Q

SABA, ICS and LTRA not controlled?

A

Add in LABA and consider improvement that LTRA gave consider stopping

53
Q

SABA and LABA and ICS +/- LTRA not controlled?

A

Low dose ICS plus MART

54
Q

Initial COPD treatments?

A

Stop smoking, pneumococcal and influenza vaccines

Pulmonary rehab, optimise comorbidities

55
Q

COPD with exercise limitation and conservative management implimented?

A

Offer SABA or SAMA

56
Q

COPD takes SABA or SAMA still feeling breathless?

A

Asthmatic features- LABA+ICS

No asthmatic features- LABA + LAMA

57
Q

COPD takes LABA+ICS still problematic?

A

Offer LAMA+LABA+ICS

58
Q

What suggests steroid responsiveness or asthma features in COPD?

A

Substantial variation in FEV1 overtime or diurnal peak flows >20%

59
Q

First investigation in pleural effusion?

WHat should be tested?

A

Aspiration guided by ultrasound.

Send for pH protein, LDH cytology and micro

60
Q

When should lights criteria be used?

A

Protein 25-35g/l

61
Q

Exudate is likely if pleural fluid protein/serum is >?

Pleural LDH/Serum LDH >?

Or Pleural fluid LDH more than what the upper limit of normal serum LDH?

A

>0.5

>0.6

>2/3 upper limits of serum LDH

62
Q

Low gluocse <2.2 in pleural effusion?

A

Glucose < 2.2 mmol/L is associated with an emphysema, rheumatoid arthritis, tuberculosis or malignancy.

63
Q

Low pH in pleural effusion seen with?

A

A pH < 7.3 is seen with emphysema, tuberculosis, malignancy, collagen vascular disease or oesophageal rupture.

64
Q

Transudative causes of pleural effusion?

A

Heart failure- most common

Liver disease

Hypothyroidism

65
Q

Ecudative causes of Effusion?

A

Infection most common

Lunc cancer

Pancreatitis

Rheumatoidćonnective tissue

66
Q

Pleural effusion, aspirate is clear in presumed infection when to place tube?

A

If pH <7.2

67
Q

Important to ask about this in asthma history if having acute exacerbation?

A

Previous ICU or hospital admissions how many exacerbations and triggers etc

68
Q

Investigation of choice in fibrosis?

A

High res CT

69
Q

Strongest association with smoking cancer?

A

Squamous cell carcinoma

70
Q

SCC of lungs tyically where?

A

Centrally affecting main bronchi and obstructing

71
Q

Most common cancer of lung in non smoker? Where does it often metastasise to?

A

Adenocarcinoma, often ends up in bones and brain

72
Q

Lung cancers associated with ectopic ADH and ACTH ? Lambert eaton syndrome

A

Small cell cancers

ADH-SIADH

ACTH-cushings

73
Q

Long term prevention of infection in bronciectasis?

A

Azithroymycin

74
Q

29 year old, cough blurred vision and this xray?

A

Sarcoidosis

Hilar lymphadenopathy seen on CXR

75
Q

What is this skin condition associated with sarcoidosis?

A

Erythema nodosum

76
Q

Skin condition associated with sarcoidosis?

A

Lupus pernio

77
Q

Treatment of sarcoidosis?

A

Corticosteroids, cytotoxics and lung transplant

78
Q

What does the CT show?

A

Pulmonary fibrosis (honeycombing) and ground glass opacities

79
Q

Treatment of Idiopathic pulmonary fibrosis?

A

Limited- pirfenidone, rehab and transplant supplementary 02

80
Q

WHat is this person doing and why?

A

Pursed lip breathing splints airways keeps a PEEP

81
Q

How to remember which drugs taken only for 2 months in TB?

A

PERI

Pyrazinimide and Ehtambutol initially with the others and then the other two continued

82
Q

Ethambutol side effect?

A

Optic neuritis

83
Q

Best test for cystic fibrosis?

A

Sweat test

84
Q

Genetics of cystic fibrosis?

A

Autosomal recessive

85
Q

Chance of two carriers passing on CF? and carrier plus affected?

A

25% and 50%

86
Q

Respiratory causes of clubbing?

A

Lung cancer, CF, Idiopathic fibrosis, TB

87
Q

What is a negative mantoux?

A

<6mm

88
Q

Signs and symptoms of CF?

A

Failure to thrive, frequent infections, does not pass meconium, absent vas deferens, increased appetite, sinusitis, polyps

89
Q

CF treatments?

Resp and GI?

A

Chest physiotherapy, Bronchodilators, Tobramycin, mucolytics, transplant etc

Creon, nutrition optimisation PPI

90
Q

History of night sweats and weight loss?

A

TB

91
Q

How many samples to diagnose pulmonary TB?

A

3 preferably one early morning

92
Q

Which Tb drug can cause peripheral neuropathy? What can you give to help?

A

Isonizid give B6

93
Q

Gout caused by which TB drug?

A

Pyrazinamide

94
Q

Yellow orange fluids caused by what drug?

A

Rifamp

95
Q

Latent TB treatment choices?

A

3 Months isoniazid and rifamp or 6 months of isoniazid (if rifamp contraindicated)

96
Q

Risks for developing active TB ?

A

Anti TNF, renal failure, HIV, Transplant, malignancy of blood

97
Q

TB vaccine not given to which age group?

A

>35 doesnt work

98
Q

Contraindications to TB vaccine?

A

previous BCG vaccination

a past history of tuberculosis

HIV

pregnancy

positive tuberculin test (Heaf or Mantoux)

99
Q

FEV1 below 30% indicates what type of COPD?

A

Very severe

100
Q

Severe COPD FEV1 of?

A

30-49%

101
Q

50-79% FEV1?

A

Moderate COPD

102
Q
A
103
Q

>80% FEV1 in obstructive pattern?

A

Mild COPD

104
Q

What type of pattern does the spirometry show?

A

Normal result

105
Q

What type of pattern does the spirometry show?

A

Obstructive

106
Q

What type of pattern does the spirometry show?

A

Restrictive

107
Q

What is trastuzumab?

A

Herceptin

108
Q

Best test for obstrutive sleep apnoea?

A

Polysomnography >15 episodes per hour

109
Q

>5 episodes on polysomnography and any of HTN, ischaemic cardiac disease, history of stroke, excessive daytime sleepiness, insomnia, mood disorder, or cognitive dysfunction.

A

Can say is sufficient to say it is OSA

110
Q

Spirometry values in restrictive disease?

A

FEV1 low FVC low Ration >0.7

111
Q

Spirometry values in obstructive pattern?

A

FEV1 reduced <80%

FVC reduced (not as much as FEV1)

FEV1/FVC ration <0.7

Finals (16 decks)

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