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MSRA my cards > Resp cards > Flashcards

Resp cards Flashcards

1
Q

CPAP works by?

A

increasing intrathoracic pressure, which decreases diastolic and systolic transmural pressures. This can reduce LV preload and afterload, which can decrease cardiac output in most situations. good for T1RF, keep alveoli open and reduce WOB

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2
Q

AECOPD?
cx?
admit?
TX in hospital?

A

HIb, Moraxella, strept pneumoniae. only tx if pneumonia/ purulent sputum. oherwise C/S 5 days reduces frequency of exacerbations.
admit: 02<90, low GCS, cyanosis,co-morbidities/sob.
tx in hosp:
28% Venturi mask at 4 l/min if RF for hypercapnia 88-92
ipr+saba nebs, CS
NIV 7.25 -7.35, HDU. Bipap

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3
Q

MX COPD? chronic?

C/S responsive features?

if features of HF?

A
  1. SABA/SAMA
  2. features of Cs responsivenmess -
  3. no features - SABA+LABA+LAMA
  4. if features - SABA/SAMA PRN+LABA+ICS
    vaccines: pneumococcal one off, annual flu

CS response features? asthma/ atopy/ eosinophils/ 400ml variation in fev1, 20% diurnal variation in PEFR

cor pulmonale - loop diuretics.

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4
Q

who is abx prophylaxis for?
(COPD )

A

proph: azithromycin, recurrent exacerbations despite no smoking and inhaler control. do cT thorax to exclude bronchiectasis and ECG to see QT interval, LFTs

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5
Q

COPD MX - when to consider theophylline?

A

. consider if patient trialled inhaled therapy but not working. dose should be reduced if macrolide or fluoroquinolone antibiotics are co-prescribed

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6
Q

when to suspect COPD?
IX?
stages?

A

35+ smoke/ ex smoker/ SOB/ cough pururlent

IX: FEV1/FVC <0.7 post bronchodialtor, hest x-ray: hyperinflation, bullae, flat hemidiaphragm, polycythaemia fbc.

stages: 1=80%+ predicted FEv1 (Sx= dx)
2 = 50=57 mod
3 = 30-49 severe
4 <30% very severe

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7
Q

pneumonia: alcoholic and diabetics
may occur following aspiration
‘red-currant jelly’ sputum
often affects upper lobes

A

klibsiella

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8
Q

Asthma chronic mx?

A
  1. SABA
  2. SABA + low ICS
  3. +mTrial LTRA
  4. SABA + low ICS + LABA +/- LTRA
  5. SABA+ MART +/- LTRA
  6. Mod MART / switch to mod ICS +LABA as above
  7. high ics + LABA stop MART
  8. trial theophylline. LAMA/ expert
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9
Q

50YO progressive exertional dyspnoea, clubbing, cough, bibasal crackle
FEV1:FVC >70%, decreased FVC
impaired gas exchange (reduced TLCO - transfer factor for carbon monoxide)

A

Restrictive pic
pulmonary fibrosis
other restrictive cx:
Asbestosis
Sarcoidosis
Acute respiratory distress syndrome
Infant respiratory distress syndrome
Kyphoscoliosis e.g. ankylosing spondylitis
Neuromuscular disorders
Severe obesity

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10
Q

why do you get low Pc02 in asthma?

A

low p02 causing hyperventilation

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11
Q

resp alkalosis cx?

A

anxiety leading to hyperventilation
pulmonary embolism
salicylate poisoning*
CNS disorders: stroke, subarachnoid haemorrhage, encephalitis
altitude
pregnancy

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12
Q

obstructive spirometry?

A

FEV1/FVC <0.7
FEV1 <80% normal
FVC reduced/ normal, not as reduced as fev1

cx: Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans
CF

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13
Q

Restrictive spirometry pattern?

A

fev1< 80% of rpedicted
FVC < 80% predicted normal
fev1/fvc ratio = >0.7
CX:
PF
pulmonary oedema
lobectomy/ pnuemectomy
paranchymal lung disease
kyphoscoliosis
connective tissue diseaseobesity/ pregnancy

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14
Q

what is bode index?

A

mortality in COPD indicator - fev1, BMI, 6 min walk, sob

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15
Q

When to insert chest drain for pneumothorax?

A

sX+ high risk - lung disease, 50+/smoking, hb unstable, haemothorax, B/L,hypoxia.
if sx and not high risk - ambulatory device - fu 2 daily/ needle aspiration/ chest drain with F/U in 2-4 weeks
no sx - F/U 2-3 daily

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16
Q

smoking cessation?

A

2 weeks of NRT therapy, and 3-4 weeks for varenicline (caution suicide) and bupropion (CI epilepsy, pregnancy).
don’t re-px within 6 months

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17
Q

abg of co2 retainer?

A

ABG triad for chronic CO2 retention:
Normal pH
High pCO2
High HCO3

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18
Q

post trans thoracic/ abdo surgery, mild pyrexia, reduced breath sounds and tachypnoeia?

A

Basal atelectasis. within 48 hrs. cx: mucus in bronchiole tree retained, bronchioles are blocked and air is re-absorbed, asal collapse. these may become infected

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19
Q

Resp acidosis cx?

A

inadequate ventilation - COPD/ gbs, opiates, MND, rib fracture, obesity.

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20
Q

What is transudate pleural effusion?

A

Fluid pushes through capillary due to capilalary hydrostatric pressure increase or decreased oncotic pressurefrom systemic causes - HF, cirrhosis, peritoneal dialysis, hypoalbuminaemia
less common: nephrotic syndrome, PE, MS, hypothyroid

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21
Q

pleural effusion: what is exudate? light’s criteria?

A

local causes: autoimmune, malignancy, infection, drugs, PE
fluid: serum LDH >0.6
fluid: serum protein >0.5
fluid LDH > 2/3upper limit of normal serum LDH

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22
Q

When to calculate anion gap in ABG? (NA-cl-hco3).
Cx of high?

A

split causes of metabolic acidosis further. high anion gap means reduced renal excretion of H+ or production
CX: DKA, lactic acisodid, aspirin OD renal failure
normal anion gap is when HCO3 is lost and replaced by Cl-

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23
Q

Normal anion gap cx?

A

RTA, addisions, GI H+ losses (ileostomy, colostomy, D+V)

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24
Q

pneuomnia cx of 20 yo uni student with bullous myringitis. cxr has more infiltrates than physically heard?

A

mycoplasma pneumoniae

25
Q

late onset HAP cx? 5 dya s+

A

MSRA, pseudomonas (green coloured sputum), gram negative: klibsiella/ ecoli

26
Q

obrustive cleep apnoea sclaes?

A

epworth sleepiness scale
stop/bang questionnaire

27
Q

2ww criteria resp cancers?

A

40+ with unexplained haemoptosis/ changes on CXr suspicious.
offer CXr in 2 weeks for 40+ and 2 + points or if smoked and 1+ points:
cough/ fatigue/ chest pain, WL, appetite
consider CXR in 40+ and thrombocytosis/LN/ finger clubbing/persistent/ recurrent illness

28
Q

most common cap cx with rust coloured sputum?
other common cap with green sputum?

A

strep pnuemoniae
other: Haemophilus influenzae - common cap, green sputum/ q will say they ahve pneumoccocal vaccine

29
Q

When Pleural effusion is aspirated what is the most common finding?
what is generally the most common cause?

A

malignancy

cx common: HF

30
Q

CXR: multiple B/L noduels different sizes through lung fields. 50YO miner and RA?

A

Caplan’s syndrome/ pulmonary fibrosis in miners/ RA

31
Q

black 30 YO woman B/L hilar lymphadenopathy?
other ix?

other features of disease?

what scan may be sued to detect extra pulmonary features?

A

sarcoidosis (non caseating granuloma disease of unknown aetiology). high ca, raised ACE, ESr, ALP /PO4 raised,
bronchiolar lavage: increased lymphocyctes, cd4/cd8
transbronchiole biopsy

other features:hepatosplenomegaly, renal stones, erythema nodosum, myalgia, lupus pernio, neurotoxicity. gallium scanning

32
Q

Paraneoplastic syndromes of lung cancer?

A

cushings syndrome
Lambert eaton - muscle weakness of limbs, SCLC, DD myasthenia gravis
Hypercalcaemia (PTH)
SIADH

33
Q

Pancoast syndrome?

A

apical lung tumour, horner’s syndrome (miosis, enopthalmos/ptosis)
intrinsic muscle wasting of hand, unilateral recurrent laryngeal nerve palsy (hoarse voice, bovine cough), arm oedema/ phrenic nerve involvement

34
Q

SOB, reduced exercise tolerence, exertional dysopnoea, upper lobe nodules egg shell appearance. retired coal miner

A

silicosis - due to occupational exposure. no cure.

35
Q

Mesothelioma
CXR features?

A

malignant tumour from pleural/ peritoneal surface. 40 yrs after working with asbestos. SOB, non pleuritic chest pain, fatgiues, fever, night sweats, WL, need pleural biopsy.
CXR: sheet like encasement of pleura, nodular thickening of pleura, obliteration of diaphramn

36
Q

chronic cough, excessive sputum pruluent, recurrent infections, crackles, ronchi,

A

bronchiectastis (irreversible dilation of bronchiole airways) - most common cause is CF
other causes: staphyloccous, klibsiella, bordatella

CXR: dilated lower lobe bronchi tracking

37
Q

most common lung injury following blunt trauma?

A

pulmonary contusion (bruiseof lung causing damage to capillaries causing leakage of blood and other fluids into the lung) SOB, chest pain, haemoptosis, tahcypnoea, diminshed sounds

38
Q

diaphramatic rupture caused by what type of injury?

A

Lateral impact in RTA. rarely occur in isolation

39
Q

N+V, tinnitus, lethargy, severe poisoning leads to resp alkalosis, bounding pulses??

A

Salicyclate poisoning
mild: 150mg/kg
moderate 250mg/kg
severe: 500+

40
Q

FEV1/ FVC ratio >70%
TLC 35%
diffusing lung capacity is low
reticular infiltrates on CXR, exertional sob

A

restrictive : interstitial disease.

41
Q

reduced diffuse lung capacity cx?

A

lung cancer,pulmonary oedema, interstitial disease
reduced diffuse lung capacity cx: pulmonary oedama,

42
Q

WHat would spirometry show in kyphoscoliosis/ muscular dystrophy disorders?

A

normal fev1/fvc ratio, diffuse lung capscity normal, reduced total lung capacity

43
Q

pneumonia cx by air condition/ hot tubs/ water?

A

legionella pneumophilia (gram negative)
do urinary antigen
tx: macroglide (axithromycin/ erythromycin)/flouroquinalone (ciproflox/levoflox)

44
Q

moderate asthma exac?

A

pef 50-75, normal speech,

45
Q

severe asthma exac?

RR values for all ages? 5-12, 12+, 2-5?
HR values?

A

33-50 pefr/ RR25+ in adults
30+ RR in 5-12YRs,
RR 40+ in 2-5YO
HR 110+ in 12yr +
125 hr+ in 5- 12 yr
140 hr + in 2-5 YO
cant complete sentences
inability to feed well
accessory muscle use
02 92+

46
Q

Life threatening asthma values?

A

pefr <33, silent chest, 02 <92, confusion, hypotension,poor effort

47
Q

MX of children with acute asthma and how to discharge?

A

nebs salbutamol
<92 02, give mgso4 with each ipraropium/saba
stop LABA
prednisolon early: <2YO 10mg, 2-5 yrs 20mg, if already on maintenance give 2mg/kh max 60

on d/c: when saba 4 hourly, pefr/ fev1 >75% predicted, 02 94%+, f/u GP 2 days and paeds asthma clinic in 1 month

48
Q

asbestos exposure, which cancer are they most likely to get?

A

lung cancer. mesothelioma is rare. sob, clubbing, end inspiratory crackles,
spirometry: reduced gas transfer, restrictive pattern
also increases: gastric, colonic, mesothelioma, renal cancers risk

49
Q

CI to influenza vaccine?

A

egg allergy, previous anaphylaxis
<6 months old

50
Q

who gets the flu vaccine?

2-8 YO who has not received one before?

A

65 YO+, healthcare staff, pregnant women, school children reception to yr 11, residential home,
anyone with live,r heart, lung, renal, bmi 40+, dm, neuro, resp, asplenia,
2-8 YO who haven’t received one before need booster 4 weeks after 1st

51
Q

20YO recurrent infections, productive sputum, haemoptosys, clubbing, ronchi, wheezing, squeaks, ill defined nodular opacities. child hospitalisation

A

bronchiectasis (irreversible dilation of bronchiole trees)

52
Q

extrinsic allergic alveolitis is?
spirometry?
later signs?
includes?
acute and chronic reaction?

A

hypersensitivity reaction to inhaled dust. type 3 - acute, type 4 chronic.
restrictive spirometry
bronchealveolar alvage: lymphocytes, mast cells
includes:farmers lung, pigieon, bird fanciers, malt worker,
later signs: t1rf, cor pulmonale, pulmonary fibrosis,
CXR: honey comb, mid zone mottling/ consolidation

53
Q

common causes of haemoptosus?

A

pneumona, pseudomonas, tb, acute bronchitis, fungal, influenza, cancer.
less common: goodpasteurs, weneger’s

54
Q

previous CVA, 6 weeks of SOB, cough, foul smelling purulent discharge?

A

Lung abscess (commonly caused by aspiration)

55
Q

skin changes with bird fancier’s lung?

A

horder’s spots

56
Q

25 YO man, recent flu illness, coughing blood, dark urine, N+V, CXR intra-alveolar shadowing?

A

Goodpasteur’s syndrome:
pulmonary haemorrhage, anti GDM and glomerulonephritis

57
Q

Tietze’s syndrome?

A

swelling of costal cartilage.
costocondritis - no swelling. pain better when keeping still

58
Q

post BCG vaccine, nodular lesion on cheek with large, sharp margins, painful?

A

lupus vulgaris. TB skin lesion. need tx or will ulcerate. RIPE for 8 weeks then 16 weeks of I and R

59
Q
A

MSRA my cards (15 decks)

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