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Finals Revision Progress > Resp > Flashcards

Resp Flashcards

1
Q

Classification system for COPD?

A

GOLD classification

  • mMRC dyspnoea score
  • Airflow limitation
  • Number of exacerbations per year
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2
Q

Non medical Mx of COPD?

A

MDT approach, regular review

Smoking cessation

Pulmonary rehab therapy (exercises, education, psychosocial support)

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3
Q

Medical Mx of COPD?

A

SABA, then anti muscarinics and LABA, then inhaled corticosteroids

LTOT if low PaO2/cor pulmonale/polycythaemia

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4
Q

Mx of acute exacerbation of COPD?

A

Sit up, 24% O2 via venturi mask, keep sats between 88-92%

Salbutamol 5mg/ipratropium 0.5mg nebs

Hydrocortisone 200mg IV/Prednisolone 40mg PO

Antibiotics if evidence of infection

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5
Q

What is the BODE index?

A

Used to predict mortality in COPD

BMI
Obstruction: FEV1
Dyspnoea mMRC score
Exercise capacity: 6 min walk

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6
Q

Define asthma

A

Episodic, reversible airway obstruction due to bronchial hyper reactivity

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7
Q

What Ix would you do for asthma?

A

Bedside: PEFR

Bloods: FBC, IgE, aspergillus serology

CXR: hyperinflation

Spirometry: would show obstructive picture, FEV1:FVC <70%

Atopy: skin prick test

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8
Q

Non medical asthma Mx

A

MDT TAME

MDT approach
Technique for inhaler use
Avoidance of triggers and allergens
Monitor with peak flow
Educate
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9
Q

Medical Mx of asthma

A 
SABA
\+ ICS low dose
\+ LABA
\+ ICS higher dose/LTRA/LAMA
\+ Specialist care, another of above
\+ Steroid tablet
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10
Q

Example of SABA, ICS, LABA, LTRA, LAMA

A 
Salbutamol - SABA
Budesonide / beclametasone - ICS
Salmeterol - LABA
Montelukast  - LTRA
Tiotropium - LAMA
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11
Q

Causes of ILD?

A 
UPPER - "TB SPACE"
TB
Sarcoidosis
Pneumoconiosis
Ankylosing spondylitis
Cystic fibrosis
Extrinsic allergic alveolitis
LOWER - "ACID"
Asbestosis
Connective Tissue disease
Idiopathic pulmonary fibrosis
Drugs

DRUGS - “AMEN”
Amiodarone
Methotrexate
Nitrofurantoin

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12
Q

What would spirometry and HRCT show in ILD?

A

Restrictive, FEV1:FVC > or equal to 70%

Honeycomb lung

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13
Q

What is bronchiectasis?

A

Chronic, permanent dilation of bronchi caused by repeated cycles of airway inflammation and infection

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14
Q

Causes of bronchiectasis?

A

Congenital:
CF
Alpha 1 antitrypsin deficiency
Hypogammaglobulinaemia

Infectious:
TB
Pertussis

Rheumatological:
RA
SLE
Sjogren’s

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15
Q

Ix for bronchiectasis?

A

Bloods: included RA screen Abs

CXR: tramlines and ring shadows (bunch of grapes)
Signet ring sign

Spirometry: obstructive

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16
Q

Complications of bronchiectasis?

A

Cahexia
Pulmonary HTN
T2 resp failure

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17
Q

Mx of bronchiectasis?

A

Conservative: MDT, physio

Medical: 
Abx
Bronchodilators
Treat underlying cause
VACCINATIONS (influenza, pneumococcus)
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18
Q

What is Kartagener’s?

A

Autosomal recessive defect in ciliary motility
Poor mucociliary clearance
Reduced sperm motility in males
Situs inversus

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19
Q

Cystic fibrosis pathophysiology and inheritance?

A

Autosomal recessive
Mutation in CFTR gene
Reduced luminal Cl- secretion and Na reabsorption causing viscous secretions

20
Q

Dx of cystic fibrosis?

A

Sweat test, Na and Cl >60mM
Faecal elastase; tests pancreatic exocrine function
Genetic screening

21
Q

Mx of CF

A

MDT

Chest:
Physio; postural drainage
Abx
Mycolytics
Vaccinations: flu, pneumococcus

GI:
Pancreatin (creon)
ADEK supplements
Insulin

22
Q

Pleural effusion causes?

A

Transudate:
Protein <25
Often bilateral
Causes: CCF, renal failure, low albumin

Exudate:
Protein >35
Often unilateral
Causes: infection, cancer, inflammation (RA, SLE)

23
Q

Ix for pleural effusion

A

Sputum: MC+S, cytology
CXR: Homogenous opacification
Volumetric CT

Bloods: look for high creatinine, low albumin, etc

DIAGNOSTIC PLEUROCENTESIS, look for

  • Chemistry
  • Bacteriology
  • Cytology
  • Immunology

Pleural biopsy if inconclusive

24
Q

Criteria for Dx of exudative effusion?

A

Transudate = protein <25g/L

Exudate = protein >35g/L

Between the two, apply Light’s criteria (lactate dehydrogenase and serum protein ratio)

25
Q

Treatment of pleural effusion?

A

Rx underlying cause

Drainage if symptomatic

26
Q

Lung cancer peripheral inspection

A 
Hands and face:
Cachexia
Clubbing
Tar staining 
Horner's syndrome
Plethora

Chest:
Thoracotomy scar
Radiotherapy burns/tattoos
Acanthosis nigricans

Lung:
COLLAPSE or EFFUSION

27
Q

Complications of lung cancer on examination?

A

SVCO
Horner’s syndrome
Recurrent laryngeal nerve palsy

28
Q

Pneumonectomy and lobectomy on examination?

A

Tracheal shift
Reduced expansion
Reduced (lobectomy) or absent breath sounds (pneumonectomy)

29
Q

Indication for lobectomy/pneumonectomy?

A

Bronchial carcinoma
Bronchiectasis
COPD; lung reduction surgery
TB; historic

30
Q

Types of lung cancer?

A

Small cell

Non small cell:

  • SCC
  • Adenocarcinoma
  • Large cell
31
Q

Paraneoplastic lung tumours?

A

ADH → SIADH (euvolaemic ↓Na+)
ACTH → Cushing’s syndrome
Serotonin → carcinoid (flushing, diarrhoea)
PTHrP → 1O HPT (↑Ca2+, bone pain)

32
Q

Ix for lung cancer?

A 
Bloods
FBC (anaemia, WCC)
U+E (SIADH)
LFT (mets)
Bone profile (higher Ca)

Imaging
CXR
Contrast volume CT

Cell analysis
Cytology (pleurocentesis)
Histology (FNA)

Staging
CT
PET
Radionucleotide bone scan
Thoracoscopy/mediastinoscopy
33
Q

Mx of lung cancer?

A

General: smoking, MDT, nutrition

NSCLC: Surgery (wedge resection, lobectomy) and chemo (platinum based and biologics)

SCLC: Usually disseminated at presentation, chemo my have benefit

Palliative: Radiotherapy (haemoptysis or bone mets), anagesia, stent for SVCO

34
Q

Prognosis for lung cancer?

A

NSCLC: 50% 5ys w/o spread; 10% with spread
SCLC: 1-1.5yrs median survival treated; 3mo untreated

35
Q

HAP vs CAP? Microbes?

A

CAP:
- Pneumococcus, mycoplasma, haemophilus

HAP: (>48 hours after admission)
- Pseudomonas, MRSA

36
Q

How to assess severity of pneumonia?

A

CURB65 score

Confusion
Urea
Resp rate
BP
>65 years old

Determines whether they need home, hospital or ITU management (>3)

37
Q

TB medical treatment?

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

RIPE for 2 months, RI for 4 months

38
Q

Side effects of rifampicin and isoniazid?

A

Rifampicin: orange secretions, liver enzyme inducer
Isoniazid: peripheral neuropathy, agranulocytosis, liver enzyme inhibitor

39
Q

Where to insert a chest drain?

A

“triangle of safety”: anterior to mid axillary line, posterior to pectoral groove, above 5th intercostal space

40
Q

Define COPD

A

Chronic bronchitis (productive cough most days of >3 months on 2>years)

Emphysema

41
Q

Peripheral signs of COPD

A

Bounding pulse
CO2 retention flap
Tar staining
Plethora

42
Q

Complications of Lung Cancer

A

SVCO
Pancoast’s tumour causing Horner’s syndrome
Recurrent laryngeal nerve palsy

43
Q

Follow up pneumonia

A

CXR after 6 weeks to look for underlying cancer and resolution

44
Q

Primary TB

A

Ghon focus then forms Ghon complex

Latent TB can be reactivated to secondary TB

45
Q

Ix for active TB

A

CXR; if suggestive, take >3 sputum samples

Microscopy for acid fast bacilli (Ziehl Neelsen stain)
Culture in Lowenstein-Jensen media

46
Q

What is alpha-1-antitrypsin deficiency?

A

Genetic disorder, onset 20s-50s

Results in not enough A1AT

Associated with COPD, cirrhosis, cancer

Vaccines recommended

Tx with bronchodilators, steroids, Abx

Finals Revision Progress (16 decks)

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