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resp Flashcards

1
Q

lung Ca causing SIADH

A

small cell carcinoma

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2
Q

mx of person with frequent IECOPD

A

home Abx (if purulent or clinical signs of pneumonia) and prednisolone 30mg (plus bronchodilator frequency increased)

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3
Q

mx COPD

A

SABA/SAMA
LABA +ICS
LAMA LABA ICS

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4
Q

pneumoconiosis where are opcaities

A

upper zones

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5
Q

Small cell cancer special features

A

ADH → hyponatraemia
ACTH → Cushing’s syndrome
ACTH secretion can cause bilateral adrenal hyperplasia, the high levels of cortisol can lead to hypokalaemic alkalosis
Lambert-Eaton syndrome: antibodies to voltage gated calcium channels causing myasthenic like syndrome

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6
Q

phases of churg strauss

A

1 allergy rhinitis asthma
2eosinophilia
3 vasculitis pANCA

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7
Q

severe asthma

A

PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm

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8
Q

buproprion contraindicated in

A

epilepsy

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9
Q

fev1 in moderate (stage 2 copd)

A

50-79% (very severe <30%)

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10
Q

sleep apnoea scale

A

epworth

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11
Q

Facial rash plus lymphadenopathy

A

sarcoidosis

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12
Q

causes ARDS

A 
infection: sepsis, pneumonia
massive blood transfusion
trauma
smoke inhalation
acute pancreatitis
cardio-pulmonary bypass
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13
Q

lung mets caused by

A 
breast cancer
colorectal cancer
renal cell cancer
bladder cancer
prostate cancer
(before computers people read books)
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14
Q

smoking cessation in preggo

A

none or nicotine replacement patch

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15
Q

long term o2 therapy if

A

pO2<7.3 twice

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16
Q

asbestos causes

A 
benign pleural plaques
asbestosis- lower lobe fibrosis
mesothelioma- blue asbestos
pleural thickening
lung Ca
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17
Q

mx sarcoidosis

A

if asymptomatic nothing

first line prednisolone (hyper calcaemia etc)

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18
Q

features of steroid responsiveness in COPD

A

previous diagnosis of asthma or atopy
a higher blood eosinophil count
substantial variation in FEV1 over time (at least 400 ml)
substantial diurnal variation in peak expiratory flow (at least 20%)

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19
Q

mx of atelectasis

A

chest physiotherapy

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20
Q

Asthma may be diagnosed if any of the following criteria are met (in adults)

A

An exhaled FeNO of 40 parts per billion or greater (hence option 1 is incorrect)
A post-bronchodilator improvement in lung volume of 200 ml (hence option 2 is incorrect)
A post-bronchodilator improvement in FEV1 of 12% or more (hence option 3 is CORRECT)
A peak expiratory flow rate variability of 20% or more (hence option 4 is incorrect)
An FEV1/FVC ratio <70% (it is an obstructive lung disease) - hence option 5 is incorrect

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21
Q

haemoptysis for the past two weeks. Clinical examination reveals a loud first heart sound, a diastolic murmur and new-onset atrial fibrillation.

A

Haemoptysis in mitral stenosis is thought to occur secondary to rupture of the bronchial veins caused by raised left atrial pressure.

22
Q

Fibrosis predominately affecting the lower zones

A

idiopathic pulmonary fibrosis
most connective tissue disorders (except ankylosing spondylitis) e.g. SLE
drug-induced: amiodarone, bleomycin, methotrexate
asbestosis

23
Q

upper zone fibrosis charts

A 
C - Coal worker's pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis
24
Q

COPD mx after SABA/SAMA in asthma feature pictue

A

LABA ICS

25
Q

Surgery contraindications

A

stage IIIb or IV (i.e. metastases present)
FEV1 < 1.5 litres is considered a general cut-off point*
malignant pleural effusion
tumour near hilum
vocal cord paralysis
SVC obstruction

26
Q

mx ptx

A

primary less than 2 discharge
more than 2 drain
2dary drain/ admit

27
Q

pH to intubate in acute asthma

A

less than 7.35 likely represents carbon dioxide retention in a tiring patient

28
Q

azithromycin ix before starting

A

ECG and LFTs

29
Q

when to use NIV in COPD

A

The evidence surrounding the use of NIV in COPD shows that patients with a pH in the range of 7.25-7.35 achieve the most benefit. If the pH is < 7.25 then invasive ventilation should be considered if appropriate

30
Q

mx A1AT deficiency (obstructive)

A

no smoking
supportive: bronchodilators, physiotherapy
intravenous alpha1-antitrypsin protein concentrates
surgery: lung volume reduction surgery, lung transplantation

31
Q

first-line treatment for moderate/severe obstructive sleep apnoea

A

Following weight loss, CPAP

32
Q

tx in COPD that helps with exercise tolerance

A

pulmonary rehab

33
Q

causes of exudative pleural effusion

A 
Exudate (> 30g/L protein)
infection: pneumonia (most common exudate cause), TB, subphrenic abscess
connective tissue disease: RA, SLE
neoplasia: lung cancer, mesothelioma, metastases
pancreatitis
pulmonary embolism
Dressler's syndrome
yellow nail syndrome
34
Q

causes of transudate effusion

A

heart failure (most common transudate cause)
hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption)
hypothyroidism
Meigs’ syndrome

35
Q

sleep apnoea ix

A

polysomnography

36
Q

varencicline moa

A

nicotinic partial agonist

37
Q

ank psond lung changes

A

restrictive- apical fibrosis and kyphosis

38
Q

haemoptysis in valvulopathy

A

Haemoptysis in mitral stenosis is thought to occur secondary to rupture of the bronchial veins caused by raised left atrial pressure.

39
Q

breathlessness after effusion drained

A

reexpansion pulmonary oedema

40
Q

Bilateral interstitial shadowing in RA pt

A

methotrexate pneumonitis

41
Q

tx and prevention of high altitude cerebral oedema

A

dexamethosone

acetazolamide

42
Q

when to assess for LTOT

A

very severe airflow obstruction (FEV1 < 30% predicted). Assessment should be ‘considered’ for patients with severe airflow obstruction (FEV1 30-49% predicted)
cyanosis
polycythaemia
peripheral oedema
raised jugular venous pressure
oxygen saturations less than or equal to 92% on room air

43
Q

mediastinal mass ddx

A

4 T’s: teratoma, terrible lymphadenopathy, thymic mass and thyroid mass

44
Q

KCO vs TLCO

A

KCO is TLCO divided by the alveolar volume, which makes it a measure of how efficient gas exchange is in relation to the alveolar-capillary surface to volume ratio. In asthma, this is increased because there is increased pulmonary blood flow which increases the number of cells which come into contact with the gas.

45
Q

causes of a rasied TLCO

A 
asthma
pulmonary haemorrhage (Wegener's, Goodpasture's)
left-to-right cardiac shunts
polycythaemia
hyperkinetic states
male gender, exercise
46
Q

how to ascend safely

A

less than 500m a day, rest every 3rd day

47
Q

empyema features

A

turbid effusion with pH<7.2, Low glucose, High LDH

48
Q

Low total gas transfer with normal/ increased transfer coefficient

A

Extrapulmonary restrictive defect, or pneumonectomy

49
Q

causes of bronchiectasis

A

post-infective: tuberculosis, measles, pertussis, pneumonia
cystic fibrosis
bronchial obstruction e.g. lung cancer/foreign body
immune deficiency: selective IgA, hypogammaglobulinaemia
allergic bronchopulmonary aspergillosis (ABPA)
ciliary dyskinetic syndromes: Kartagener’s syndrome, Young’s syndrome
yellow nail syndrome

50
Q

indications for chest drain from aspirate info

A

Patients with frankly purulent or turbid/cloudy pleural fluid on sampling should receive prompt pleural space chest tube drainage.
The presence of organisms identified by Gram stain and/or culture from a non-purulent pleural fluid sample indicates that pleural infection is established and should lead to prompt chest tube drainage.
Pleural fluid pH < 7.2 in patients with suspected pleural infection indicates a need for chest tube drainage.

51
Q

when is surgery an optioin in bronchiectasis

A

localised disease only

52
Q

problem with CRP in pneumonia monitoring

A

it lags behind actual infection (2 types of error)

revision (24 decks)

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