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NAM: med / surg / specialties > resp > Flashcards

resp Flashcards

1
Q

causes of pleural effusion

A

exudate (protein > 35g/dl): infection (pneumonia), inflammation (SLE, rheumatoid arthritis), malignancy (lung cancer, mets)
transudate (protein < 25g/dl): cardiac, liver, renal failure

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2
Q

causes of ILD

A

idiopathic pulmonary fibrosis
occupational / environmental: extrinsic allergic alveolitis / pneumoconiosis
drugs: methotrexate, amiodarone
inflammatory: SLE, RA, sarcoidosis, ank spond, systemic sclerosis
other: radiation

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3
Q

ILD investigations

A

bloods: FBC, CRP/ESR,
serology: RF, ANA, anti-CCP, anti-Jo
lung function tests (restrictive pattern)
CXR (initial)
high-res CT → honeycombing
bronchoscopy + biopsy (diagnostic)

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4
Q

definition of COPD

A

emphysema + chronic bronchitis
emphysema = enlargement of alveolar spaces
chronic bronchitis = chronic productive cough for at least 3mths/year for at least 2 years

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5
Q

signs of hyperexpansion

A 
reduced cricosternal distances (normal = 3 fingers) 
tracheal tug
barrel chest
reduced chest expansion 
loss of cardiac dullness
displaced liver edge
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6
Q

signs on examination for COPD

A 
hyperexpansion
hyperresonance
reduced breath sounds + vocal resonance 
coarse crackles 
expiratory wheeze
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7
Q

causes type 1 resp failure

A 
ventilation perfusion mismatch:
pneumonia
PE
pulmonary oedema 
asthma
ARDS
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8
Q

causes type 2 resp failure

A

resp disease: COPD, asthma, pneumonia, obstructive sleep apnoea
reduced resp drive: sedatives, CNS tumour / trauma
neuromuscular disease: guillain-barre, myasthenia gravis
thoracic wall disease: flail chest, kyphoscoliosis

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9
Q

pulmonary embolism ECG findings

A

S1Q3T3
deep S waves in lead I
deep Q waves in lead III
inverted T waves in lead III

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10
Q

management suspected pulmonary embolism

A

Well’s score:
4 or less = PE unlikely → D-dimer → immediate CTPA + admission if +ve
5 or more = PE likely → admission + immediate CTPA

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11
Q

management confirmed pulmonary embolism

A
  1. LMWH (tinzaparin 175units/kg once daily SC) / fondaparinux for > 5 days / until INR > 2 for > 24hrs
    for 6mths for pts w active cancer
  2. start warfarin within 24hrs
    continue for at least 3mths and reassess whether should be continued
    continue for >3mths if unprovoked PE
  3. thrombolysis for massive PE w haemodynamic instability: tPa, streptokinase
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12
Q

management stable COPD

A
  1. short acting bronchodilator: SABA (salb) / SAMA (ipratropium)
    • long acting bronchodilator: LABA (salmeterol), LAMA (tiotropium)
    • inhaled corticosteroid (combined inhalers if poss)
      long-term oxygen therapy
      surg: lung volume reduction surg / transplant
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13
Q

management acute COPD

A

ABCDE

  1. neb salb / ipratropium
  2. oxygen if sats < 90 (aim for 88-92%) via venturi
  3. oral steroids 5 days
  4. NIV (BiPAP) if respiratory insufficiency
  5. antibiotics if infective exacerbation
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14
Q

management acute asthma

A 
ABCDE 
oxygen: high-flow 15L via non-rebreathe mask 
neb 5mg salb (oxygen-driven / via spacer) 
oral pred 40mg (5 days) 
neb ipratropium
IV magnesium sulphate 
IV aminophylline 
intubation + ventilation
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15
Q

management stable asthma

A
  1. PRN inhaled SABA (salb)
    • BD inhaled low-dose CS (beclamethasone)
    • inhaled LABA (salmeterol)
      if not effective consider: increased steroid dose, LTRA (montelukast), SR theophylline, oral beta-agonist
  4. daily oral steroids
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16
Q

indications for NIV (BiPAP)

A

COPD w respiratory acidosis 7.25-7.35
type 2 respiratory failure (neuromuscular disease or chest wall deformities)
failure of CPAP for pulmonary oedema

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17
Q

indications for CPAP

A

chronic severe obstructive sleep apnoea

type 1 respiratory failure e.g. acute pulmonary oedema

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18
Q

ILD management

A

cons: MDT approach, smoking cessation, pulmonary rehabilitation
med: anti-fibrotic drugs e.g. pirfenidone, nintedanib
steroids (exacerbation fo Sx)
LTOT
surgery: lung transplant (curative)

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19
Q

signs on examination ILD

A

clubbing

fine end-inspiratory crepitations

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20
Q

causes of upper lobe fibrosis

A 
ROTAS:
radiation
occupational: EAA / pneumoconiosis 
TB 
ank spond
sarcoidosis
21
Q

causes of lower lobe fibrosis

A 
DR CIA: 
drugs: methotrexate, amiodarone
connective tissue disease e.g. RA, SLE 
idiopathic pulmonary fibrosis 
asbestos
22
Q

indications for pneumonectomy

A 
primary lung cancer
pulmonary metastases 
traumatic lung injury 
bronchiectasis 
infection: TB, fungal
23
Q

indications for lobectomy

A

primary lung cancer
lung volume reduction (COPD)
bronchiectasis
infection: TB (upper lobe), fungal

24
Q

differentials for thoracotomy scar

A 
pneumonectomy 
lobectomy 
lung transplant 
chest wall resection 
oesophagectomy
25
Q

indications for lung transplant

A 
COPD
ILD 
cystic fibrosis 
alpha1-antitrypsin deficiency 
pulmonary HTN
bronchiectasis
26
Q

differentials for coarse crackles vs fine crackles

A

corase: bronchiectasis, COPD, pneumonia
fine: ILD, pulmonary oedema, pneumonia, atelectasis

27
Q

differentials for wheeze

A

asthma / COPD
bronchiectasis
anaphylaxis
foreign body

28
Q

signs on examination bronchiectasis

A 
clubbing 
coarse crackles
high-pitched inspiratory squeaks 
monophonic wheeze
rhonchi (low-pitched rattling due to secretions in bronchial airways)
29
Q

causes of bronchiectasis

A

idiopathic
post-infective: TB, measles, ABPA
genetic: a1antitrypsin, cystic fibrosis, Kartagener’s
bronchial obstruction: malignancy, foreign body, lymphadenopathy
connective tissue disease: RA, sjogren’s EDS, marfan

30
Q

management bronchiectasis

A

cons: airway clearance therapy (postural drainage, percussion, vibration)
pulmonary rehabilitation
med: ABx for acute exacerbations
long-term macrolide if >2 / year
bronchodilators / theophylline if trial shows improvement
LTOT
surg: resection of bronchiectatic areas of lung
lung transplant

31
Q

investigations bronchiectasis

A

bedside: sputum culture
bloods: FBC, U&Es
alpha1 antitrypsin
screen for immunodeficiency / connective tissue disease
aspergillus markers
cystic fibrosis testing
imaging:
CXR
high-res CT is diagnostic (ring shadows, tramlines)
other:
lung function testing (obstructive)

32
Q

types of lung cancer

A

non-small cell:
squamous cell: PTHrP → Ca
adenocarcinoma: non-smokers
large cell

small cell:
ectopic hormone production (ADH, ACTH, PTH, GnRH)

33
Q

presentation pancoasts tumour

A

apical lung tumour → compression of structures:
brachial plexus → hand muscle wasting
arteries → oedema of arms
sympathetic ganglion → Horner’s syn (ptosis, miosis, anhydrosis)
SVC → facial swelling / flushing, difficulty breathing
small cell tumours → ectopic hormone production (ACTH, ADH, PTH)

34
Q

investigations lung cancer

A 
bloods: FBC, U+Es, LFTs, bone profile
CXR, contrast CT 
PET-CT → distant mets 
bronchoscopy + biopsy
lung function testing (?fit for surg)
35
Q

complications of old TB

A

aspergilloma in old TB cavity
bronchiectasis (lymph node causes obstruction)
risk of bronchial carcinoma

36
Q

causes of consolidation

A

fluid: pulmonary oedema
pus: pneumonia
blood: pulmonary haemorrhage
cells: malignancy

37
Q

pneumonia severity score + resulting action

A

confusion
urea > 7
resp rate > 30
BP < 90/60 (either systolic OR diastolic)
age > 65
1: community management
2: community management if sats > 90 + normal CXR
3: admit
4: consider ITU
5: manage in ITU (30% mortality at 30 days)

38
Q

types of pneumothorax

A

spontaneous: no precipitating event
traumatic: penetrating / blunt chest injury
tension: one-way valve → air entry during inspiration (emergency)

39
Q

management pneumothorax

A

primary: no underlying lung disease
< 2cm / no SOB: conservative, discharge w advice + follow-up CXR
> 2cm / SOB: aspiration 2nd ICS MCL w large-bore cannula
failure → chest drain: 5th ICS MAL

secondary: underlying lung disease e.g. asthma, COPD, cystic fibrosis 
admit for > 24hrs 
< 1cm: oxygen + analgesia + observation
1-2cm: aspiration
>2cm / > 50years: chest drain
40
Q

borders of safe triangle (for chest drain)

A

base of axilla
lat border pec major
ant border latissimus dorsi
5th ICS / line superior to horizontal level of nipple

41
Q

signs on examination pneumothorax

A

reduced chest expansion
hyperressonance
absent / reduced breath sounds + TVF
tracheal deviation from affected side in tension pneumothorax

42
Q

management recurrent pleural effusion

A

recurrent aspiration
pleurodesis: insertion of temporary chest drain + talc (sclerosing agent)
indwelling pleural catheter
opioids relieve dyspnoea

43
Q

management pneumonia

A

ABCDE
oxygen, analgesia, fluids
ABx:
mild: 5 days oral amox (macrolide if allergic / atypical)
mod: 7-10 days oral / IV amox + macrolide
severe: IV co-amox + macrolide
repeat CXR in 6wks post-resolution

44
Q

mechanism of BiPAP

A

iPAP > ePAP
iPAP: ventilates
ePAP: recruits collapsed / underventilated alveoli

45
Q

causes of tracheal deviation

A

pulls towards: lobar / lung collapse, pneumonectomy, pulmonary hypoplasia
pushes away: tension pneumothorax, massive pleural effusion, large thoracic mass, diaphragmatic hernia

46
Q

management of anaphylaxis (incl dose)

A 
IM adrenaline 0.5mg 1:1000
IV hydrocortisone 200mg
neb salb
IV chlorphenamine 10mg 
\+ IV fluids if shock
47
Q

management hospital acquired pneumonia

A

< 5 days: co-amox / cefuroxime
> 5 days: tazocin / ciprofloxacin
pseudomonas: tazocin
MRSA: vancomycin

48
Q

causes of ARDS

A

pulmonary: trauma, pneumonia, inhalation of smoke / soot

extra-pulmonary: sepsis, DIC, pancreatitis

NAM: med / surg / specialties (18 decks)

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