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F year medicine facts > resp > Flashcards

resp Flashcards

1
Q

How much salbutomol neb would you give in acute asthma

A

2.5mg

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2
Q

how much pred/ hydro would you give in asthma

A

pred - 30mg PO

Hydro - 100mg IV

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3
Q

what are you looking for in the metacholine histamine challenge for asthma

A
  • 20% reduction in fev1; how much metacholine is required to do this
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4
Q

RF for asthma

A
  • low birthweight
  • atopy triad
  • fhx atopy/ personal
  • maternal viral infection esp RSV
  • Maternal smoking
  • not breastfed
  • antenatal smoking
  • high exposure to allergens
  • air pollution
  • hygiene hypothesis
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5
Q

sx of acute severe ashtma

A
  • 33-50% PEFR
  • UNABLE to compelte sentences
  • pulse >110
  • RR>25
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6
Q

SX of life threatening asthma

A
  • hypotension
  • silent chest
  • confusion
  • pao2<8 but paco2 normal
  • exhaustion
  • bradycardia
  • PEFR<33%
  • near fatal paco2 will be high
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7
Q

rx pathway for adults with ashtma

A
  • SABA for all
  1. ICS
  2. ICS +LABA
  3. ICS +LABA + LTRA.
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8
Q

rx pathway for asthma in kids

A
  • SBA for all
  1. ICS very low dose
  2. ICS + if <5 = LTRA. if >5 = LABA
  3. Add whatever was not given before
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9
Q

when do you refer a patient with acute asthma to ITU

A
  • Decreased PEF
  • Confused/ drowsy
  • hypercapnic
  • low PH/ high H+
  • needs ventilatory support
  • worsenign hypxia
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10
Q

acute asthma rx

A
  • o2
  • neb salb 2.5mg through 02 back to back
  • pred/ hydro
  • ipratropium bromide
  • mg sulphate
  • aminophylline
  • ITU
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11
Q

what are the rx of copd before starting inhalers

A
  • pulmonary rehab
  • stop smoking
  • vaccines
  • self manage plan
  • comorbidities optimisation of rx
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12
Q

COPD inhaler rx pathway

A
  • SABA/SAMA
    IF non asthma like
    1. LABA +LAMA
    2. LABA + LAMA + ICS

If asthma like

  • ICS + LABA
  • ICS + LABA/LAMA

+ mucolytic if sputum heavy

NEXT LEVVEL

  • amino/theo
  • LTOT
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13
Q

what exam findings should you assess for in copd when considering LTOT

A
  • <30% FEV1
  • Cyanosis
  • polycythaemia
  • high JVP
  • peripheral oedema
  • <92% o2 sats

ABGS twice at least 3 weeks apart with stable COPD and on optimal rx

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14
Q

Criteria for LTOT in COPD-

A

PO2<7.3KPA or p02 7.3 -8 +

  • secondary polycythaemia
  • peripheral oedema
  • pulmonary HTN

Do not give if still smoking

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15
Q

in alpha 1 antitrypsin deficiency what is the rx

A
  • replace with IV if <310 + abnormal lung function
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16
Q

secondary polycythaemia rx

A
  • venesect
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17
Q

what advise should be given about air travel with COPD

A
  • Need trial 15% o2 instead of room air 21%. if falls below 85% sats need supplementary o2
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18
Q

what ix to do in resp failure

A
  • FBC, U and E, CRP, ABG, CXR, sputum culture if debrile

- spirometry if thinking of certain pathologies

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19
Q

complications of intubation and ventilation

A
  • traumat to URTI
  • Secondary pulm infection
  • barotrauma; = surgical emphysema/ tension pneumo
  • reduced CO - increase intrathoracic pressure and so impairs filling
  • abdo distention due to inestinal ileus
  • increased ADH and reduced ANP = salt and wter retention
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20
Q

which peripheral chemoreceptors detect ph, co2 and blood 02

A
  • carotid body

aortic does not do ph

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21
Q

what does the pneumotaxic centre of the brain do

A
  • inhivits apneustic centre of pons so reduces inspiration
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22
Q

why do you get pulmonary HTN in massive PE but not small PE-

A
  • Small PE = blocking segmental pulmonary artery so still being ventilated but not perfused
  • in massive PE = proximal Pulmonary artery blocked causing backflow of blood .
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23
Q

how do you treat pneumonia caused by staph

A
  • fluclox and rifampicin
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24
Q

how does mycoplasma pneumonia present and rx

A
  • dry cough and atypical chest signs/CXR. flu like sx then cough.

+/- autoimmune haemolytic anaemia and erythema multiforme

  • CXR; reticular nodular shadowing or patchy consoloidation often LOWER lobe
  • rx clarithro/doxy
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25
Q

in legionella what happens to na and lymphocytes-

A

hyponatraemia nd lymphopenia

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26
Q

how do legionella pneumonia present

A
  • flu like x then dry cough and SOB
  • Anroexia, D and V, hepaitis, renal failure, confusion, coma
  • Bibasal consolidation on CXR

rx - fluoroquinolone

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27
Q

who is klebsiella pneumonia more common in

A
  • DM
  • Elderly
  • Alcoholics
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28
Q

rx klebsiella

A
  • ceoftaxime
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29
Q

what happens to neutrophils in bacterial pneumonia

A
  • neutrophilia
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30
Q

what bloods to do for pneumonia

A
  • FBC
  • U and E
  • LFT
  • CRP
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31
Q

if you do a point of care CRP test for pneumonia , when do you give abx

A
  • CRP <20 = no abx
  • 20-100 - delayed prescription
  • > 100 = abx
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32
Q

when do you admit patietns with pneumonia

A
  • CURB65 > or equal to 2
  • if 1 then if sat s <92% admit
  • if 1 and >92% then do cxr, if bilateral or multilobar then admit
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33
Q

common empirical abx for pneumonia

A

CAP

  • Doxy/amoxi if mod
  • clarithro and benpen if severe

HAP
- Benpen and gent

aspiration
- benpen, gent and metro

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34
Q

when should you discharge a patient who has had pneumonia

A
  • if in last 24hrs

no temp, RR<24, HR <100, SBP >90, O2>90%, ABNORMAL AMTS, Cant eat without assistance

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35
Q

how long after pneumonia do you stop having a fever

A

1 week

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36
Q

how long after pneumonia does chest pain and sputum production go

A
  • 4 weeks
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37
Q

how long after pneumonia does cough resolve

A
  • 6 weeks
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38
Q

when does fatigue resolve after pneumonia

A
  • 3/12
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39
Q

empyema; what is the ph, glucose and LDH

A
  • LDH is high
  • ph = low <7.2
  • glucose is low
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40
Q

what wells score do we need to do USS for DVT

A

2+

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41
Q

WHAT DO you do if d dimer is high on a patient suspected of DVT but there USS is -ve

A
  • repeat USS in 1 week
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42
Q

how long do you treat for after unprovoked DVT-

A
  • 3/12
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43
Q

post thrombotic limb syndrome rx

A
  • elevate, compress, weight manage etc

- vasc surgery if conservative not working

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44
Q

what type of smokers is pneumothorax more common in

A
  • healthy smokers
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45
Q

ECG changes in pneumothorax

A

left sides:
- V2-V6 = reduced QRS amplitude

right sides:
- v5-v6 = increased amplitude

STE/D in pneumothorax

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46
Q

how do you treat pneumothorax due to traum or mechanical ventilation

A
  • chest drain
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47
Q

where to insert chest drain for pneumothorax-

A

4th intercostal space in between ant and median axillary line

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48
Q

rx pneumothorax primary

A
  • <2cm / asymptomatic - go home

- >2cm / breathless - aspirate then chest drain if need

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49
Q

rx pneumothorax secondary

A

<1cm - admit and observe 24hrs + 02

1-2cm = aspirate

2cm/ breathless= drain

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50
Q

indications for surgery in pneumothorax

A
  • bilateral
  • unresolving after 48hrs of chest draian
  • persistent air leak
  • 2 or more previous pneumothoraxes on same side
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51
Q

advise for flying post pneumothorax

A
  • no flying for 1 - 4/52 after; check airlines

- also no scuba divign ever

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52
Q

where do you insert the needle for emergency decompression in pneumothorax-

A

2nd intercostal space mid clavicular line

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53
Q

Non small cell carcinoma pathology

A
  • EGFR; TK mutation. can target with TKI; gefitinib and erlotinib
  • inversion of chr short arm = EML4+ ALK gene fusion. = fusion TK. target with crizotinib
54
Q

what is PDL1 and how is it related to lugn cancers

A
  • PDL1 is produced by lugn cancer cells to attach to T cells to inhbiit their function
  • can give PDL1 inhibitors to stop this = MABS = Pendormulizab
55
Q

what side of Lung cancer often causes SVC obstruction

A
  • right sided. often Smal cell
56
Q

PTHRP , SIADH, ACTH, Lambeth eaton; is most common in which kind of lung cancer

A
  • small cell
57
Q

where on CXR would you see TB related problems

A
  • Upper lope.
58
Q

what is the difference between the IGRA test and mantoux test in TB

A
  • Mantoux ; test immunity

- IGRA - tests latency

59
Q

WHO gets DOT therapy in TB

A
  • Homeless with active TB
  • Prisoners with active or latent
  • those with pooor concordance
60
Q

what drugs should you not give rifampicin with

A
  • OCP, Prednisolone
61
Q

which Tb drug gives you peripheral polyneuropathy

A
  • Isoniazid
62
Q

which TB drug gives you gout

A
  • pyrazinamide
63
Q

what is lights criteria for pleural effusions

A

fluid is exudate if:
1. pleural fluid protein divided by serum protein >0.5

  1. pleural fluid LDH >
    Divided by seurm LDH >0.6
  2. fluid LDH >2/3rds of ULMN of serum
64
Q

if pleural fluid has low glucose - what is the cause of pleural effusion?

A
  • rheumatoid arthritis

- TB

65
Q

IF pleural fluid has raised amyalse - what is the cause of pleural effusion

A
  • pancreatitis

- oeseophageal perforation

66
Q

if pleural fluid has lots of blood - what is the cause

A
  • mesothelioma
  • pulmonary embolism
  • TB
67
Q

Common cause of transudates of pleural effusions

A
  • hypoalbuminaema
  • CCF
  • Constrictive pericarditis
  • Meig’s syndrome (right pleural effusion, ovarian fibroma and ascites)
  • HypoTH
68
Q

common causes of exudate pleural effusions

A
  • autoimmune disease
  • oeseophageal rupture
  • infection
  • malingnacy
  • pancreatitis
  • post CABG
  • PE
69
Q

ix imaging for pleural effusion

A
  • CXR

- USS

70
Q

RX pleural effusions

A
  • small: diagnostic tap
  • moderate: therapeutic aspiration
  • large: drain

never take more than 1.5l in one go = pulmonary oedema

71
Q

If a pleural effusion is parapneumonic, what will the pH be

A

7.2 or less - chest drain if moderate+ size

72
Q

ix for pleural effusions samples

A
  • pH, biochem (LDH, Protein, glucose, adenosine deaminase)
  • cytology
  • microbiology = MCS
73
Q

rx for pleural effusion due to pulmonary oedema

A
  • diuretics
74
Q

borders of the safe triangle for chest drain insertion

A
  • lateral border of pec major
  • anterior border lat dorsi
  • superior border of 5th rib
  • base of axilla
75
Q

killer conditions in chest traums (ATOMFC)

A
  • Airway obstruction
  • Tension pneumothorax
  • Open pneumothorax
  • Massive haemothorax
  • Flail chest
  • Cardiac tamponade
76
Q

what does crepitus with airway obstruction indicate

A
  • Laryngeal fracture
77
Q

what does surgical emphysema causing airway obstruction sound like

A
  • bubble wrap
78
Q

why are most haemothoraxs not detectable on scans

A
  • need 500ml of blood to obliterate the costophrenic angle on erect CXR
  • supine is not helpful
79
Q

how big a drain should you use in adults with haemothorax

A
  • 32F for adults to prevent clotting , if can get 36 the better
80
Q

who gets a thoracotomy in haemothorax

A
  • unstable
  • large ; >1500ml
  • ouput from drain not reducing (1-1.5l)
81
Q

complications of haemothorax

A
  • clotted residual haemothorax which doesnt drain - gets infected = empyema
  • even uninfected = organissation and fibrosis = loss of lugn volume and reduce function
82
Q

how do you know if someone with haemothorax now has empyema

A
  • fever
  • air fluid levels on CT
  • leukocytosis
83
Q

rx empyema post haemothorax

A
  • surgery
84
Q

traumatic pneumothorax rx

A

= - drain . only mechanically ventilate if need, after the drain

85
Q

most common cause of haemothorax

A
  • laceration of lung, intercostal vessel or internal mammary artery
86
Q

what is becks triad for cardiac tamponade

A
  • elevated venous pressure
  • reduced arterial pressure,
  • reduced heart sounds
87
Q

what happens to pulse in cardiac tamponade

A
  • pulsus paradoxus
88
Q

how to treat pulmonary contusion

A

= lethal chest injury

  • ABG and pulse ox
  • early intubate within 1hr if significant hypoxcia
89
Q

when do blunt cardiac injuries occur

A
  • secodnary ot chest wall iniurt
90
Q

in cardiac injury, what do ECGs look ike

A
  • MI
91
Q

cause of aortic disruption in trauma

A
  • deceleration injuries
92
Q

what do you see on XR in aortic disruption

A
  • widened mediastinum

- cotnained haematoma

93
Q

diaphgram disruption causes and which side is it more common on

A
  • motor vehicle accidents and blutnt rauma cuasing large radial tears;
  • left side
94
Q

how to identify diaphragm disruption

A
    • NG tube -> passes through to thoracic cavity
95
Q

what inheritance pattern does Cystic fibrosis have

A
  • autosomal recessive
96
Q

which infection in cystic fibrosis is associated with accelerated disease and rapid death

A
  • burkholderia cepacia
97
Q

Presentation of CF

A
  • Repeated childhood respiratory infection
  • Sinusitis and nasal polyps
  • pancreatic insufficiency; steatorrhoea
  • gallstones of cholesterol
  • cirrhosis
  • peptic ulcers and GI malignancy high risk
  • malnutirition due to malabsorption
  • meconium ileus
  • SOB and haemoptysis due to bronchiectasis
  • delayed puberty and skeletal maturity
  • male infertile due to lack of vas deferens and epidydmis
  • females; secondary amenorrhoea with time
98
Q

sx broncheictasis

A
  • recurrent infections
  • cough with yellow or green sputum
  • persistent halitosis
  • clubbing
  • coarse crackles over bases
  • haemoptysis if severe or even massive haemorrhage (bronchoscopy –> embolization)
99
Q

rx bronchiectasis

A
  • postural drainage
  • treat infections
  • bronchodilators
100
Q

what is kartageners syndrome triad

A
  • bronchiectasis
  • situs inversus
  • chronic sinusitis
101
Q

what chromosome is affected in CF

A

7

102
Q

CF signs in a neonate

A
  • meconium ileus
  • FTT
  • rectal prolapse
103
Q

CF signs in children

- resp

A
  • cough, sputum
  • wheeze
  • recurrent chest infection
  • haemoptysis
  • bronchiectasis
  • pneumothorax
  • sinusitis
  • cor pulmonale
  • hyperinflation
  • nasal polyps
104
Q

CF sign in kids; Skin

A
  • bruisinng due to vit K deficiency

- salty sweat

105
Q

CF sign in kids - GI

A
  • Steatorrhoea
  • DM
  • ADEK deficiency
  • gallstones
  • cirrhosis
106
Q

what does bronchiectasis look like on CXR

A
  • Tram track opacities seen in cylindrical pattern
107
Q

is bronchiectasis obstructive or restrictive on spirometry

A
  • obstructive
108
Q

what tests should you regularly do for CF patients

A
  • FBC
  • U and E
  • clotting
  • Vit ADEK
  • Annual glucose
  • sputum mcs
  • CXR
  • Spirometry
109
Q

what organism is common for infections in cf and what is the rx

A
  • pseudomonas

- ciprofloxacin and nebulised tobramycin

110
Q

what fev1 do you need to have lung transplant in CF

A
  • <30%
111
Q

What cranial nerve is affected in sarcoidosis

A
  • CNVII palsy
112
Q

what endocrine problem is common in sarcoidosis

A
  • DIabetes insipidus
113
Q

acute sarcoidosis presentation

A
  • bilateral hular LNA
  • anterior uveitis
  • CNVII palsy
114
Q

chronic sarcoidosis presentation

A 
- permanent organ damag
e
- pulmonary fibrosis 
- lupus pernio 
- posterior uveitis
115
Q

sarcoidosis stages

A

1 = Bilateral hilar lympadenopathy (BHL)

2 = BHL + Infiltrate

3 = Infiltrate without NHL

4 = Fibrosis

116
Q

is sarcoidosis restrictive or obstructive

A
  • restrictive
117
Q

what does ecg show in sarcoidosis

A
  • arrhytmias

- BBB

118
Q

GS ix for sarcoidosis

A
  • Biopsy
119
Q

rx acute sarcoidosis

A
  • bed rest

- NSAIDs

120
Q

indications for steroids in sarcoidosis

A
  • uveitis
  • high ca
  • neuro and ca involved
  • parenchymal lung disease
121
Q

what steroids to give for sarcoid

A

= pre 4-6 weeks then taper over a year

122
Q

what conditions cause Upper lobe shadowing on CXR

A
  • TB
  • Ank spond
  • RDT
  • Fibrosis
123
Q

what caonditions cause middle lobe shadowing on CXR

A
  • Histoplasmosis

- sarcoidosis

124
Q

what conditions cause lower zone shadowing on CXR

A
  • Idiopathic fibrosis

- asbestos

125
Q

extrinsic allergic alveolitis sx

A
  • 4-6hrs post exposure
  • fevers, rigors, Dry cough, SOB, fine bibasal crackles
  • ltm = clubbing, weight loss, SOBOE, T1RF, Cor pulmonale
126
Q

extrinsic allergic alvoeolitis rx

A
  • steroids
127
Q

is ANA +ve in Idiopathic fibrosis

A
  • in 30%
128
Q

describe appearance of IDPF on CXR and CT

A
  • HONEYCOMB LUNG - in advanced
129
Q

what happens to spirometry in IDPF

A
  • Restrictive, lower transfer factor
130
Q

what is caplans syndrome

A
  • pulmonary rheumatoid nodules, pneumoconiosis, RA

F year medicine facts (19 decks)

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