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Finals > Resp > Flashcards

Resp Flashcards

1
Q

pres of asthma

A

wheezing, sob, chest tightness, cough (nocturnal)

diurnal variation
wheeze (polyphonic, expiratory)

FHx atopy/nasaly polyposis

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2
Q

triggers of asthma?
allergic?
non-allergic?

A

house dust mite, pet fur, grass pollen -> IgE

exercise, cold air, stress, emotion, viral infection, smoking

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3
Q

drugs CI in asthma?

A

Beta blockers -> B2 = airway obstruction

NSAIDs/aspiring -> block COX-1 -> decrease PGs + overprod of inflam leukotrienes

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4
Q

what happens in acute airway inflammation?

A

constriction
oedema
mucus hypersecretion

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5
Q

features of chronic airway inflammation?

A

airway remodelling

airway hyperresponsiveness

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6
Q

pathology of early phase asthma?

A

allergen -> mast cells release IgE

histamines, leukotrienes and TNFa -> increased vascular permeability and hypersecretion of mucus

AIRWAY OEDEMA

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7
Q

key cell in later phase asthma? what happens?

A

eosinophil mediated

increase goblet cells -> hyperresponsive

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8
Q

effect of acute vs chronic inflam?

A

acute inflam -> bronchoconstriction

chronic -> airway hyperresponsiveness

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9
Q

Qs to assess asthma control?

A

in the last 4 weeks how often have you:

i) been SoB?
ii) woken from sleep?
iii) used reliever?
iv) been stopped from doing normal activities?
v) how would you rate asthma control?

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10
Q

what should you always check in asthma?

A

inhaler technique

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11
Q

ix in asthma?

A 
PEFR
Reversibility testing [FEV1 improves by 15% on SABA]
spirometry 
CXR
FBC
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12
Q

mx of asthma?

A
  1. saba
    • ics
    • ltra
    • ltra + laba
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13
Q

ix in acute exacerbation of asthma

A

PEF
SpO2
ABG

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14
Q

mx of acute asthma exacerbation?

if exhausted?

A 
OSHIT
O2 (94-98)
Salbutamol (neb)
Hydrocortisone/pred
Ipratropium (neb)
Theophyline (IV)
MgSO4 (IV)

if exhausted -> intubate

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15
Q

features of life threatening asthma attack?

A 
33,92,CHEST
33>PEFR
92>O2 sats
Cyanosis
Hypotension
Exhaustion
Silent chest
Tachypniea
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16
Q

what is COPD

A

chronic obstruction, irreversible -> air trapping and hyperinflation

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17
Q

pathology of COPD

A

chronic inflam -> increased goblet cells, narrow airways + vascular changes -> pulm HTN

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18
Q

o/e of COPD

A

barrel chest
CO2 flap
hyperresonant

In actue exacerbation -> coarse crackles + wheeze

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19
Q

comps of COPD

A 
cor pulmonale
pneumonia
depression
polycythaemia
resp failure
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20
Q

signs of cor pulmonale

A

raised JVP
distended neck veins
hepatomegaly

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21
Q

mx of cor pulmonale

A

LT O2

Loop diuretic

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22
Q

T1 vs T2 resp failure

A

T1 = V/Q mismatch [pink puffer]

T2 = alveolar hypoventilation [blue bloater]

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23
Q

spiro finding in COPD

A

obstructive: FEV1/FVC<0.7

non reversible

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24
Q

ix in COPD

A 
Spirometry 
ABG
CXR
FBC
sputum culture
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25
Q

CXR signs of COPD

A

flat diaphragm
increased intercostal spaces
hyperlucent lungs
increased AP diameter

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26
Q

severity of COPD - FEV1

A

mild > 80%
mod 50-80%
severe 30-50%
v severe <30%

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27
Q

non pharma mx of COPD

A

education
vaccinations
smoking cessation
obesity mx

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28
Q

pharma mx of COPD

A

SABA/SAMA

if FEV1>50% [LABA, LABA+ICS]

if FEV1<50% [LABA+ICS]

then: LABA+LAMA+ICS

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29
Q

common causes of COPD exacerbation

A

H. influenza
S. pneumoniae
M. catarrhalis

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30
Q

mx of acute exacerbation of COPD

A 
SHONA
Steroids
Heparin
O2 (88-92%)
Neb bronchodilators
Abx
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31
Q

Abx in COPD exacerbation?

CAP vs HAP?

A

CAP = amoxicillin / doxycycline

HAP = vancomycin / tazocin

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32
Q

when is pneumonia classified as HAP?

A

if LRTI >2d post admission

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33
Q

pneumonia risk score? + where to treat?

A

CURB 65

0-1 = low risk, o/p 
2 = mod risk -> admit
3-5 = high risk -> ITU
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34
Q

cause of CAP in younger adults?

pres?

A

Mycoplasma pneumoniae

dry cough + atypical CXR + AI haemolytic anaemia + erythema multiforme

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35
Q

possible cause of HAP in immunocomp patient?

A

fungus; pneumocystis jirovecii = PCP

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36
Q

how does PCP pres?

A

CD4 < 200
cough
sats drop on exertion

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37
Q

mx of PCP?

A

co-trimoxazole

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38
Q

pres of CAP?

A

cough with sputum + expectoration
fever (high in pneumococcal)
dyspnoea
pleuritic pain

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39
Q

o/e of pneumonia

A

crackles
reduced air entry (u/l)
pleural rub
vocal fremitus

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40
Q

ix for pneumonia

A 
FBC, CRP
ABG
sputum - MC+S
CXR
blood cultures
\+/- urinary antigen -> for legionella and pneumococcus
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41
Q

CXR of pneumonia?

A

air bronchograms
consolidation
atelectasis

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42
Q

CURB 65 score = which abx?

A

0-1 -> amoxicillin/clarithromycin 5d PO

2 -> amoxicililn + clarithromycin 7-10d PO

3 -> co-amoxiclav + clarithromycin (IV) 7-10d

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43
Q

if high risk pneumonia and penicillin allergic; what abx?

A

cefotaxime

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44
Q

mx of HAP?

A

IV cefotaxime + gentamicin

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45
Q

mx of legionella

A

clarithromycin + fluoroquinolone

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46
Q

mx of chalmydia pneumonia

A

doxycycline

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47
Q

comps of pneumonia

A

septic shock
ARDS
pleural effusion + empyema

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48
Q

RFs for TB

A 
birth endemic
immunocomp
poor nutrition
over crowding
IVDU
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49
Q

screen for TB

A

tuberculin skin test

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50
Q

what type of infection is active TB

A

granulomatous

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51
Q

ix in TB

A

CXR

3x sputum acid fast bascilli smear

sputum culture
FBC
NAAT
?HIV

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52
Q

stain for TB

A

Ziehl-Neelsen turns pink

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53
Q

seen on CXR of TB:

primary?
healed primary?
post primary?

A
  • consolidation + ipsilat hilar lymphadenopathy
  • Ghon focus = large round calcified lesion near hilum
  • upper zone opacities with cavitation + calcification + consolidation of hilum
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54
Q

Mx of TB

what to check before?

A 
RIPE DOTS
Rifampicin (6m)
Isoniazid (6m)
Pyrazinamide (2m)
Ethambutol (2m)

directly observed therapy 3x/week

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55
Q

TB drugs + SEs?

A

Rifampicin -> liver toxicity, orange wee
Isoniazid -> liver tox, peripheral neuropathy
Pryazinamid -> liver tox, hepatitis
Ethambutol -> visual disturbance, optic neuritis

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56
Q

pres of extra-pulmonary TB

A 
pleural effusions
LN - scrofula
GU - frequency, dysuria, haematuria
Bone - osteomyelitis; Pott's disease
Brain - meningitis
Abdo - ascites
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57
Q

CT of disseminated TB

A

millet seed appearance

liver/spleen/lung

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58
Q

RFs for DVT

A

cancer, trauma, major surgery, hospitalisation, immobilisation, COCP, obesity

genetics -> factor V leiden, antiphospholipid

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59
Q

Virchow’s triad in DVT

A

venous stasis
vessel injury
activation of clotting system

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60
Q

DVT score

A

Wells >2

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61
Q

Ix in wells 0-1?

A

D-dimer

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62
Q

ix in wells >=2

A

PVUSS

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63
Q

comps of PE

A

RHF -> cardiac arrest

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64
Q

types of emboli in PE

A 
thrombus
amniotic fluid embolus
fat embolus
air embolus 
tumour
65
Q

o/e PE

A 
pleural rub
tachyc, tachyp
elevated JVP
hypoxia 
shock
66
Q

ddx of PE

A

ACS
aortic dissection
pneumothorax

67
Q

ix in PE

A 
Wells
CXR
ECG
CXR
ABG
D-dimer

CTPA (if Wells>4 or D-dimer +ve)

68
Q

mx of PE?
stable?
unstable?

A

100% O2, IV fluids, morphine

Stable -> LMWH

Unstable -> heparin +/- thrombolysis

69
Q

long term mx of PE

A

warfarin for 3m

70
Q

mx symptomatic DVT

A

dalteparin

71
Q

Prevention of VTE

A

early mobilisation
stockings
avoid COCP

72
Q

spiro of pulm fibrosis

A

restrictive

FVC reduced
FEV1/FVC normal

73
Q

pres of Pulm fibrosis

A 
4Ds 
Dry cough 
Dyspnoea
Diffuse inspiratory crackles
Digital clubbing
74
Q

causes of pulm fibrosis

A

connective tissue disease

occupational

iatrogenic [amiodarone, bleomycin, MTX]

irritants [hypersensitiviy, pneumonitis]

radiation

75
Q

RFs for idiopathic pulm fibrosis

A

smoking
dust exposure
chronic aspiration

76
Q

Q in IPF?

A

occupation

77
Q

main comp of IPF

A

pulm HTN -> cor pulmonale

78
Q

ix in IPF

A 
CXR
CT
spiro -> restrictive
ANA (?SLE)
Biospy
79
Q

XR findings in IPF

A

reticular shadowing

shaggy heart border

80
Q

high res CT of IPF?

A

ground glass
honeycomb
reticular

81
Q

general mx of IPF

A 
O2
physio
exercise / wt loss
vaccine
smoking cessation
82
Q

pharma mx of IPF

A

anti-fibrotic
pirfenidone

(inhibits collagen synthesis)

83
Q

DDx for upper lung fibrosis

A 
Upper - ESCHART (granulomatous)
Extrinsic allergic alveolitis
Sarcoid/silicosis
Coal worker's pneumoconiosis
Histiocytosis X
Ank spond
Radiotherapy
TB
84
Q

DDx for lower lung fibrosis

A 
Lower - RASCO (systemic)
RA
Asbestosis
Systemic sclerosis/SLE
Cryptogenic fibrosing alveolitis
Other (drugs)
85
Q

upper vs lower lung fibrosis?

A

upper = granulomatous

lower = systemic

86
Q

Caplans syndrome?

A

pulm fibrosis in coal workers with RA

87
Q

EAA - RFs

A

hx of exposure to organic dust / birds / agricultural / mould

88
Q

Pathophys of EAA

A

Non-IgE mediated inflam of alveoli and distal bronchioles

89
Q

ix in EAA

A

WCC, CRP
CXR -> diffuse interstitial shadowing (upper zone)
CT -> reticulo-nodular shadowing, ground glass
Spiro -> restrictive
Bronchoalveolar lavage = CD8

90
Q

Mx of EAA?

A

allergen avoidance

O2 + pred

91
Q

Pneumoconioses?
Cause?
Latent period?
curable?

A

chronic lung disease from exposure to mineral dust or metal

coal, silicosis, asbestosis

coal - 10y
asbestos - 15-60y

incurable

NOTIFIABLE ? compensation

92
Q

Coal worker with RA = ?

A

caplans syndrome

93
Q

conditions causing black sputum?

A

coal workers pneumoconiosis

silicosis

94
Q

ix in asbestosis

A

CXR -> ground glass

95
Q

asbestosis can cause what cancer?

A

pleural mesothelioma

96
Q

sx of pleural mesothelioma

A

dry cough, dyspnoea, clubbing, pleuritic chest pain

+/- pleural effusion

+/- wt loss, fatigue, fever, night sweats

97
Q

ix in pleural mesothelioma

A

CXR -> irreg thickening
CT
thoracentesis -> exudate
pleural biopsy

98
Q

mx of pleural mesothelioma

A

operable at stage 1 + chemo

if > 1 -> chemoradio

+ COMPENSATION

99
Q

pleural effusion?

A

fluid in potential space between visceral and parietal pleura

100
Q

types of effusion?
causes?
how to tell the difference?

A

Transudate (protein<30g/L) -> HF, cirrhosis, hypoalbuminaemia, nephrotic

Exudate (protein>30g/L) -> pneumonia, malignancy, TB, AI disease

101
Q

o/e pleural effusion

A

u/l reduced chest expansion
stony dull to percussion
decreased breath sounds

102
Q

CXR in small pleural effusion

A

blunted costophrenic angle

103
Q

bilateral effusion, transudate or exudate?

A

likely to be transudate

104
Q

mx pleural effusion?
transudate?
exudate?

A

trans - do not tap!!

ex - symptomatic -> pleural tap

105
Q

mx of malignant cause of effusion

A

pleurodesis to prevent recurrence

106
Q

causes of bilat hilar lymphadenopathy

A 
TIMES
TB 
Inorganic dust [silicosis]
Malignancy [lymphoma, carcinoma, mediastinal]
EAA 
Sarcoidosis
107
Q

pneumothorax?

A

air in the pleural space

108
Q

RFs for pneumothorax

A

primary spontaneous -> tall thin males, smoking, marfans, FH

secondary spontaneous -> lung disease; COPD, CF, TB, PCP

Trauma

109
Q

tension pneumothorax?

A

intrapleural pressure > atmospheric pressure

valve mechanism lets air in but not out

-> lung deflates and mediastinum shits contralaterally compressing great veins and reducing venous return to heart

110
Q

pres of pneumothorax

A

pain on breathing in

111
Q

o/e of pneumothorax

A

hyperresonant
reduced expansion
decreased breath sounds

112
Q

pres + o/e tension pneumothorax

A

resp distress
distended neck veins
tracheal deviation away
hyperexpanded hemithorax

113
Q

CXR of pneumothorax

A

visceral pleural line

no lung markings

114
Q

mx pneumothorax?

if initially unsuccessful?

A

high flow O2
aspirate 16-18G cannula in 2nd IC space, mid-clav line

if this doesnt work -> chest drain + admit

115
Q

where to put chest drain?

A

mid-axillary line

IC 4-6

116
Q

DDx of pleuritic chest pain?

A 
ACS
aortic dissection 
pneumothorax
PE
pneumonia
malignancy
117
Q

bronchiectasis?

A

permanent dilatation and thickening of airways due to recurrent infection and inflammation

118
Q

causes of bronchiectasis?

A

post-infection

immunocomp

genetic [CF, ciliary dyskinesia, A1AD]

Connective tissue diseas

IBD

119
Q

Bugs often seen in bronchiectasis

A

aspergillus fumigatus

S.aureus, H. influenza, S.pneumonia, Pseudomonas aeruginosa

120
Q

pres on infective bronchiectasis

A

cough + sputum (+/- blood)

dyspnoea + wheeze

wt loss + fatigue

121
Q

o/e bronchiectasis

A

inspiratory coarse crackles (shift on cough)

inspiratory squeaks

122
Q

ix in bronchiectasis

A

CXR - dilate bronchi with thick walls
TRAM-TRACK SIGN

CT is gold standard

sputum -MC+S

123
Q

Bronchiectasis bugs:
gram +ve?
gram -ve?

A

+ve = S.aureus, S.pneumonia

-ve = pseudomonas aeruginosa (high risk in CF)

124
Q

mx bronchiectasis

A

exercise, nutrition, airway clearance (postural drainage)
+ mucolytics
+inhaled bronchodilator
+inhaled hypertonic saline

125
Q

mx recurrent pseudomosas

A

neb gentamicin

126
Q

mx severe exacerbation of bronchiectasis?

A

IV ciprofloxacin

127
Q

Gene in CF?

A

CFTR

Cl- channel

128
Q

organs affected by CF

A 
lungs
bowel
pancreas
sweat
reproductive organs

–> thick sticky secretions

129
Q

screening for CF?

A

immunoreactive trypsinogen on heel prick (Guthrie test)

130
Q

pres of CF

A

neonates -> failure to pass meconium, FTT, cough

resp -> recurrent infections, cough, wheeze, mucus

GI -> gallstones, decreased motility

Panc _> DM, steatorrhoea

Reprod -> male infertility

+/- clubbing

131
Q

ix for CF

A

serum immunoreactive trypsiogen

sweat test

genetic test

faecal elastase (pancreatic assessment)

132
Q

mx for CF

A

chest physio

inhaled bronchodilator

inhaled mucolytic (dornoase alfa + hypertonic saline)

vaccinations

prophylactic abx [fluclox]

pancreatic enzymes (DEAK)

133
Q

pressure for pulm HTN

A

> 25mmHg at rest

134
Q

mx pulm HTN

A

CCB / sildenafil
anticoag
furosemide

+/- O2

135
Q

types of lung Ca?

A

NSCLC (85%) - adenocarcinoma, squamous cell carcinoma large cell carcinoma

SCLC (25%)

136
Q

2ww for lung ca?

A 
>40 + 2 of: 
cough
fatigue
sob
chest pain
wt loss
anorexia
smoker
137
Q

paraneoplastic features of SCLC

A

LEMS [anti-VGCaC]
SIADH
ACTH [HTN, hyperglycaemia, hypoK, alkalosis]

138
Q

paraneoplastic features of squamous cell Ca

A

PTH-rP -> hypercalcaemia + bone pain

TSH -> hyperthyroidism

139
Q

paraneoplastic feature of adenocarcinoma

A

gynaecomastia

140
Q

where are lung adenocarcinomas

A

peripheral lung

141
Q

where are lung squamous cell carcinomas?

usual pres?

A

central airway

-> obstruction

142
Q

pancoast tumour invades? (3)

A

brachial plexus -> weakness, paraesthesia, pain

sympathetic chain -> horners

recurrent laryngeal nerve -> hoarse

143
Q

where is pancoast tumour found?

A

superior sulcus

144
Q

signs of lung Ca

A

monophonic wheeze
pleural effusion
SVCO
clubbing

145
Q

ix for lung ca

A 
CXR
CT/MRI brain
spirometry
FBC
LFT
bone scan
biopsy
146
Q

common mets of lung Ca

A

liver, bones, brain, adrenals

147
Q

mx SCLC

A

not surgery!

chemo + radio
+ prophylactic cranial irradiation

148
Q

palliative care sx+mx in lung Ca

A 
SoB -> opiate
Obstruction -> radio
Pleural effusion -> aspiration
Cough -> opiate
Hoarse ->ENT
SVCO -> chemo+radio
Bone pain -> radio
SCC -> dexamethasone
149
Q

Good pastures?

A

anti-GBM

collagen type IV

150
Q

pres of goodpastures

A

kidney -> oedema, reduced UO, haematuria

lung -> haemoptysis, cough, SoB

151
Q

ix in goodpastures

A

urinalysis
U+Es
Renal biopsy -> crescentic glomerulonephritis

CXR
Anti-GBM
ANA (normal, r/o lupus nephrtitis)
Anti-steptolysin O -> r/o post strep glomerulonephritis

152
Q

mx goodpastures

A

oral corticosteroid
+plasmapheresis
+cyclophosphamide

O2+ blood products for severe pulmonary haemorrhage

153
Q

ABG in resp failure?
Type 1?
Type 2?

A

T1; O2<8kPa

T2; O2<8kPA + CO2>6kPa

154
Q

mx resp failure

A

admit + resus

aim for sats>90%

155
Q

what is ARDS?

A

non-cardiogenic pulm oedema and diffuse lung inflammation

156
Q

causes of ARDS?

A

sepsis

pancreatitis

157
Q

ix ARDS

A 
low tidal volume ventilation
CXR
ABG
blood cultures
sputum culture
urine culture
158
Q

mx ARDS

A

supportive care - resus

Abx + treat cause

Finals (20 decks)

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